Cancer therapy and the preservation of adolescent fertility

The increasing survival of adolescents with cancer, achieved through intensive therapy, is often associated with sterility. For most teenagers, the ability to have biological children is psychologically and socially important. Methods of preserving fertility, some standard and other experimental, have proliferated, but their use raises ethical issues. This review poses three hypothetical cases, describes the preservation methods, and identifies and analyzes the ethical issues. The discussion asks what needs to be told, who decides what to do, when can a pediatrician refuse to follow a family's choice, and what is the pediatrician's role as advocate for adolescents.