Ethical and Legal Issues in Female Fertility Ppreservation

سال انتشار: 1401
نوع سند: مقاله کنفرانسی
زبان: انگلیسی
مشاهده: 39

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RROYAN23_167

تاریخ نمایه سازی: 17 دی 1401

چکیده مقاله:

Fertility preservation (FP) is a term referring to cryopreservationof oocytes, embryos or in special cases, female ovary tissueto achieve pregnancy in the future. FP is offered for two differentsituations: a. medical and b. non-medical. Medical situationor FP with Medical Reasons is mainly for patients undergoingradiotherapy or chemotherapy for cancer or some other diseases(e.g. invasive mole). As we know chemo and radiotherapy candes troy gametes and make the cancer patient infertile. So, FP isoffered to make the future pregnancy possible.As for every woman, menopause happens in their life and fromthat time no mens trual cycle happens, so no ovulation will beperformed by body. Recently, age of marriage has been increasedand there is a fear for woman to become infertile becauseof age. This is the situation of Non-medical FP in whicheggs of the woman are cryopreserved for the future use.Each type of FP (cryopreservation of embryos, eggs or tissue)and also FP for medical and non-medical reasons have theirown ethical issues. Here we discuss the ethical issues in everysituation separately.FP for medical reason: It seems that overall, FP for medicalreasons is ethically acceptable, but there are some ethical considerationsin this procedure.Firs t, the procedure can be cryopreservation of embryo, oocyteor ovarian tissue. Embryo freezing is the oldes t and the mos tpromising procedure for FP, but is performed in two conditions:firs t producing embryos is normally for couples not for singleperson. Ethically, doctors mus t offer both embryo and eggfreezing to married people, so, in case of any uncertainty in thecouples’ relationship, woman can freeze their eggs and decidefor the usage in the future. For, mature woman, egg freezing ismore promising than cryopreservation of ovarian tissue. Cryopreservationof ovarian tissue is used for immature girls or veryinvasive cancer in which, time is very important and there is notime for ovarian s timulation and oocyte pick-up. As said, it isnot promising and cannot guarantee the future pregnancy at al.Second, as the prognosis of each cancer in different s tagesare different, it is very important for oncologis t to explain thesituation and FP possibilities to the patient ang guide them tothe FP centers. There are two problems in this regard: it is thephysician’s responsibility to inform the patient about FP procedureotherwise patient cannot know about such procedure andmay lose their fertility after chemo/radiotherapy and normallyin Iran, cancer patients are not well informed about the cancersituation and prognosis, so, they cannot decide about performingFP or not. A person can decide to do a procedure for beingpregnant in the future only if they know about the prognosisof the disease and the survival rate which, very few physicianshave adequate information about FP methods and believe thatthey mus t inform their patients about it. Also, cancer patientsare seldom informed about their survival time because physicianbelieve that it makes the patient hopeless and fragile, sothey never give enough information about the prognosis andsurvival rate of the cancer. In this situation, as the patient doesnot know their life expectancy, they cannot make a good decisionabout choosing FP or not. Although it seems worthless todo FP for low life expectancy, but ethically it is the patient’schoice.One of the mos t important points is the possibility of transmissionof cancer cells to the offspring. If this possibility is high,for example in ovarian cancers, it will put the offspring in danger.Although it is jus t a possibility, but mus t be considered.There are some other considerations like breas t cancer with estrogenand proges terone receptors which are sensitive to hormonetherapy. In these cases, special ovarian s timulation (usingletrozole) is needed for oocyte retrieval.Some ethicis ts believe that it is unjus tified that medical resourcesare used for poor prognosis or cancers with possibilityof transmission of cancer to the offspring. Resource allocationto FP is not always jus tified and mus t not be offered to all. Onthe other hand, prevention of future infertility for women withreasonable life expectancy is a good reason that makes FP ethicallyacceptable.It seems that informing the patient about the cancer situationand FP procedure is the mos t important point about FP and decisionabout the methods and procedures should be done by atriangle including oncologis t, gynecologis t and embryologis tfor bes t results. Detail counseling with the clients are necessaryalong with informed consent that for minors mus t be gottenfrom their parents.FP for non-medical reason: Az the age of marriage is increasingworldwide and people pos tpone their marriage or even childbearingbecause of education, social or economic s tates andetc… , infertility due to menopause became common worldwide.As the chromosomal abnormality in the oocyte is morecommon at higher ages, the risk of miscarriage and childrenwith abnormalities is increasing too. Possibility to freezing theoocyte brings the hope for healthy child for women, by freezingtheir oocytes in a good age and then pos t pone the pregnancyto later.The main ethical issue here is public information about this procedureis good or bad. Firs t we shall say that: “people have theright to know”. Meanwhile there are two opposite arguments:if we inform people about FP, this may change the trend of thesociety and increase the age of marriage or childbearing moreand more, but if we don’t inform, single or childless peoplerealize the possibility of being infertile in their advanced age inwhich physicians can do nothing for them. So, it seems that weare responsible for pubic information about FP.Detail counseling the clients about their situation, success rateof pregnancy in the future, possible complications of IVF, procedurephases and length and etc… is necessary.Virginity is an issue in Islamic and Middle Eas tern countries.It is obvious that FP procedure injures hymen. According to Islamiclaw, when a procedure is medically necessary, there isno need to think about virginity. An informed consent in whichthere is complete information about the procedure and possibleinjury to the hymen is enough and if some girls needed virginityconfirmation certificate before operation, it is the duty of forensicmedicine department where they can be referred.So, it seems that FP both for medical and non-medical reasonsis ethically acceptable with special consideration.

نویسندگان

R Omani-Samani

Department of Medical Ethics and Law, Reproductive BiomedicineResearch Center, Royan Ins titute for Reproductive Biomedicine,ACECR, Tehran, Iran

S Shariatinasab

Department of Medical Ethics and Law, Reproductive BiomedicineResearch Center, Royan Ins titute for Reproductive Biomedicine,ACECR, Tehran, Iran