Addressing the three most frequently asked questions of a bioethicist in an oncofertility setting

Many ethical issues surround the provision of fertility preservation for patients diagnosed with cancer. Three of the most common questions—who should be offered or undergo fertility preservation procedures, who should pay for those procedures, and the ownership of the resulting banked reproductive materials—are discussed in detail in this chapter. Patient age, marital status, and prognosis are important issues that must be considered when determining who should undergo fertility preservation procedures. A case is made for insurance coverage of fertility preservation for cancer patients, as infertility is a consequence of cancer treatment. Finally, the complex legal issues with regard to ownership of gametes (eggs, sperm), embryos, and gonadal tissue that are banked as a result of fertility preservation procedures are discussed, as well as approaches to preventing disputes over reproductive material, such as the use of advance directives. Clinicians will need to anticipate these ethical issues and their patients' questions and consider each patient's individual needs and circumstances in order to provide appropriate care.