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Postmortem sperm retrieval: the effect of instituting guidelines
Jennifer A Tash1, Linda D Applegarth, Susan M Kerr
1James Buchanan Brady Urology Foundation, Department of Urology, New York-Presbyterian Hospital/Weill Medical College of Cornell University, 525 East 68th Street, Starr 900, New York, NY 10021, USA.
Purpose:
Postmortem sperm retrieval (PMSR) raises serious medical and ethical concerns. In this study we report the effect of intra-institutional guidelines developed for the permissibility of the procedure on the number of procurement procedures performed.
Materials And Methods:
The family members of 22 men who died suddenly sought PMSR. We performed an institutional review board approved chart review of the requests for PMSR from 1994 to 2002. A set of guidelines addressing PMSR was developed by a panel of experts at our institution. Key elements included 1) evidence of intended paternity for the deceased man, 2) next of kin/legal consent (i.e. only the wife can give consent for PMSR), 3) the death was sudden (permitting retrieval less than 24 hours post mortem) and 4) consent to a 1-year waiting period for bereavement and assessment of recipient.
Results:
Of the 22 families who sought PMSR 18 were not candidates for retrieval based on the criteria established by the guidelines. Four men 29 to 36 years old underwent PMSR after death and maintained on a respiratory (2) or within the first 24 hours after death (2). Procedures performed included vasal aspiration in 3 patients and epididymal/testicular retrieval in 1. Average specimen volume (including medium) was 2.1 cc, the average number of vials cryopreserved per patient was 3, sperm count was 17.6 million per ml and motility was 8.7%. All specimens demonstrated post-thaw motility. Only 1 wife used retrieved sperm for an in vitro fertilization cycle, and no pregnancy was obtained.
Conclusions:
The exclusionary guidelines presented provide a framework utilized at 1 institution for consideration of requests for PMSR and dramatically decreased the number of postmortem sperm retrievals performed.
Insights
Developing strict guidelines for postmortem sperm retrieval (PMSR) significantly reduced the number of procedures performed. These guidelines ensure ethical considerations and eligibility criteria are met for PMSR requests.
Area of Science:
- Reproductive Medicine
- Medical Ethics
- Urology
Background:
- Postmortem sperm retrieval (PMSR) presents complex medical and ethical challenges.
- The demand for PMSR necessitates clear institutional protocols to manage requests ethically and effectively.
Purpose of the Study:
- To evaluate the impact of newly developed intra-institutional guidelines on the number of postmortem sperm retrieval (PMSR) procedures performed.
- To establish a framework for assessing the permissibility of PMSR requests.
Main Methods:
- A retrospective chart review of 22 PMSR requests from 1994 to 2002 was conducted.
- Institutional guidelines were established, requiring evidence of intended paternity, consent from next of kin (wife only), sudden death within 24 hours, and a 1-year waiting period.
- These criteria were applied to assess the eligibility of PMSR requests.
Main Results:
- Out of 22 requests, 18 families were ineligible for PMSR based on the established guidelines.
- Four men (ages 29-36) underwent PMSR, with sperm retrieved via vasal aspiration (3) or testicular retrieval (1).
- All retrieved specimens showed post-thaw motility, but only one cycle of in vitro fertilization was attempted, resulting in no pregnancy.
Conclusions:
- The implemented exclusionary guidelines effectively reduced the number of postmortem sperm retrievals.
- These guidelines provide a structured approach for institutions to consider and manage PMSR requests, balancing ethical concerns with clinical practice.
