Journal of Law, Medicine & Ethics

Oncofertility in Prepubertal Girls: A Qualitative Study of Canadian and French Pediatric Oncologists’ Perspectives on Ovarian Tissue Cryopreservation

Abstract Background It is now acknowledged that possible negative effects of cancer therapies on future reproductive autonomy are a major concern. In the bioethics literature, some advocate that the child’s right to fertility preservation (FP) should be recognized as a right to an open future. Research objectives The aim of this qualitative study is to (1) explore pediatric oncologists’ perceptions regarding barriers and facilitators of OTC in prepubertal girls and (2) analyze the ethical, legal, social, and policy implications of these barriers and facilitators in Canada and France. Participants and research design Between November 2022 and August 2023, 10 French and 6 Canadian oncopediatricians took part in semi-directed interviews. The content of the interviews was analyzed using thematic content analysis. Findings All the participants emphasized the importance of FP, describing it as a fundamental right and central part of care. However, they identified ethical issues associated with the cost and the uncertainties of ovarian tissue cryopreservation (OTC). The majority thought that OTC should be covered by the public healthcare system to promote equity of access. French oncopediatricians of this study considered OTC to be standard of care, while the majority of Canadian oncopediatricians still considered it experimental, due to the risk of reintroducing malignant cells. Discussion/conclusions The results highlight the importance of FP for prepubertal girls as a right, linked to the child’s right to an open future, as described in bioethics literature. According to these findings, the fact that OTC is not systematically discussed, offered, or not covered by the healthcare system constitutes a barrier and fails to protect patients, who may experience future infertility as a consequence of their treatment, thus curtailing their reproductive autonomy.