That's the topic of a new report from the ethics committee of the American Society for Reproductive Medicine. "Cancer treatment often results in reduced fertility," according to the committee's report, published in June's issue of Fertility and Sterility.
However, reproductive technology may help preserve fertility if cancer treatment brings unavoidable damage to the reproductive organs. For instance, when cyclist Lance Armstrong learned in 1996 that he had testicular cancer that had spread to his lungs and brain, he banked his sperm before treatment in the hopes of having children later on. He and his former wife, Kristin, now have a son and twin girls conceived through in vitro fertilization from those sperm.
Some techniques -- like freezing sperm and embryos -- are well established, while other methods (like freezing unfertilized eggs and ovarian tissue) are still experimental, says the committee.
The report makes seven main points:
- Doctors should tell cancer patients before treatment about options for fertility preservation and future reproduction.
- Sperm cryopreservation in men and embryo cryopreservation in women are the only established methods of fertility preservation.
- Experimental procedures, such as egg or ovarian tissue cryopreservation, should only be offered in an appropriate research setting.
- Concerns about the welfare of resulting offspring should not be cause for denying cancer patients assistance in reproducing.
- Parents may act to preserve the fertility of cancer patients who are minors if the child assents and the intervention is likely to provide net benefits to the child.
- Precise instructions should be given about the disposition of stored gametes, embryos, or gonadal tissue in the event of the patient's death, unavailability, or other contingency.
- Preimplantation genetic diagnosis to avoid the birth of offspring with a high risk of inherited cancer is ethically acceptable.
The committee members say they wrote their report as a service to the society's members and other doctors. However, they say it "is not intended to be the only approved standard of practice or to dictate an exclusive course of treatment in all cases."