Skip to main content
SpringerLink
Log in

Preserving children’s fertility: two tales about children’s right to an open future and the margins of parental obligations

  • Scientific Contribution
  • Published:
Medicine, Health Care and Philosophy Aims and scope Submit manuscript

Abstract

The sources, extent and margins of parental obligations in taking decisions regarding their children’s medical care are subjects of ongoing debates. Balancing children’s immediate welfare with keeping their future open is a delicate task. In this paper, we briefly present two examples of situations in which parents may be confronted with the choice of whether to authorise or demand non-therapeutic interventions on their children for the purpose of fertility preservation. The first example is that of children facing cancer treatment, and the second of children with Klinefelter syndrome. We argue that, whereas decisions of whether to preserve fertility may be prima facie within the limits of parental discretion, the right to an open future does not straightforwardly put parents under an obligation to take actions that would detect or relieve future infertility in their children—and indeed in some cases taking such actions is problematic.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Bauer, D., et al. 1980. Special supplement: The XYY controversy: Researching violence and genetics. The Hastings Center Report 10(4): 1–31.

    Article  Google Scholar 

  • BBC News, Ovarian transplant first welcomed. August 2, 2007. http://news.bbc.co.uk/2/hi/health/6924014.stm. Last accessed August 2014.

  • Bizet, P., et al. 2012. Sperm cryopreservation before cancer treatment: A 15-year monocentric experience. Reproductive biomedicine online 24(3): 321–330.

    Article  Google Scholar 

  • Borelli, J., et al. 1984. The meaning of early knowledge of a child’s infertility in families with 47, XXY and 45, X children. Child Psychiatry and Human Development 14(4): 215–222.

    Article  Google Scholar 

  • Borry, P., et al. 2014. Is there a right time to know? The right not to know and genetic testing in children. Journal of Law, Medicine & Ethics 42(1): 19–27.

    Google Scholar 

  • Borry, P., et al. 2009. Genetic testing in asymptomatic minors: Background considerations towards ESHG recommendations. European Journal of Human Genetics 17(6): 711–719.

    Article  Google Scholar 

  • Bourke, E., et al. 2014. A qualitative exploration of mothers’ and fathers’ experiences of having a child with Klinefelter syndrome and the process of reaching this diagnosis. European Journal of Human Genetics 22(18): 24.

    Google Scholar 

  • Cobo, A., and C. Diaz. 2011. Clinical application of oocyte vitrification: A systematic review and meta-analysis of randomized controlled trials. Fertility and Sterility 96(2): 277–285.

    Article  Google Scholar 

  • Cobo, A., et al. 2013. Is vitrification of oocytes useful for fertility preservation for age-related fertility decline and in cancer patients? Fertility and Sterility 99(6): 1485–1495.

    Article  Google Scholar 

  • Davis, D.S. 2010. Genetic dilemmas: Reproductive technology, parental choices, and children’s futures. Oxford: Oxford University Press.

    Google Scholar 

  • Dittrich, R., et al. 2012. Live birth after ovarian tissue autotransplantation following overnight transportation before cryopreservation. Fertility and Sterility 97(2): 387–390.

    Article  Google Scholar 

  • Donnez, J., et al. 2011. Pregnancy and live birth after autotransplantation of frozen-thawed ovarian tissue in a patient with metastatic disease undergoing chemotherapy and hematopoietic stem cell transplantation. Fertility and Sterility 95(5): 1787 e1781–1784.

  • Edgar, D.H., and D.A. Gook. 2012. A critical appraisal of cryopreservation (slow cooling versus vitrification) of human oocytes and embryos. Human reproduction update 18(5): 536–554.

    Article  Google Scholar 

  • Fallat, M.E., and J. Hutter. 2008. Preservation of fertility in pediatric and adolescent patients with cancer. Pediatrics 121(5): e1461–e1469.

    Article  Google Scholar 

  • Feinberg, J. 1980. The child’s right to an open future. In Whose Child? Children’s rights, parental authority, and state power, ed. W. Aiken, and H. LaFollette. Totowa, NJ: Rowman and Littlefield.

    Google Scholar 

  • Feinberg, J. 1992. Freedom and fulfilment: Philosophical essays. Princeton: Princeton University Press.

    Google Scholar 

  • Fujita, K., et al. 2005. Transplantation of spermatogonial stem cells isolated from leukemic mice restores fertility without inducing leukemia. The Journal of Clinical Investigation 115(7): 1855–1861.

    Article  Google Scholar 

  • Fullerton, G., et al. 2010. Should non-mosaic Klinefelter syndrome men be labelled as infertile in 2009? Human Reproduction 25(3): 588–597.

    Article  Google Scholar 

  • Gies, I., et al. 2012. Spermatogonial stem cell preservation in boys with Klinefelter syndrome: to bank or not to bank, that’s the question. Fertility and Sterility 98(2): 284–289.

    Article  Google Scholar 

  • Goossens, E., et al. 2013. Spermatogonial stem cell preservation and transplantation: From research to clinic. Human Reproduction 28(4): 897–907.

