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As fertility treatment options improve and are used for cancer patients, religious leaders and scientists try to reconcile religious values with the emerging technology. The viewpoints of Christianity, Judaism and Islam in this developing area of medicine are still being defined.


Reconciling religion and infertility

by Alina Dain
July 30, 2009


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The  medical, ethical and religious issues involving different treatments to extend the fertility of cancer patients was a key  topic of discussion at a Oncofertility summit held at Northwestern University in Evanston July 23-24.

Related Links

Women’s reproductive health: monotheistic religious perspectives, by Joseph G. SchenkerInfertility evaluation and treatment according to Jewish law, by Joseph G. Schenker

Fertility treatment options for cancer patients

As cancer survivors increase in number and treatment options steadily improve, an increasing population of young cancer patients treated with aggressive chemotherapy and radiation discover that they are infertile. Not all cancer treatments render the patient completely infertile, but for those struggling with infertility, there are many options, said Teresa Woodruff, a professor at Northwestern University who directs the Oncofertility Consortium. The National Institutes of Health-funded initiative studies reproductive preservation and options for cancer patients. 

Below are some fertility options for both male and female cancer patients

To view a complete list, visit:

Fertility options for women

Fertility options for men
 

Options for men:
• Sperm banking
• Testicular biopsy to extract sperm
• Shielding of the testicles form radiation
• Freezing of sperm
• Use of donor sperm for artificial insemination or in vitro fertilization
• Adoption

Options for women:
• Embryo freezing: Harvesting eggs, in vitro fertilization and freezing of embryos for later implantation
• Ovarian tissue freezing: freezing of  a woman's ovary tissue to be transplanted back after cancer treatment
• Ovarian transposition and radical trachelechtomy: two procedures that surgically move the ovaries or the uterus away from the radiation field
• Use of donor embryos or eggs
• Surrogate pregnancy
• Adoption






Ten percent of the 10 million people diagnosed with cancer globally this year are under the age of 45 years old and may require fertility treatment, according to Northwestern University’s Oncoferility Consortium.

Yet the advent of increasing fertility options raises moral concerns that vary widely by religion, said researchers and theologians at the second annual Oncoferility Summit that the consortium hosted last week in Evanston.

Aggressive chemotherapy and radiation treatments can sometimes cause infertility, but addressing and recognizing the issue is now common.

“Cancer patients are very similar to any other person who has a medically severe disease that’s going to impact their fertility. The really new thing is that nobody was offering fertility preservation options to either cancer patients or to patients that had severe disease,” said Teresa Woodruff, a researcher and professor at Northwestern University who directs the Oncofertility Consortium.

The initiative, funded by National Institutes of Health, studies reproduction for cancer patients. Woodruff coined the word Oncofertility, a term denoting an interdisciplinary field that explores fertility preservation options for the patients.

Judaism alone offers many different moral interpretations of those options.

Reform Judaism covers about 39 percent of Americans in the Jewish faith who belong to synagogues, conservative Judaism represents about 33 percent, orthodox followers represent about 21 percent, with 7 percent classified in other groups, according to the most recent statistics. The orthodox position in particular can be contradictory when it comes to Oncofertility, said Dr. Sherman Silber, director of the Infertility Center of St. Luke’s Hospital in St. Louis. Silber, who spoke at the summit, is a pioneer in microsurgery and infertility treatment.

In orthodox beliefs, the edict in Genesis to be fruitful and multiply requires that an infertile couple trying to have a child must be assisted in every permissible way. Insemination with the husband’s sperm is permissible if the wife cannot become pregnant in any other way, according to the article Women’s reproductive health: monotheistic religious perspectives by Joseph Schenker at the Department of Obstetrics and Gynecology, Hebrew University, Jerusalem, Israel. However, Orthodox Jewish law prohibits masturbation due to “seed wasting.”

Although egg donation can be helpful for the production of offspring, orthodox Jewish beliefs view the egg donor as interfering in the couple’s marriage, Silber said, challenging family integrity. Not so for ovary transplantation.

