Woodruff / Zoloth / Campo-Engelstein Oncofertility

Ethical, Legal, Social, and Medical Perspectives
1. Auflage 2010
ISBN: 978-1-4419-6518-9
Verlag: Springer
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, Band 156, 522 Seiten

Reihe: Cancer Treatment and Research

Oncofertility has emerged as a way to address potential lost or impaired fertility in cancer patients and survivors, with active biomedical research that is developing new ways to help these individuals preserve their ability to have biological children. In order to move beyond oncofertility as a science and medical technology and begin to address the ethical, legal, and social ramifications of this emerging field, we must give voice to scholars from the humanities and social sciences to engage in a multidisciplinary discussion. This book brings together a pool of experts from a variety of fields, including communication, economics, ethics, history, law, religion, and sociology, to examine the complex issues raised by recent developments in oncofertility and to offer advice from national and international perspectives as we create new technology. Given the inherent interdisciplinary nature of oncofertility, this book is not only valuable, but also necessary to cultivate a deep understanding of new issues with the eventual aim of offering proposals for addressing them. Indeed, this book will be useful for people not only within the humanities and social sciences disciplines but also for those who are confronted with cancer and the possibility of impaired fertility and the medical practitioners within oncology and reproductive medicine who are at the front lines of this emerging field.

Teresa Woodruff, Ph.D. - Teresa K. Woodruff, Ph.D. is a Thomas J. Watkins Professor of Obstetrics & Gynecology at the Northwestern University Feinberg School of Medicine and Professor of Biochemistry, Molecular Biology and Cell Biology in the Weinberg College of Arts and Sciences. She is the Chief of a newly created Division of Fertility Preservation and the Founder and Director of the Institute for Women's Health Research. She is the immediate past Director of the Basic Science Programs for the Robert H. Lurie Comprehensive Cancer Center (2000-2007). She is the basic science Associate Editor for Fertility and Sterility (2008-present) and member of several editorial boards including Molecular Cellular Endocrinology, Journal of Molecular Endocrinology and Endocrine Reviews. She serves on the Endocrine Society council (2008-present) and the Society for the Study of Reproduction Board of Directors (2008-present). Her awards include the Distinguished Teaching Award from Northwestern University, the Endocrine Society's Richard E. Weitzman Memorial Award, The Alumae Award from Northwestern University, and the Distinguished Women in Medicine and Science Award. She was elected a fellow of the American Association for the Advancement of Science in 2005. As a member of the faculty of the Undergraduate Program in Biological Sciences, Dr. Woodruff teaches graduate and undergraduate students in Systems Physiology and the medical student module on female reproduction. She also created the Oncofertility Saturday Academy (OSA) to provide science experiences to high school girls attending the Young Women's Leadership Charter School (YWLCS). She received her PhD from Northwestern University in 1989. Dr. Woodruff has published more than 100 peer-reviewed papers as well as 40 editorials and book chapters. She is the Principal Investigator on 2 R01 NIH grants, a P01 grant and core facility, and is the PI and director of two NIH funded center grants (The Center for Reproductive Research (U54) and the Oncofertility Consortium (UL1). In 2008 she was the recipient of a prestigious W.M. Keck Foundation Medical Research award (2008). The major goals of her laboratory are to identify the mechanisms underlying ovarian follicle development, selection and recruitment and to provide new angles on ovarian disease and fertility conserving options for women. Dr. Woodruff has established a team of oncologists, fertility specialists, social scientists, and education and policy makers to translate her research to the clinical care of women who will lose their fertility due to cancer treatment. She coined the term oncofertility to describe this work, a word that is now officially recognized as a new 'slang' term in the English language. She edited the first book on this topic called Oncofertility (Springer, 2007) where the scope of the problem and current technology, clinical practice tables, procedural guidelines and patient stories are collected. Hallmarks of Woodruff career include a strong focus on ovarian biology, on interdisciplinary approaches to problems and application of the work to the human. Laurie Zoloth, Ph.D. - Laurie Zoloth is a Professor of Medical Humanities, Bioethics, Jewish Studies and Religion. She is also the Director of the Northwestern University Center for Bioethics, Science and Society, and Director of the Brady Program for Ethics and Civic Life, in the Weinberg College of Arts and Sciences. In 2009 she was appointed as the Charles Deering McCormick Professor for Excellence in Teaching. Lisa Campo-Engelstein, Ph.D. - Senior Research Fellow, Oncofertility Consortium and Center for Bioethics, Science and Society Sarah Rodriguez, Ph.D. - Senior Research Fellow, Oncofertility Consortium and Center for Bioethics, Science and Society

Autoren/Hrsg.

