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• W2079686316 abstract "ObjectiveTo describe the medical and ethical dilemmas regarding fertility preservation (FP) in autoimmune limbic encephalitis (AILE).DesignCase report.Materials and MethodsFP was requested by the parents of an unconscious patient in the pediatric intensive care unit. Experts in pediatrics, immunology, neurology, intensive care, hematology/oncology, gynecology, ethics, and law were consulted to help determine whether FP was medically feasible and ethically sound.ResultsA 17 yo with previous good health and normal development suffered acutely with headaches, behavioral changes and profound anemia. She was diagnosed with AILE which is a paraneoplastic syndrome mediated by anti-NMDA receptor antibodies. Due to deterioration of her condition she required sedation and intubation. Anti-NMDA receptor antibodies are associated with teratomas and thus surgical intervention is recommended. Imaging did not identify intra or extra-ovarian teratoma. As a result, medical management was pursued. The patient failed to respond to high dose corticosteroids and total plasma exchange and therefore second line medical therapy involving high dose chemotherapy with cyclophosphamide and rituxamib was recommended. A consultation regarding FP was requested given the potential for ovarian failure associated with alkylating agents. The ensuing discussion involving the medical teams included obtaining consent for minors, ascertainment of the medical risks associated with FP, estimation of long term intact survival of the patient and logistical planning associated with ovarian stimulation and egg retrieval in an intubated patient. The multidisciplinary team was in favor of FP but the family ultimately declined because of the potential medical risks of retrieval given her severe anemia.ConclusionThe decision to proceed with FP in minors with complex medical issues requires a multi-disciplinary approach to assess the medical and ethical issues related to the individual case. ObjectiveTo describe the medical and ethical dilemmas regarding fertility preservation (FP) in autoimmune limbic encephalitis (AILE). To describe the medical and ethical dilemmas regarding fertility preservation (FP) in autoimmune limbic encephalitis (AILE). DesignCase report. Case report. Materials and MethodsFP was requested by the parents of an unconscious patient in the pediatric intensive care unit. Experts in pediatrics, immunology, neurology, intensive care, hematology/oncology, gynecology, ethics, and law were consulted to help determine whether FP was medically feasible and ethically sound. FP was requested by the parents of an unconscious patient in the pediatric intensive care unit. Experts in pediatrics, immunology, neurology, intensive care, hematology/oncology, gynecology, ethics, and law were consulted to help determine whether FP was medically feasible and ethically sound. ResultsA 17 yo with previous good health and normal development suffered acutely with headaches, behavioral changes and profound anemia. She was diagnosed with AILE which is a paraneoplastic syndrome mediated by anti-NMDA receptor antibodies. Due to deterioration of her condition she required sedation and intubation. Anti-NMDA receptor antibodies are associated with teratomas and thus surgical intervention is recommended. Imaging did not identify intra or extra-ovarian teratoma. As a result, medical management was pursued. The patient failed to respond to high dose corticosteroids and total plasma exchange and therefore second line medical therapy involving high dose chemotherapy with cyclophosphamide and rituxamib was recommended. A consultation regarding FP was requested given the potential for ovarian failure associated with alkylating agents. The ensuing discussion involving the medical teams included obtaining consent for minors, ascertainment of the medical risks associated with FP, estimation of long term intact survival of the patient and logistical planning associated with ovarian stimulation and egg retrieval in an intubated patient. The multidisciplinary team was in favor of FP but the family ultimately declined because of the potential medical risks of retrieval given her severe anemia. A 17 yo with previous good health and normal development suffered acutely with headaches, behavioral changes and profound anemia. She was diagnosed with AILE which is a paraneoplastic syndrome mediated by anti-NMDA receptor antibodies. Due to deterioration of her condition she required sedation and intubation. Anti-NMDA receptor antibodies are associated with teratomas and thus surgical intervention is recommended. Imaging did not identify intra or extra-ovarian teratoma. As a result, medical management was pursued. The patient failed to respond to high dose corticosteroids and total plasma exchange and therefore second line medical therapy involving high dose chemotherapy with cyclophosphamide and rituxamib was recommended. A consultation regarding FP was requested given the potential for ovarian failure associated with alkylating agents. The ensuing discussion involving the medical teams included obtaining consent for minors, ascertainment of the medical risks associated with FP, estimation of long term intact survival of the patient and logistical planning associated with ovarian stimulation and egg retrieval in an intubated patient. The multidisciplinary team was in favor of FP but the family ultimately declined because of the potential medical risks of retrieval given her severe anemia. ConclusionThe decision to proceed with FP in minors with complex medical issues requires a multi-disciplinary approach to assess the medical and ethical issues related to the individual case. The decision to proceed with FP in minors with complex medical issues requires a multi-disciplinary approach to assess the medical and ethical issues related to the individual case." @default.
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• W2079686316 date "2013-09-01" @default.
• W2079686316 modified "2023-09-30" @default.
• W2079686316 title "Fertility preservation associated with limbic encephalitis: ethical and medical considerations" @default.
• W2079686316 doi "https://doi.org/10.1016/j.fertnstert.2013.07.1472" @default.
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