Ethical Issues in Pediatric and Adolescent Fertility Preservation



According to recent estimates, there are more than 270,000 survivors of pediatric cancer and long-term survivorship for pediatric cancer is around 80 % [28]. Given the large number of survivors as well as the high survivorship rate, coupled with the fact that pediatric cancer survivors typically have a full lifetime ahead of them, it is increasingly important to examine their quality of life issues. Our goal in this chapter is to highlight some of the ethical issues that arise in the context of fertility preservation for pediatric cancer patients and survivors. Specifically, we explore assent/consent, best interest standard, parental and provider pressure, cost and insurance coverage, and experimental treatment.


Assisted Reproductive Technology Fertility Preservation Pediatric Cancer Pediatric Cancer Patient Ovarian Tissue Cryopreservation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Informed consent, parental permission, and assent in pediatric practice. Committee on Bioethics, American Academy of Pediatrics. Pediatrics. 1995;95(2):314–7.Google Scholar
  2. 2.
    Parekh SA. Child consent and the law: an insight and discussion into the law relating to consent and competence. Child Care Health Dev. 2007;33(1):78–82.CrossRefPubMedGoogle Scholar
  3. 3.
    Ruhe KM, et al. Decision-making capacity of children and adolescents-suggestions for advancing the concept’s implementation in pediatric healthcare. Eur J Pediatr. 2014;174(6):775–82.CrossRefPubMedGoogle Scholar
  4. 4.
    Weithorn LA, Campbell SB. The competency of children and adolescents to make informed treatment decisions. Child Dev. 1982;53(6):1589–98.CrossRefPubMedGoogle Scholar
  5. 5.
    Weithorn LA. Children’s capacities to decide about participation in research. IRB. 1983;5(2):1–5.CrossRefPubMedGoogle Scholar
  6. 6.
    Palmer R, Gillespie G. Consent and capacity in children and young people. Arch Dis Child Educ Pract Ed. 2014;99(1):2–7.CrossRefPubMedGoogle Scholar
  7. 7.
    McCabe MA. Involving children and adolescents in medical decision making: developmental and clinical considerations. J Pediatr Psychol. 1996;21(4):505–16.CrossRefPubMedGoogle Scholar
  8. 8.
    Cohen CB. Ethical issues regarding fertility preservation in adolescents and children. Pediatr Blood Cancer. 2009;53(2):249–53.CrossRefPubMedGoogle Scholar
  9. 9.
    Basco D, Campo-Engelstein L, Rodriguez S. Insuring against infertility: expanding state infertility mandates to include fertility preservation technology for cancer patients. J Law Med Ethics. 2010;38:832–9.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Campo-Engelstein L. Consistency in insurance coverage for iatrogenic conditions resulting from cancer treatment including fertility preservation. J Clin Oncol. 2010;28:2184–1286.CrossRefGoogle Scholar
  11. 11.
    Crawshaw MA, Sloper P. ‘Swimming against the tide’ – the influence of fertility matters on the transition to adulthood or survivorship following adolescent cancer. Eur J Cancer Care. 2010;19(5):610–20.CrossRefGoogle Scholar
  12. 12.
    Donnez J, Dolmans MM, Pellicer A, Diaz-Garcia C, Sanchez Serrano M, Schmidt KT, Ernst E, Luyckx V, Andersen CY. Restoration of ovarian activity and pregnancy after transplantation of cryopreserved ovarian tissue: a review of 60 cases of reimplantation. Fertil Steril. 2013;99(6):1503–13.CrossRefPubMedGoogle Scholar
  13. 13.
    Feinberg J, et al. The child’s right to an open future. In: Aiken W, LaFollette H, editors. Whose child? Totowa: Rowman & Littlefield; 1980. p. 124–53.Google Scholar
  14. 14.
    Gardino S, Russell AE, Woodruff TK. Adoption after cancer: adoption agency attitudes and perspectives on the potential to parent post-cancer. Cancer Treat Res. 2010;156:153–70.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Jadoul P, Dolmans MM, Donnez J. Fertility preservation in girls during childhood: it is feasible, efficient and safe and to whom should it be proposed. Hum Reprod Update. 2010;93:1–14.Google Scholar
