Bioetica

Aggiornamento del 27 novembre  2012

ARTICOLI

1. Gynecol Obstet Fertil. 2012 Nov;40(11):687-90. doi: 10.1016/j.gyobfe.2012.09.016.
Epub 2012 Oct 23.

[Oocyte vitrification and its impact on the clinical practice of assisted
reproduction].

[Article in French]

Boyer P, Tourame P, Gervoise-Boyer M.

Service de médecine et biologie de la reproduction, hôpital
Saint-Joseph-de-Marseille, 26, boulevard de Louvain, 13008 Marseille, France.
Electronic address: pb.boyer@gmail.com.

Oocyte vitrification is a new technique in cryobiology that will lead to a number
of improvements in assisted reproduction practices, oocyte donation and the
preservation of female fertility. Professionals already versed in the techniques
of micromanipulation will be able to master the new procedures, which should not
be delegated to unqualified staff. When adopted by clinical units, oocyte
vitrification will require changes in laboratory and administrative organization.
The technique will also modify the ethical outlines of reproductive biology.
France today is running behind in the application of this major development in
cryobiology. The reasons are many and have to do with a long waiting period for
authorization from national health authorities, a lack of material and human
resources and a foreseeable shake-up in the nationally established egg donation
program. However, recently a new law of bioethics has recognized the breakthrough
that this new technique represents by allowing couples covered by the French
national health care program for Assisted Reproductive Technologies (ART) to
choose oocyte vitrification as an option.

Copyright © 2012 Elsevier Masson SAS. All rights reserved.

PMID: 23099025  [PubMed – in process]

2. Hum Reprod. 2012 Oct;27(10):2886-93. doi: 10.1093/humrep/des250. Epub 2012 Jul
15.

Implications of oocyte cryostorage for the practice of oocyte donation.

Mertes H, Pennings G, Dondorp W, de Wert G.

Bioethics Institute Ghent, Ghent University, Ghent, Belgium.
heidi.mertes@ugent.be

As the efficiency of oocyte cryopreservation has increased rapidly in recent
years, oocytes are currently being stored either in the course of IVF treatments
or as a fertility preservation measure. These practices may have an impact on the
number of available donor oocytes due to two different dynamics: first, a certain
percentage of women for whom oocytes were cryopreserved will eventually not use
their oocytes and may decide to donate them to others; secondly, especially in
the practice of social freezing, women may opt to donate a portion of the
retrieved oocytes in ‘freeze-and-share’ schemes in order to reduce the costs. In
this article, we aim to sketch the ethical implications of such developments in
general and the issue of payment to oocyte donors in particular.

PMID: 22802093  [PubMed – in process]

3. Arch Dis Child. 2012 Sep;97(9):767-8. doi: 10.1136/archdischild-2012-301836. Epub
2012 Jul 11.

The ethical obligation to preserve fertility in the face of all therapies that
might adversely affect it.

Larcher V.

Adolescent Medicine, Great Ormond Street Hospital NHS Trust, Great Ormond Street,
London, UK. victor.larcher@gosh.nhs.uk

PMID: 22789439  [PubMed – indexed for MEDLINE]

4. Ceska Gynekol. 2012 Apr;77(2):163-6.

[Medical, legal and ethical aspects of fertility preservation in cancer
survivor].

[Article in Czech]

Záhumenský J, Kucera E, Kosová T, Zmrhal J, Stejskal M, Stejskal D.

Gynekologicko-porodnická klinika 3. LF UK a FN KV. jozef.zahumensky@fnkv.cz

In recent years the number of the young women in fertile age which are
oncologically treated is increasing. For these women chemotherapy and
radiotherapy introduces potential risk of reproductive dysfunctions. Present
techniques of assisted reproduction are offering possibilities to save
reproductive functions even after the oncological treatment. As a perspective
outlook seems to be frozen premature oocytes with IVM and fertilisation. With
these fertility savings methods are naturally coming up some of the ethical and
legal issues.

PMID: 22702076  [PubMed – indexed for MEDLINE]

5. Best Pract Res Clin Obstet Gynaecol. 2012 Dec;26(6):853-63. doi:
10.1016/j.bpobgyn.2012.04.002. Epub 2012 May 16.

Ethical issues in infertility treatment.

Pennings G, Mertes H.

Bioethics Institute Ghent, Ghent University, Blandijnberg 2, Gent 9000, Belgium.
Electronic address: Guido.Pennings@UGent.be.

Two currently contentious domains in infertility treatment are discussed:
assisted reproduction for same-sex couples and fertility preservation for women
with cancer. Despite an increasing recognition of the rights of same-sex couples,
in many countries they are still not eligible for assisted reproductive
technology. The main justification for excluding same-sex couples from treatment
is that the welfare of the future children would be compromised. Empirical
evidence, however, shows that this is not the case. Another group of
non-infertile women seeking assistance from reproductive medicine are women with
cancer who are at risk of impaired or lost fertility as a result of their illness
or cancer treatment. In this field, the future holds many promising options.
Several of these, however, are currently in an experimental phase, which elicits
ethical concerns about participant recruitment and research participation of
children.

