FERTILITY PRESERVATION: Exploring the complexities of posthumous reproduction in fertility preservation for oncology patients with poor prognosis

Abstract

The field of fertility preservation (FP) for oncology patients has evolved significantly in recent years, offering new possibilities for individuals with life-threatening illnesses. We commend Jones et al. for their comprehensive ethical review of offering FP to patients with poor prognoses, acknowledging the potential benefits that it may bring. ‘Poor prognosis’ in this context implies a high likelihood of death due to cancer progression. We highlight the importance of considering posthumous reproduction, involving the use of cryopreserved gametes or embryos to conceive a child after one or both partners have passed away, a topic briefly mentioned by Jones et al. Posthumous reproduction raises complex ethical, logistical, and legal questions. Distinctions between cryopreserved sperm and oocytes are discussed, with each scenario presenting unique challenges. The article also examines the complexities faced by same-sex couples in posthumous reproduction, addressing issues related to donor selection, legal parentage, and rights. Legal and regulatory aspects play a crucial role, including obtaining clear and legally valid consent, defining parental rights, navigating surrogacy laws, and addressing inheritance and estate planning. Ethical dilemmas require healthcare professionals to ensure informed decision-making, consider psychological impacts, and offer information on alternative family-building options. Lay summary Cancer treatments can have a negative impact on a person’s ability to have children, and some cancer survivors may end up being unable to conceive. Fortunately, there are currently available technologies that can help preserve fertility for these patients. These options include freezing eggs or sperm before starting cancer treatment. For patients who have been diagnosed with cancer and have a poor prognosis, meaning they are not likely to survive their illness, it is crucial to think about what happens to their frozen eggs and sperm in case of their death. This process of conceiving a child after someone's passing is known as ‘posthumous reproduction’. In our article, we explore the ethical, legal, and logistical challenges that the surviving partners of patients who may not live long enough to have a child with their frozen eggs or sperm might face. We pay particular attention to same-sex couples because their surviving partners often encounter more obstacles. In some countries, posthumous reproduction in these circumstances is even prohibited by law. There is a significant variation in the regulations related to posthumous reproduction, both between different countries and within individual countries. These differences need to be carefully considered when healthcare professionals counsel patients and their family members.