Oncofertility: Beyond Biological Motherhood, Towards Reproductive Justice

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Rethinking Normative Expectations

As professionals, we have to balance our responsibility to care, inform and research for safer fertility treatments while respecting women’s choices that may at times go against dominant models of womanhood. In doing so, it is crucial to acknowledge several problems stemming from norms about reproduction assuming all women want to, and should, become mothers.

Oncofertility Brochure

Oncofertility Brochure

First, the promise of oncofertility to restore ‘motherhood’ encourages health professionals to urge women to undergo treatments to preserve fertility. Studies show that up to two thirds of young patients are counseled about fertility before they even begin their cancer treatment. While counseling is good practice, the marketing of “safeguarding motherhood” as the preferred option for women diagnosed with cancer reinforces the belief that biological motherhood is preferable to alternatives. This insistence may actually limit women’s treatment choices, particularly if less treatment is preferred.

Second, the promise of motherhood through fertility treatments sets high expectations, with physical and psychological effects. Most women using new reproductive technologies have to undergo several rounds of treatments to become pregnant, and some never conceive at all. The chances of carrying a child to term through these technologies are even lower. An estimated 70 percent of In Vitro Fertilization (IVF) cycles fail to produce a live birth. The high expectation of having a successful pregnancy can, in light of these realities, be devastating for women’s psychological well-being. This information is, however, rarely included in the content of the promotional and educational materials offered to women.

Third, there is uncertainty about the role of oncofertility treatments in the development of cancer. A recent study published in JAMA found no increased risk of breast cancer for IVF-treated women. “Among women undergoing fertility treatment in the Netherlands between 1980 and 1995, IVF treatment compared with non-IVF treatment was not associated with increased risk of breast cancer after a median follow-up of 21 years.” While breast cancer risk among IVF-treated women was not significantly different from that in the general population, however, it is not clear whether the findings would hold for women diagnosed with hormone-dependent cancers. Many types of breast, ovarian, and uterine cancers depend on hormones (particularly estrogen) to grow. It stands to reason, then, that for women diagnosed with hormone-dependent cancers, the heavy exposure to estrogen required for successive oncofertility treatments may increase the risk of their cancer coming back (recurrence). It is prudent to exercise caution while studying the risks and long-term effects of post-cancer oncofertility treatments.

Fourth, in addition to a lack of data on long-term effects of artificial reproductive technologies on women and children born as a result of ART, fertility treatments come with known side effects for the women that include pain, vision problems, vertigo, blood clots, and sometimes ovarian rupture. ART is also associated with having multiple births, preterm birth, and low birth weight among infants, and a slight increase in the risk of congenital structural abnormalities and chromosomal aberrations. The Society of Obstetricians and Gynecologists of Canada advises that, “Until sufficient research has clarified the independent roles of infertility and treatment for infertility, couples should be counseled about the risks associated with treatment. There is a role for closer obstetric surveillance of women who conceive with assisted human reproduction.” A judicious recommendation.

The uncertainty surrounding ART generally and oncofertility in particular begs two questions: (1) How many cycles of IVF are safe for women who have a history of cancer diagnosis? (2) If fertility treatments are psychologically straining and potentially hazardous, and there are safe alternatives to biological motherhood, should we not take the precautionary approach and simply presume that oncofertility treatments are dangerous until proven otherwise? This better safe than sorry approach has a strong precedent, especially with activists who have argued that “the suggestion of harm, rather than proof of harm should be good enough to propel action.”

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