Perimortem and postmortem sperm acquisition: review of clinical data.

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.

Posthumous Reproduction and the Law: Tissue Transplantation, Property Rights and the Reproductive Relational Autonomy.

This paper examines the history of Australian superior court decisions on the retrieval of gametic material from deceased men. It examines the history of case law and legislation on the issue and then provides a summary of the current operative principles. The paper concludes with some reflections on the harms caused by posthumous retrieval of gametes, the role of property rights and the nature of reproductive autonomy.

Australia after Cresswell and Chapman: A Legal and Regulatory Paradox, or an Opportunity for Uniformity?

Australia, like many overseas jurisdictions, has recognised the need to cope with advancing medical technology and changing community attitudes towards assisted reproductive technology (ART). Despite this, several States in Australia still do not have legislative instruments regulating ART, and those that have legislated have done so in a non-uniform way. In 2018/2019, four cases came before State Supreme Courts, where the female applicants had to endure significant legal battle in order to utilise their late partner's gametes, highlighting the inability of the law to provide an appropriate clinical framework. This article outlines and discusses the current position of Australian States on the utilisation of posthumous gametes and how the recent decisions of the Supreme Courts of New South Wales, Queensland and Western Australia augment the current law and National Health and Medical Research Council Guidelines, and finally, considers how future legislation might account for the potential posthumous utilisation of oocytes.

Parents' posthumous use of daughter's ovarian tissue: Ethical dimensions.

In recent years, progress in cancer treatment has greatly increased the chances of recovery. Yet, treatment may have irreversible effects on patients' fertility. In order to protect future fertility, preservation of ovarian tissue may be offered today even to very young girls, involving a surgical procedure that may be performed by minimally invasive laparoscopy, under general anesthesia. However, in the tragic event of a girl's death, questions may arise regarding the possible use of the preserved ovarian tissue by her parents. Should posthumous reproductive use of ovarian tissue without the girl's prior consent (due to her young age) be considered a violation of her rights? On the other hand, can it be argued that it is in the interest of a child who died young to leave a genetic trace through posthumous reproduction, because genetic continuity is in the interest of every human being? After presenting the relevant clinical facts, we explore the ethical dimensions of this possible practice through an analysis of the interests of the deceased, her parents, and the child that may be born posthumously.

(Un) Natural Grief: Novelty, Tradition and Naturalization in Israeli Discourse on Posthumous Reproduction.

This article examines Israeli discourse on posthumous reproduction (PR) and the related cultural construction of "(un)natural" grief. Based mainly on an analysis of in-depth interviews with family members who submitted a request for PR, we examine the regimes of justification used by supporters and opponents of this technology. With both sides using the notion of "nature" to support their claim, the dispute centers on whether PR constructs a new social expression of grief (and hence should be seen as unnatural) or is only a reflection of an age-old grieving process (and is thus natural). We argue that by employing a twofold, novel/traditional justification, PR supporters aim to go one step further, from a symbolic continuity of the dead to a so-called real one. This progression highlights the flexibility of the natural category at the intersection of technology and culture and the abandonment of such binary distinctions as life/death and nature/culture.

Reproductive function: the protection of the rights of the people which are sent to the area of the fighting.

OBJECTIVE: Introduction: The issues of problems of the legal regulation of posthumous reproduction in Ukraine and foreign countries are analysis in the article. The author substantiates the necessity in the creation and acceptance of the State Program of the retrieval of reproductive cells in people who are sending to the area of the fighting. The aim:the purpose of our work is a comprehensive study of post-mortem (post-mortem) reproduction and substantiation of the possibility and necessity of adopting a state program for the selection of reproductive cells of individuals who are sent to a combat zone to ensure their full social protection and assistance in the realization of the right to fatherhood or motherhood. PATIENTS AND METHODS: Materials and methods: the experience of certain countries is analyzed in the research. Additionally, we used statistical data of international organizations, conclusions of experts and foreign legal acts dealing with posthumous reproduction and auxiliary reproductive technologies, judicial practice, doctrinal ideas and views on this issue. RESULTS: Review: there are medical (practical) preconditions for the introduction of posthumous reproduction programs. Among them is the technology of obtaining reproductive cells (post-mortem too), their preservation and successful subsequent use. In addition, foreign experience shows the success of the application of these technologies and the real guarantee of full implementation of the range of rights to the family, fatherhood or maternity. CONCLUSION: Conclusions: we note the urgent need to develop and adopt a state reproductive cell selection program for individuals who are sent to the combat zones (according to a model that exists in such countries as the USA and Israel).

