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Fertility preservation in cancer patients with a poor prognosis: the controversy of posthumous reproduction


For many cancer patients, dreams of genetically related children may be diminished after cancer treatments, which may compromise patients’ fertility. Systemic chemotherapy or radiation therapy may impact reproductive or endocrine functioning. These treatments may impact future fertility in several ways: gonadal damage; diminished reproductive function such as hormonal regulation; structural damage to organs such as the uterus, reducing the possibility of conception or carrying a pregnancy to term; and diminished erectile functioning that may impact the likelihood of natural conception. For many patients, especially those who desire genetically related children, cancer treatment related infertility may adversely affect quality of life and increase emotional distress [1]. Fertility preservation (FP) may address this concern by offering additional options for future parenting. FP preserves gametes using a range of assisted reproductive technology (ART) techniques, such as sperm and embryo cryopreservation.

The American Society of Clinical Oncology (ASCO) [2] and the American Society for Reproductive Medicine (ASRM) [3] guidelines recommend providers discuss possible infertility and FP options prior to the start of cancer treatments, thereby allowing patients to make informed decisions before their fertility is impacted. Although the guidelines state patients with a poor prognosis or late stage disease should also receive this information, limited studies on the topic with healthcare providers highlight the controversy of this population as candidates for FP. Quinn et al. [4] documented oncologists had negative attitudes toward posthumous reproduction/parenting in young adult cancer patients. Vadaparampil et al. [5] also reported this concern among pediatric oncologists. However, research with patients suggests posthumous reproduction is positively regarded [6,7].

Click here to view the full article in Future Oncology.