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The New Reproductive Frontier

A program at the University of Pittsburgh portends the inevitable—children are eligible for interventions aimed at preserving or restoring fertility.  The processes might involve the harvesting of reproductive tissues, collecting semen, and cryopreserving what doctors collect from children.  The Magee-Women’s Research Institute, the Magee-Women’s Hospital, the Children’s Hospital of Pittsburgh of UPMC, and the Pittsburgh School of Medicine are collaborators in the nation’s first comprehensive program of its kind.  Eager parents are already calling to register their children.

Critics are rightfully doubtful about an all gain/no harm approach to assisted reproductive technology (ART), because it poses serious health risks, can result in dangerous multiple births, and the field is unregulated (remember Nadya Suleman?).  For some of ART’s most ardent critiques, the field is like the Wild West of biotechnology where nearly nothing is outlawed.  The only existing federal law requires that fertility clinics report their “success rates.”

However, supporters of the program hope that doubters will take a second look.

It is estimated that one in every 1,000 adults is a survivor of childhood cancer. Even more alarming, Dr. Carrie Nieman and her research partners predict that, “an estimated 1 in every 250 adults will be living with a history of childhood cancer.” Their article, Fertility Preservation and Adolescent Cancer Patients: Lessons from Adult Survivors of Childhood Cancer and Their Parents, published in 2007, provides compelling evidence that preserving fertility is an important matter for teenage cancer patients and their parents.

Proponents of fertility programs designed for children contend that while the harmful reproductive effects of toxic exposures from cancer treatments may be lower in younger children, overall, it is estimated that the probability of achieving a pregnancy after surviving cancer as a child, adolescent, or young adult is reduced by approximately one-half.  Dr. Teresa Woodruff, a researcher in Northwestern University’s Oncofertility Consortium, explains that for girls the problem is compounded by “the prospect of menopause in their 20s or 30s.”

Dr. Nieman suggests that one of the ways to combat infertility in girls will be through ovarian transplantation, which entails harvesting and cryopreserving “ovarian tissue before treatment” and reintroducing the tissue later, after chemotherapy and radiation treatments are stopped.  Researchers working in this domain seem to agree that the key to preserving fertility in childhood cancer patients is to begin the tissue harvesting process before “fertility-threatening treatments” begin.

For some parents, saving their child’s life through cancer treatments comes at a very difficult cost: their child’s fertility.  In an effort to spare their children from the high probability of infertility due to radiation exposure, a growing number of parents have enrolled their children and even babies in research trials to store stem cells that for boys will, they hope, produce sperm.  For girls, a similar experiment, banking ovarian tissues, might lead to future reproductive possibilities.

Nieman’s study reveals that fertility is an important matter for adult survivors of childhood cancer.  For example, one of the study’s participants acknowledged that she wanted to end chemotherapy and radiation treatments because she learned that her fertility might be compromised.  Others told researchers that as they became well or approached adulthood, fertility mattered even more.  For some cancer patients and their parents, these new research trials hold the promise of fully restoring life and health.

The challenge for legislators and judges is that biotechnological advancements often outpace legislative awareness and responsiveness, leaving judges and juries ill-equipped to insightfully and appropriately respond to trend-setting technological advancements when problems arise or harms result.  These issues are all the more relevant when conflicts of interest may arise between parents and children, doctors and parents, and doctors and adolescent patients.  This is an important issue for thoughtful dialogue, increased medical awareness, and legal understanding.

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