Ethics of non-oncological fertility preservation from the perspective of the four principles of bioethics

Introduction and aims Fertility preservation refers to the cryopreservation of gametes, embryos, or gonadal tissue before age, disease, or medical treatment affects reproductive capacity. Fertility preservation techniques were originally developed for cancer patients. Over time, more population groups have been interested in using these technologies—such as endometriosis patients, transgender individuals, and healthy women opting for social egg freezing. While ethics in oncological fertility preservation is well studied, the ethics of non-oncological cases remains less explored. The aim of our research is to identify the ethically distinctive features of non-oncological fertility preservation in women with endometriosis, women opting for social egg freezing, and transgender individuals. Materials and methods We performed an ethical analysis of scientific literature on ethical aspects of non-oncological fertility preservation, using the four principles of bioethics. The literature review encompassed four databases: Science Direct, Web of Science, PubMed, and BELIT. After the exclusion of ineligible records, 56 scientific articles were analysed further. Results In relation to reproductive autonomy and informed consent, we found challenges such as decisional pressure, provision of proper information, and questionable ability to make future-oriented decisions. The principle of beneficence encompasses various notions of medical, psychological, social, and personal benefit, most notably the benefits of safeguarding genetic parenthood and prevention of future regret. Concerning the principle of non-maleficence, non-oncological fertility preservation was accompanied by medical, psychological, and social risks, such as delay in therapy, misinformation, and false hope. The principle of social justice highlighted problems like unequal access, lack of health insurance coverage, and gender discrimination concerns. Conclusion Our study has provided identification and ethical analysis of the issues linked to fertility preservation in women with endometriosis, women opting for social egg freezing, and transgender individuals. The underlined differences in ethical sense between non-oncological and oncological fertility preservation support the need for a tailored ethical approach to these patients. Future research is needed to examine how ethical challenges evolve as technologies develop and clinical use expands.