Adolescent cancer patients: sperm storage, consent and emotion

G. Bahadur1,5, J. Whelan2, D. Ralph3 and P. Hindmarsh4

1 University College London and UCLH Trust, Fertility & Reproductive Medicine Laboratories, Department of Obstetrics & Gynaecology, 86–96 Chenies Mews, London. WCIE 6HX, 2 The Meyerstein Institute of Oncology, Middlesex Hospital, UCLH Trust, Mortimer St., London WIN 8AA, 3 The Middlesex Hospital, The Institute of Urology & Nephrology (St. Peter's Hospital), Mortimer St., London, WIN 8AA, 4 Department of Medicine, Paediatric Endocrinology Division, Centre for Human Growth and Maturation, Middlesex Hospital, W1N 8AA, UK

Dear Sir,

The comments by Broome and Allegretti are welcomed, and especially for sharing their extensive experience with adolescent patients. They also provide an important direction for future research. The regret expressed by both of their 15 and 16 year old patients for not having stored spermatozoa is a significant message. These regrets tie in with the views expressed by childhood cancer survivors (Lozowski et al., 1993Go). The message here is poignant in so far that their main concerns were `whether they were able to have children' and secondly, `if their children would be healthy'. These concerns even overrode the concerns of `having a relapse' or `having another cancer'. Significantly, `information about their cancer' was most desired by the long-term survivors. It is entirely plausible and sensible therefore that we should take time and care in handling and disseminating the information related to, in our case, their fertility aspects in relation to cancer.

The idea of encouraging parents can be useful as we stated. However, parental participation should be at a point where the adolescent is not deterred or made to feel awkward about providing a semen sample by masturbation. Consent should be that of the patient only. However, gaining consent for an intrusive type of procedure raises complex issues, since if surgery or electroejaculation is involved parental consent will almost inevitably be required for those under the legal age covered under parental responsibility (Bahadur and Hindmarsh, 2000Go). However, actually freezing gametes taken under surgery provides a tension with regards to autonomous consent and in the UK it is illegal to store spermatozoa on the basis of parental consent. In a recent report on electrostimulation, which requires anaesthesia, it is worth noting that parents gave consent for the procedure. It is however unclear at present as to what happened next since there still appears to be parental control and direction over the frozen semen (Hovav et al., 2001).

In our experience the role of emotionality has been complex and there is a need to begin teasing out the emotions expressed by parents, guardians and those health care workers who may accompany these patients. This is a potentially interesting area of study to help unravel its effect on the adolescent cancer-patients banking spermatozoa, and the expertise and interest of Broome and Allegretti would be invaluable in this area. It is interesting to note that they advocate the age of 13 years and upwards for evaluation of their feelings but is unclear whether they advocate sperm storage in younger patients. We advocate spermatozoa storage for any post-pubertal patient who has understood the issues. In our experience 11 year olds have understood the issues but the youngest for whom we have stored sperm with autonomous consent is 12 years of age. Muller et al. (2000) advocate clinical examination for pubertal maturity from 10 years old and upwards for the purpose of offering sperm storage (Muller et al., 2000Go). Their youngest patients storing spermatozoa by masturbation and by electroejaculation were 13 years of age. We agree it is only right and crucial to see the patient alone in order that permission may be gained from him to involve others, no matter how closely related they may be. More importantly, this forms the basis of autonomous consent thereby encouraging and respecting the adolescent towards adopting a mature approach, in making a decision commensurate to an adult-like activity.

Notes

5 To whom correspondence should be addressed Back

References

Bahadur, G and Hindmarsh, P. (2000) Age definitions, childhood and adolescent cancers in relation to reproductive issues. Hum. Reprod., 15, 227.[Free Full Text]

Hovav, Y., Dan-Goor, M., Yaffe, H., and Almagor, M. (2001) Electroejaculation before chemotherapy in adolescents and young men with cancer. Fertil. Steril., 75, 811–813.[ISI][Medline]

Lozowski, S.L. (1993) Views of childhood survivors. Cancer, 71, (Suppl.), 3354–3357.

Muller, J., Sonksen, J., Sommer, P. et al. (2000) Cryopreservation of semen from pubertal boys with cancer. Medical and Pediatric Oncology, 34, 191–194.[ISI][Medline]





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