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García Rojo E, Lujan S, Alonso Isa M, García Gómez B, Medina Polo J, Romero Otero J. [Postmortem sperm retrieval: Two cases report and review of technical and legislative aspects in Spain]. Rev Int Androl 2022; 20 Suppl 1:S61-S66. [PMID: 35599150 DOI: 10.1016/j.androl.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/03/2021] [Accepted: 02/20/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION AND OBJECTIVES Advances in assisted reproductive techniques (ART) have caused an increase in requests for postmortem sperm retrieval (PMER). The use of these techniques is usually tied to legal, ethical and medical/casuistic problems. The objective of this work is to analyze technical and legal aspects of PMER in Spain using two real cases and to establish guidelines to help in decision-making after a PMER request. MATERIAL AND METHODS Two real cases in which a PMER was requested and others published in Spain in recent years are presented. We proceed to an exposition of the techniques used in postmortem ART cases and specifically in PMER, and a detailed study of the current legal framework is carried out. RESULTS In Spain we have a complete law on ART. Article 9 expressly requires an authorization from the deceased male partner for the use of his reproductive material in the following 12 months. Regarding the PMER, technical and logistical considerations require a quick and organized decision-making. The time until extraction should not exceed 24-36hours from death and a good choice of biological material is essential. CONCLUSIONS Medical-scientific advances now allow PMER and the use of postmortem ART. A good knowledge of the technical, logistical and legal aspects is necessary for a fast and coordinated action.
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Affiliation(s)
- Esther García Rojo
- Servicio de Urología, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, España; Servicio de Urología, Hospital Universitario HM Montepríncipe, HM Hospitales, Madrid, España; Servicio de Urología, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, España.
| | - Saturnino Lujan
- Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Manuel Alonso Isa
- Servicio de Urología, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, España; Servicio de Urología, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, España
| | - Borja García Gómez
- Servicio de Urología, Hospital Universitario HM Montepríncipe, HM Hospitales, Madrid, España; Servicio de Urología, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, España
| | - José Medina Polo
- Servicio de Urología, Hospital Universitario HM Montepríncipe, HM Hospitales, Madrid, España; Servicio de Urología, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, España
| | - Javier Romero Otero
- Servicio de Urología, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, España; Servicio de Urología, Hospital Universitario HM Montepríncipe, HM Hospitales, Madrid, España; Servicio de Urología, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, España; Servicio de Urología, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, España
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Perimortem and postmortem sperm acquisition: review of clinical data. J Assist Reprod Genet 2022; 39:977-986. [PMID: 35190958 PMCID: PMC9050980 DOI: 10.1007/s10815-022-02427-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 02/02/2022] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To provide the clinicians with the most comprehensive medical information about sperm acquisition peri/postmortem. METHODS The review was conducted according to the PRISMA statement. MEDLINE and Cochrane databases were searched up to January 2021. All studies reporting post or perimortem harvesting of sperm with any indication of an outcome, recognition and viability of sperm, and its utilization and treatment outcome were included. Studies that recorded cases but discussed only the ethical or legal issues without any information about the medical details were excluded. RESULTS Twenty-four studies were included in this review. One hundred forty-eight cases were described; in 113 of them, sperm was retrieved. A variety of techniques for sperm acquisition were used. The data collected are limited and comparing the efficacy of the different approaches is not feasible. The longest time interval described between the death and viable sperm acquisition was 3 days. The sperm quality varies between the studies. One hundred thirty-six mature oocytes were injected with the retrieved sperm; the fertilization rate was 41%. Transfer cycles of 25 embryos and 8 live births are reported in the medical literature. CONCLUSION The overall low quality and high heterogeneity of the available data impair the ability to draw definitive conclusions. However, it can be stated that sperm acquisition up to at least 3 days postmortem can result in the live birth of healthy offspring. Further studies are needed to clarify the medical questions regarding the best techniques, success rates, and wellbeing of the parties involved.
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Robson SJ, Campbell S, McDonald J, Tremellen K, Carlin E, Maybury G. Pregnancy and childhood health and developmental outcomes with the use of posthumous human sperm. Hum Reprod 2016; 30:2259-62. [PMID: 26384405 DOI: 10.1093/humrep/dev191] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Although there is now considerable experience in obtaining sperm from a cadaver, there is little or no published data regarding pregnancy, birth and long-term childhood health and development outcomes when posthumous sperm is used in in vitro fertilisation (IVF). We report the results from treatment of four women undergoing IVF treatment using posthumously acquired human sperm from their deceased partners. In all cases, testicular tissue was obtained in a mortuary setting, and the duration from death to posthumous sperm retrieval ranged from 12 to 48 h. The age of women treated ranged from 31 to 41 years. Fertilization rates ranged from 40 to 100%. Singleton pregnancies were obtained for each of the four women. One pregnancy was complicated by preterm birth at 31 weeks; the other three delivered at term. One baby was growth restricted but morphologically normal; the other children had term birthweights in the normal range. All four children were have shown normal health and developmental outcomes, with the follow-up ranging from 1 to 7 years.
