Ethical considerations and management strategies for fertility preservation in women of reproductive age with malignant tumors: Chinese practices and perspectives.
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BACKGROUND: Approximately 2 million women of childbearing age worldwide are diagnosed with malignant tumors each year, with tens of thousands of them facing the risk of fertility loss due to cancer treatment. With the advancement of tumor treatment technology, patient survival rates have significantly improved, and the demand for fertility preservation is increasing. However, tumor treatment damages ovarian function through various mechanisms, leading to temporary or permanent infertility. How to maximize the protection of fertility while controlling tumors has become a key issue in the overall management of tumors. Our review focuses on the ethical and regulatory landscape in China, while drawing selective international comparisons. METHOD: This article provides a comprehensive narrative review of the pathological mechanisms of fertility damage in women with malignant tumors of childbearing age, summarizes the effectiveness and safety of current major fertility preservation techniques (oocyte freezing, embryo freezing, ovarian tissue freezing, in vitro maturation techniques), analyzes the psychological challenges and family communication difficulties faced by patients in the decision-making process, explores the construction path of multidisciplinary collaboration models, and focuses on ethical and legal gaps in clinical practice. RESULT: ① The survival rate of frozen mature oocytes after thawing can reach 80% -90%, with a cumulative live birth rate of about 33%. However, unmarried patients face legal gray areas such as cross institutional transportation of frozen eggs and the right to dispose of them after death; ② Embryo freezing technology is the most mature, and the pregnancy rate of frozen thawed embryo transfer is higher than that of fresh embryos, but it is only suitable for married patients, and their reproductive autonomy is limited after divorce; ③ Ovarian tissue freezing is suitable for patients in need of emergency treatment or pre puberty, with a sustained pregnancy/live birth rate of approximately 37.7% after transplantation, but there is a risk of tumor cell reintroduction (approximately 1%, with leukemia patients having the highest risk); ④ In vitro maturation technology does not require ovarian stimulation and does not delay treatment, but the live birth rate (8.9%) is significantly lower than that of mature egg freezing; ⑤ Patients generally have a need for fertility information (66% -100%), and anxiety and depression affect decision-making ability, requiring specialized and repetitive counseling and psychological intervention; ⑥ Multidisciplinary collaboration can optimize treatment timing, balance tumor control and fertility protection, but even if doctors have positive cognition, the actual referral rate is still not ideal; ⑦ Ethical challenges involve issues such as decision-making autonomy, the right to dispose of frozen gametes, long-term follow-up of offspring health, and social equity accessibility. However, there are divergent attitudes among the public towards the use of frozen gametes for research, emphasizing patients' calls for inclusion in medical insurance and legal regulation. CONCLUSION: Fertility preservation requires the establishment of a patient-centered decision support system, incorporating psychological assessment and family communication into the counseling process; Establishing an institutionalized multidisciplinary collaboration model to eliminate the practical gap from cognition to referral; Improve ethical regulations and legal frameworks, clarify gray areas such as egg freezing, cross institutional transportation, and post death disposal rights for unmarried patients; Establish a long-term follow-up and social support network to accumulate offspring health and safety data. Only through multidimensional collaboration of technological application, ethical considerations, standardized management, and social support can we protect the fertility hope and dignity of cancer patients while curing the disease.