Infertility

Fertility issues for cancer patients can also bring legal headaches

Reproductive technology has made it easier for cancer survivors to start families despite being infertile after treatment, but some patients may still find their future parenthood plans dashed by legal complications, says a group of U.S. doctors and lawyers.

Some tumors, and many types of chemotherapy and radiation, can leave cancer patients infertile. Often, patients can postpone initial cancer treatments for a few weeks to pursue fertility preservation efforts, which might include egg or embryo freezing for women and sperm banking for men.

Though these efforts are no guarantee, they can make it possible to start a family down the line.

The trouble is that even when the technology works, it still takes more than one person to donate genetic material to make a baby, and the courts can become involved when not everyone agrees on how to proceed, Ehren Fournier, an attorney at Foley and Lardner in Chicago, argues in JAMA Oncology.

"Decisions regarding fertility preservation need to be made quickly so the patient can start their oncologist's treatment plan," Fournier said by email. "It is difficult to expect a patient to try to anticipate the future legal consequences of their fertility treatment while being faced with those competing pressures."

Courts might be called on to decide, for example, what happens when a woman creates a frozen embryo with her own eggs and donor sperm prior to cancer treatment but the donor later decides he doesn't want to his sperm used to father a child. Particularly if the donor was her partner or spouse, and the couple separates or divorces, he might assert a right not to father her child.

To reduce the odds of pushing patients into this legal quagmire, doctors should be aware of the legal approach followed in their state and make sure patients consult with lawyers to draw up contracts for future use of any donated genetic material, Fournier writes.

While this type of dispute might be averted with fertility consent agreements that treat partners and spouses like anonymous sperm donors and require them to waive any future rights to the embryo, this option might not appeal to couples in a romantic relationship, Dr. Clarisa Gracia of the University of Pennsylvania in Philadelphia and colleagues point out in an accompanying editorial.

"In general, I would recommend freezing gametes (sperm or eggs) rather than embryos for unmarried couples," Gracia said by email. "This is the only way to prevent any legal entanglements with a partner."

Patients also need to recognize that infertility isn't the only reproductive health issue related to cancer, Teresa Woodruff and colleagues at Northwestern University in Chicago note in a separate viewpoint paper in the journal.

Doctors still need to discuss contraception, because some patients can still become pregnant or father children during cancer treatment, they write.

When the ovaries or testes are damaged by treatment, this can impact the amount of hormones that are made, with implications for reproductive and sexual health, Woodruff noted by email. Hormonal changes may mean young patients don't go through natural puberty, and that young women in particular may go through early menopause.

"Cancer patients face an immediate need to protect their fertility before the first sterilizing treatment," Woodruff said. "Paying attention to overall reproductive health is also important for those who may already have the number of children they wish - so we try not to limit the discussion to just fertility."

SOURCE: http://bit.ly/1nKNmW9, http://bit.ly/1QFjpQp, http://bit.ly/1nKNpkH and http://bit.ly/1nDOGJE JAMA Oncology, online January 28, 2016.