  16. 16.
    Jain T. Socioeconomic and racial disparities among infertility patients seeking care. Fertil Steril. 2006;85:876–81.CrossRefPubMedGoogle Scholar
  17. 17.
    Loren AW, Mangu PB, Beck LN, Brennan L, Magdalinski AJ, Partridge AH, Quinn G, Wallace WH, Oktay K, American Society of Clinical Oncology. Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013;31(19):2500–10.CrossRefPubMedGoogle Scholar
  18. 18.
    Luyckx V, Scalercio S, Jadoul P, Amorim CA, Soares M, Donnez J, Dolmans MM. Evaluation of cryopreserved ovarian tissue from prepubertal patients after long-term xenografting and exogenous stimulation. Fertil Steril. 2013;100(5):1350–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Kelly M. Women’s voluntary childlessness: a radical rejection of motherhood? Women Stud Q. 2009;37.3(4):157–72.Google Scholar
  20. 20.
    Lee MC, Gray J, Han SH, et al. Fertility and reproductive considerations in premenopausal patients with breast cancer. Cancer Control. 2010;17:162–72.PubMedGoogle Scholar
  21. 21.
    LiveStrong. Parenthood options for women. Accessed 18 Oct 2015.
  22. 22.
    Luster T, Okagaki L. Multiple influences on parenting: ecological and life-course—perspectives. In: Luster T, Okagaki L, editors. Parenting: an ecological perspective. Hillsdale: Lawrence Erlbaum Associates; 1993. p. 227–50.Google Scholar
  23. 23.
    McDougall R. The ethics of fertility preservation for paediatric cancer patients: from offer to rebuttable presumption. Bioethics. 2015;29:639–45.CrossRefPubMedGoogle Scholar
  24. 24.
    Petropanagos A, Campo-Engelstein L. Tough talk: discussing fertility preservation with adolescents and young adults with cancer. J Adolesc Young Adult Oncol. 2015;4(3):96–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Quinn GP, Stearsman DN, Campo-Engelstein L, Murphy D. Preserving the right to future children: an ethical case analysis. Am J Bioeth. 2012;12(6):38–43.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Quinn GP, Vadaparampil ST, Jacobsen PB, et al. Frozen hope: fertility preservation for women with cancer. J Midwifery Women Health. 2010;55:175–80.CrossRefGoogle Scholar
  27. 27.
    RESOLVE, T.N.I.A. The costs of infertility treatment. [Cited 2 Nov 2014]. Available from:
  28. 28.
    Ries LA, Harkins D, Krapcho M, et al. SEER cancer statistics review, 1975–2008. Bethesda: National Cancer Institute; 2008.Google Scholar
  29. 29.
    Schover LR. Motivation for parenthood after cancer: a review. J Natl Cancer Inst Monogr. 2005;34:2–5.CrossRefGoogle Scholar
  30. 30.
    Shin D, Lo KC, Lipshultz LI. Treatment options for the infertile male with cancer. J Natl Cancer Inst Monogr. 2005;34:48–50.CrossRefGoogle Scholar
  31. 31.
    Shnorhavorian M, Johnson R, Shear SB, Wilfond BS. Responding to adolescents with cancer who refuse sperm banking: when “no” should not be the last word. J Adolesc Young Adult Oncol. 2011;1(3):114–7.CrossRefPubMedGoogle Scholar
  32. 32.
    Gardino SS, Rodriguez, Campo-Engelstein L. “Infertility, cancer, and changing gender norms.” Journal of Cancer Survivorship 5.1 (March 2011).Google Scholar
  33. 33.
    Upchurch D, Lillard L, Constantijn WA, Panis. Nonmarital childbearing: influences of education, marriage, and fertility. Demography. 2002;39(2):311–29.Google Scholar
  34. 34.
    Mesen TB et al. Optimal timing for elective egg freezing. Fertil Steril. 2015;103(6):p.1551–6.e1–4.Google Scholar
  35. 35.
    Georgina M, et al. The economic impact of assisted reproductive technology: a review of selected developed countries. Chambers, Fertility and Sterility. 2009;91(6):2281–94.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Alden March Bioethics Institute, Department of Obstetrics & GynecologyAlbany Medical CollegeAlbanyUSA
  2. 2.Division of Adolescent MedicineAnn & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of MedicineChicagoUSA

Personalised recommendations