As you’ve seen in previous blog posts, we’ve discussed the religious implications of assisted reproductive technologies (ART) in certain faiths and challenged ourselves to rethink oncofertility in the context of religious traditions. Through analysis and close examination, we can often discuss the challenges oncofertility poses to religious communities in a way that encourages thoughtful reflection. One area I knew little about and wanted to better understand was how the practice of oncofertility fit into Islamic conceptions of motherhood. To do this I turned to Dr. Ayesha S. Chaudhry’s, “Unlikely Motherhood in the Qur’an: Oncofertility as Devotion.”

To start, Muslim attitudes toward ART are by no means uniform, and often depend on the inclination of the legal scholars in any given community. In general though, Muslim jurists have been obliging on matters of reproductive technologies, so long as paternity is protected. When it comes to oncofertility, the repercussions are minimal if the ovarian tissue belongs to the woman it was removed from and any eggs removed are fertilized by the husband or future husband only. Using donor sperm becomes problematic since it puts paternity into question and establishing the patrilineal lineage of a child is paramount in Islamic law. This is the main reason why adoption is not allowed in Islam.

Although Muslim women would face few barriers in Islamic law if they were to pursue oncofertility procedures with their husband, they may struggle with the role of God in their infertility. Muslim means, “submission to God,” and it’s an important value for followers to exemplify. According to Dr. Chauhdry, “Muslim women might feel that by choosing to engage in fertility-enhancing technology, they are demonstrating a lack of trust in God and that they are not ‘submitting’ to His will in the matter of their infertility.” Thus it would be a huge religious obstacle if Muslim women felt that they were subverting God’s will rather than submitting to it.

While there is pressure to procreate in Muslim communities, motherhood is not considered essential to womanhood, therefore her infertility or potential infertility need not compromise her identity. While only one of Muhammad’s 11 wives bore him children, they are nonetheless referred to as “the Mothers of the Believers” in the Qur’an. Nevertheless, offspring is considered a basic marital right and impotence or infertility are grounds for divorce. This further complicates the decision-making process to pursue fertility preservation methods as opposed to being content with God’s will.

In Dr. Chauhdry’s “Unlikely Motherhood in the Qur’an: Oncofertility as Devotion,” in Oncofertility: Ethical, Legal, Social and Medical Perspectives, she offers new ways for women to think about their choices when making fertility preservation decisions. She uses Qur’anic stories to provide a religious framework which places fertility preservation in a sympathetic context rather than a subversive one. To learn more, read the full chapter here.

Assisted Reproductive Technology (ART) first came onto the Vatican’s radar in the early 1950s and by 1956 Pope Pius XII, proclaimed artificial reproduction as unlawful in the Catholic Church, because it produced human lives by separating procreation and normal sexual function.  Fast-forward to Catholic moral teaching today and you will find that it accepts some forms of ART; however, only those that involve a married couple engaging in sexual intercourse resulting in procreation without any physician interference in the act itself. Some of these applications include hormonal treatments and surgery for endometriosis.  With those guidelines in mind, some of the current technologies in oncofertility seem to be consistent with Catholic moral teaching, specifically autologous ovarian tissue transplantation (OTT) which involves removing ovarian tissue to be frozen and thawed for re-implantation at a later date. This transplantation provides undamaged follicles to the cancer survivor and can restore normal endocrine function, allowing her to procreate “naturally,” according to the church.