Mapping French people's views regarding posthumous reproduction.

OBJECTIVE: The study mapped French people's views regarding the acceptability of posthumous reproduction. BACKGROUND: Posthumous reproduction - the use of a deceased person's gametes for procreative purposes -is a controversial procedure because it involves a series of ethical issues, namely the surviving partner's rights to procreation, the emotional feelings and financial interests of other family members, and the government's interest in maintaining orderly inheritance rules. METHODS: A convenience sample of participants aged 19-68 (104 lay people, 47 health professionals and 15 lawyers) were presented with 48 realistic stories that were composed according to a four-factor within-subject design: marital status (married for about 10 years with children, married for about three years without children, and cohabiting for three years without children) × attitude of the deceased's parents (favourable vs. unfavourable to posthumous procreation) × time elapsed since the partner's death (three months vs. nine months) × deceased's wishes (written consent, oral consent given in front of credible witnesses, unknown wishes, and unfavourable attitude). RESULTS: Through cluster analysis, four qualitatively different positions were found. They were called Never Acceptable (35% of the sample, mostly health professionals, lawyers and regular attendees to the church or temple), Tolerable in a Few Cases (28%), Depends on Deceased's Wishes (22%, mostly lay people) and Quite Acceptable (16%, mostly lay people). CONCLUSIONS: About half of French lay people view the current legislation regarding posthumous assisted reproduction in a country such as the UK as more appropriate than the French legislation.

Blurring the line between life and death: a review of the psychological and ethical concerns related to posthumous-assisted reproduction.

Posthumous-assisted reproduction (PAR), though viewed unfavourably by some, is desirable to many individuals whose partners die prior to the completion of family building. PAR is technically feasible for males and females both pre- and post-mortem and these procedures have previously been completed on numerous occasions. However, such treatment is associated with three primary ethical concerns: autonomy; beneficence; and justice for the living, the deceased, and the soon-to-be conceived. Further, there are many psychological risks of PAR which may affect all involved parties. As such, early psychological counselling of patients and surviving family members is warranted.

Posthumous Reproduction (PHR) in Israel: Policy Rationales Versus Lay People's Concerns, a Preliminary Study.

Israeli policy concerning PHR has been decided upon in an expertocratic manner, leaving the voice of the public unheard. Based on 26 semi-structured in-depth interviews with 13 Jewish-Israeli young couples, this preliminary study provides the first empirical data regarding lay attitudes toward PHR in Israel. Findings suggest major dissimilarities between the policy and lay people's wishes and rationales. While policy is built on the "presumed wish" assumption, supposing all men living in a loving relationship wish to have their partner carry their child post-mortem, this was empirically unsupported. However, the findings suggest that many interviewees were willing to defer to their surviving spouse's wishes to have their post-mortem child, sometimes even against their own wish, indicating a support for presumed consent. Respecting the wishes of the dead, a dominant argument in the bioethical discussion in Israel and beyond, was mainly irrelevant to informants, whereas interviewees considered the future child's welfare, a concern overlooked by Israeli policy. Likewise, while posthumous grandparenthood is on the rise in Israel, it clearly contradicts the wishes of the majority of this study's informants. Nonetheless, existing policy is not expected to raise any opposition, due to the extreme liberalism of the participants and their support of reproductive autonomy.

