RESUMEN
This comprehensive review delves into the moral and ethical dilemmas surrounding post-mortem sperm retrieval (PMSR) and its implications for creating new individuals. The paper examines the challenges posed by unusual requests for sperm retrieval from the deceased's widow and parents, as well as the broader socio-ethical considerations associated with PMSR. These requests have often been denied due to the absence of established laws and guidelines governing posthumous sperm retrieval and subsequent births, which were once deemed impossible. While some countries have implemented institutional policies to regulate its use to some extent, there remains a lack of standardized rules and procedures for the collection and retrieval of sperm after death. It is essential to introduce institutional guidelines to facilitate requests for assisted reproductive technology (ART) following successful sperm retrieval. Additionally, the development of PMSR legislation is necessary to ensure a proper balance between the moral rights and fundamental rights of the deceased, their family, and any current or future offspring, while providing adequate protection for all parties involved.
Asunto(s)
Recuperación de la Esperma , Humanos , Masculino , Recuperación de la Esperma/ética , Recuperación de la Esperma/legislación & jurisprudencia , Concepción Póstuma/ética , Concepción Póstuma/legislación & jurisprudencia , Técnicas Reproductivas Asistidas/ética , Técnicas Reproductivas Asistidas/legislación & jurisprudenciaRESUMEN
Posthumous gamete (sperm or oocyte) retrieval or use for reproductive purposes is ethically justifiable if written documentation from the deceased authorizing the procedure is available. Retrieval of sperm or eggs does not commit a center to their later use for reproduction, but may be permissible under the circumstances outlined in this opinion. Embryo use is also justifiable with such documentation. In the absence of written documentation from the decedent, programs open to considering requests for posthumous use of embryos or gametes should only do so when such requests are initiated by the surviving spouse or partner. This document replaces the report of the same name, last published in 2012.
Asunto(s)
Criopreservación/ética , Embrión de Mamíferos , Células Germinativas , Recuperación del Oocito/ética , Concepción Póstuma/ética , Recuperación de la Esperma/ética , Comités de Ética , Testimonio de Experto , Femenino , Humanos , Recién Nacido , Consentimiento Informado , Masculino , Recuperación del Oocito/métodos , Concepción Póstuma/legislación & jurisprudencia , Concepción Póstuma/psicología , Embarazo , EspermatozoidesRESUMEN
Advances in surgical sperm retrieval have greatly increased the chances of men with Klinefelter syndrome achieving biological paternity. Despite this, the vast majority of attempts to achieve fertility by using extracted gametes to fertilize eggs in vitro do not result in viable pregnancies. A powerful obstacle to success lies with the natural history of seminiferous tubule and germ cell function in Klinefelter syndrome, which typically peak (and thereafter steeply decline) up to a decade before most individuals would be contemplating paternity. Herein we discuss, in relation to a real clinical case, both the exciting technical advances surgical sperm retrieval and the logistic and ethical factors that, in practice, may act to limit their successful application.
Asunto(s)
Preservación de la Fertilidad/métodos , Síndrome de Klinefelter/terapia , Recuperación de la Esperma , Niño , Preservación de la Fertilidad/tendencias , Humanos , Síndrome de Klinefelter/psicología , Masculino , Recuperación de la Esperma/ética , Recuperación de la Esperma/psicología , Recuperación de la Esperma/tendenciasAsunto(s)
Toma de Decisiones/ética , Concepción Póstuma , Recuperación de la Esperma/ética , Esposos , Criopreservación/ética , Femenino , Humanos , Consentimiento Informado/ética , Inseminación Artificial/ética , Masculino , Concepción Póstuma/ética , Concepción Póstuma/legislación & jurisprudencia , Embarazo , Preservación de Semen/ética , Recuperación de la Esperma/legislación & jurisprudencia , Obtención de Tejidos y Órganos/éticaRESUMEN
Conception of a child using cryopreserved sperm from a deceased man is generally considered ethically sound provided explicit consent for its use has been made, thereby protecting the man's autonomy. When death is sudden (trauma, unexpected illness), explicit consent is not possible, thereby preventing posthumous sperm procurement (PSP) and conception according to current European Society of Human Reproduction and Embryology and the American Society for Reproductive Medicine guidelines. Here, we argue that autonomy of a deceased person should not be considered the paramount ethical concern, but rather consideration of the welfare of the living (widow and prospective child) should be the primary focus. Posthumous conception can bring significant advantages to the widow and her resulting child, with most men supporting such practice. We suggest that a deceased man can benefit from posthumous conception (continuation of his 'bloodline', allowing his widow's wishes for a child to be satisfied), and has a moral duty to allow his widow access to his sperm, if she so wishes, unless he clearly indicated that he did not want children when alive. We outline the arguments favouring presumed consent over implied or proxy consent, plus practical considerations for recording men's wishes to opt-out of posthumous conception.
