Sperm and oocyte cryopreservation: comprehensive consent and the protection of patient autonomy

Sperm cryopreservation and increasingly oocyte cryopreservation are common forms of fertility preservation for oncology patients facing gonadotoxic therapy. Both procedures present challenging ethical issues with regard to informed consent, given that the context for these procedures is a disease that carries a significant risk of mortality. We argue that the current consent process does not allow for adequate collection of information about a patient's wishes for the custody of cryopreserved gametes in the case of premature death. After review of the European Society of Human Reproduction and Embryology and the American Society of Reproductive Medicine guidelines we propose that a new, comprehensive consent procedure for sperm and oocyte cryopreservation including a 'roll-down' option is imperative to protect the autonomy of these oncology patients. This 'roll-down' option should allow for the transfer of custody of gametes to a pre-selected alternative recipient(s) if the original recipient no longer intends to use the gametes to create a child. We also demonstrate that objections over non-spousal custody of gametes can be overcome with sound ethical arguments.