Fertility Preservation: Techniques and ethical considerations in fertility preservation [Video]

Fertility Preservation: Techniques and ethical considerations in fertility preservation for cancer patients and individuals undergoing gender transition.

Fertility Preservation Techniques
For Cancer Patients
Cryopreservation of Oocytes (Eggs):

Procedure: Hormonal stimulation followed by egg retrieval and freezing.
Use: Later fertilized with sperm and implanted.
Considerations: Time-sensitive; requires delay of cancer treatment.
Cryopreservation of Embryos:

Procedure: Similar to oocyte cryopreservation, but eggs are fertilized before freezing.
Use: Higher success rates compared to oocytes.
Considerations: Requires a partner or donor sperm; ethical considerations regarding unused embryos.
Cryopreservation of Sperm:

Procedure: Sperm collection and freezing.
Use: Simple and effective, with good success rates.
Considerations: Less invasive, can be performed multiple times.
Ovarian Tissue Cryopreservation:

Procedure: Removal and freezing of ovarian tissue.
Use: Tissue is reimplanted after cancer treatment.
Considerations: Experimental; can restore hormonal function and fertility.
Testicular Tissue Cryopreservation:

Procedure: Removal and freezing of testicular tissue.
Use: For prepubescent boys or men who cannot produce sperm.
Considerations: Experimental, less established than other methods.
Gonadal Shielding:

Procedure: Protecting reproductive organs during radiation therapy.
Use: Reduces exposure and damage.
Considerations: Less effective if gonads are within the radiation field.
For Individuals Undergoing Gender Transition
Cryopreservation of Oocytes or Embryos:

Procedure: Similar to cancer patients, pre-transition.
Use: Allows for future biological children post-transition.
Considerations: Requires hormonal stimulation; ethical and personal considerations about using gametes collected pre-transition.
Cryopreservation of Sperm:

Procedure: Collection and freezing of sperm pre-transition.
Use: Allows for future biological children post-transition.
Considerations: Less invasive; psychological considerations about using gametes collected pre-transition.
Ovarian Tissue Cryopreservation:

Procedure: Potential option for trans men.
Use: Can restore hormonal function and fertility.
Considerations: Experimental; ethical and psychological considerations.
Testicular Tissue Cryopreservation:

Procedure: Potential option for trans women.
Use: Reproductive options still largely experimental.
Considerations: Experimental; ethical and psychological considerations.
Ethical Considerations
Autonomy and Informed Consent
Informed Decision-Making: Patients must be fully informed about the risks, benefits, and limitations of fertility preservation techniques.
Age and Capacity: Special considerations for minors and individuals with diminished decision-making capacity.
Equity and Access
Insurance Coverage: Varied coverage for fertility preservation can create disparities.
Economic Barriers: High costs can limit access to fertility preservation.
Timing and Urgency
Cancer Treatment Delay: Balancing the urgency of cancer treatment with the time needed for fertility preservation procedures.
Transition Timeline: Timing fertility preservation relative to the start of hormone therapy or surgery for transgender individuals.
Psychological Impact
Cancer Patients: The psychological burden of potential infertility and the hope provided by fertility preservation.
Transgender Individuals: The emotional and psychological considerations of using gametes collected before transition.
Ethical Concerns with Embryo Use
Embryo Ownership: Decisions about unused embryos, especially in cases of separation or death.
Disposal of Embryos: Ethical implications of discarding unused embryos.
Experimental Techniques
Ovarian and Testicular Tissue Cryopreservation: Ethical considerations about the use of experimental techniques and the consent process.
Conclusion
Fertility preservation is a complex field with rapidly evolving techniques. Ethical considerations are integral to ensuring that patients are supported and informed throughout the process. Balancing medical, psychological, and ethical factors is crucial in providing comprehensive care to cancer patients and individuals undergoing gender transition.