    Article  Google Scholar 

  • Grundy, R., et al. 2001a. Fertility preservation for children treated for cancer (1): Scientific advances and research dilemmas. Archives of Disease in Childhood 84(4): 355–359.

    Article  Google Scholar 

  • Grundy, R., et al. 2001b. Fertility preservation for children treated for cancer (2): Ethics of consent for gamete storage and experimentation. Archives of Disease in Childhood 84(4): 360–362.

    Article  Google Scholar 

  • Hayashi, K., et al. 2012. Offspring from oocytes derived from in vitro primordial germ cell-like cells in mice. Science 338(6109): 971–975.

    Article  Google Scholar 

  • Hayashi, K., et al. 2011. Reconstitution of the mouse germ cell specification pathway in culture by pluripotent stem cells. Cell 146(4): 519–532.

    Article  Google Scholar 

  • Heindryckx, B., et al. 2007. Embryo development after successful somatic cell nuclear transfer to in vitro matured human germinal vesicle oocytes. Human Reproduction 22(7): 1982–1990.

    Article  Google Scholar 

  • Hens, K., et al. 2011. The return of individual research findings in paediatric genetic research. Journal of Medical Ethics 37(3): 179–183.

    Article  Google Scholar 

  • Hens, K., et al. 2013. Developing a policy for paediatric biobanks: Principles for good practice. European Journal of Human Genetics 21(1): 2–7.

    Article  Google Scholar 

  • Herlihy, A.S., et al. 2011. Postnatal screening for Klinefelter syndrome: Is there a rationale? Acta Paediatrica 100(6): 923–933.

    Article  Google Scholar 

  • Herlihy, A.S., et al. 2010. Assessing the risks and benefits of diagnosing genetic conditions with variable phenotypes through population screening: Klinefelter syndrome as an example. Journal of community genetics 1(1): 41–46.

    Article  Google Scholar 

  • Jadoul, P., et al. 2010. Fertility preservation in girls during childhood: Is it feasible, efficient and safe and to whom should it be proposed? Human reproduction update 16(6): 617–630.

    Article  Google Scholar 

  • Jahnukainen, K., et al. 2006. Clinical potential and putative risks of fertility preservation in children utilizing gonadal tissue or germline stem cells. Pediatric Research 59(4 Pt 2): 40R–47R.

    Article  Google Scholar 

  • Jonas, H. 1997. Tecnica, medicina ed etica. Prassi del principio responsabilita. Torino: Einaudi.

  • Kelleher, S., et al. 2001. Long-term outcomes of elective human sperm cryostorage. Human Reproduction 16(12): 2632–2639.

    Article  Google Scholar 

  • Lanfranco, F., et al. 2004. Klinefelter’s syndrome. Lancet 364(9430): 273–283.

    Article  Google Scholar 

  • Larcher, V. 2012. The ethical obligation to preserve fertility in the face of all therapies that might adversely affect it. Archives of Disease in Childhood 97(9): 767–768.

    Article  Google Scholar 

  • Laurie, G. 2014. Recognizing the right not to know: Conceptual, professional, and legal implications. Journal of Law, Medicine & Ethics 42(1): 53–63.

    Google Scholar 

  • Laurie, G. 1999. In defence of ignorance: Genetic information and the right not to know. European Journal of Health Law 6: 119–132.

    Article  Google Scholar 

  • Magelssen, H., et al. 2005. Twenty years experience with semen cryopreservation in testicular cancer patients: Who needs it? European Urology 48(5): 779–785.

    Article  Google Scholar 

  • Medicine T. E. C. o. t. A. S. f. R. 2013. Fertility preservation and reproduction in patients facing gonadotoxic therapies: A committee opinion. Fertility and Sterility 100(5): 1224–1231.

    Article  Google Scholar 

  • Mehta, A., et al. 2013. Successful testicular sperm retrieval in adolescents with Klinefelter syndrome treated with at least 1 year of topical testosterone and aromatase inhibitor. Fertility and Sterility 100(4): 970–974.

    Article  Google Scholar 

  • Mehta, A., and D.A. Paduch. 2012. Klinefelter syndrome: An argument for early aggressive hormonal and fertility management. Fertility and Sterility 98(2): 274–283.

    Article  Google Scholar 

  • Mertes, H., and G. Pennings. 2011. Social egg freezing: For better, not for worse. Reproductive biomedicine online 23(7): 824–829.

    Article  Google Scholar 

  • Paduch, D.A., et al. 2009. Reproduction in men with Klinefelter syndrome: The past, the present, and the future. Seminars in reproductive medicine 27(2): 137–148.

    Article  Google Scholar 

  • Paduch, D.A., et al. 2008. New concepts in Klinefelter syndrome. Current Opinion in Urology 18(6): 621–627.

    Article  Google Scholar 

  • Poirot, C., and B. Schubert. 2011. Fertility preservation in prepubertal children. Bulletin du Cancer 98(5): 489–499.