Zoloth, Laurie

Campo-Engelstein, Lisa

Woodruff, Teresa K.

Rodriguez, Sarah

Inhaltsverzeichnis

1;Preface;4
1.1;References;5
2;Contents;7
3;Contributors;11
4;Part I The Science and Technology of Oncofertility;16
4.1;1 Reproductive Health After Cancer;17
4.1.1; Introduction;17
4.1.2; Gonadotoxicity of Treatments;17
4.1.3; Fertility;18
4.1.4; Contraception;19
4.1.5; Menopausal Symptoms;20
4.1.6; Sexual Function;20
4.1.7;References;21
4.2;2 Designing FollicleEnvironment Interactions with Biomaterials;24
4.2.1; Introduction;24
4.2.2; Extraovarian Interactions;26
4.2.2.1; Introduction to Mass Transport in Hydrogels;27
4.2.3; Ovarian Tissue Interactions;28
4.2.3.1; Designer Environments for Follicle Culture;29
4.2.3.1.1; Modification of Synthetic Biomaterials for Follicle Culture;30
4.2.3.1.2; Incorporation of Natural Biomaterials for Follicle Culture;31
4.2.3.2; Interactions with the Mechanical Environment;32
4.2.4; Conclusion;35
4.2.5;References;35
4.3;3 Gamete Preservation;38
4.3.1; Introduction;38
4.3.2; Organization of Gametes in the Human Ovary;38
4.3.3; Cryopreservation Techniques;40
4.3.4; Embryo and Oocyte Cryopreservation;42
4.3.5; Experimental Options for Gamete Preservation;44
4.3.5.1; Ovarian Tissue Cryopreservation and Transplantation;44
4.3.5.2; In Vitro Follicle Cryopreservation and Maturation;45
4.3.6; Conclusion;47
4.3.7;References;48
4.4;4 To Transplant or Not to Transplant That Is the Question;53
4.4.1; Introduction;53
4.4.2; Transplant Technologies and Their Success;54
4.4.3; Surgical Technique;55
4.4.4; Ovarian Tissue Vitrification;56
4.4.5; Preserving Fertility in Cancer Patients;57
4.4.6; Recent Progress on Culturing Follicles In Vitro;60
4.4.7; Conclusions and Final Thoughts;62
4.4.8;References;63
4.5;5 Clinical Cases in Oncofertility;67
4.5.1; Introduction;67
4.5.2; Clinical Scenario 1;67
4.5.3; Use of GnRH Antagonist for Luteolysis and Cycle Synchronization;68
4.5.4; GnRH Agonist Trigger to Prevent OHSS;68
4.5.5; Oocyte Cryopreservation;69
4.5.6; Clinical Scenario 2;70
4.5.7; Ovarian Stimulation with Aromatase Inhibitors;70
4.5.8; Combined Embryo and Oocyte Cryopreservation;71
4.5.9; Anticoagulation with IVF Stimulation;72
4.5.10; Clinical Scenario 3;72
4.5.11; Ovarian Tissue Cryopreservation;73
4.5.12; Clinical Scenario 4;74
4.5.13; Gonadotoxicity of Cancer Therapy;74
4.5.14; Ovarian Transposition;75
4.5.15; Selecting More than One Fertility Preservation Option;75
4.5.16; Conclusions;76
4.5.17;References;76
4.6;6 Cancer Genetics: Risks and Mechanisms of Cancer inINTtie;Women with Inherited Susceptibility to EpithelialOvarian Cancer;80
4.6.1; Introduction;80
4.6.2; Epithelial Ovarian Cancer;81
4.6.3; Heritable Cancer Syndromes and EOC;83
4.6.4; Genetic Mechanisms;83
4.6.5; Heritable Cancer Syndromes and EOC;84
4.6.5.1; Hereditary Breast and Ovarian Cancer (HBOC);84
4.6.5.2; Site-Specific Ovarian Cancer;87
4.6.5.3; Lynch Syndrome;88
4.6.6; Other Genetic Syndromes Associated with EOC;91
4.6.7; Counseling of Women at Increased Risk for Developing EOC;92
4.6.8; Conclusions;94
4.6.9;References;95
4.7;7 Protecting and Extending Fertility for Females of Wild and Endangered Mammals;97
4.7.1; Introduction;97
4.7.2; Value of Reproductive Studies and Fertility Preservation for Rare and Wild Species;98
4.7.3; Value of Animal Models for Preserving and Extending Fertility in Wild Species;100
