Ethical Considerations in Pediatric Fertility Preservation Michelle L. McGowan, PhD Research Associate Professor Ethics Center, Cincinnati Children’s Departments of Pediatrics and Women’s, Gender & Sexuality Studies, University of Cincinnati

Ethical considerations regarding the practice of fertility preservation Sociocultural and religious values regarding gametes, embryos, and assisted reproduction Gendered moral dimensions of fertility preservation techniques Degree to which decision about fertility preservation presumes a particular kind of future life after treatment Values regarding impact of fertility preservation on future offspring Whose values matter here? These issues may be particularly salient for decision-makers considering fertility preservation for younger children who may not have articulated a particular vision of their future selves

Ethical issues in the practice of fertility preservation Education and informed decision-making regarding safety, efficacy, and short- and long-term health risks associated with fertility preservation procedures costs of the procedure and later use (e.g. IUI, IVF), insurance coverage, storage fees, and “use by” dates realistic success rates ideal window and timing for fertility preservation E.g. https://www.cincinnatichildrens.org/service/f/fertility-preservation/females Disposition of cryopreserved gametes if patient does not survive/posthumous reproduction

Ethical issues unique to pediatric fertility preservation Degree to which pediatric patients are involved in decision-making Consent Assent Best interests Pubertal + gendered complexities of established treatments vs. experimental procedures Pre-and post-pubertal considerations

Justice implications Fair distribution? Equality of opportunity? Benefits and burdens Scarce medical resources Equality of opportunity? Potential for exclusionary access along the lines of insurance coverage and socioeconomic status From a reproductive justice perspective fertility preservation has the potential to promote stratified reproduction

Question for co-panelists How can health care providers optimize pediatric patients’ and families’ understanding and informed decisions regarding fertility preservation?