Single men's attitudes towards posthumous use of their sperm cryopreserved due to illness in Israel.

BACKGROUND: Banking of frozen spermatozoa by single men opens the possibility of procreation long after their death. Requests for posthumous reproduction by the families of the deceased are growing, raising an ethical debate, especially when written instructions were not left by the patients and in cases of unplanned perimortem collection. The issue of the progenitors' intention to procreate after death is the key to ethically based decision-making in these cases. OBJECTIVES: To evaluate the attitude of single men cryopreserving spermatozoa before life-threatening medical situations towards post-mortem usage of their cryopreserved spermatozoa. MATERIALS & METHODS: Adult single men prior to sperm cryopreservation before cytotoxic therapy were asked to sign a structured form declaring their will and instructions for the usage of their cryopreserved spermatozoa in case of their demise. RESULTS: Four hundred fifty-two men of diverse ethnicity, religious and cultural backgrounds signed the form providing instructions for the use of their cryopreserved spermatozoa in case of mortality. Their age was 27.4 ± 8.06 years. Seven (1.5%) patients willed their spermatozoa for posthumous reproduction to a sibling, 22 (4.9%) to parents, and 26 (5.7%) to their informal female partners. The significant majority (n = 397; 87.8 %) of the single men were ordered to destroy their cryopreserved spermatozoa in case of their expiry. Note that, 26-39 years old men were less likely (81.8% vs. >90% in other ages) to order sperm destruction, as well as men with a poorer prognosis (83% vs. 90%). DISCUSSION: In this study group, most single men cryopreserving spermatozoa in the face of future life-threatening morbidity do so for their own future live parenthood, and are not interested in posthumous reproduction. CONCLUSION: Our results doubt the claim that single men who had an unplanned perimortem sperm collection can be universally presumed to have wished to father a child posthumously. Any claimed assumed consent in these cases should be considered for each case individually based on its specific circumstances.

Ethical and Practical Considerations of Perimortem Gamete Procurement for Palliative Care Providers.

Requests for perimortem gamete procurement (PGP) typically arise by a surrogate decision maker after the unexpected death or incapacitation of a reproductive-aged individual. Palliative care clinicians should have a working knowledge of the medical, ethical, and practical considerations pertaining to such requests. In this paper, we describe a case in which the PGP request originated from an incapacitated patient's parents. We review the technologies associated with PGP and posthumous assisted reproduction (PAR) and discuss the ethical and legal issues involved in such cases, including recent position statements from national and international reproductive health groups. Finally, we provider readers with a stepwise approach for considering requests for PGP.

Posthumous conception in Australia - legal and ethical considerations.

Posthumous conception, the ability to conceive a child after the death of one partner, is increasingly prevalent due to advances in Artificial Reproduction Technology (ART). This paper considers the complexities surrounding the practice in Australia, focusing primarily on the ethical and legal dimensions. It observes that state-based regulations in Australia create disparities in accessibility: some states prohibit the procedure without the deceased's written consent, while others permit it based on guidelines or lack explicit prohibitions. Addressing the juxtaposition of Will Theory and Interest Theory, it emphasises the ongoing debate on whether rights, particularly reproductive autonomy, outlive a person's demise. Finally, the paper highlights an evident inconsistency in Australian legislation and promotes a uniform approach across states.

Post-Dobbs legal conundrums surrounding preimplantation in vitro fertilization embryo dispositions.

The legal issues surrounding in vitro fertilization from its beginnings have found their way into courtrooms and legislatures, with disposition of cryopreserved in vitro fertilization preimplantation embryos presenting legal and policy conundrum for patients, providers, and lawmakers in a myriad of contexts. This article examines the legal aspects of selected embryo disposition issues and the potential impact of laws enacted following the US Supreme Court's recent removal of Constitutional protections for reproductive choice and autonomy in Dobbs v. Jackson Women's Health Organization.

Posthumous reproduction in Iranian law.

