ABSTRACT
The field of fertility is rapidly evolving, bringing opportunities for improvement
in our patients' quality of life as well as bringing new ethical dilemmas. As medical
science continues to advance, significant numbers of the reproductive-aged population
are living with chronic and/or terminal conditions but have reasonable odds of lengthy
survival and wish to have children. Likewise, there are adolescents diagnosed with
cancer who are increasingly expected to achieve an improved, if not normal, life expectancy
after treatment. Oftentimes these children are told they must sacrifice their ability
to later have genetically related offspring; however, technologies to preserve fertility
are changing this prognosis. Patients with chronic infection are living longer, more
normal lives and are increasingly seeking reproductive assistance. Moreover, there
is an increasing number of patients' families desiring posthumous use of gametes,
which also raises ethical and legal issues. This article discusses ethical principles
of bioethics and then highlights specific ethical issues through four plausible cases
that may be seen in a fertility practice providing medical care to patients with chronic
illness or terminal disease. It concludes that prompt referral of patients to the
reproductive endocrinologist, along with a multidisciplinary approach to care, provides
increased chances of successful treatment of this group of patients.
KEYWORDS
Fertility preservation - cancer - infection - transplantation - ethics
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Rebecca A ChilversM.D.
Department of Obstetrics and Gynecology, The University of Texas Medical Branch at
Galveston
301 University Blvd., Galveston, TX 77555-0587
Email: rachilve@utmb.edu
