Zusammenfassung
Die Therapie einer Krebserkrankung kann bei jungen Frauen zur Unfruchtbarkeit führen. In den vergangenen Jahren wurden zunehmend experimentelle Verfahren zur Fertilitätsprotektion bei Frauen entwickelt. Die Patientin sollte trotz der Belastung durch die Diagnose der Karzinomerkrankung und die anstehende Therapie über Methoden und Optionen der Fertilitätsprotektion aufgeklärt werden. Eine autonome Entscheidung sollte ihr ermöglicht werden. Ethische Aspekte und Problemstellungen der fertilitätsprotektiven Maßnahmen, welche diese Entscheidungssituation beeinflussen, werden hier diskutiert.
Abstract
Cancer therapy in young women can cause infertility. In previous years experimental procedures for fertility preservation in women have increasingly been developed. Young female patients are not only confronted with a life-threatening disease but at the same time with the likelihood of therapy-induced fertility and the methods and options for fertility preservation should be explained in detail. Decision-making in this vulnerable situation is challenging. Ethical aspects and problems associated with measures for fertility preservation which can influence the decision situation are discussed.
Literatur
Ethics Committee of the American Society for Reproductive Medicine et al. (2005) Fertility preservation and reproduction in cancer patients. Fertil Steril 83:1622–1628
ESHRE Task Force on Ethics and Law (2004) Taskforce 7: ethical considerations for the cryopreservation of gametes and reproductive tissues for self use. Hum Reprod 19:460–462
Boivin J, Pennings G (2005) Parenthood should be regarded as a right. Arch Dis Child 90:784–785
Böttcher B, Paul NW (2013) Personale Autonomie: Diskussion eines zentralen ethischen Konzepts am Beispiel von fertilitätsprotektiven Maßnahmen bei Krebspatientinnen. Ethik Med 25:47–59
Cohen CB (2009) Ethical issues regarding fertility preservation in adolescents and children. Pediatr Blood Cancer 53:249–253
Duffy C, Allen S (2009) Medical and psychosocial aspects of fertility after cancer. Cancer J 15:27–33
Duffy CM, Allen SM, Clark MA (2005) Discussions regarding reproductive health for young women with breast cancer undergoing chemotherapy. J Clin Oncol 23:766–773
Fallat ME, Hutter J (2008) Preservation of fertility in pediatric and adolescent patients with cancer. Pediatrics 121:e1461–e1469
Green DM, Sklar CA, Boice JD Jr et al (2009) Ovarian failure and reproductive outcomes after childhood cancer treatment: results from the Childhood Cancer Survivor Study. J Clin Oncol 27:2374–2381
Grundy R, Larcher V, Gosden RG et al (2001) Fertility preservation for children treated for cancer (2): ethics of consent for gamete storage and experimentation. Arch Dis Child 84:360–362
Hawkins MM (1994) Pregnancy outcome and offspring after childhood cancer. BMJ 309:1034
Jadoul P, Dolmans MM, Donnez J (2010) Fertility preservation in girls during childhood: is it feasible, efficient and safe and to whom should it be proposed? Hum Reprod Update 16:617–630
Kucuk M (2012) Fertility preservation for women with malignant diseases: ethical aspects and risks. Gynecol Endocrinol 28:937–940
Larcher V (2012) The ethical obligation to preserve fertility in the face of all therapies that might adversely affect it. Arch Dis Child 97:767–768
Lee SJ, Schover LR, Partridge AH et al (2006) American Society of Clinical Oncology recommendations on fertility preservation in cancer patients. J Clin Oncol 24:2917–2931
Nisker J, Baylis F, Mcleod C (2006) Choice in fertility preservation in girls and adolescent women with cancer. Cancer 107:1686–1689
Oosterhuis BE, Goodwin T, Kiernan M et al (2008) Concerns about infertility risks among pediatric oncology patients and their parents. Pediatr Blood Cancer 50:85–89
Partridge AH, Gelber S, Peppercorn J et al (2004) Web-based survey of fertility issues in young women with breast cancer. J Clin Oncol 22:4174–4183
Patrizio P, Caplan AL (2010) Ethical issues surrounding fertility preservation in cancer patients. Clin Obstet Gynecol 53:717–726
Peate M, Meiser B, Friedlander M et al (2011) It’s now or never: fertility-related knowledge, decision-making preferences, and treatment intentions in young women with breast cancer–an Australian fertility decision aid collaborative group study. J Clin Oncol 29:1670–1677
Poirot C, Vacher-Lavenu MC, Helardot P et al (2002) Human ovarian tissue cryopreservation: indications and feasibility. Hum Reprod 17:1447–1452
Quinn GP, Murphy D, Knapp C et al (2011) Who decides? Decision making and fertility preservation in teens with cancer: a review of the literature. J Adolesc Health 49:337–346
Robertson JA (2004) Procreative liberty and harm to offspring in assisted reproduction. Am J Law Med 30:7–40
Saito K, Suzuki K, Iwasaki A et al (2005) Sperm cryopreservation before cancer chemotherapy helps in the emotional battle against cancer. Cancer 104:521–524
Schover LR (1999) Psychosocial aspects of infertility and decisions about reproduction in young cancer survivors: a review. Med Pediatr Oncol 33:53–59
Schover LR, Brey K, Lichtin A et al (2002) Knowledge and experience regarding cancer, infertility, and sperm banking in younger male survivors. J Clin Oncol 20:1880–1889
Schover LR, Rybicki LA, Martin BA et al (1999) Having children after cancer. A pilot survey of survivors‘ attitudes and experiences. Cancer 86:697–709
Stark DP, House A (2000) Anxiety in cancer patients. Br J Cancer 83:1261–1267
Stegmann BJ (2010) Unique ethical and legal implications of fertility preservation research in the pediatric population. Fertil Steril 93:1037–1039
Thewes B, Meiser B, Taylor A et al (2005) Fertility- and menopause-related information needs of younger women with a diagnosis of early breast cancer. J Clin Oncol 23:5155–5165
Tschudin S, Bitzer J (2009) Psychological aspects of fertility preservation in men and women affected by cancer and other life-threatening diseases. Hum Reprod Update 15:587–597
Urech C, Tschudin S (2012) Fertilitätsprotektion bei Krebspatientinnen − Die psychologische Dimension. Gyn Endo 10:116–120
Wiesemann (2006) Von der Verantwortung, ein Kind zu bekommen. Eine Ethik der Elternschaft. CH Beck, München
Einhaltung ethischer Richtlinien
Interessenkonflikt. B. Böttcher und M. Goeckenjan geben an, dass kein Interessenkonflikt besteht.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Böttcher, B., Goeckenjan, M. Jetzt oder nie?. Gynäkologe 46, 642–647 (2013). https://doi.org/10.1007/s00129-013-3193-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00129-013-3193-z