Testicular Tissue Cryopreservation and Ethical Considerations: A Scoping Review
- 174 Downloads
Testicular tissue cryopreservation (TTCP) aims to preserve the future option of genetic reproduction for prepubescent cancer patients who are at risk of infertility as a result of their cancer therapies. This technology is experimental and currently only offered in the research context. As TTCP moves towards becoming more widely available, it is imperative that healthcare providers recognize the complex ethical issues surrounding this technology. This scoping review study identifies and assesses the range and depth of ethical concerns related to this testicular tissue cryopreservation technology. At present, no such scoping review of ethical concerns exists in the TTCP literature. The forty-three full-text articles included in this study yielded twenty-two different ethical considerations discussed in relation to TTCP. It was observed that these ethical considerations fit within a mainstream Principlism approach to bioethics. Accordingly, there are ethical gaps in the TTCP literature that can be identified with alternative moral lenses. In particular, it was found that ethical concerns related to context and relational aspects of identity were absent in nearly all ethical examinations of TTCP. Furthermore, only 9 per cent of articles reviewed in this study focused primarily on the ethics of TTCP, thus demonstrating a need for further in depth ethical analyses of this technology. The results of this study are important for supporting the ethical provision of TTCP and can contribute to policy and guideline development. The findings of this study demonstrate the need for greater depth and diversity in analyses of ethical considerations related to this technology.
KeywordsTesticular tissue cryopreservation Fertility Preservation Pediatric cancer patients Clinical trials Ethical considerations Scoping Review
Funding in support of this research was provided by the Canada Research Chair in Bioethics and Philosophy on “Impact Ethics: Making a Difference.” I also gratefully acknowledge the support of the Brocher Foundation in Hermance, Switzerland (www.brocher.ch) which provided an idyllic setting in which to complete my writing.
- Anderson, R.A., R.T. Mitchell, T.W. Kelsey, N. Spears, E.E. Telfer, and W.H.B. Wallace. 2015. Cancer treatment and gonadal function: Experimental and established strategies for fertility preservation in children and young adults. The Lancet Diabetes Endocrinology 3(7): 556–567.CrossRefPubMedGoogle Scholar
- Beauchamp, T., and J. Childress. 1979. Principles of Biomedical Ethics. Oxford: Oxford University Press.Google Scholar
- Clarke, D.L. 2009. Moral Principlism alone is insufficient, and traditional moral theories remain important for practical ethics. South African Journal of Bioethics and Law 2(2): 54–58.Google Scholar
- Ginsberg, J.P., C.A. Carlson, K. Lin, et al. 2010. An experimental protocol for fertility preservation in prepubertal boys recently diagnosed with cancer: A report of acceptability and safety. Andrology 25(1): 37–41.Google Scholar
- Mitchell, R.R., P.T.K. Saunders, R.M. Sharpe, CJ.H. Kelnar, and W.H.B. Wallace. 2009. Male fertility and strategies for fertility preservation following childhood cancer. In Endocrine Development, Vol. 15, 101–134. Karger Publishers.Google Scholar
- Rumrill, P.D., S.M. Fitzgerald, and W.R. Merchant. 2010. Using scoping literature reviews as a means of understanding and interpreting existing literature. Work: A Journal of Prevention, Assessment & Rehabilitation 35(3): 399–404.Google Scholar
- Wyns, C., M. Curaba, B. Martinez-Madrid, A. Van Langendonckt, W. François-Xavier, and J. Donnez. 2007. Spermatogonial survival after cryopreservation and short-term orthotopic immature human cryptorchid testicular tissue grafting to immunodeficient mice. Human Reproduction 22(6): 1603–1611.CrossRefPubMedGoogle Scholar