Is it ethical to cryopreserve ovarian tissue from prepubertal girls who are to undergo cancer treatment?
When a cancer patient is treated with radio and/or chemotherapy, they can become infertile, both men and women. Consequently, ovarian tissue cryopreservation prior to treatment is recommended in women, with the cryopreserved tissue then transferred again to the patient if she survives. The extent of this negative therapeutic effect depends on the specific treatment applied in each case, so the individual risk is variable. Cancer treatment in older adolescents has a roughly 86% risk of infertility.
With the survival of pediatric cancer patients becoming increasingly longer (currently around 80%), the possibility of cryopreserving ovarian tissue seems to be a thriving therapeutic practice.
Around 60 children have been born to date worldwide using cryopreserved ovarian tissue in adult women or older adolescents, but only one case of a child born after using frozen ovarian tissue in a premenarchal girl has been reported. Although the evidence seems to support this practice, one question that immediately arises is: is it ethically justifiable to preserve ovarian tissue in prepubertal girls? In adult women or older adolescents, it appears that it is.
A recent article published in the Journal of Medical Ethics asked this question, with the authors concluding that freezing ovarian tissue is ethically permissible, but not ethically required.
When the medical procedure is safe, it appears that it is the decision of the parents — having been well informed about the clinical risks and the likelihood of success of this technique for their daughters, and, if possible, consensus with the treating doctors — that should prevail.
The authors of the article also suggest that ethical support should be given to the clinicians responsible for these practices because in many cases, the ethical decision to make is not easy so that a collegiate decision seems the more reasonable.
However, apart from consensus between parents and doctors, there are also other ethical aspects of a social and health management nature, such as the cost of these practices as well as possible problems of equity, as regards the possibility of access to them, which must be considered. The authors, therefore, concluded that a more detailed ethical evaluation of these cases is needed, taking into account the aforementioned considerations.