Aggiornamento del 6 marzo 2013


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

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

[Article in Czech]

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

Gynekologicko-porodnická klinika 3. LF UK a FN KV.

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]

2. 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.

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]


3. 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]


4. Fertil Steril. 2011 Jan;95(1):72-8. Epub 2010 Jun 23.

State laws and regulations addressing third-party reimbursement for infertility treatment: implications for cancer survivors.

Quinn GP, Vadaparampil ST, McGowan Lowrey K, Eidson S, Knapp C, Bukulmez O.

OBJECTIVE: To examine codified state policies related to infertility and assess their implications for cancer patients. Lack of insurance is often identified as  a barrier to use of fertility preservation (FP) services.


SETTING: A keyword search was developed to identify statutes and administrative regulations of insurance coverage for FP in the United States.



MAIN OUTCOME MEASURE(S): Laws addressing the general population but pertaining to FP were compiled using Lexis-Nexis. Data were analyzed by reviewing the "plain meaning" of the text, legislative/administrative history, and annotated case law. Legal reasoning and common rules of statutory construction and legislative interpretation were used.

RESULT(S): Fifteen states (29.4%) had laws relating to insurance coverage for infertility or in vitro fertilization (IVF) procedures and two states (CA and IL) specifically excluded IVF from a mandatory offer of coverage. No state laws or regulations addressed insurance coverage for FP methods specific to cancer patients.

CONCLUSION(S): There is an argument for policies that require coverage for FP for cancer survivors before treatment.

Copyright © 2011 American Society for Reproductive Medicine. Published by

Elsevier Inc. All rights reserved.

PMID: 20576264  [PubMed – indexed for MEDLINE]


5. J Assist Reprod Genet. 2010 Feb;27(2-3):69-74. Epub 2010 Feb 6.

Oocyte cryopreservation: is it time to remove its experimental label?

Noyes N, Boldt J, Nagy ZP.

Erratum in

    J Assist Reprod Genet. 2010 May;27(5):259.

Comment in

    J Assist Reprod Genet. 2010 Feb;27(2-3):67-8.

As more reproductive-age women survive cancer at the expense of gonadotoxic therapy, the need for viable fertility preservation options has become paramount. Embryo cryopreservation, often using donor sperm, has been the standard offered these women over the past 20 years. Preservation of unfertilized oocytes now represents an acceptable and often equally viable alternative, particularly for single women, due to technologic advances made in the past decade. Given such, oocyte cryopreservation's experimental designation and need for IRB approval should thus be revisited.

PMCID: PMC2842870

PMID: 20140641  [PubMed – indexed for MEDLINE]


6. Fertil Steril. 2010 Mar 1;93(4):1037-9. Epub 2010 Jan 25.

Unique ethical and legal implications of fertility preservation research in the pediatric population.

Stegmann BJ.

Research in fertility preservation for children and adolescents receiving gonadotoxic chemotherapy has brought forth ethical and legal concerns that require special consideration. This article will discuss many of these issues and possible methods to safeguard the rights of these children.

Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier 

Inc. All rights reserved.

PMID: 20100618  [PubMed – indexed for MEDLINE]


7. Fertil Steril. 2009 Nov;92(5):1513-4. Epub 2009 Oct 17.

ASRM Practice Committee response to Rybak and Lieman: elective self-donation of oocytes.

Practice Committee of the American Society for Reproductive Medicine.

American Society for Reproductive Medicine, Birmingham, Alabama, USA.

Comment in

    Fertil Steril. 2009 Nov;92(5):1509-12.

Oocyte cryopreservation has great promise for applications in oocyte donation and fertility preservation and for decreasing the number of unused cryopreserved embryos. The Practice Committee has and will continue to review the published medical literature relating to oocyte cryopreservation at regular intervals and is prepared to reconsider its position when evidence warrants.

PMID: 19836735  [PubMed – indexed for MEDLINE]


8. Hum Reprod. 2001 Jan;16(1):188-193.

Gaining consent to freeze spermatozoa from adolescents with cancer: legal, ethical and practical aspects.

Bahadur G, Whelan J, Ralph D, Hindmarsh P.

University College London and UCLH Trust, The Meyerstein Institute of Oncology,

Middlesex Hospital, London, UK.

Comment in

Hum Reprod. 2001 Nov;16(11):2473-5.

Sperm banking for early adolescent cancer patients requires delicate, sensitive handling and, in the UK, consideration is required of statutory elements. No information at present exists about how adolescents with cancer are normally treated or counselled for sperm banking. Here we highlight the type of issues in  relation to fertility preservation faced by clinicians and those faced by adolescents at a sperm storage laboratory. We explore the very real difficulties of bringing together these medical fields of assisted reproduction, oncology and the various pieces of legislation and focus specifically on gaining consent. Attention is paid to counselling and communication to help the patient reach an effective and informed decision to store spermatozoa. The role of parents in contributing towards communication and support, together with the legal constraints in decision making, is acknowledged. How absolute and fully 'informed' consent should be will always remain a contentious issue amongst the various specialists and disciplines. In relation to sperm storage, as a minimum the patients should understand the process that they are undertaking so that it is undertaken freely and without pressure. The practical approach to gaining consent that we are using seems a logical and practical method to help early adolescent patients to store spermatozoa.

PMID: 11139561  [PubMed – indexed for MEDLINE]


9. Hum Reprod. 2000 Oct;15(10):2154-9.

Fertility preservation of boys undergoing anti-cancer therapy: a review of the

existing situation and prospects for the future.

Aslam I, Fishel S, Moore H, Dowell K, Thornton S.

With the advancement of medical science, most cancers in children are now treatable, the cure rate being almost 85%. In boys, one side effect of treatment  (chemotherapy and radiotherapy) is destruction of the sperm precursor cells in the testis, resulting in the failure of sperm formation after puberty, and consequent infertility. At the time of anti-cancer treatment, future fertility of the boy patient is at the very bottom of the relative quality of life (RQL) parameters list; however, in adults infertility is an important issue following cure from cancer. In this article we have first reviewed the existing situation with regard to the state of the art of fertility preservation in young boys with  cancer, and have then raised clinical and ethical issues and suggested a way forward. The review concludes with the emphasis that certain important issues still need to be resolved and, until these are, then the different techniques available should be confined to approved, ethical clinical trials where efficacy  and safety can be fully evaluated.

PMID: 11006191  [PubMed – indexed for MEDLINE]

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