Asunto(s)
Concepción Póstuma/ética , Concepción Póstuma/legislación & jurisprudencia , Recuperación de la Esperma/ética , Criopreservación , Europa (Continente) , Femenino , Fertilización In Vitro , Humanos , Consentimiento Informado , Masculino , Medicina Reproductiva/normas , Recuperación de la Esperma/legislación & jurisprudenciaRESUMEN
Posthumous gamete (sperm or oocyte) procurement and reproduction are ethically justifiable if written documentation from the deceased authorizing the procedure is available. In the absence of written documentation from the decedent, programs open to considering requests for posthumous gamete procurement or reproduction should only do so when such requests are initiated by the surviving spouse or life partner. This document replaces the ASRM Ethics Committee report, "Posthumous reproduction," published in September 2004 (Fertil Steril 2004;82[Suppl 1]:S260-2).
Asunto(s)
Criopreservación , Comités de Ética , Recuperación del Oocito , Concepción Póstuma , Recuperación de la Esperma , Directivas Anticipadas , Formularios de Consentimiento , Consejo , Criopreservación/ética , Pesar , Humanos , Consentimiento Informado , Recuperación del Oocito/ética , Recuperación del Oocito/legislación & jurisprudencia , Padres , Concepción Póstuma/ética , Concepción Póstuma/legislación & jurisprudencia , Recuperación de la Esperma/ética , Recuperación de la Esperma/legislación & jurisprudencia , EspososRESUMEN
Post-mortem Sperm Retrieval (PMSR) is seldom requested in Australasia. The retrieval of sperm is permitted only by prior written consent or by order of the court. Sperm should be retrieved within 24 h following death; however, collection within 36 h may still be successful. The clinical response to such a request must be mindful of complex ethical and legal considerations. Clear, accessible and consistent law in this area would benefit medical, legal and societal stakeholders.
Asunto(s)
Fertilización In Vitro/legislación & jurisprudencia , Recuperación de la Esperma/ética , Recuperación de la Esperma/legislación & jurisprudencia , Directivas Anticipadas/ética , Directivas Anticipadas/legislación & jurisprudencia , Australasia , Fertilización In Vitro/ética , Humanos , Masculino , Guías de Práctica Clínica como Asunto , Recuperación de la Esperma/normas , Encuestas y Cuestionarios , Consentimiento por Terceros/ética , Consentimiento por Terceros/legislación & jurisprudencia , Factores de TiempoRESUMEN
INTRODUCTION: Assisted reproductive technologies are increasingly more present in our everyday life: from classical sperm/egg donation or in vitro fertilization to newer, more controversial methods such as surrogate motherhood, male pregnancies or posthumous sperm procurement. Every year, new concepts are emerging in this field and the medical world is not always prepared to deal with them. MATERIAL AND METHOD: The greatest problem of using posthumous sperm procurement as an assisted reproductive method resides in analyzing consent related. An extensive research of the scientific literature revealed eight possible situations which we will present and analyze in this article. RESULTS: By analyzing consent related issues we present a decision making algorithm for posthumous sperm procurement.
