Nav: Home

Fertility preservation for children with differences of sex development

June 02, 2017

Chicago...Children with differences of sex development (DSD) are born with reproductive organs that are not typically male or female. They may face infertility from abnormal development of testes or ovaries, and in some patients these organs are surgically removed to prevent an increased risk of germ cell cancer. With advancing techniques, however, children with DSD may be able to preserve their fertility for the future. This potential also presents important ethical issues, which are examined in an article published in the Journal of the Endocrine Society.

"Our earlier research suggests that in children with DSD, we might be more successful in preserving fertility at younger ages," says senior author Courtney Finlayson, MD, from Stanley Manne Children's Research Institute at Ann & Robert H. Lurie Children's Hospital of Chicago. "This poses a dilemma in terms of the ideal timing for surgical removal of testes or ovaries for patients who need it. If we wait until the age of majority, when the patient can give consent, we might miss the opportunity for fertility preservation. And yet we might want to delay the surgery since we must also take into account a person's sense of self as a man or a woman and autonomous decision making. It is a delicate balance."

Fertility preservation techniques involve preserving at very low temperatures the mature or immature tissue from the testes or ovaries. The procedure is still experimental for pre-pubertal patients, since it relies on the development of technologies to mature germ cells in the lab. Given the uncertainty of success, there is concern that these techniques can lead to false hope for patients and parents. Cost and insurance coverage are additional concerns. Fertility preservation is expensive, ranging from thousands to tens of thousands of dollars. It is rarely covered by insurance and is mostly considered an elective procedure.

"We can make an argument that fertility preservation in children with DSD should be covered by insurance since DSD treatment can cause infertility, which can result in serious psychological distress," says Finlayson, an endocrinologist with the Gender and Sex Development Program at Lurie Children's and an Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine. "Lack of insurance coverage significantly limits access to preserving future fertility in these children."

Because many DSD are genetic conditions that can be inherited, there is also concern about transmission to offspring. Some ethicists argue that it is irresponsible to knowingly have children with a medical condition or disability. On the other hand, advocates assert that people with disabilities can lead happy, productive lives. Furthermore, many with DSD object to their condition being referred to as a disorder or disease. In either case, adults concerned about having children with the same condition could benefit from pre-implantation genetic screening of embryos.

Another ethical consideration revolves around gender dysphoria, or the distress that some individuals with DSD experience when their early sex assignment does not match their eventual gender identity. For example, youth initially assigned male but identifying as female might feel emotional distress at providing sperm for fertility preservation. Also, high-dose estrogen or testosterone required for fertility preservation can cause irreversible physical changes that are inconsistent with gender identity.

"There are no easy answers to any of these ethical concerns," says Finlayson. "Fertility-related care for children with DSD is in its infancy. We must carefully consider the unique ethical issues that fertility preservation presents in this population."
-end-
Research at Ann & Robert H. Lurie Children's Hospital of Chicago is conducted through the Stanley Manne Children's Research Institute. The Manne Research Institute is focused on improving child health, transforming pediatric medicine and ensuring healthier futures through the relentless pursuit of knowledge. Lurie Children's is ranked as one of the nation's top children's hospitals in the U.S.News & World Report. It is the pediatric training ground for Northwestern University Feinberg School of Medicine. Last year, the hospital served more than 198,000 children from 50 states and 51 countries.

Ann & Robert H. Lurie Children's Hospital of Chicago

Related Fertility Articles:

Fertility preservation use among transgender adolescents
Transgender adolescents often seek hormonal intervention to achieve a body consistent with their gender identity and those interventions affect reproductive function.
A new way to assess male fertility
Current tests for male fertility include measuring the concentration and motility of spermatozoa.
Male fertility after chemotherapy: New questions raised
Professor Delbès, who specializes in reproductive toxicology, conducted a pilot study in collaboration with oncologists and fertility specialists from the McGill University Health Centre (MUHC) on a cohort of 13 patients, all survivors of pediatric leukemia and lymphoma.
Vaping may harm fertility in young women
E-cigarette usage may impair fertility and pregnancy outcomes, according to a mouse study published in the Journal of the Endocrine Society.
Are fertility apps useful?
Researchers at EPFL and Stanford have carried out an analysis of the largest datasets from fertility awareness apps.
Marijuana and fertility: Five things to know
For patients who smoke marijuana and their physicians, 'Five things to know about ... marijuana and fertility' provides useful information for people who may want to conceive.
How could a changing climate affect human fertility?
Human adaptation to climate change may include changes in fertility, according to a new study by an international group of researchers.
Migrants face a trade-off between status and fertility
Researchers from the universities of Helsinki, Turku and Missouri as well as the Family Federation of Finland present the first results from a new, extraordinarily comprehensive population-wide dataset that details the lives of over 160,000 World War II evacuees in terms of integration.
Phthalates may impair fertility in female mice
A phthalate found in many plastic and personal care products may decrease fertility in female mice, a new study found.
Climate change damaging male fertility
Climate change could pose a threat to male fertility -- according to new research from the University of East Anglia.
More Fertility News and Fertility Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Climate Mindset
In the past few months, human beings have come together to fight a global threat. This hour, TED speakers explore how our response can be the catalyst to fight another global crisis: climate change. Guests include political strategist Tom Rivett-Carnac, diplomat Christiana Figueres, climate justice activist Xiye Bastida, and writer, illustrator, and artist Oliver Jeffers.
Now Playing: Science for the People

#562 Superbug to Bedside
By now we're all good and scared about antibiotic resistance, one of the many things coming to get us all. But there's good news, sort of. News antibiotics are coming out! How do they get tested? What does that kind of a trial look like and how does it happen? Host Bethany Brookeshire talks with Matt McCarthy, author of "Superbugs: The Race to Stop an Epidemic", about the ins and outs of testing a new antibiotic in the hospital.
Now Playing: Radiolab

Speedy Beet
There are few musical moments more well-worn than the first four notes of Beethoven's Fifth Symphony. But in this short, we find out that Beethoven might have made a last-ditch effort to keep his music from ever feeling familiar, to keep pushing his listeners to a kind of psychological limit. Big thanks to our Brooklyn Philharmonic musicians: Deborah Buck and Suzy Perelman on violin, Arash Amini on cello, and Ah Ling Neu on viola. And check out The First Four Notes, Matthew Guerrieri's book on Beethoven's Fifth. Support Radiolab today at Radiolab.org/donate.