4.7.4; Ways by Which Oocyte and Embryo Culture in Domestic Animals and Humans Can Help Preserve and Extend Fertility in Females of Wild Species;101
4.7.5; Oncofertility Preservation Approaches that Have Special, Potential Value for Wildlife;103
4.7.5.1; Ovarian Tissue Cryopreservation;103
4.7.5.2; Ovarian Tissue Grafting;104
4.7.5.3; Follicle In Vitro Culture;105
4.7.5.4; Oocyte Preservation;105
4.7.6; Conclusion and Prospects;106
4.7.7;References;107
5;Part II Historical and Legal Perspectives;111
5.1;8 Placing the History of Oncofertility;112
5.1.1;References;118
5.2;9 Medical Hope, Legal Pitfalls: Potential Legal Issues in the Emerging Field of Oncofertility;120
5.2.1; Introduction;120
5.2.2; What Is at Stake;121
5.2.2.1; Is There a Right to Reproduce?;121
5.2.2.2; What Are the Reproductive Rights of Minors?;124
5.2.3; The Legal and Moral Questions;124
5.2.3.1; Who Can Consent to a Medical Procedure and What Are the Limits?;124
5.2.3.2; Are There Limitations to Proxy Consent in the Reproductive Context?;127
5.2.3.2.1; Male Circumcision;127
5.2.3.2.2; Female Genital Cutting;128
5.2.3.2.3; Sex Assignment Surgery;129
5.2.3.2.4; Sterilization;129
5.2.3.2.5; Variations in Parental Consent Requirements;130
5.2.3.3; How Does Current Law on Proxy Consent Apply to Oncofertility?;130
5.2.3.4; Is Failing to Preserve Fertility the Same as Active Sterilization?;132
5.2.3.5; Who Controls the Fate of the Excised Tissue While the Patient Is Alive?;134
5.2.3.6; Who Controls the Fate of the Excised Tissue When the Patient Is Dead?;135
5.2.3.7; Can Research on the Tissue Be Conducted and if So, What Steps Must the Researchers Take?;138
5.2.3.8; Are There Additional Concerns?;139
5.2.4; Conclusion;140
5.2.5;References;140
5.3;10 Domestic and International Surrogacy Laws: Implications for Cancer Survivors;144
5.3.1; Introduction;144
5.3.2; The Inability to Gestate Due to Cancer and Cancer Treatment;145
5.3.3; Types of Surrogacy;146
5.3.4; Surrogacy Laws in the United States;148
5.3.5; International Surrogacy Laws;152
5.3.5.1; Free Market;152
5.3.5.2; Regulated;155
5.3.5.3; Prohibition;156
5.3.6; Options for Cancer Survivors: Surrogacy Tourism;157
5.3.7; Conclusion;159
5.3.8;References;160
5.4;11 Adoption After Cancer: Adoption Agency Attitudes and Perspectives on the Potential to Parent Post-Cancer;162
5.4.1; Introduction;162
5.4.2; Adoption in the United States;163
5.4.3; Adoption and the Law: United States;164
5.4.4; Existing Discrimination in the Adoption Process;166
5.4.5; Interpreting the Law: Adoptive Potential of Cancer Survivors;167
5.4.6; Methods;168
5.4.7; Results;169
5.4.8; Discussion;172
5.4.9; Expanding the Discussion: The Experience of Potential Adoptive Parents;175
5.4.10; Defining the Discrimination;176
5.4.11; Conclusions;177
5.4.12;References;178
6;Part III Clinical and Theoretical Ethics;180
6.1;12 Ovarian Tissue Cryopreservation and Bioethical Discourse;181
6.1.1; Introduction;181
6.1.2; Medical Solutions to Social Problems;182
6.1.3; Making Room for a Language of Care;182
6.1.4; Replacing Present Operations with Future Vocations;184
6.1.5; Adaptation or Transformation;185
6.1.6; The Patients Best Interest;186
6.1.7;References;188
6.2;13 The Lessons of Oncofertility for Assisted Reproduction;189
6.2.1; Introduction;189
6.2.2; How Is Cancer-Related Infertility Different from All Other Infertility;190