If the ovary tissue from a donor were transplanted inside the woman who is getting pregnant, it would not be considered an infringement on the marriage on a spiritual basis, though not on a DNA basis, Silber said. The transplant means the woman will ovulate the donor's eggs but, so far, this procedure has only been done successfully when the donor is an identical twin.

“They’re dealing with these kinds of contradictions all the time, as modern science develops,” he said.

Reform Judaism has approved of artificial insemination using the husband’s sperm since the movement first discussed the issue in 1952, according to a second article by Schenker. Since the 1970s, the movement has approved of artificial insemination that relies on a donor. In-vitro fertilization and surrogate motherhood are accepted as well.

But defining Jewish views on fertility treatments based solely on a branch of Judaism is problematic since  many different opinions  cross over and compete for moral authority, said Laurie Zoloth, director of the Center for Bioethics, Science and Society at Northwestern University and another speaker at the consortium.

”Could you find a Rabbi who would want to do something else? Absolutely, there is no question,“ she said.

Similarly, “Muslims attempt to articulate what they understand to be the 'Islamic position' on a matter and these articulations are often quite divergent,” said Rumee Ahmed, a consortium speaker and assistant professor of religion and Islamic civilizations at Colgate University in New York.

Islam supports fertility treatment but in-vitro fertilization can be performed only with the egg and sperm of the husband and wife, Schenker’s research shows. Egg and sperm donation are forbidden because they are viewed as adulterous. Donations of embryos also are prohibited. Also, resistance to donor tissue transplants might be found in some Muslim communities, Ahmed said.

However, more than a billion Muslims populate the world and their leaders and ideas diverge on many issues. “In our community being a doctor is a big thing because it carries with it certain expectations of what the doctor should be able to provide the patient," he said. Doctors can't be expected to know the interpretation of fertility treatments from different religious perspectives, he added.

Unlike Judaism and Islam, Catholicism has a definitive teaching authority, the Catholic Church. Dignitas Persone, the 2008 papal encyclical outlining Catholic views on bioethics, did not address Oncofertility, said consortium speaker Paul Lauritzen, professor of religious studies at John Carroll University in Ohio.

However, looking at this document and at the earlier 1987 document, Donum Vitae, “we have a fairly reliable set of indicators about how they’re likely to respond to Oncofertility issues,” Lauritzen said.

These documents express two basic values, Lauritzen said. First, that from conception an embryo is viewed as an individual and must be treated as if it is a person. Second, that procreation be undertaken through sex in marriage.

Catholic doctrine forbids in vitro fertilization because discarding embryos may be part of the process. Embryo freezing is also problematic, and so is embryonic stem cell research.

“The Vatican, in the most recent document, said that even though it is a person with a right to life, you can’t thaw it and transfer it because that is essentially complicity in the original injustice of creating the embryo,” Lauritzen said.

Artificial insemination with the husband’s sperm is morally unacceptable because sex and procreation become separated in the process. For similar reasons, the use of donor gametes would be a problem.

The thawing of a woman's ovarian tissue and transplanting it back to the same woman so she can ovulate and conceive naturally should be accepted because sex and procreation are not separate, Lauritzen said. Furthermore, Lauritzen speculates that using donor tissue for a transplant so that the woman still conceives naturally, could also be accepted.

“I can’t see anything in Catholic tradition that requires genetic and social parenthood to remain together,” he said.

However, it is important to note, Lauritzen said, that “official Catholic teaching does not necessarily map on to the practices of Catholics in the pew.”

The majority of protestant denominations accept various infertility treatments, according to Schenker’s research. Most denominations accept in vitro fertilization as long as the egg and sperm come from the spouse and there is no embryo wastage.

Ahmed hopes that getting more of these perspectives and these potential problems will help understand the potential problems that patients might have with Oncofertility as members of a religious community. 

“I also hope that it will help clinicians counsel patients to have a conversation in the broader community," he said.