Oncofertility Publications

Abstract

Scholars have shown that organ transplantation may transform ideas about one’s body, with recipients feeling that they are receiving not just a body part but also a part of the donor’s identity. This article focuses on a different way in which organ transplantation shapes recipient identity: the idea of becoming whole. We present the case studies of two women separated by a century (one in 1902 and the other in 2004) who sought ovarian transplantation, and examine how ovarian transplantation can engender a sense of wholeness on the individual, the familial, and the cultural levels, due to its ability to enable a recipient to naturally conceive and experience pregnancy.

Rodriguez S, Campo-Engelstein L. Conceiving Wholeness: Women, Motherhood, and Ovarian Transplantation, 1902-2004. Perspect Biol Med. 2011;54(3):409-16. PMID: 21857130

Abstract

INTRODUCTION:
Recent improvements in cancer detection, treatment, and technology have increased survivorship rates. These same life-saving treatments, however, can lead to infertility or sterility. Oncofertility, an emerging field at the intersection of cancer and oncology, centers on providing cancer patients with the potential to preserve their biological fertility.

METHODS:
We examine the history of how men and women have been treated for infertility and analyze contemporary studies of how women without cancer respond to infertility.

RESULTS:
Both female and male cancer patients and survivors value their fertility, although there is conflicting evidence on the degree to which women and men value fertility. Some studies have found that women and men value their fertility equally while others found that women value their fertility more than men. Gendered norms around fertility and parenthood seem to be changing, which may minimize these discrepancies. DISCUSSIONS/

CONCLUSIONS:
Although oncofertility is a nascent field, infertility is a historically relevant medical condition that is characterized by gendered narratives and norms. An analysis of the historical evolution of the understanding and treatment of infertility leads insight into modern conceptualizations of infertility both generally and in the case of cancer. Understanding these historical and current gendered influences helps to define the current context in which cancer patients are confronting potential infertility. IMPLICATIONS FOR CANCER SURVIVORS: The insight gained from this analysis can be used to inform clinical practice, offering guidance to healthcare providers approaching cancer patients about potential infertility, regardless of gender.

Shauna Gardino, Sarah Rodriguez, & Lisa Campo-Engelstein. Journal of Cancer Survivalship, 2010 Dec 31. [Epub ahead of print]

“Fertility preservation treatments can be expensive; cost and the lack of insurance coverage are often the major reasons given by oncologists for why they do not provide information on fertility preservation options to their patients. One method of ensuring people in their reproductive years or children who are diagnosed with cancer have access to and insurance coverage for FPT is to legally treat them as a distinct group from people diagnosed with infertility.”

Basco D, Campo-Engelstein L, and Rodriguez, S. Journal of Law, Medicine, and Ethics.

The United States annually spends over  $200 billion on cancer treatment and research. Over the past several decades, tremendous progress has been made in combating this disease.  The five-year survival rate for cancer has increased from thirty-five percent in 1950-1954 to sixty-seven percent in 1996-2004.  Moreover, over the last forty years, survival rates for childhood cancer have risen from twenty percent to eighty-one percent. However, the very success of new and improved therapies has created a host of problems that were not previously considered.  One of the results of the increased rate of post-cancer survival is the commensurate desire of former cancer patients to return to healthy lives, which for many includes having children.’  Unfortunately, for many this desire is difficult to fulfill, because the medication that succeeded in battling cancer is also quite often toxic to the reproductive organs.  Thus, many people are able to live longer lives, yet feel that their lives are incomplete because they became infertile. Whereas in the past fertility was not even part of the discussion when deciding on the proper treatment, now it is a top concern of many newly diagnosed cancer patients…

Gregory Dolin, MD, JD; Dorothy E. Roberts, JD; Lina M. Rodriguez, Teresa K. Woodruff, PhD.  49 Santa Clara L. Rev. 2009

Dolin G, Roberts D E., Rodriguez L M., Woodruff T K. Cancer Treatment and Research. 2010; 156: 111-34. PMID: 20811829.

By Co-editors Teresa K. Woodruff, Laurie Zoloth, Lisa Campo-Engelstein, and Sarah Rodriguez

Part I: The Science and Technology of Oncofertility

1. Reproductive Health After Cancer by Clarisa Garcia
2. Designing Follicle-Environment Interactions with Biomaterials by Rachel M. Smith, Teresa K. Woodruff, and Lonnie D. Shea
3. Gamete Preservation by Susan L. Barrett and Teresa K. Woodruff
4. To Transplant or Not to Transplant – That is the Question by Sherman J. Silber, Teresa K. Woodurff and Lonnie D. Shea
5. Clinical Cases in Oncofertility by Laxmi A. Kondapalli, Fanzhen Hong, and Clarisa R. Gracia
6. Cancer Genetics: Risks and Mechanisms of Cancer in Women with Inherited Susceptibility to Epithelial Ovarian Cancer by Lee Shulman and Jeffrey Dungan
7. Protecting and Extending the Fertility Options for Female Wildlife and Endangered Mammals by Pierre Comizzoli, David Wildt, and Nucharin Songsasen