6.2.3;References;194
6.3;14 Morally Justifying Oncofertility Research;195
6.3.1; Introduction;195
6.3.2; Why Do the Research;195
6.3.3; Conclusion;200
6.3.4;References;201
6.4;15 Ethical Dilemmas in Oncofertility: An Exploration of Three Clinical Scenarios;203
6.4.1; Introduction;203
6.4.2; Case 1: Description;204
6.4.2.1; Who Should Make Decisions in Adolescent Medical Care: Adolescent Patients or Parents?;204
6.4.2.2; Should a Physician Abide by or Reject Different Cultural Traditions with Respect to Disclosure and Medical Decision Making?;205
6.4.3; Case 2: Description;206
6.4.3.1; Should Cancer Patients with Poor Prognosis Be Allowed to Pursue Fertility Preservation or Should They Be Denied Treatment?;207
6.4.3.2; Should Physicians Discard Abandoned Frozen Embryos and Gametes or Continue Their Cryopreservation?;207
6.4.4; Case 3: Description;208
6.4.4.1; Should Patients with Medically Complicated Conditions Be Offered or Denied Methods to Preserve Fertility?;209
6.4.5; Theoretical Strategies;209
6.4.6; Practical Strategies;212
6.4.7; Specific Suggestions for Case 1;212
6.4.7.1; Who Should Make Decisions About Adolescent Medical Care and to What Extent Should Cultural Factors Play a Role in Informing Patients of Their Condition?;212
6.4.8; Specific Suggestions for Case 2;213
6.4.8.1; Should Cancer Patients with Poor Prognosis Be Allowed to Pursue Fertility Preservation?;213
6.4.8.2; What Should Be Done with Abandoned Frozen Embryos and Gametes?;213
6.4.9; Specific Suggestions for Case 3;214
6.4.9.1; Should Patients with Medically Complicated Conditions Be Offered Methods to Preserve Fertility?;214
6.4.10; Conclusion;214
6.4.11;References;215
6.5;16 Participation in Investigational Fertility Preservation Research: A Feminist Research Ethics Approach;217
6.5.1; Introduction;217
6.5.2; Feminist Approaches to ART and Biomedical Research;218
6.5.3; Oncofertility: Patients, Basic Research, and Clinical Research;219
6.5.4; Potential Participants in Investigational Fertility Preservation Research;219
6.5.4.1; Cancer Patients;220
6.5.4.2; Fertility Patients;222
6.5.4.3; Reproductive Oocyte Donors;223
6.5.4.4; Healthy Research Volunteers;224
6.5.5; Conclusions and Directions for Future Research;226
6.5.6;References;227
6.6;17 Reproductive Choice and Egg Freezing;230
6.6.1; Introduction;230
6.6.2; Disease-Related Versus Age-Related Egg Freezing;233
6.6.3; Goold and Savulescu on Timing and Cause ;234
6.6.4; Objections to Goold and Savulescu;235
6.6.5; Why the Problem is Not So Easy to Fix and the Choice is Not So Voluntary;237
6.6.6; Discussion and Conclusion;240
6.6.7;References;241
6.7;18 The Impact of Infertility: Why ART Should Be a Higher Priority for Women in the Global South;243
6.7.1; Introduction;243
6.7.2; Why a Feminist Approach;244
6.7.3; The Deleterious Effects of Infertility for Women in the Global South;245
6.7.3.1; Africa;245
6.7.3.2; Asia;246
6.7.3.3; Middle East;246
6.7.3.4; Latin America;246
6.7.3.5; Global South Overall;247
6.7.4; The Big Objection: There Are More Important Priorities than Infertility;248
6.7.5; Three Responses to the Objection;248
6.7.5.1; Response 1: ART Need Not Be Expensive;248
6.7.5.2; Response 2: Justice and the Right to Reproduce;249
6.7.5.3; Response 3: Women's Development, Countries' Development;250
6.7.6; Infertility and Cancer;251
6.7.7;References;253
