Fertility and Cancer

Bioethics is about dealing with the difficult topics, so here is one that I find particularly difficult. The more I learn about the infertility industry, the more opposed I am to IVF and many of the variants of in vitro procedures. The United States has very few regulations on this billion dollar industry, and the risks to mother and child seem to be underreported (See the web site for the documentary, Eggsploitation). Furthermore, I am skeptical of companies that make a substantial profit off of something that is so emotionally laden. Oftentimes, these companies are not up-front with the success rates of IVF, so an emotionally distraught couple is willing to pay thousands of a dollars for a procedure that has a success rate of 30-40% . One couple that I talked to told me that there are bioethical decisions at every step of the process and couples walk in ill-prepared to make these decisions. Many couples are so upset that they may not be in a position to think through these decisions. Personally, I am particularly wary of cryogenic freezing of embryos. There are a number of ethical issues related to this one particular procedure, such as what to do with left over embryos, or how does freezing affect the health of the embryos, considering how very delicate they are.

In general, however, I am also against dismissing certain medical procedures just because they may be used for unethical purposes. For example, I cannot categorically dismiss a DNC procedure even though this is used for aborting a pregnancy. DNC is also used when a miscarriage occurs, and in that sense, it is a much more humane procedure for the death of a baby in utero than the alternative. I also cannot categorically dismiss cosmetic procedures even though some people undergo them for trivial purposes because there are many cases where cosmetic procedures have helped restore a patient’s physical features and facial mobility after accidents or burns.

So, when I came across this article from ABC news about a young woman in her twenties who wanted to freeze her eggs (not embryos) because chemotherapy can cause early menopause in women, I am not sure if this situation can be evaluated from the same ethical categories as a typical IVF case. The young woman wanted to preserve her fertility so she had several of her eggs frozen. She had to take drugs that cause hyper-ovulation, a risky procedure in and of itself, and will likely have to conceive through IVF, although there may be other options available, such as inserting the unfertilized egg into her fallopian tubes.

A news story is one thing. About a year ago I had given a talk on faith and science. After the talk, I met a young woman who was in the audience. She had just recently completed chemo therapy for breast cancer, and was finally trying to put her life back together. She was young, probably not yet thirty and her mom was with her. She told me that she and her husband decided to have some embryos frozen until she was cancer free and was ready to have children. They had to quickly make this decision because, in her case, it was likely that the chemo would affect her fertility. To make the already cloudy ethical waters even murkier, she refers to the embryos as her children. They had apparently only fertilized (or only saved, I am not sure) 2 or 3 embryos, as many as she and her husband planned on having. She referred to them has her children and sees them as such; not something to be discarded or stored indefinitely.

Both of these young women give me pause. Ethical problems abound in reproductive technology. But these women, particularly the second girl that I talked to, do not view these children as commodities. And the technology may very well help them to be able to have children even if cancer treatment might take that opportunity away. Usually I hold a firm stance against IVF, but is this a case where reproductive technologies are less morally tenuous?

On a final note, the ABC article mentions an experimental drug called triptorelin that women can take concurrently with chemo that decreases the chances of infertility (or early onset of menopause) in women. Hormonal drugs always come with risks, however this seems like an ethically robust alternative to an in vitro procedure. Furthermore, this drug is cheaper than freezing eggs or embryos, and thus far seems to be safer than the hyper-ovulation drugs. Also, because tripotorelin can be taken during chemo, chemotherapy does not need to be delayed as it would with freezing procedures.

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