Fertility impairments caused by some cancers and cancer therapies have triggered the development and provision of a number of technologies that aim to preserve the fertility of cancer patients. Arguably, fertility preservation is desirable for those cancer patients who wish to have biologically-related children post-cancer. Some studies have found that the majority of childless cancer survivors express a desire to have children in the future (Schover et al., 1999). Further, the social and personal importance placed on fertility (or potential fertility) is highlighted in numerous studies that cite the severe psychological distress that infertility can have on individuals (Carter et al., 2005; Carter et al 2010; Cousineau & Domar, 2007; Domar et al., 1993; McQuillan et al., 2003). Although not all cancer patients desire biological offspring in the future or wish to ever become parents, FP technologies aiming to secure the option of future biological reproduction address the desires and/or needs of some (if not many) cancer patients.
FP technologies have developed, in part, on the premise that biological reproduction holds great value for individuals. Cancer patients are no exception. According to some oncofertility researchers, many people find parenting their own genetic child compelling and some believe that this is because “a deep desire to propagate our own germ line is part of who we, as people, are” (Gardino et al., 2010, p. 447). The underlying assumption here is that desire to reproduce is a strong and natural desire for people. Biological
reproduction is seen as a primary (and perhaps superior) way of creating a family and FP technologies aim to secure this valuable family-building option.26
Given the strong pronatalist pressures in society, it seems as though patriarchal
pronatalism could compel some female patients to use FP technologies in an attempt to get pregnant in the future. It is not surprising that a coercive pronatalism that grounds women’s value on their reproductive function could compel some women to seek medical interventions to preserve or protect their fertility. Since childbearing is perceived as a route to achieving womanhood, many women whose cancer therapies will threaten their fertility might perceive FP technologies as a sort of insurance plan, if attempts at natural coital conception post-cancer fail.
However it is not clear that patriarchal pronatalism alone, can compel women into pursuing FP. There are two reasons for thinking that pronatalism cannot fully explain why some women are compelled to use FP technologies. To begin with, FP cannot guarantee that pregnancy will be achieved in the future. Many FP procedures are
experimental and the success rates have not yet been determined and even if reproductive material is successfully removed, cryopreserved and thawed in the future for subsequent use, the IVF procedures which may be required to achieve pregnancy cannot guarantee a viable pregnancy will occur. Pregnancy and birth are required to fulfill the pronatalist mandate, so the mandate will dictate that women use the eggs that are most likely to result in a viable pregnancy. Since one’s chances of bearing a child are higher with fresh donor eggs than thawed cryopreserved ones, the logical choice (if compelled by
pronatalism alone), would be to opt for using donor eggs in the future.
Another reason for believing that pronatalism cannot by itself compel women to choose FP is that the choice to pursue FP is accompanied by a host of physical and psychological risks that could otherwise be avoided if one were to choose a different avenue of
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For some people, biological reproduction is also more affordable and less complicated than other family building options, such as adoption or the use of assisted reproductive technologies.
achieving pregnancy. This is especially true in the cancer context where some patients are seriously ill and preparing to undergo taxing cancer treatments, such as radiation and chemotherapy. As mentioned in the first chapter, some of the risks associated with FP include a delay in the onset of cancer treatment (often 4-6 weeks for those procedures involving oocyte removal); speeding up the progression of cancer when using hormonal stimulation therapies required for egg retrieval; reintroducing cancer into the patient’s body when ovarian tissues are re-implanted; and an unwanted pressure to use
cryopreserved reproductive material in the future. Pronatalism cannot explain why some women expose themselves to these additional physical and psychological risks because if pregnancy is the goal, it would be possible to avoid many of these risks by using donor eggs in the future, if necessary.27
Of course, it may be the case that the availability of donor eggs could influence a woman’s decision to pursue FP. If a woman believes that donor eggs will be difficult to acquire in the future, she may be compelled to cryopreserve her own eggs rather than taking the risk of trying to obtain donor eggs. Some government regulations surrounding ART can make the acquisition of donor eggs more difficult. In Canada, for example, donor oocytes can sometimes be difficult to acquire. One reason for this is that Canada’s
Assisted Human Reproduction Act (2004) prohibits both the purchase of gametes and financial reimbursements or compensation for gamete donors. Although some studies have shown that some women donate eggs for altruistic reasons (Winter & Daniluck, 2004; Yee et al., 2007), it has also been found that financial compensation can be a primary reason why some women will undergo invasive and risky ovarian stimulation and oocyte extraction in order to donate their eggs to strangers (Kafoglou & Gittelsohn, 2000; Klock et al., 2003; Lindeheim et al., 2001). The risks associated with egg donation, the prohibition on gamete sales, and the regulations on compensation make it unlikely that the supply of oocyte donors will meet the growing demand for oocytes. Thus,
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Likewise, if raising children is the goal, then one could also choose to adopt post-cancer.
without a known donor, such as a sister or friend, it can be difficult for many women and couples to obtain donor eggs.
Obtaining donor eggs might also be more difficult for individuals or couples who wish to obtain a particular kind of donor egg. For example, a woman or couple might seek out an egg donor who has physical traits similar to the intending mother’s physical traits.
Prospective egg recipients might desire an oocyte donor who meets particular physical criteria, has certain character traits or originates from a particular ethnic group. For those individuals who desire a particular type of egg donor, obtaining donor eggs that meet their criteria can make finding an egg donor even more challenging. Furthermore, donor eggs might be difficult or very expensive to obtain in some places, such as Canada where the sale of oocytes in prohibited or eggs or in high demand. However, as I discussed in the previous chapter, FP technologies can also be quite expensive. Furthermore, growing trends in reproductive tourism and a booming online marketplace for third-party assisted reproduction are making oocytes more readily available, even in Canada. Also, certain experimental FP technologies, such as those involving IVM, for example can yield much lower success rates than established procedures such as IVF using oocyte donation. Insofar as the costs of oocyte donation and FP are comparable, oocytes are available and the risks and uncertainty of FP outweigh the risks associated with third-party assisted reproduction, patriarchal pronatalism cannot fully explain why some women choose FP technologies. In the remainder of this chapter, I explore a feminist conception of
biologism and consider whether it can compel some women to choose oncofertility technologies.