Part II: Historical and Legal Perspectives

1. Placing the History of Oncofertility by Sarah Rodriguez
2. Medical Hope, Legal Pitfalls: Potential Legal Issues in the Emerging Field of Oncofertility by Gregory Dolin, Dorothy E. Roberts, Teresa K. Woodruff, and Lina M. Rodriguez
3. Domestic and International Surrogacy Laws: Implications for Cancer Survivors by Kiran Sreenivas and Lisa Campo-Engelstein
4. Adoption After Cancer: Adoption Agency Perspectives on the Potential to Parent Post-Cancer by Shauna Gardino, Andrew Russell, and Teresa K. Woodruff

Part III: Clinical and Theoretical Ethics

1. Ovarian Tissue Cryopreservation and Bioethical Discourse by Christina L.H. Traina
2. The Lessons of Oncofertility for Assisted Reproduction by Adrienne Asch
3. Morally Justifying Oncofertility Research by Carolyn McLeod
4. Ethical Dilemmas in Oncofertility: An Exploration of Three Clinical Scenarios by Clarisa R. Gracia, Jorge J.E. Gracia, and Shasha Chen
5. Participation in Investigational Fertility Preservation Research: A Feminist Ethics Approach by Michelle L. McGowan
6. Reproductive “Choice” and Egg Freezing by Angel Petropanagos
7. The Impact of Infertility: Why ART Should Be a Higher Priority for Women in the Global South by Amanda Fleetwood and Lisa Campo-Engelstein
8. Oncofertility and Informed Consent: Addressing Beliefs, Values and Future Decision Making by Felicia Cohn

Part IV: Religious Perspectives

1. Bioethics and Oncofertility: Arguments and Insights from Religious Traditions by Laurie Zoloth and Alyssa A. Hennings
2. Sacred Bodies: Considering Resistance to Oncofertility in Muslim Communities by Rumee Ahmed
3. Unlikely Motherhood in the Qur’an: Oncofertility as Devotion by Ayesha S. Chaudry
4. Technology and Wholeness: Oncofertility and Catholic Tradition by Paul Lauritzen
5. Jewish Perspectives on Oncofertility: The Complexities of Tradition by Laurie Zoloth

Part V: Ramifications for Education and Economics

1. The Oncofertility Saturday Academy: A Paradigm to Expand the Educational Opportunities and Ambitions of High School Girls by Megan Faurot and Teresa K. Woodruff
2. MyOncofertility.org: A Web-Based Patient Education Resource Supporting Decision Making Under Severe Emotional and Cognitive Overload by Kemi Jona and Adam Gerber
3. Anticipating Ovarian Tissue Cryopreservation in the Health-care Marketplace: A Willingness to Pay Assessment by Shauna L. Gardino, Andrew Sfekas, and David Dranove
4. Perspectives on Oncofertility from Demography and Economics by Rosalind King
5. For the Sake of Consistency and Fairness: Why Insurance Companies Should Cover Fertility Preservation Treatment for Iatrogenic Infertility by Lisa Campo-Engelstein

Part VI: Repercussions of Oncofertility for Patients and their Families

1. Health Care Provider Perspectives on Fertility Preservation for Cancer Patients by Caprice A. Knapp and Gwen P. Quinn
2. Counseling and Consenting Women with Cancer on their Oncofertility Options: A Clinical Perspective by Emily S. Jungheim, Kenneth R. Carson, and Douglas Brown
3. The Fertility-Related Treatment Choices of Cancer Patients: Cancer-Related Infertility and Family Dynamics by Karrie Ann Synder, May Kyaw Thazin, William B. Pearse, and Mehwish Moinuddin
4. Whose Future Is It? Ethical Family Decision Making About Daughters’ Treatment in the Oncofertility Context by Marla L. Clayman and Kathleen M. Galvin
5. Choosing Life when Facing Death: Understanding Fertility Preservation Decision-Making for Cancer Patients by Shauna L. Gardino and Linda L. Emanuel

Part VII: Health Care Provider Stories and Final Thoughts

1. Discussing Fertility Preservation with Breast Cancer Patients by Jackie S. Jeruss
2. Warning: Google can be Hazardous to Your Health: Fertility Preservation Is an Important Part of Cancer Care by Jennifer Hirschfield-Cytron
3. The Role of a Patient Navigator in Fertility Preservation by Jill Scott-Trainer
4. Judaism and Reproductive Technology by Sherman J. Silber
5. Reading Between the Lines of Cancer & Fertility: A Provider’s Story by Leonard S. Sender
6. A Rewarding Experience for a Pediatric Urologist by Margarett Shnorhavorian
7. Final Thoughts by Laurie Zoloth

Summary

Both medical and non-medical factors have equally contributed to the emerging field of oncofertility. It is a microcosm of the medical, cultural and personal that shapes this field including, but not limited to: changes in cancer research, survival rates and treatment; cancer as a publicly acknowledged diagnosis; and a growing cultural acceptance of assisted reproductive technologies (ART). Taking a closer look at this history will help both patients and practitioners be more receptive to the overlapping issue that influence the field of oncofertility in the future.

Rodriguez S. Cancer Treatment and Research. 2010; 156: 103-10. PMID: 2081128