Fertility Preservation in the Pediatric Cancer Patient

Richard N. Yu


Curr Opin Urol. 2019;29(5):477-480. 

In This Article

Ethics of Prepubertal Tissue Cryopreservation

As prepubertal testicular tissue cryopreservation becomes more widely available, providers should be aware of the ethical concerns related to offering this experimental option. One important concern is whether it is ethically justifiable to offer a largely unproven technology that requires a surgical procedure to families of prepubertal patients. McDougall et al.[21] recently examined the existing literature and reviewed their experience during ethics case consultations and concluded that offering this option is ethically justifiable in certain circumstances, but not ethically required. Therefore, the decision to pursue prepubertal preservation remains solely with the child's parent or guardian, and only when the option is medically safe.[21] In considering the clinical application of prepubertal testicular tissue preservation, respect for patient autonomy and the potential benefits (beneficence) of preservation must be weighed against the potential risks of the procedure (nonmaleficence) and these deliberations are frequently discussed in the ethics literature.[22] Another area of discussion is that of fairness in terms of patient access to this technology (justice) since not all centers currently offer this option.[22] Detailed consideration of each element of the four bioethical principles (autonomy, beneficence, nonmaleficence, and justice) is beyond the scope of this review but clearly merits additional ethical scrutiny.