Asunto(s)
Consentimiento Informado , Recuperación de la Esperma , Obtención de Tejidos y Órganos , Algoritmos , Toma de Decisiones , Humanos , Consentimiento Informado/ética , Consentimiento Informado/legislación & jurisprudencia , Masculino , Concepción Póstuma/ética , Concepción Póstuma/legislación & jurisprudencia , Recuperación de la Esperma/ética , Recuperación de la Esperma/legislación & jurisprudencia , Espermatozoides , Donantes de Tejidos , Obtención de Tejidos y Órganos/ética , Obtención de Tejidos y Órganos/legislación & jurisprudenciaRESUMEN
Fertility assistance to HIV-positive men is now accepted practice in many parts of the world. We analyze the legislative, ethical, and clinical factors that explain the differences across continents with the aim of opening up the debate within the United States on whether clinics can justify denying HIV-infected men the opportunity of parenting through a now well-established risk reduction method with a proved safety record.
Asunto(s)
Descontaminación/métodos , Infecciones por VIH , Cooperación Internacional , Técnicas Reproductivas Asistidas , Recuperación de la Esperma , Separación Celular , Descontaminación/ética , Descontaminación/legislación & jurisprudencia , Descontaminación/normas , Transmisión de Enfermedad Infecciosa/ética , Transmisión de Enfermedad Infecciosa/legislación & jurisprudencia , Transmisión de Enfermedad Infecciosa/prevención & control , Femenino , Infecciones por VIH/transmisión , Infecciones por VIH/virología , Humanos , Cooperación Internacional/legislación & jurisprudencia , Masculino , Embarazo , Técnicas Reproductivas Asistidas/ética , Técnicas Reproductivas Asistidas/legislación & jurisprudencia , Técnicas Reproductivas Asistidas/normas , Técnicas Reproductivas Asistidas/estadística & datos numéricos , Recuperación de la Esperma/ética , Recuperación de la Esperma/legislación & jurisprudencia , Recuperación de la Esperma/normas , Espermatozoides/citología , Espermatozoides/virología , Reino Unido , Estados UnidosRESUMEN
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.
Asunto(s)
Enfermedad Crítica , Recuperación de la Esperma , Muerte Encefálica/fisiopatología , Conducta Cooperativa , Cuidados Críticos/ética , Ética Médica , Femenino , Fertilización In Vitro/ética , Humanos , Consentimiento Informado/ética , Consentimiento Informado/legislación & jurisprudencia , Comunicación Interdisciplinaria , Masculino , Grupo de Atención al Paciente , Embarazo , Análisis de Semen/ética , Inyecciones de Esperma Intracitoplasmáticas/ética , Recuperación de la Esperma/ética , Espermatogénesis/efectos de los fármacos , Espermatogénesis/fisiología , Resultado del TratamientoRESUMEN
DEFINITION OF THE PROBLEM: Due to new technological advances in assisted reproduction, perimortem sperm retrieval has developed into a subject of increasing interest for families of comatose or dying male patients in critical care facilities. These requests raise a number of medical, ethical, legal and psychological issues. ARGUMENTS AND CONCLUSIONS: The case of a comatose dying male patient is used to illustrate the variety of positions and problems which have to be discussed. The importance of written consent of the donor, the interest of the unborn child and the legal limitations are highlighted.