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Affiliation(s)
- Stephen J Robson
- Australian National University Medical School, PO Box 5235, Garran, ACT 2605, Australia
| | - Simone Campbell
- City Fertility Centre, Watkins Medical Centre, Brisbane, QLD 4000, Australia
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Healy MW, Yauger BJ, James AN, Jezior JR, Parker P, Dean RC. Seminal vesicle sperm aspiration from wounded warriors. Fertil Steril 2016; 106:579-83. [PMID: 27341990 DOI: 10.1016/j.fertnstert.2016.05.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/10/2016] [Accepted: 05/31/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess whether seminal vesicle sperm aspiration (SVSA) is an option for wounded warriors with severe genital and testicular injuries, with the goal of cryopreservation to use in future assisted reproductive technology (ART) cycles. DESIGN Retrospective case series. SETTING Tertiary care military hospital. PATIENT(S) Six wounded warriors. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Seminal vesicle fluid analysis after harvest, after thaw analysis, fertilization rates, pregnancy rates (PRs), live birth. RESULT(S) Six patients with lower extremity, pelvic, and genital injuries from dismounted improvised explosive devices underwent SVSA within 5-12 days of the initial injury. Sperm retrieved were analyzed (volume, 0.4-1.8 mL; concentration, 40-2,200 K; motility, 0-5%), washed, and cryopreserved. Two patients underwent IVF/intracytoplasmic sperm injection (ICSI) cycles using their samples. In one couple, fertilization rate was 38%. One grade V embryo was transferred with a negative pregnancy test. The second couple underwent two cycles. In their first cycle, fertilization rate was 44%, with one blastocyst transferred and a negative pregnancy test. In the second cycle, fertilization rate was 47%. Two blastocysts were cryopreserved due to ovarian hyperstimulation syndrome (OHSS) concerns. One blastocyst was later transferred in a frozen cycle resulting in a live birth. CONCLUSION(S) The SVSA is a reasonable option to retrieve sperm in wounded warriors or trauma patients with extensive genital injuries.
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Affiliation(s)
- Mae Wu Healy
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland; Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
| | - Belinda J Yauger
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland; Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Aidita N James
- A.R.T. Institute of Washington Inc., Walter Reed National Military Medical Center, Bethesda, Maryland
| | - James R Jezior
- Division of Andrology, Department of Urology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Patrick Parker
- Division of Andrology, Department of Urology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Robert C Dean
- Division of Andrology, Department of Urology, Walter Reed National Military Medical Center, Bethesda, Maryland
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Kroon F. Presuming consent in the ethics of posthumous sperm procurement and conception. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2015; 1:123-130. [PMID: 29911193 PMCID: PMC6001348 DOI: 10.1016/j.rbms.2016.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 05/19/2016] [Indexed: 05/22/2023]
Abstract
This paper compares standard conceptions of consent with the conception of consent defended by Kelton Tremellen and Julian Savulescu in their attempt to re-orient the ethical debate around posthumous sperm procurement and conception, as published in Reproductive BioMedicine Online in 2015. According to their radical proposal, the surviving partner's wishes are, in effect, the only condition that needs to be considered for there to be a legitimate moral case for these procedures: the default should be presumed consent to the procedures, whether or not the agent did consent or would have consented. The present paper argues that Tremellen and Savulescu's case for this position is flawed, but offers a reconstruction that articulates what may well be a hidden, and perhaps reasonable, assumption behind the argument. But while the new argument appears more promising, the reconstruction also suggests that the position of presumed consent is currently unlikely to be acceptable as policy.
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Kroon B, Kroon F, Holt S, Wong B, Yazdani A. Post-mortem sperm retrieval in Australasia. Aust N Z J Obstet Gynaecol 2012; 52:487-90. [DOI: 10.1111/j.1479-828x.2012.01469.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Accepted: 06/23/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Benjamin Kroon
- Queensland Fertility Group Research Foundation; University of Queensland; Brisbane; QLD; Australia
| | - Frederick Kroon
- Department of Philosophy; University of Auckland; Auckland; New Zealand
| | - Saul Holt
- Department of Criminal Law; Victoria Legal Aid; Melbourne; Vic.; Australia
| | - Brittany Wong
- Queensland Fertility Group Research Foundation; University of Queensland; Brisbane; QLD; Australia
| | - Anusch Yazdani
- Queensland Fertility Group Research Foundation; University of Queensland; Brisbane; QLD; Australia
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Abstract
Objective of this study is to review technical methods to retrieve sperm from critically ill/injured patients after an appropriate family request, possible harmful effects on sperm production/function by ICU medications or concurrent illnesses, and ethical considerations for hospitals and care providers in providing this resource. Design used for this study includes: literature review, PubMed 1998-2009, and authors' files. There are no interventions. In conclusion, although successful and unsuccessful pregnancies following sperm removal from critically-ill patients are reported, no firm probability predictions for either result are known. Acute and chronic diseases that effect the hypothalamic-pituitary-gonadal axis and multiple medications common to the ICU may reduce sperm production or function. Retrieval methods before and after cardio-respiratory death differ and often require intracytoplasmic sperm injection or other in vitro fertilization techniques to achieve a subsequent pregnancy. The proactive development of a collaborative policy/procedure to identify appropriate roles for the hospital, its employees, and affiliated critical care and urology physicians is strongly recommended.