    Google Scholar 

  • Quinn, G.P., et al. 2012. Preserving the right to future children: An ethical case analysis. The American Journal of Bioethics 12(6): 38–43.

    Article  Google Scholar 

  • Rieker, P.P., et al. 1990. Adaptive behavioral responses to potential infertility among survivors of testis cancer. Journal of Clinical Oncology 8(2): 347–355.

    Google Scholar 

  • Rochman, B. 2011. Even as babies, cancer patients strive to preserve fertility. http://healthland.time.com/2011/03/22/children-having-children-when-a-kids-got-cancer-fertility-preservation-can-help/ (last accessed August 2014).

  • Ruutiainen, T., et al. 2013. Expanding access to testicular tissue cryopreservation: An analysis by analogy. The American journal of bioethics 13(3): 28–35.

    Article  Google Scholar 

  • Saito, K., et al. 2005. Sperm cryopreservation before cancer chemotherapy helps in the emotional battle against cancer. Cancer 104(3): 521–524.

    Article  Google Scholar 

  • Sanchez-Serrano, M., et al. 2010. Twins born after transplantation of ovarian cortical tissue and oocyte vitrification. Fertility and Sterility 93(1): 268 e211–263.

  • Satkoske, V.B., and L.S. Parker. 2013. Preserving testicular tissue and a boy’s open reproductive future. The American journal of bioethics 13(3): 36–37.

    Article  Google Scholar 

  • Schiff, J.D., et al. 2005. Success of testicular sperm extraction [corrected] and intracytoplasmic sperm injection in men with Klinefelter syndrome. The Journal of clinical endocrinology and metabolism 90(11): 6263–6267.

    Article  Google Scholar 

  • Schover, L.R. 2005. Motivation for parenthood after cancer: A review. Journal of the National Cancer Institute Monographs 34: 2–5.

    Article  Google Scholar 

  • Schover, L.R., et al. 2002. Knowledge and experience regarding cancer, infertility, and sperm banking in younger male survivors. Journal of Clinical Oncology 20(7): 1880–1889.

    Article  Google Scholar 

  • Silber, S.J. 2012. Ovary cryopreservation and transplantation for fertility preservation. Molecular Human Reproduction 18(2): 59–67.

    Article  Google Scholar 

  • Simon, B., et al. 2005. Preserving fertility after cancer. CA: A Cancer Journal for Clinicians 55(4): 211–228.

    Google Scholar 

  • Smajdor, A., and D. Cutas. 2013. Will artificial gametes end infertility? Health Care Analysis. doi:10.1007/s10728-013-0268-x.

    Google Scholar 

  • Thomson, A.B., et al. 2002. Semen quality and spermatozoal DNA integrity in survivors of childhood cancer: A case-control study. Lancet 360(9330): 361–367.

    Article  Google Scholar 

  • van Casteren, N.J., et al. 2008. Use rate and assisted reproduction technologies outcome of cryopreserved semen from 629 cancer patients. Fertility and Sterility 90(6): 2245–2250.

    Article  Google Scholar 

  • Visootsak, J., and J.M. Graham Jr. 2006. Klinefelter syndrome and other sex chromosomal aneuploidies. Orphanet journal of rare diseases 1: 42.

    Article  Google Scholar 

  • White, Y.A., et al. 2012. Oocyte formation by mitotically active germ cells purified from ovaries of reproductive-age women. Nature Medicine 18(3): 413–421.

    Article  Google Scholar 

  • Wosnitzer, M.S., and D.A. Paduch. 2013. Endocrinological issues and hormonal manipulation in children and men with Klinefelter syndrome. American journal of medical genetics. Part C, Seminars in medical genetics 163C(1): 16–26.

    Article  Google Scholar 

  • Yoon, T.K., et al. 2003. Live births after vitrification of oocytes in a stimulated in vitro fertilization-embryo transfer program. Fertility and Sterility 79(6): 1323–1326.

    Article  Google Scholar 

Download references

Acknowledgments

Part of this work was supported by the Centre for Society and Life Sciences, and the Netherlands Organisation for Health Research and Development (research grant “Artificial gametes: dynamics and ethics”, at Maastricht University, now completed), and part by the Swedish Research Council (research grant “Close personal relationships, children and the family: ethical and political analysis against a changing background”, at Umeå University).

Author information

Authors and Affiliations

  1. Department of Historical, Philosophical and Religious Studies, Umeå University, Umeå, Sweden

    Daniela Cutas

  2. Department of Philosophy, Linguistics and Theory of Science, University of Gothenburg, Gothenburg, Sweden

    Daniela Cutas

  3. Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands

    Kristien Hens

  4. GROW, School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands

    Kristien Hens

Authors
  1. Daniela Cutas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kristien Hens
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniela Cutas.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cutas, D., Hens, K. Preserving children’s fertility: two tales about children’s right to an open future and the margins of parental obligations. Med Health Care and Philos 18, 253–260 (2015). https://doi.org/10.1007/s11019-014-9596-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11019-014-9596-3

Keywords

Search

Navigation