Asunto(s)
Recuperación de la Esperma/ética , Recuperación de la Esperma/legislación & jurisprudencia , Adulto , Niño , Coma , Cuidados Críticos , Muerte , Derechos Humanos , Humanos , Consentimiento Informado , Masculino , Autonomía Personal , Técnicas Reproductivas Asistidas/ética , Técnicas Reproductivas Asistidas/legislación & jurisprudencia , Técnicas Reproductivas Asistidas/psicología , Recuperación de la Esperma/psicologíaRESUMEN
BACKGROUND: Klinefelter syndrome is a common genetic condition. Affected non-mosaic men are azoospermic and have been labelled as infertile. Despite reports that these men can have children using assisted reproduction techniques, it is not common practice in the UK to offer sperm retrieval to these men. METHODS: Medline and EMBASE (1980-2009) were searched independently by two authors and all studies involving surgical sperm retrieval in non-mosaic Klinefelter syndrome were included. The primary outcome was success of surgical sperm retrieval and the secondary outcome was live birth rate. RESULTS: The overall success rate for sperm retrieval was 44%, with a higher rate of success using micro-dissection testicular sperm aspiration (micro-TESE) (55%). This, along with ICSI, has led to the birth of 101 children. However, there are no known predictors for successful sperm retrieval. Although there are concerns about genetic risk to the offspring of non-mosaic Klinefelter patients, this risk has not been found to be greater than that of patients with non-obstructive azoospermia with normal karyotype. CONCLUSIONS: It is possible for a man with non-mosaic Klinefelter to father a child. However, before these techniques are offered, some ethical issues need to be explored.
Asunto(s)
Infertilidad Masculina/etiología , Síndrome de Klinefelter/complicaciones , Recuperación de la Esperma/ética , Adulto , Factores de Edad , Aneuploidia , Azoospermia , Anomalías Congénitas/genética , Femenino , Humanos , Masculino , Mosaicismo , Embarazo , Resultado del Embarazo , Diagnóstico Preimplantación/ética , Riesgo , Inyecciones de Esperma IntracitoplasmáticasAsunto(s)
Muerte , Propiedad , Recuperación de la Esperma/ética , Espermatozoides , Humanos , MasculinoRESUMEN
In re Matter of Daniel Thomas Christy authorized post mortem gamete retrieval under the most recent revision of the Uniform Anatomical Gift Act. This article recommends that the National Conference of Commissioners on Uniform State Laws explicitly address the issue of post mortem gamete retrieval for reproductive purposes; that legislators specify whether their states will follow the Christy ruling; and that ethics committees and consultants prepare for the questions about human identity and self determination that post mortem gamete retrieval raises.
Asunto(s)
Donación Directa de Tejido/legislación & jurisprudencia , Concepción Póstuma/legislación & jurisprudencia , Recuperación de la Esperma/legislación & jurisprudencia , Adulto , Donación Directa de Tejido/ética , Femenino , Humanos , Consentimiento Informado/legislación & jurisprudencia , Iowa , Masculino , Donación de Oocito/legislación & jurisprudencia , Concepción Póstuma/ética , Recuperación de la Esperma/ética , Estados UnidosRESUMEN
Postmortem sperm retrieval has been used worldwide. Following retrieval, sperm can then be used (usually by the surviving partner) to produce a child related to the now-deceased male. This paper describes a request for postmortem sperm retrieval made by the family of a man who had suffered trauma leading to his death. The man had not given written consent for the retrieval and use of his sperm before his accidental death. The case illustrates some of the complex ethical and legal issues occurring in Canada and describes the new Canadian regulations, which prohibit postmortem sperm retrieval unless explicit written consent has been provided by the deceased.
Asunto(s)
Técnicas Reproductivas Asistidas/legislación & jurisprudencia , Preservación de Semen/ética , Recuperación de la Esperma/legislación & jurisprudencia , Autopsia/ética , Autopsia/legislación & jurisprudencia , Canadá , Criopreservación/ética , Humanos , Masculino , Técnicas Reproductivas Asistidas/economía , Técnicas Reproductivas Asistidas/ética , Recuperación de la Esperma/ética , Recolección de Tejidos y Órganos/éticaRESUMEN
Posthumous sperm retrieval is still a controversial procedure. The Israel Ministry of Health has recently issued guidelines to regulate the procedure and a recent unusual petition in Israel for posthumous retrieval sheds new and interesting light on the dilemmas involved. This paper examines the petition, both in its own right and by comparing it to the more frequent situation where the surviving partner of a suddenly deceased man petitions for his sperm to be collected for insemination into herself. The analysis considers the best interests of the child to be born, the good of other family members, the wishes of the deceased and the interests of society as a whole.