In a recent article in Theological Studies, Paul Lauritzen, PhD, and Andrea Vicini, MD, PhD, discuss the potential dialogue between theologians and evolving technologies, such as OTT. As a former graduate student of a very traditional Jesuit university, I have a pretty clear understanding of Catholic moral teaching and traditionally the Catholic response to ART has not been favorable. I asked Paul Lauritzen, philosopher and ethicist, if he found that conscience and technology were mutually exclusive or if they had the ability to meet each other halfway in an effort to move forward with some reciprocity? He replied that, “what you find if you pay attention to the kind of debates raised by emerging technology is that many religious traditions seek to wrestle with the issues raised by the new technology in ways rooted in tradition to be sure, but also seeking to engage the new technologies in creative ways and often what happens is there is a kind of give and take.”  In the article “Oncofertility and the Boundaries of Moral Reflection” Dr. Lauritzen also recognizes the interdisciplinary approach the oncofertility community has taken. In our discussion he stated that, “there’s been an effort to engage both religious leaders and also those familiar with the ethical teachings of religious traditions to get them to reflect on the technology from within those traditions and at least help frame how the tradition is likely to approach the technology.”

In order for OTT to even get on the radar of the Vatican, enough people at the grassroots level would have to question this application and bring enough attention to it so those questions start to filter up. This line of questioning and discussion has already opened up at the Oncofertility Consortium and with time, one can hope that it reaches the Pope. You can read the full article in “Oncofertility and the Boundaries of Moral Reflection” here.

An article on infertility and religion in the context of Oncofertility came out today on the Medill Reports Web site. In “Reconciling religion and infertility,” Alina Dain uses the discussions from the Second Annual Oncofertility Summit to explain the different points of view various religions have on what is morally acceptable when trying to conceive after cancer.

The article covers Judaism, Islam and Catholism and includes quotes from Dr. Sherman Silber, Laurie Zoloth, Rumee Ahmed and Paul Lauritzen, all speakers at this year’s Summit.

WIRED magazine ran a story last week based on the research article published in the journal Human Reproduction received many comments.

“A Fertility First: Human Egg Cells Grow Up in Lab” written by Hadley Leggett has already gotten 18 comments on the WIRED Web site. People were interested to learn about the study from “In vitro grown human ovarian follicles from cancer patients support oocyte growth” by Min Xu, Susan Barrett, Erin West-Farrell, Laxmi Kondapalli, Sarah Kiesewetter, Lonnie Shea and Teresa Woodruff.

Someone was curious about how the alginate used in the study doesn’t actually make contact with the follicles but still supports them and other people asked interesting questions about religion, adoption and ethics. 

By the way, many of these topics will be discussed at the Oncofertility Summit this week.

My name is Shauna Gardino and I am clinical research coordinator at the Oncofertility Consortium. I manage the portfolio of social science studies related to fertility preservation for cancer patients. There are five current social science initiatives that provide a vital perspective of the social implications and considerations associated with oncofertiltiy in the lived world, including:
• An examination of the ethical, legal and religious issues associated with emerging fertility preservation technologies, including issues such justice and access to treatment, consent and disclosure, international perspectives and prospective ethics.
• A willingness to pay assessment spearheaded by the Kellogg School of Economics to understand the economic value of oncofertility technologies
• A shared decision-making study aimed at developing, implementing, evaluating and disseminating a shared decision making model for family, patients and health care providers to use in deciding what to do about fertility issues when a young girl has been diagnosed with cancer
• An examination of how breast cancer patients navigate fertility concerns and treatment options, looking at how doctors and patients discuss the topic of infertility and possible treatment options and identifying facilitators and barriers to this exchange of information
• A quality of life study aiming to assess reproductive concerns and psychosocial functioning in cancer patients and to compare longitudinally the overall psychosocial functioning in cancer patients referred for fertility consultation and cancer patients not referred for fertility consultation.

Additional information related to the social science initiatives can be found on the Oncofertility Website:
http://oncofertility.northwestern.edu/research/social-science-and-oncofertility

I am also currently conducting an independent study on adoption agency attitudes and perspectives on the potential to parent for individuals with a history of cancer. I also assist with administrative duties at the Consortium and will be in charge of the Annual Oncofertility Consortium Conference this September 14-16th in Chicago, IL. The conference is an opportunity for researchers and clinicians to disseminate knowledge and share progress and ideas in the field of oncofertility, and a testament to our growing network and emerging field. Mark your calendars!

Looking forward to sharing this exciting research with all of you!!

Shauna