6.8;19 Oncofertility and Informed Consent: Addressing Beliefs, Values, and Future Decision Making;255
6.8.1; Introduction;255
6.8.2; The Belief that Fertility Is Preserved: Immediate Risk for Future Benefit;256
6.8.3; Emotional Implications of the Decision-Making Process;258
6.8.4; Future Decisions;260
6.8.5; Conclusion;262
6.8.6;References;263
7;Part IV Religious Perspectives;265
7.1;20 Bioethics and Oncofertility: Arguments and Insights from Religious Traditions;266
7.1.1; Introduction;266
7.1.2; Why Religion;267
7.1.3; Catholicism;268
7.1.4; Evangelical Christianity;270
7.1.5; Islam;273
7.1.6; Judaism;274
7.1.7; Hinduism;277
7.1.8; Buddhism;279
7.1.9; Conclusion;281
7.1.10;References;282
7.2;21 Sacred Bodies: Considering Resistance to Oncofertility in Muslim Communities;284
7.2.1; Introduction;284
7.2.2; The Narrative of Bodily Inviolability;286
7.2.3; Beyond Jurisprudence: Widespread Muslim Attitudes Toward the Body;288
7.2.4; The Clinicians Burden;290
7.3;22 Unlikely Motherhood in the Qurn: Oncofertility as Devotion;292
7.3.1; Introduction;292
7.3.2; Mohammads Wives: Mothers of Believers;292
7.3.3; Islamic Law on Sex, Paternity, and the Right to Bear Children;294
7.3.4; Unlikely Conception as Divine Intervention: Sarah, the Wife of Zakhariah, and Mary;296
7.3.5; Conclusion;299
7.4;23 Technology and Wholeness: Oncofertility and CatholicTradition;300
7.4.1; Introduction;300
7.4.2; Part One;300
7.4.3; Part Two;304
7.4.4; Conclusion;310
7.4.5;References;310
7.5;24 Jewish Perspectives on Oncofertility: The Complexitiesof Tradition;312
7.5.1; Introduction;312
7.5.2; Stewardship and Technology;315
7.5.3; 2003--2006: The Joseph Project;317
7.5.4; Who Was It that Said Yes Emerging Research, Truth Claims, and Identity as a Question in Jewish Bioethics;318
7.5.4.1; The Case;318
7.5.5; Humanities to the Rescue: The Text;320
7.5.6; The Recommendation: Here Is What I Wrote;321
7.5.7; Conclusion;322
7.5.8;References;322
8;Part V Ramifications for Education and Economics;323
8.1;25 The Oncofertility Saturday Academy: A Paradigmto Expand the Educational Opportunities and Ambitionsof High School Girls;324
8.1.1; Introduction;324
8.1.2; The Development of the Oncofertility Saturday Academy (OSA);326
8.1.3; Practices of the Oncofertility Saturday Academy;328
8.1.3.1; Practice --1: High School--University Science Partnership Model;328
8.1.3.1.1; Partnership Role of NU;329
8.1.3.1.2; Partnership Role of YWLCS;330
8.1.3.1.3; Shared Partnership Roles of NU and YWLCS;331
8.1.3.2; Practice #2: Authentic and Relevant Science Learning Modules;331
8.1.3.2.1; Junior Oncofertility Saturday Academy (JOSA) Modules;333
8.1.3.2.2; Senior Oncofertility Saturday Academy (SOSA) Modules;334
8.1.3.3; Practice #3: Science Mentor and Support Network;336
8.1.3.3.1; OSA Supports Students, Parents, and Faculty Development;337
8.1.3.4; Practice #4: Web-Based Science Communication Platform;340
8.1.4; Expandable and Sustainable;342
8.1.4.1; Expandability;342
8.1.4.2; Sustainability;343
8.1.5; Conclusion;344
8.1.6;References;346
8.2;26 MyOncofertility.org: A Web-Based Patient Education Resource Supporting Decision Making Under Severe Emotional and Cognitive Overload;348
8.2.1; Introduction;348
8.2.2; The Internet as a Powerful Tool for Patient Education;349
8.2.3; Fertility Preservation and Patient Education;350
