Ethical perspectives of fertility preservation through experts' opinions

Fertility preservation is the process of saving or protecting a person's reproductive substance of human origin intended to be used later in that person's life. Fertility preservation technologies have benefits and risks. Among the most discussed issues is the access to these technologies and their funding. Our study aims at the identification and analysis of specific ethical challenges associated with fertility preservation through the perspective of experts in this field.

Between March and July 2026, 16 qualitative interviews with experts were conducted. The interview guide consisted of 12 open-ended main questions and 5 follow-up questions. The content of the interviews was analysed using thematic analysis by Braun and Clarke.

Themes identified through the method of thematic analysis were: 1) autonomous decision-making; 2) benefits and risks of fertility preservation; 3) access to fertility preservation; and 4) funding. Within the themes, sub-themes could be identified. The experts supported the involvement of children in decision-making in an age-appropriate manner. Most experts did not support the allowance of postmortem reproduction, but supported information provision in this regard. Medical benefits and risks prevailed over social benefits and risks. All patients' groups, including those for non-medical indications, should have access to fertility preservation, but funding through health insurance was unanimously supported only for medical indications.

The decisions about fertility preservation are decisions influencing the rest of the life of the patients and the fulfilment of the right to reproduction. All patient groups that can benefit from fertility preservation technologies should have access to them, including minors, healthy women, and transgender individuals. Medical indications for fertility preservation should be covered by health insurance, while the funding of non-medical indications is still debatable. The importance of informed consent for fertility preservation was underlined, particularly in paediatric cancer cases, where the involvement of children in decision-making is supported in accordance with their maturity. As successful as fertility preservation technologies might be, full, proper, and individualised information should be provided to patients to avoid the risk of false hope.