Posthumous assisted reproduction
- Shane T Lipskind, MD
Shane T Lipskind, MD
- Clinical Assistant Professor
- Department of Obstetrics and Gynecology
- University of Arizona College of Medicine
- Elizabeth S Ginsburg, MD
Elizabeth S Ginsburg, MD
- Associate Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
Assisted reproductive technologies (ART), including in vitro fertilization (IVF) and cryopreservation of gametes (eggs and sperm) and embryos, are intended to address an innate human drive - the desire to reproduce. These procedures, which enable human reproduction across a myriad of medical and social situations, also make it possible to create life using gametes or embryos from a genetic parent who is no longer living.
Posthumous assisted reproduction (PAR) is the process by which ART is used to establish pregnancy and produce genetic offspring after the death of the parent. This distinctly modern phenomenon raises numerous challenges for patients, their families and clinicians, as well as society at large.
Postmortem conception by artificial insemination using cryopreserved sperm has been available since the 1950s [1,2]. One of its first uses was to offer men in high risk professions (eg, astronauts, soldiers) an option for fathering children in the event of injury or death. Postmortem sperm retrieval was first reported in 1980. Development of now routine techniques, such as oocyte retrieval, in vitro fertilization (IVF), and cryopreserved embryo transfer, expanded the possibilities of parenting after death for both men and women.
Few studies have assessed the utilization of posthumous assisted reproduction (PAR), and an accurate number of births that have resulted from PAR is not known. Several factors likely contribute to the lack of information. First, PAR probably accounts for a relatively small proportion of all assisted reproductive technology (ART) procedures. In addition, individuals who request gamete or embryo banking for PAR may never actually use them [3,4]. Lastly, both patients and clinicians may be reluctant to report these pregnancies and births in the medical literature to avoid drawing media attention to this controversial practice. Nevertheless, it seems inevitable that PAR will gain more public awareness and acceptance as utilization of ART and fertility preservation services increase .
USE OF POSTHUMOUS REPRODUCTION
Posthumous reproduction is intended to fulfill a couple's desire to reproduce. Since it is considered within the context of the untimely death or imminent demise of at least one genetic parent, it is assumed that at least one invested party, including the intended social parent(s), desires children through posthumous reproduction and that the requisite gametes or embryos are available.
- Shufaro Y, Schenker JG. Cryopreservation of human genetic material. Ann N Y Acad Sci 2010; 1205:220.
- Gilbert S. Fatherhood from the grave: an analysis of postmortem insemination. Hofstra Law Rev 1993; 22:521.
- Raziel A, Friedler S, Strassburger D, et al. Nationwide use of postmortem retrieved sperm in Israel: a follow-up report. Fertil Steril 2011; 95:2693.
- Shefi S, Raviv G, Eisenberg ML, et al. Posthumous sperm retrieval: analysis of time interval to harvest sperm. Hum Reprod 2006; 21:2890.
- Barton SE, Correia KF, Shalev S, et al. Population-based study of attitudes toward posthumous reproduction. Fertil Steril 2012; 98:735.
- ESHRE Task Force on Ethics and Law, Pennings G, de Wert G, et al. ESHRE Task Force on Ethics and Law 11: Posthumous assisted reproduction. Hum Reprod 2006; 21:3050.
- Batzer FR, Hurwitz JM, Caplan A. Postmortem parenthood and the need for a protocol with posthumous sperm procurement. Fertil Steril 2003; 79:1263.
- Conley M. Israeli Court Allows Family to Harvest Dead Daughter's Eggs. ABC News 2011.
- Greer DM, Styer AK, Toth TL, et al. Case records of the Massachusetts General Hospital. Case 21-2010. A request for retrieval of oocytes from a 36-year-old woman with anoxic brain injury. N Engl J Med 2010; 363:276.
- Kindregan CP Jr, McBrien M. Posthumous reproduction. Fam Law Q 2005; 39:579.
- Herrero L, Martínez M, Garcia-Velasco JA. Current status of human oocyte and embryo cryopreservation. Curr Opin Obstet Gynecol 2011; 23:245.
- Society for Assisted Reproductive Technology. SART Clinic Summary Report. 2013. https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=0 (Accessed on November 03, 2015).
- Practice Committees of American Society for Reproductive Medicine, Society for Assisted Reproductive Technology. Mature oocyte cryopreservation: a guideline. Fertil Steril 2013; 99:37.
- Nakhuda GS. Posthumous assisted reproduction. Semin Reprod Med 2010; 28:329.
- Kindregan CP. Dead Dads: Thawing an Heir from the Freezer. William Mitchell Law Review 2009; 35:433.
- Côté S, Affdal AO, Kadoch IJ, et al. Posthumous reproduction with surplus in vitro fertilization embryos: a study exploring users' choices. Fertil Steril 2014; 102:1410.
- Bahadur G. Ethical challenges in reproductive medicine: posthumous reproduction. International Congress Series: Advances in Fertility and Reproductive Medicine. Proceedings of the 18th World Congress on Fertility and Sterility 2004.
- Bostwick JM, Coddington CC, Stewart EA. Case 21-2010: anoxic brain injury and a request for oocyte retrieval. N Engl J Med 2010; 363:1679.
- Ethics Committee of the American Society for Reproductive Medicine. Posthumous collection and use of reproductive tissue: a committee opinion. Fertil Steril 2013; 99:1842.
- Snyder L, American College of Physicians Ethics, Professionalism, and Human Rights Committee. American College of Physicians Ethics Manual: sixth edition. Ann Intern Med 2012; 156:73.
- Fisseha S. A match made in heaven: posthumous fatherhood and postmenopausal motherhood. Virtual Mentor 2007; 9:630.
- Landau R. Posthumous sperm retrieval for the purpose of later insemination or IVF in Israel: an ethical and psychosocial critique. Hum Reprod 2004; 19:1952.
- Knapp C, Quinn G, Bower B, Zoloth L. Posthumous reproduction and palliative care. J Palliat Med 2011; 14:895.
- Kindregan CP. Genetically Related Children: Harvesting of Gametes from Deceased or Incompetent Persons. Journal of Health and Biomedical Law 2011; 7:147.
- USE OF POSTHUMOUS REPRODUCTION
- PROCEDURES FOR OBTAINING GAMETES AND EMBRYOS
- Ovarian tissue and testicular tissue
- Premeditated posthumous reproduction
- Unplanned posthumous reproduction
- ETHICAL ISSUES
- Respect for autonomy
- Social justice
- LEGAL ISSUES
- Ownership of gametes and embryos
- Inheritance rights of children
- Third parties
- SUMMARY AND RECOMMENDATIONS