8.2.4; Fertility Preservation Communication Barriers and Challenges;350
8.2.5; MyOncofertility.org Design Goals;351
8.2.5.1; The Use of Media;351
8.2.5.2; An Appropriate Design Motif;354
8.2.5.3; User Control and Participation;355
8.2.6; Applying Design Principles from MyOncofertility.org to Other Patient Education Web Sites;357
8.2.7; Insights from MyOncofertility.org Usage Data;359
8.2.8; Conclusion;363
8.2.9;References;363
8.3;27 Anticipating Ovarian Tissue Cryopreservation in the Health-Care Marketplace: A Willingness to Pay Assessment;365
8.3.1; Introduction;365
8.3.2; Fertility Preservation Options;366
8.3.3; Willingness to Pay;367
8.3.4; Survey Methods;368
8.3.5; Results;370
8.3.6; Discussion;371
8.3.7; Conclusions;371
8.3.8;References;372
8.4;28 Perspectives on Oncofertility from Demography and Economics;373
8.4.1; Introduction;373
8.4.2; Why Have Children in the Twenty-First Century;374
8.4.3; How Can Economic and Social Demography Help Us to Understand Oncofertility;375
8.4.3.1; Why Would Patients Pursue Fertility Preservation Rather than Adoption?;375
8.4.3.1.1; Risk, Information, and Uncertainty Reduction;375
8.4.3.2; Why Do Some Patients Pursue Fertility Preservation When It Is Unlikely that They Will Produce Usable Gametes or Survive to Use Them?;376
8.4.3.2.1; Value;376
8.4.3.2.2; Normative Life Course;376
8.4.3.2.3; Reference-Dependent Preferences;377
8.4.3.3; Who Should Make the Decision about Fertility Preservation When the Patient Is a Minor?;377
8.4.3.3.1; Utility, Maximizing Behavior, and Altruism;377
8.4.3.3.2; Salience of Available Information;378
8.4.3.3.3; Time Preferences and Time Perspective;379
8.4.3.4; Should the Public Support the Provision of Fertility Preservation Procedures and Services?;379
8.4.3.4.1; Externalities and Public Goods;379
8.4.4; Conclusion;380
8.4.5;References;381
8.5;29 For the Sake of Consistency and Fairness: Why Insurance Companies Should Cover Fertility Preservation Treatment for Iatrogenic Infertility;382
8.5.1;References;389
9;Part VI Repercussions of Oncofertility for Patients and Their Families;390
9.1;30 Healthcare Provider Perspectives on Fertility Preservation for Cancer Patients;391
9.1.1; Introduction;391
9.1.1.1; Oncologists;393
9.1.2; Adolescent and Pediatric Providers;396
9.1.2.1; Physician Studies;396
9.1.2.2; Nurse Studies;397
9.1.3; Conclusion;400
9.1.4;References;401
9.2;31 Counseling and Consenting Women with Cancer on Their Oncofertility Options: A Clinical Perspective;402
9.2.1; Introduction;402
9.2.1.1; The Challenges of Counseling Oncofertility Patients;402
9.2.1.2; The Oncofertility Patient--Clinician Dialogue;402
9.2.1.2.1; Risks of Cancer Care to a Woman's Future Fertility;402
9.2.1.2.2; Initiating the Discussion of Oncofertility Options;404
9.2.1.3; Established Oncofertility Options for Women: Embryo Banking;404
9.2.1.3.1; Success of Embryo Cryopreservation: Evidence from the Society for Assisted Reproductive Technology (SART);405
9.2.1.3.2; Unknowns of Embryo Banking for Women with Cancer: Evidence from Embryo Cryopreservation Literature;406
9.2.1.4; Experimental Oncofertility Treatments: Oocyte Cryopreservation;407
9.2.1.5; Experimental Oncofertility Treatments: Ovarian Tissue Banking;408
9.2.1.6; Achieving Informed Consent in the Care of Oncofertility Patients;408
9.2.2; Conclusions;410
9.2.3;References;410
