Ethical and Legal Issues in Pre- Pubertal Cancer Pa-tients

Recently oncology is well developed bringing hope for cancer patients to live longer and have a family life and possibly children. Unfortunately cancer treatments like chemotherapy and radiotherapy destroy gametes and may cause secondary infer-tility. Fertility preservation (FP) is introduced to prevent this complication. There are different FP procedures and also dif-ferent types and stages of cancer making the decision to choose the best protocol. Ethical issues about FP mostly are focused around choosing the method and patient. The prognosis of the cancer and survival rate so life expectancy is very important. It doesn’t seem to be ethical to put a patient with little life ex-pectancy in the FP procedure. The situation of the patients and their wish is also important, if they are married, I they have chil-dren and if the wish to have children in the future considering their possible short life or not. The possibility of transmission of the cancer to the children is always raised. There are two way of transmission of cancer one is from cancer cells among the gametes and inside gonads and the second is to transmit genetically. The patient must know the transmission possibility to make his/her own decision. For immature patients there are no FP procedure other than cryopreservation of their gonadal tissue. This procedure is still in research phase and there are not high possibility to be successful in the future conception. For married people embryo freezing is the best and most promising way. But some prefer to freeze their oocytes for covering the possibility of future divorce. Both ways need controlled ovarian stimulation (COS) using hormonal drugs which cannot be used in hormone sensitive cancers. Also, COS takes time and maybe more than one cycle is needed so, invasive cancer patients can-not wait and post pone their chemotherapy to finish the oocyte retrieval. Sperm freezing is more practical and has been prac-ticed for ages. So, it seems that the decision for FP and the type of FP procedure should be made in a triangle consist of oncolo-gist, gynecologist and cryobiologist to make the best decision. Informing the patient about FP is the responsibility of oncolo-gist otherwise there is no way for the patient to know about FP. Informed consent with full information covering any possibility and complication must be taken from the patient for prevention any misguide. Posthumous reproduction can be raised by these procedures because there are frozen gametes and the patient is at risk of death. There is a need for a law and guidelines about FP in Iran.

کلیدواژه ها:

Fertility Preservation ، Oncology ، Cryopreservation ، Gametes ، Cancer