[Semen cryopreservation in a sedated patient]

Semen cryopreservation is a way to preserve sperm before treatments that may affect fertility, such as chemo- and radiotherapy. Typically, semen is collected through masturbation, though alternatives like electrostimulation or testicular sperm extraction (TESE) exist for patients unable to provide a sample. Informed consent is required for these procedures. We describe a case of a young patient sedated in the ICU due to a therapy-resistant status epilepticus. His physicians planned to treat him with the gonadotoxic agent Cyclophosphamide, which can harm sperm quality. His family requested semen cryopreservation before treatment. However, due to the patient's sedation, obtaining his consent was not possible. A multidisciplinary team debated the legal and ethical concerns, balancing respect for the patient's presumed wishes with his right to bodily integrity. The decision was made to collect and store the semen, with future use contingent on the patient's consent.