Posthumous reproduction (PHR) is the process by which assisted reproductive technology is used to establish pregnancy and produce genetic offspring following the death of a parent. There are different ethical and legal approaches towards this method of reproduction around the world. This paper will study the legality of PHR and its legal consequences for the family status of a child born by this technology according to Iranian law. This research uses the descriptive-analytical method to study Iranian legislation, the opinion of jurists and jurisconsults, and case law in the area of PHR. The only statute regarding assisted reproductive technology in Iranian law - the Embryo Donation Act 2003 - and the associated regulation contain no explicit provision on PHR. The subject is therefore very controversial among Iranian jurists and jurisconsults. This issue has also been the subject of divergent court decisions. This study shows that the current legislation is insufficient to address various issues raised by PHR, and there is a need for the legislature to provide legislative clarity. Although advocates of this technique use the approval of some jurisconsults (fuqahâ) as justification for the legal recognition of PHR during the idda period in Iranian law, some concerns regarding the practice, especially the child's best interests, support prohibition or at least restriction to specific, limited cases.

Posthumous sperm retrieval: a procreative revolution.

Aim Postmortem sperm retrieval with consequent artificial insemination has become a technically possible option for future use in assisted reproductive technology (ART). The authors have set out to discuss the social and ethical significance of posthumous sperm retrieval, and the laws currently in force in Italy, the United States and elsewhere. Methods International literature from 1997 to 2020 has been reviewed from Pubmed database, Google Scholar and Scopus, drawn upon American, Italian and international sources (an ethically acceptable solution can only be achieved through an overhaul of the laws currently in effect). One of the most contentious issues was about donor consent. In Italy, a donor's will to retrieve his sperm in the event of premature disappearance can be proven according to the Law 219/2017, through advance health care directives. Results A substantial increase, both in requests and protocols, was documented in the United States. In Italy, over the last two years, three rulings were issued concerning posthumous insemination. However, no official standardized protocols, guidelines or targeted legislation exist at the national level to regulate medical activity in that realm, whereas established laws often set implicit limitations. Conclusion Current legal frameworks appear to be inadequate, because in most cases they were conceived under conditions that have radically changed. The need for newly-updated regulatory frameworks to promptly bridge that gap is increasingly clear, if current social needs related to reproductive rights are to be met in the foreseeable future.

Posthumous assisted reproduction policies among a cohort of United States' in vitro fertilization clinics.

OBJECTIVE: To assess the presence and content of policies toward posthumous assisted reproduction (PAR) using oocytes and embryos among Society for Assisted Reproductive Technology (SART) member clinics in the United States. DESIGN: Cross-sectional questionnaire-based study. SETTING: Not applicable. PATIENTS: A total of 62 SART member clinics. INTERVENTIONS: Questionnaire including multiple choice and open-ended questions. MAIN OUTCOME MEASURES: Descriptive statistics regarding presence and content of policies regarding PAR using oocytes and embryos, consent document content regarding oocyte and embryo disposition, and eligibility of minors and those with terminal illness for fertility preservation. RESULTS: Of the 332 clinics contacted, 62 responded (response rate 18.7%). Respondents were distributed across the United States, and average volume of in vitro fertilization (IVF) cycles per year ranged from <250 to >1,500, but 71.2% (n = 42) reported a volume of <500. Nearly one-half (42.4%, n = 25) of clinics surveyed reported participating in any cases of posthumous reproduction during the past 5 years, and 6.8% (n = 4) reported participation in >5 cases. Participation in cases of posthumous reproduction was not significantly associated with practice type or IVF cycle volume among those surveyed. Only 59.6% (n = 34) of clinics surveyed had written policies regarding PAR using oocytes or embryos, whereas 36.8% (n = 21) reported they did not have a policy. Practice type, IVF cycle volume, fertility preservation volume, and prior participation in cases of PAR were not significantly associated with the presence of a policy among respondent clinics. Of those with a policy, 55.9% (n = 19) reported they had used that policy, 59.1% (n = 13) without a policy reported they had considered adopting one, and 63.6% (n = 14) reported they had received a request for PAR services. Only 47.2% (n = 25) of clinics surveyed specified that patients not expected to survive to use oocytes due to terminal illness are eligible for oocyte cryopreservation, whereas 45.3% (n = 24) did not specify. CONCLUSIONS: Respondent clinics reported receiving an increasing number of requests for PAR services, but many also lacked PAR policies. Those with policies did not always follow ASRM recommendations. Given the low response rate, these data cannot be interpreted as representative of SART clinics overall. As PAR cases become more common, however, this study highlights poor reporting of PAR and institutional policies toward PAR, suggesting that SART clinics may not be equipped to systematically manage the complexities of PAR.

