Submitted by wcm_male_infert... on April 28, 2015 - 11:50am
The sudden loss of a loved one is truly difficult. The discussion below seeks to better assist those that are looking for more information on a topic that has been discussed in the literature, but is unaddressed by national regulation. Currently, as there are no national regulations or restrictions related to postmortem sperm retrieval, it is recommended that regulations are implemented at the local or institutional level prior to the need arising for discussions with patients or families around this medical procedure.
Weill Cornell Medicine (WCM) has created guidelines for this procedure1, 2 that help address the issue. The WCM guidelines were created by a panel of legal, ethical, medical, psychological, administrative, and lay experts. They are described in more detail in the two attached references, with initial results of requests for sperm retrieval at our center.
WCM Guidelines for PMSR1, 2
Consent:
Weill Cornell Medicine only considers requests for sperm retrieval from the decedent's wife, not other family, next-of-kin or other family members. Such a request should elicit convincing evidence that the man would have wanted to conceive children this way, and evaluation of the request should also be supported by unanimous agreement among available members of the immediate family.
At the heart of this issue is ensuring that the lost loved one genuinely intended to procreate or was already trying to conceive with his wife. Consideration of whether the decedent would have wanted conception to occur postmortem with his wife should also be evaluated. This can be determined through their actions or discussions prior to death with respect to conception/pregnancy. Their stated, written, or acted on wishes prior to death should weigh significantly in any decision-making regarding PMSR.
Postmortem Sperm Retrieval is Turning Dead Men into Fathers
"Peter Schlegel, a professor of urology and reproductive medicine at Weill Cornell Medicine in New York City and one of the leading experts in the field, estimates that several dozen children have been born in the US this way. “We turn down most requests, because they don’t fit our guidelines,” he says. “The biggest issue is intent—evidence that the man would want children in this way.”Read the full article from Businessweek here
The wife should be the primary provider of the deceased's intentions to procreate and giving permission for PMSR, as well as considered the only person for whom the sperm could be used for procreation.
It should also be noted that permission for PMSR is not to be equated with intention or consent to proceed with assisted reproduction with the specimen. If the wife does not decide to proceed with assisted reproductive techniques, the control of the retrieved sperm still resides with her, as she was whom the deceased intended to have children.
Medical & Logistical/Resources Considerations:
At Weill Cornell Medicine, sperm retrieval is only considered when it can be done within 24 hours of death and cryopreservation resources are available to the family.
Recovery of viable sperm is significantly less common more than 24 hours postmortem, although temperature of the body and other medical considerations may be taken into account. To be able to retrieve and freeze/store the sperm within this 24-hour period requires cryopreservation resources that are both suitable and in close proximity, while also being available for immediate processing of the retrieved specimen. These arrangements should be made by the family of the decedent.
Infection & Health of PMSR Candidate:
Weill Cornell Medicine only considers retrieval when there is no evidence of communicable disease and there are no adverse medical conditions, genetic or otherwise, that would have substantially interfered with sperm production. This will include a known medical history or a postmortem examination (autopsy evaluation) and additional testing that can include HIV, hepatitis, or genetic tests.
Deciding to Use Retrieved Sperm:
At Weill Cornell Medicine, the wife should be counselled at the time of retrieval that: (1) the retrieval of sperm does not necessarily indicate that assisted reproductive treatment will be provided at our center, and (2) a 1-year quarantine period is strongly recommended after sperm retrieval with appropriate psychological counseling to re-evaluate the woman's intentions before she attempts assisted reproduction.
Over the course of the year since the sudden loss of a loved one, it is expected that the wife will undergo medical and psychological evaluations/consultations to discuss the procedures involved with assisted reproduction, along with associated costs of such medical interventions. These consultations also assess the wife's family stability, support system and implications of raising a child as a single parent or without the biological father present, among other considerations. The potential risk of coercive efforts for the former wife to proceed with assisted reproduction should be evaluated and considered.
After the completion of a year postmortem quarantine period, it is hoped that the wife is then able to begin decision-making based more on thoughtful consideration of the treatment and consequences of assisted reproduction, rather than from a state of grief alone. Observations indicate that most women reconsider their decision and do not proceed with assisted reproductive techniques to conceive with the retrieved specimen. However, it is our hope and goal that these guidelines create a framework to begin a conversation that allows the wife and the deceased loved one's family to make the best decision possible for them in a time of grief.
Our office may be reached at 212-746-5491. For further information related to male fertility, procedures, or urologic conditions, please visit us online.
For additional information:
1. Schlegel PN. (2005). Postmortem sperm retrieval. Amer J of Urol Rev. 3(4): 169-171.