Abstract
BackgroundChemotherapy and/or radiotherapy treatments may cause premature ovarian failure and irreversible loss of fertility. In the context of childhood cancers, it is now acknowledged that possible negative effects of therapies on future reproductive autonomy are a major concern. While a few options are open to post-pubertal patients, the only immediate option currently open to pre-pubertal girls is cryopreservation of ovarian tissue and subsequent transplantation. The aim of the study was to address a current gap in knowledge regarding the offer of fertility preservation by Ovarian Tissue Cryopreservation (OTC) for prepubescent girls with cancer, and to explore current practices and attitudes of Canadian, French and Moroccan pediatric heme oncologists. The comparative perspective is relevant since legal frameworks surrounding fertility preservation and funding offered by the healthcare system vary greatly.MethodsAn online survey was sent to the 45 pediatric oncology centers in Canada, France and Morocco.ResultsA total of 39 centers responded (86.6%). OTC is offered by almost all pediatric heme oncologists in France (98%), very few in Canada (5%), and none in Morocco (0%). For pediatric hematologists/oncologists who do not propose fertility preservation in Canada, the reasons are: the technique is still experimental (54%), it is not available locally (26%) and cost of the technique for the family (14%). 97% of Canadian and 100% of Moroccan pediatric hematologists/oncologists think OTC should be funded by the healthcare system as it is in France and in the province of Quebec in Canada.ConclusionsThe results of this study show tremendous diversity in the provision of OTC across countries, whereby its offer is correlated with legislation and funding. We argue that the current reality, in which this technology is often not offered to families, raises ethical issues related to justice and equity of access, as well as informed consent and future reproductive autonomy.
Highlights
Chemotherapy and/or radiotherapy treatments may cause premature ovarian failure and irreversible loss of fertility
The results of this study show tremendous diversity in the provision of Ovarian Tissue Cryopreservation (OTC) across France, Canada and Morocco and show that its offer is correlated with legislation and funding
The current reality, in which this technology is often not offered to and not discussed with families, raises ethical issues related to justice and equity of access, as well as informed consent and respect for future reproductive autonomy and the child’s right to an open future
Summary
Chemotherapy and/or radiotherapy treatments may cause premature ovarian failure and irreversible loss of fertility. The American Society of Clinical Oncology and National Comprehensive Cancer Network guidelines state that OTC is an investigational method of fertility preservation and the possibility of reseeding cancer through transplanted tissue exists [6,7,8]. It already resulted in the birth of over 130 babies, 2 of them born from ovarian tissue that has been cryopreserved in childhood [9,10,11]
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