Creating life after death: should posthumous reproduction be legally permissible without the deceased's prior consent?

Scientific advances enable to retrieve and use gametes of a deceased person, thereby creating a child after the death of a genetic parent. This article reviews and compares legislation governing posthumous reproduction in the United States, the United Kingdom, Australia, and Israel. It shows that each country has its own distinctive features, yet three common elements exist-legal ambiguity, a requirement for prior consent, and permission for the partner, but not the parents, to retrieve and use the deceased's gametes. The article demonstrates that courts often do not follow the legal requirements, and thus there are no clear guiding principles regarding posthumous reproduction. The article then discusses three justifications for permitting posthumous reproduction in the absence of the deceased's prior consent. The first justification relates to an interest in 'genetic continuity', which reflects people's desire in leaving a 'piece' of themselves in the world and maintaining a chain of continuity. The second justification concerns the 'respect-for-wishes' model of autonomy, according to which people must be treated in a way that we assume they would want to be treated. The third justification touches upon the interests of the deceased's partner and parents, as well as of the resulting child.

Present-day posthumous reproduction and traditional levirate marriage: two types of interactions.

The paper studies the position of Jewish law on posthumous reproduction and its mutual interaction with the legal and bioethical discussion of this issue. It examines two types of interactions: a direct, legal-positive interaction and a meta-legal interaction, which may be defined as inspiration. The first relates to how Jewish law responds to the new technology, as reflected in the practical laws of levirate marriage, and how this new technology affects a wider spectrum of laws and conceptualizations from a religious-law perspective. The paper points to two interesting phenomena: (1) how a legal definition in the religious realm (fatherhood for the purpose of levirate marriage) affects legal definitions in the civil realm (eg, inheritance), and (2) the significance of value-based principles in framing Jewish law as a legal system whose 'ways are ways of pleasantness'. The second (indirect interaction) deals with two rationales, individualistic and familial, behind the Israeli debate over posthumous sperm retrieval of fallen soldiers and their equivalents in the Jewish law discussion of the early 'forefather' of this technology: levirate marriage. The paper concludes that the complex interaction-both direct and indirect-provides us with a striking picture of the conjunction of modernity, law, and religion.

A cross-cultural analysis of posthumous reproduction: The significance of the gender and margins-of-life perspectives.

The scholarly discussion of posthumous reproduction (PHR) focuses on informed consent and the welfare of the future child, for the most part overlooking cultural differences between societies. Based on a cross-cultural comparison of legal and regulatory documents, analysis of pivotal cases and study of scholarly and media discussions in Israel and Germany, this paper analyses the relevant ethical and policy issues, and questions how cultural differences shape the practice of PHR. The findings challenge the common classifications of PHR by highlighting the gender perspective and adding brain-dead pregnant women to the debate. Based on this study's findings, four neglected cultural factors affecting social attitudes towards PHR are identified: (i) the relationship between the pregnant woman and her future child; (ii) what constitutes the beginning of life; (iii) what constitutes dying; and (iv) the social agent(s) seeking to have the future child. The paper argues that PHR can be better understood by adding the gender and margins-of-life perspectives, and that future ethical and practical discussions of this issue could benefit from the criteria emerging from this cross-cultural analysis.