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Affiliation(s)
- David J Powner
- Departments of Neurosurgery and Internal Medicine, University of Texas Health Sciences Center at Houston Medical School, 6431 Fannin Street, MSB 7.154, Houston, TX 77030, USA.
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Using sperm posthumously: national guidelines versus practice. Fertil Steril 2010; 94:1154-6. [DOI: 10.1016/j.fertnstert.2009.10.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2009] [Revised: 09/21/2009] [Accepted: 10/16/2009] [Indexed: 11/23/2022]
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Shefi S, Raviv G, Eisenberg ML, Weissenberg R, Jalalian L, Levron J, Band G, Turek PJ, Madgar I. Posthumous sperm retrieval: analysis of time interval to harvest sperm. Hum Reprod 2006; 21:2890-3. [PMID: 16959804 DOI: 10.1093/humrep/del232] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Current recommendations regarding posthumous sperm retrieval (PSR) are based on a small number of cases. Our purpose was to determine the time interval from death to a successful procedure. METHODS Seventeen consecutive PSR procedures in 14 deceased and 3 neurologically brain-dead patients at two male infertility centres [Sheba Medical Center (SMC), Tel-Hashomer, Israel and University of California San Francisco (UCSF), San Francisco, CA, USA] were analysed. Main outcome measures were retrieval of vital sperm, pregnancies and births. RESULTS PSR methods included resection of testis and epididymis (n = 8), en-block excision of testis, epididymis and proximal vas deferens with vasal irrigation (n = 6), electroejaculation (EEJ) (n = 2) and epididymectomy (n = 1). PSR was performed 7.5-36 h after death. Sperm was retrieved in all cases and was motile in 14 cases. In two cases, testicular and epididymal tissues were cryopreserved without sperm evaluation, and in one case, no motility was detected. IVF and ICSI were performed in two cases in which sperm had been retrieved 30 h after death, and both resulted in pregnancies and live births. CONCLUSIONS Viable sperm is obtainable with PSR well after the currently recommended 24-h time interval. PSR should be considered up to 36 h after death, following appropriate evaluation. No correlation was found between cause of death and chance for successful sperm retrieval.
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Affiliation(s)
- Shai Shefi
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
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Nakhuda GS, Pena JE, Sauer MV. Deaths of HIV-positive men in the context of assisted reproduction: five case studies from a single center. AIDS Patient Care STDS 2005; 19:712-8. [PMID: 16283831 DOI: 10.1089/apc.2005.19.712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Provision of reproductive services to individuals infected with HIV-1 is gaining popular acceptance and is generally endorsed by specialists in reproductive medicine. In the situation in which the male is HIV positive and the female partner is not infected, a large body of evidence has demonstrated that the use of assisted reproductive technology is effective for achieving pregnancy, while eliminating the risk of viral transmission to the mother and fetus. No reports have documented the well-being of the HIV-infected partners subsequent to seeking fertility services. In the current report, we document the cases of five HIV-positive men who died secondary to complications of HIV infection shortly after participating in the assisted reproduction program for HIV-1-serodiscordant couples at Columbia University. Three of these couples successfully achieved pregnancy and live birth, including one set of triplets, and one case of posthumous conception; the fourth case resulted in the cryopreservation of all embryos after the sudden death of the male before the time of embryo transfer; the fifth couple failed to conceive. None of the deaths, which occurred within a few months to 2 years from initial consultation, were related to infertility treatment. The demographic and social statuses of these patients were not different from the general population of men seeking assisted reproduction in our clinic. Regarding the HIV infection status of these cases, three patients had a longer duration of infection compared to the general population of men in our cohort, and one had a significantly lower CD4 cell count. All five men had stable HIV viral loads, and were determined by their primary care providers to be clinically healthy at the time of entry into the program for assisted reproduction. The untimely deaths of these patients underscores the importance of the thoughtful consideration of the complex issues involved in family planning for these individuals, including advanced directives for the use of cryopreserved gametes and embryos, and the social, emotional, and practical issues for the children and surviving partners subsequent to the death of the HIV-positive parent.
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Affiliation(s)
- Gary S Nakhuda
- Columbia University College of Physicians and Surgeons, Department of Obstetrics and Gynecology, New York, New York, USA
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