9.3;32 The Fertility-Related Treatment Choices of Cancer Patients: Cancer-Related Infertility and Family Dynamics;412
9.3.1; Introduction;412
9.3.2; Background Younger Women with Breast Cancer and Cancer-Related Infertility;413
9.3.3; Methods;414
9.3.3.1; Sample Recruitment;414
9.3.3.2; Sample Characteristics;415
9.3.3.3; Interview Procedures and Data Analysis;416
9.3.4; Findings The Interplay Between Infertility and Family Relationships;417
9.3.4.1; Who Is Your family?;417
9.3.4.2; Infertility Concerns -- Shows of Familial Support;418
9.3.4.3; Potential Infertility and Family Relationship Stress;419
9.3.4.4; Family Influence and Fertility-Related Decisions;422
9.3.5; Conclusion;425
9.3.6;References;426
9.4;33 Whose Future Is It Ethical Family Decision Making About Daughters Treatment in the Oncofertility Context;428
9.4.1; Introduction;428
9.4.2; Ethical Consent and Children;429
9.4.3; The Family Rule Approach;430
9.4.4; Family Communication and Ethical Decision Making: Issues and Complications;433
9.4.4.1; Parental Disagreement;434
9.4.4.2; Complicated Family Forms;435
9.4.4.3; A Child's Right to Options;435
9.4.4.4; Parental/Familial Rights to Options;436
9.4.4.5; Difficulties and Assumptions Inherent in Language Used by Biomedicine;437
9.4.4.6; Discussions at Time of Treatment;437
9.4.4.7; Discussions about Sexuality;438
9.4.4.8; Disclosing the Decision in the Future;439
9.4.4.9; Keeping the Topic a Secret;440
9.4.4.10; Decision Making Based on Current Child, Not Forecasted Adult Child;441
9.4.5; Conclusion;441
9.4.6;References;442
9.5;34 Choosing Life When Facing Death: Understanding Fertility Preservation Decision-Making for Cancer Patients;445
9.5.1; Framing the Paradox: Understanding Reproduction in Current Society;445
9.5.2; Motherhood in the Face of Cancer;447
9.5.3; Fatherhood in the Face of Disease;449
9.5.4; A Transgenerational Perspective;451
9.5.5; Decision-Making: Confronting Life and Death Simultaneously;452
9.5.6; Implications and Conclusions;454
9.5.7;References;455
10;Part VII Healthcare Provider Stories and Final Thoughts;457
10.1;35 Discussing Fertility Preservation with Breast Cancer Patients;458
10.1.1; Introduction;458
10.1.2; Case 1: A Young Patient Who Refused Fertility Preservation;460
10.1.3; Case 2: A Young Patient Who Desired Fertility Preservation;461
10.1.4; Conclusion;462
10.1.5;References;463
10.2;36 Warning: Google Can Be Hazardous to Your Health: Fertility Preservation Is an Important Part of Cancer Care;464
10.2.1;References;465
10.3;37 The Role of a Patient Navigator in Fertility Preservation;466
10.4;38 Judaism and Reproductive Technology;468
10.4.1; Introduction;468
10.4.2; Basic Tenets of Orthodox Judaism;469
10.4.3; Orthodox Jewish Legal System;470
10.4.4; Major Jewish Themes;471
10.4.5; The Most Important Two Commandments;471
10.4.6; Confusion Which Can Result from Attempting to Follow the Commandments;472
10.4.7; Infertility, IVF, Embryonic Stem Cells, Ovary Transplantation, and Judaism;473
10.4.8; Commandments in Conflict;473
10.4.9; Controversial Issues Such as Donor Gametes;474
10.4.10; Ovary (and Testicle) Transplantation;475
10.4.11; Torah and Science Do Not Conflict;476
10.4.12;References;476
10.5;39 Reading Between the Lines of Cancer and Fertility: A Providers Story;478
10.6;40 A Rewarding Experience for a Pediatric Urologist;482
10.7;41 Final Thoughts;483
10.8;Index;486