Some tumors, and many types of chemotherapy and radiation, can leave
cancer patients infertile. Often, patients can postpone initial
cancer treatments for a few weeks to pursue fertility preservation
efforts, which might include egg or embryo freezing for women and
sperm banking for men.
Though these efforts are no guarantee, they can make it possible to
start a family down the line.
The trouble is that even when the technology works, it still takes
more than one person to donate genetic material to make a baby, and
the courts can become involved when not everyone agrees on how to
proceed, Ehren Fournier, an attorney at Foley and Lardner in
Chicago, argues in JAMA Oncology.
“Decisions regarding fertility preservation need to be made quickly
so the patient can start their oncologist’s treatment plan,”
Fournier said by email. “It is difficult to expect a patient to try
to anticipate the future legal consequences of their fertility
treatment while being faced with those competing pressures.”
Courts might be called on to decide, for example, what happens when
a woman creates a frozen embryo with her own eggs and donor sperm
prior to cancer treatment but the donor later decides he doesn’t
want to his sperm used to father a child. Particularly if the donor
was her partner or spouse, and the couple separates or divorces, he
might assert a right not to father her child.
To reduce the odds of pushing patients into this legal quagmire,
doctors should be aware of the legal approach followed in their
state and make sure patients consult with lawyers to draw up
contracts for future use of any donated genetic material, Fournier
While this type of dispute might be averted with fertility consent
agreements that treat partners and spouses like anonymous sperm
donors and require them to waive any future rights to the embryo,
this option might not appeal to couples in a romantic relationship,
Dr. Clarisa Gracia of the University of Pennsylvania in Philadelphia
and colleagues point out in an accompanying editorial.
“In general, I would recommend freezing gametes (sperm or eggs)
rather than embryos for unmarried couples,” Gracia said by email.
“This is the only way to prevent any legal entanglements with a
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Patients also need to recognize that infertility isn’t the only
reproductive health issue related to cancer, Teresa Woodruff and
colleagues at Northwestern University in Chicago note in a separate
viewpoint paper in the journal.
Doctors still need to discuss contraception, because some patients
can still become pregnant or father children during cancer
treatment, they write.
When the ovaries or testes are damaged by treatment, this can impact
the amount of hormones that are made, with implications for
reproductive and sexual health, Woodruff noted by email. Hormonal
changes may mean young patients don’t go through natural puberty,
and that young women in particular may go through early menopause.
“Cancer patients face an immediate need to protect their fertility
before the first sterilizing treatment,” Woodruff said. “Paying
attention to overall reproductive health is also important for those
who may already have the number of children they wish – so we try
not to limit the discussion to just fertility.”
SOURCE: http://bit.ly/1nKNmW9, http://bit.ly/1QFjpQp, http://bit.ly/1nKNpkH
and http://bit.ly/1nDOGJE JAMA Oncology, online
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