Tash Jennifer A, Applegarth Linda D, Kerr Susan M, Fins Joseph J, Rosenwaks Zev, Schlegel Peter N
James 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.
J Urol. 2003 Nov;170(5):1922-5. doi: 10.1097/01.ju.0000092832.37190.94.
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.
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.
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.
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.
死后精子采集（PMSR）引发了严重的医学和伦理问题。在本研究中，我们报告了为该程序的可允许性制定的机构内部指南对所执行采集程序数量的影响。
22名猝死男性的家属寻求死后精子采集。我们对1994年至2002年期间机构审查委员会批准的死后精子采集请求进行了图表审查。我们机构的一个专家小组制定了一套关于死后精子采集的指南。关键要素包括：1）死者预期父亲身份的证据；2）近亲/法律同意（即只有妻子可以给予死后精子采集同意）；3）死亡是突然发生的（允许在死后24小时内采集）；4）同意有1年的丧亲之痛等待期以及对接受者进行评估。
在寻求死后精子采集的22个家庭中，根据指南制定的标准，有18个家庭不符合采集条件。4名年龄在29至36岁的男性在死后接受了死后精子采集，其中2名在呼吸维持状态下采集，2名在死后24小时内采集。所执行的程序包括3例输精管抽吸和1例附睾/睾丸采集。平均标本体积（包括培养基）为2.1立方厘米，每位患者冷冻保存的小瓶平均数量为3个，精子计数为每毫升1760万，活力为8.7%。所有标本解冻后均显示有活力。只有1名妻子将采集到的精子用于体外受精周期，但未成功受孕。
所提出的排除性指南为一家机构考虑死后精子采集请求提供了一个框架，并显著减少了死后精子采集的执行数量。
