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The ethical obligation to preserve fertility in the face of all therapies that might adversely affect it
  1. Vic Larcher
  1. Adolescent Medicine, Great Ormond Street Hospital, London, UK
  1. Correspondence to Vic Larcher, c/o Adolescent Medicine, Great Ormond Street Hospital NHS Trust, Great Ormond Street, London WC1N 3JH, UK; victor.larcher{at}gosh.nhs.uk

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Sterility (an inability to conceive without clinical intervention) and infertility (the inability to conceive after 1 year or more of unprotected intercourse) both produce psychological distress and reduced quality of life.1 ,2 Prevalence of sterility and infertility is variably increased after some types of cancer treatment, and similar adverse outcomes are reported among survivors.3 ,4 Despite the possibility of adoption and gamete/embryo donation, most adult patients with cancer prefer to have biological offspring5; advances in assisted reproduction technologies (ART) have made this possible.3 ,4

The provision of ART in these circumstances is grounded in the moral obligation to respect the autonomous choices of individuals, which is fundamental to a free society. In general we do not prevent adults from exercising freely made reproductive choices unless to do so poses serious risks of harm to the children conceived or to others.

Considerations of reproductive medicine, with exceptions such as the provision of contraceptive advice in adolescents, have not historically formed a significant part of paediatric practice. Children may not possess—and may never develop—some or all of the characteristics that enable them to make autonomous reproductive choices. They may lack sufficient cognitive ability to use information; the presence of a coherent set of values in which such fundamental choices might be framed; and a sense of identity, developed over time, that enables them to formulate and implement life plans. But even if children lack these attributes there is evidence to suggest that parents are interested in fertility preservation on behalf of their children.3 Moreover infertility has adverse psychosocial consequences for the increasing number of adult survivors of childhood cancer.6,,8

Concerns about fertility preservation are not the sole prerogative of patients with cancer in childhood.9 Others affected include …

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