What Can We Learn about Postmortem Sperm Retrieval after Extra Long-term Follow Up?

Itai Gat 1,2,3 Ana Umanski 1 Sarita Kaufman 1 Alon Kedem 2,3 Sarit Avraham 2 Michal Youngster 2 Gil Yerushalmi 2,3 Chen Kugel 3,4 Ariel Hourvitz 2,3 Osnat Levtzion-Korach Levtzion-Korach 3,5
1Sperm Bank & Andrology Unit, Shamir Medical Center, Israel
2IVF Department, Shamir Medical Center, Israel
3Sackler Medical School, Tel Aviv University, Israel
4National Institute of forensic Medicine, National Institute of forensic Medicine, Israel
5Shamir Medical Center, Shamir Medical Center, Israel

Introduction:
Postmortem sperm retrieval (PMSR) is an accepted but uncommon procedure. Although simple and effective from medical and laboratory perspectives, usage raises ethical dilemmas. Israeli regulations are suppurative upon deceased`s relatives request for PMSR. However, legal conception limits sperm usage for widows only.

Aim:
To describe spermatozoa extraction rate by testicular sperm extraction (TESE) for PMSR and examine harvest time impact on sperm motility; To compare long term sperm usage between married vs. single deceased men.

Materials:
This retrospective study included all PMSR cases in Shamir Medical Center during 2003-2021. We evaluated sperm cryopreservation according to latency time after death and examined sperm usage.

Results:
The study included 69 (35 married and 34 singles) deceased men with average age of 30.3±7.8 years. Sperm was cryopreserved in 65 cases (94.2%) after maximum and average harvest time of 40 and 16.5±8.1 hours, respectively. Motile sperm extraction was associated with significantly shorter harvest time compared with non-motile sperm (13.8±7.3 vs. 18.7±8.1 hours, p=0.046). Sperm usage among married deceased was significantly higher than single (15.6% vs. 0%, p=0.05). Single men had significantly higher rate of non-used cryopreserved samples (93.8% vs 69.6%, p=0.01).

Conclusions:
This large long term cohort study demonstrates high efficacy of PMSR. We found significant harvest latency time difference between motile and non-motile sperm. Clinical sperm usage rate justifies PMSR among married deceased. However, contradicting policy regarding single men (liberal sperm preservation but rigid usage prevention) results with high non-used sperm rate and relatives` extremely sophisticated emotional burden.