Copyright © 2012 Elsevier Ltd. All rights reserved.

PMID: 22595822  [PubMed – in process]

 

6. Gynecol Endocrinol. 2012 May 10. [Epub ahead of print]

Fertility preservation for women with malignant diseases: ethical aspects and risks.

Küçük M.

Department of Obstetrics and Gynecology, Faculty of Medicine, Adnan Menderes University , Aydin , Turkey.

As cancer treatment becomes more and more effective, there is greater life expectancy for cancer patients. Because of this, depending upon the modality used in the treatment of cancer, the matter of infertility emerges before us as an issue of increasing significance. Sperm cryopreservation and embryo cryopreservation are well-established methods of fertility preservation (FP). Besides these validated FP options, some FP techniques such as oocyte cryopreservation and ovarian tissue cryopreservation are as yet in the experimental stage. FP medicine has experienced some rapid developments in recent years. The advances in this branch of medicine, however, have also brought about  new ethical, medical and legal issues. Some of these include problems with obtaining the informed consent of minors, issues that arise because of the experimental nature of some methods, financial problems and the accessibility of  FP methods, and the question of what happens to gametes when a patient dies. This review seeks to discuss, in the light of current literature, some ethical and technical issues and risks related to the implementation of FP methods in women with cancer.

PMID: 22571650  [PubMed – as supplied by publisher]

7. Obstet Gynecol Int. 2012;2012:139193. Epub 2012 Feb 16.

Fertility preservation in girls. Michaeli J, Weintraub M, Gross E, Ginosar Y, Ravitsky V, Eizenman E, Mitrani E, Lebovich M, Laufer N, Kennedy S, Revel A.

Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical

Center, 91120 Jerusalem, Israel.

Children that undergo treatment for cancer are at risk of suffering from subfertility or hormonal dysfunction due to the detrimental effects of radiotherapy and chemotherapeutic agents on the gonads. Cryopreservation of ovarian tissue prior to treatment offers the possibility of restoring gonadal function after resumption of therapy. Effective counseling and management of pediatric patients is crucial for preserving their future reproductive potential. The purpose of this article is to review recent literature and to revise recommendations we made in a 2007 article. Pediatric hemato-oncology, reproductive endocrinology, surgery, anesthesia and bioethics perspectives are discussed and integrated to propose guidelines for offering ovarian cryopreservation to premenarcheal girls with cancer.

PMCID: PMC3307018

PMID: 22496695  [PubMed – in process]

8. Fertil Steril. 2012 May;97(5):1044-7. Epub 2012 Mar 3.

A persistent misperception: assisted reproductive technology can reverse the “aged biological clock”.

Wyndham N, Marin Figueira PG, Patrizio P.

Center for Bioethics, Yale University, New Haven, Connecticut.

Delaying motherhood should be a free choice made in full knowledge of all the consequences, but modern women have alarming misconceptions about their own reproductive systems and the effectiveness of assisted reproductive technologies. Doctors and health professionals must begin to discuss fertility preservation with their patients and make sure that young women truly understand all their options. Preventing age-related infertility is the responsibility not only of doctors and medical practitioners but also of society at large. Social, economic, and personal pressures are causing women to decide to conceive later in life, yet those who choose to delay motherhood are stigmatized as being selfish and unconcerned about starting a family. This stigma must be banished, and age-related infertility should be faced as a medical problem.

Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

PMID: 22386844  [PubMed – in process]

9. Adv Exp Med Biol. 2012;732:187-96.

Fertility preservation in cancer patients: ethical considerations.

Bower B, Quinn GP.

bethannebower@gmail.com

PMID: 22210262  [PubMed – indexed for MEDLINE]

10. Pediatr Clin North Am. 2011 Oct;58(5):1201-15, x.

Optimizing potential for fertility: fertility considerations for the

pediatrician.

Lee PA, Rogol A, Houk CP.

USA. plee@psu.edu

Whether for the prepubertal or pubertal child, the goal of fertility preservation  is to obtain cells or tissues to be used to produce future children. For the prepubertal child, preservation efforts involve germ cells, earlier forms of sperm, and immature follicles, rather than mature spermatozoa or follicles. Options for prepubertal children include for boys freezing testicular tissue and  extracting testicular sperm or for girls obtaining ovarian cortical or follicular tissue for storage. These procedures involve extraction and storage of immature gametes for subsequent in vitro maturation, although attempts for sperm currently involve only animal studies. For adolescent subjects who have sufficient gonadal  development and reserve, sperm, oocytes, and ovarian cortex can be retrieved as among adults.

Copyright © 2011 Elsevier Inc. All rights reserved.

PMID: 21981956  [PubMed – indexed for MEDLINE]

11. J Adolesc Health. 2011 Oct;49(4):337-46. Epub 2011 Mar 15.

Who decides? Decision making and fertility preservation in teens with cancer: a review of the literature.

Quinn GP, Murphy D, Knapp C, Stearsman DK, Bradley-Klug KL, Sawczyn K, Clayman

ML.

Florida, Tampa, Florida 33612, USA. gwen.quinn@moffitt.org

PURPOSE: The knowledge that cancer treatment may impair fertility in pediatric populations is an emerging aspect of quality of life in this population. However, decision making and use of fertility preservation (FP) among adolescent cancer patients and their families has not been well studied. This review summarizes the available published data on aspects of decision making and FP in adolescent cancer patients.

METHODS: An electronic search was performed to identify peer-reviewed studies published between 1999 and 2009 using key Medical Subject Heading terms and inclusion criteria. Inclusion criteria limited eligible studies to those that focused on adolescent decision making in cancer treatment or FP, fertility concerns in pediatric oncology, capacity for decision making, and health decision making in pediatrics. Studies that did not meet at least one of these criteria were excluded.

RESULTS: A total of 29 articles were reviewed and summarized. Three categories of results were seen: a focus on adolescent decision making in oncology, decision making in chronic illness, and decision making in cancer-related infertility and preservation.

CONCLUSION: Most of the studies showed that adolescents have a strong desire to participate in decisions related to their cancer treatment and many have concerns regarding their future fertility, although barriers often prevented these discussions. More research is needed to explore the role of teenagers and parents in decisions about fertility in relation to cancer treatment.

Copyright © 2011 Society for Adolescent Health and Medicine. Published by

Elsevier Inc. All rights reserved.

PMCID: PMC3179606 [Available on 2012/10/1]

PMID: 21939862  [PubMed – indexed for MEDLINE]

12. Womens Health (Lond Engl). 2011 Sep;7(5):537-43.

Fertility preservation in women with cancer: importance of a multidisciplinary approach.

Treves R, Grynberg M, Hesters L, Frydman R.

Antoine Béclère, Clamart, France. rachel.treves@abc.aphp.fr

For all patients affected by a disease that could impair fertility before or during the reproductive lifespan, strategies to preserve their fertility and the ability to bear their own children is likely to be of utmost importance. While fertility preservation is a promising option, most of the technologies currently  used are far from being well-established or are still experimental. Patients should be aware that no method guarantees success. Psychological and ethical impacts of fertility preservation are major concerns and should be included in the multidisciplinary approach to the patients.

PMID: 21879822  [PubMed – indexed for MEDLINE]

13. Gynecol Obstet Fertil. 2011 Sep;39(9):497-500. Epub 2011 Aug 4.

[Female fertility preservation: feasibility of emergency IVF for embryo freezing].

[Article in French]

Courbiere B, Saias-Magnan J, Metzler-Guillemain C, Perrin J, Noizet A, Gamerre M.

Conception, 147 boulevard Baille, Marseille, France. blandine.courbiere@ap-hm.fr

With the improvement of the anticancerous treatments, the preservation of the feminine fertility before gonadotoxic treatment tends at present to stand out as  a legal obligation, with a duty of information to patients. When emergency IVF can be performed, the cryopreservation of embryos is the best mastered method which offers most chances to patients to obtain a pregnancy after cancer remission thanks to the transfer of frozen embryos. This article proposes an overview about the indications, the feasibility and the ethical and practical limitations of IVF emergency for embryo freezing before gonadotoxic anticancerous treatment.

Copyright © 2011 Elsevier Masson SAS. All rights reserved.

PMID: 21820346  [PubMed – indexed for MEDLINE]

14. Int J Gynaecol Obstet. 2011 Oct;115(1):11-5. Epub 2011 Jul 20.

Medical, ethical, and legal considerations in fertility preservation.

Shah DK, Goldman E, Fisseha S.

Medical School, Boston 02115, USA. dkshah@partners.org

The past 2 decades have seen a significant rise in cancer survival rates, and an increasing proportion of survivors at reproductive age are interested in childbearing. Although assisted reproduction provides physicians with an array of potential possibilities to help patients whose fertility is compromised by cancer treatment, there is still a dearth of regulation regarding the application of this technology. The present paper reviews the current options for fertility preservation, with a particular focus on the legal and ethical challenges that confront providers of this type of care.

Copyright © 2011 International Federation of Gynecology and Obstetrics. Published

by Elsevier Ireland Ltd. All rights reserved.

PMID: 21767834  [PubMed – indexed for MEDLINE]

15. J Gynecol Obstet Biol Reprod (Paris). 2011 Oct;40(6):487-91. Epub 2011 Jul 1.

[Fertility preservation in cancer women: a multidisciplinary approach].

[Article in French]

Trèves R, Grynberg M, Hesters L, Fanchin R, Frydman R.

Service de gynécologie-obstétrique et médecine de la reproduction, hôpital

Antoine-Béclère, AP-HP, 157, rue de Porte-de-Trivaux, 92141 Clamart, France.

Over the past two decades, major advances in diagnostic modalities and treatment  have markedly improved rates of cure for adult cancers. As a consequence, the number of long-term survivors is increasing, and fertility preservation has become a major issue for young patient about to start treatment for cancer. Whether fertility preservation is a promising option, most of the technologies currently used are far from being well established or are even still experimental. Patients should be aware that no method guarantees success. Psychological and ethical impacts of fertility preservation are major concerns and should be included in the multidisciplinary approach of the patients.

Copyright © 2011 Elsevier Masson SAS. All rights reserved.

PMID: 21723676  [PubMed – indexed for MEDLINE]

16. J Gynecol Obstet Biol Reprod (Paris). 2010 Dec;39(8 Suppl 2):S53-66.

[Preservation of fertility in case of sterilizing treatment].

[Article in French]

Bringer-Deutsch S, Belaisch-Allart J, Delvigne A.

France. sbringer76@yahoo.fr

The different options of fertility preservation must be approached with all patients before initiating any cancer therapy and physicians should refer each patient treated during their reproductive years to specialists in a specialized center that will evaluate the best available alternatives to preserve male and female fertility.The only efficiently proven ways of fertility preservation are sperm cryopreservation for men and embryo cryopreservation to preserve couple fertility. However, the recent progress observed with oocyte cryopreservation (in particular the oocyte vitrification) may change our practices in the future if vitrification is allowed in France. Although the law of Bioethics of 2004 authorizes the ovarian cryopreservation today, its modalities of use stay at present at the stage of the research. But in spite of the low number of published births today in France and in the world, the ovarian tissue cryopreservation is a promising technique. It remains the last possible alternative to protect fertility of prepubertal girls. The sperm cryopreservation must be systematically proposed to all men (even teenagers) undergoing a treatment for cancer potentially harmful for their fertility whatever their sperm quality. The testicular tissue cryopreservation is also a method to be discussed for adults, teenagers in case of failure of sperm banking or for prepubertal boys.

Copyright © 2010 Elsevier Masson SAS. All rights reserved.

PMID: 21185487  [PubMed – indexed for MEDLINE]

17. J Law Med Ethics. 2010 Winter;38(4):832-9. doi: 10.1111/j.1748-720X.2010.00536.x.

Insuring against infertility: expanding state infertility mandates to include fertility preservation technology for cancer patients.

Basco D, Campo-Engelstein L, Rodriguez S.

Northwestern University, Evanston, IL, USA.

In this paper, we recommend expanding infertility insurance mandates to people who may become infertile because of cancer treatments. Such an expansion would ensure cancer patients can receive fertility preservation technology (FPT) prior  to commencing treatment. We base our proposal for extending coverage to cancer patients on the infertility mandate in Massachusetts because it is one of the most inclusive. While we use Massachusetts as a model, our arguments and analysis of possible routes to coverage can be applied to all states’ seeking inclusive coverage for infertility treatment. Furthermore, our proposal can also be applied to people with other diseases who may be rendered infertile by treatment.

© 2010 American Society of Law, Medicine & Ethics, Inc.

PMCID: PMC3097090

PMID: 21105946  [PubMed – indexed for MEDLINE]

18. Clin Obstet Gynecol. 2010 Dec;53(4):717-26.

Ethical issues surrounding fertility preservation in cancer patients.

Patrizio P, Caplan AL.

pasquale.patrizio@yale.edu

Fertility preservation is a newly developed branch of reproductive medicine aimed at preserving the potential for genetic parenthood in adults of reproductive age or children, who are at risk of sterility before undergoing anticancer treatments. Except for embryo and semen freezing, all the available options to preserve fertility are considered experimental and thus, they raise ethical issues. In this study, we reviewed the informed consent and the risk-benefit analysis of offering experimental procedures for both adults and children when they are in vulnerable situations. In particular, children represent a special category of patients and their assent to treatment to be sought at anytime should be possible. Overall, there should be no ethical objections to offer these services as they are offered with the scope of preserving future fertility.

PMID: 21048439  [PubMed – indexed for MEDLINE]

19. Preservare la fertilità in età pediatrica: la crioconservazione di tessuto ovarico / Maria Luisa Di Pietro.

Medicina e Morale: rivista internazionale bimestrale di bioetica, deontologia e morale medica , p. 383-395, v.3(2010)

Associazione Gemme Dormienti ONLUS