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.
Ethical considerations of the new reproductive technologies. Ethics Committee of The American Fertility Society. Fertil Steril 1990:1S – 104.
2
Kocher T, Wagner R, Klausegger A, Guttmann-Gruber C, Hainzl S, Bauer J, et al. Improved double-nicking strategies for COL7A1editing by homologous recombination. Mol Ther Nucleic Acids 2019:496–507.
3
Cummings B, Paris J. From death to life: ethical issues in postmortem sperm retrieval as a source of new life. Camb Q Healthc Ethics 2020:369–74.
4
Katz K. Parenthood from the Grave: Protocols for Retrieving and Utilizing Gametes from the Dead or Dying 2006:11.
5
Kindregan C, Snyder S. Clarifying the Law of ART: The New American Bar Association Model Act Governing Assisted Reproductive Technology. Family Law Quarterly 2008:203–29.
6
National Conference of Commissioners on Uniform State Laws. Uniform Parentage Act 2002.
7
Brumback K. Judge tosses suit claiming sperm bank misrepresented donor. The Associated Press. Published October 21 st 2015.
8
Yoon M. The Uniform Status of Children of Assisted Conception Act: does it protect the best interests of the child in a surrogate arrangement? Am J Law Med 1990:525–8.
9
Simana S. Creating life after death: should posthumous reproduction be legally permissible without the deceased’s prior consent? J Law Biosci 2018:329–54.
10
Marinelli S, Rio D, A. Beginning of life ethics at the dawn of a new era of genome editing: are bioethical precepts and fast-evolving biotechnologies irreconcilable? Clin Ter 2020:407–11.
11
Minerva F. Conscientious objection in Italy. J Med Ethics 2015:170–3.
12
Vergallo M, Zaami G, S, Luca D, Marinelli N, E. The conscientious objection: debate on emergency contraception. Clin Ter 2017:113–9.
13
Tremellen K, Savulescu J. A discussion supporting presumed consent for posthumous sperm procurement and conception. Reprod Biomed Online 2015:6–13.
14
Montanari V, Marinelli E, Di Luca N, Zaami S. Gamete donation: are children entitled to know their genetic origins? A comparison of opposing views. The Italian State of Affairs. Eur J Health Law 2018:322–37.
15
Zaami S. Assisted heterologous fertilization and the right of donor conceived children to know their biological origins. Clin Ter 2018:39–43.
16
Tremellen K, Savulescu J. Posthumous conception by presumed consent. A pragmatic position for a rare but ethically challenging dilemma. Reprod Biomed Soc Online 2016:26–9.
17
Kroon F. Presuming consent in the ethics of posthumous sperm procurement and conception. Reprod Biomed Soc Online 2016:123–30.
18
Caso Englaro-Interruzione dei trattamenti e incapacità Sentenza di Cassazione 2007.
19
Baldini D, Beck R, Negro F, Viti D, D. Assisted reproductive technologies and metabolic syndrome complications: medico-legal reappraisal. Clin Ter 2019:364–7.
20
Asplund K. Use of in vitro fertilization-ethical issues. Ups J Med Sci 2020:192–9.
21
Baldini D, Savoia M, Sciancalepore A, Malvasi A, Vizziello D, Beck R, et al. High progesterone levels on the day of HCG administration do not affect the embryo quality and the reproductive outcomes of frozen embryo transfers. Clin Ter 2018:91–5.
22
Beck R, Brizzi A, Cinnella G, Raimondo P, Kuczkowski K. Anesthesia and Analgesia for Women Undergoing Oocyte Retrieval 2020:99–119.
23
Ricci G, Campanozzi L, Marinelli S, Midolo E, Ruggeri L. The human embryo, subjectivity and legal capacity. Notes in the light of art. 1 of the Italian law on "medically assisted procreation. Clin Ter 2019:102–7.
24
Jonlin E. Informed Consent for Human Embryo Genome Editing. Stem Cell Reports 2020:530–7.
25
Marinelli S. Medically-assisted procreation and the rise of off-center, new types of “parenthood”: it is incumbent upon lawmakers to intervene. Clin Ter 2019:241–4.
26
Benagiano G, Filippi V, Sgargi S, Gianaroli L. Italian Constitutional Court removes the prohibition on gamete donation in Italy. Reprod Biomed Online 2014:662–4.
27
Marinelli S. No more only one mom? European Court of Human Rights and Italian jurisprudences’ ongoing evolution. Clin Ter 2020:36–43.
28
Vergallo M, Zaami G, Bruti S, Signore V, Marinelli F, E. How the legislation on medically assisted procreation has evolved in Italy. Med Law 2017:5–28.
29
Waler N, Clavijo R, Brackett N, Lynne C. Ramasamy R. Policy on posthumous sperm retrieval: survey of 75 major Academic Medical Centers 2018:45–51.
30
Zinkel A, Ankel F, Milbank A, Casey C, Sundheim J. Postmortem Sperm Retrieval in the Emergency Department: A Case Report and Review of Available Guidelines. Clin Pract Cases Emerg Med 2019:405–8.
31
Storrow R. Judicial review of restrictions on gamete donation in Europe. Reprod Biomed Online 2012:655–9.
32
Vergallo M, Zaami G, Sparic S, R. Medically Assisted Procreation: European Legislation and Ensuing Ethical Issues 2020:361–73.
33
Supreme Civil Court -1 st Section. Ruling 13000 2019.
34
Bahadur G. Death and conception. Hum Reprod 2002:2769–75.
35
Hostiuc S, Curca C. Informed consent in posthumous sperm procurement. Arch Gynecol Obstet 2010:433–8.
36
Bahm S, Karkazis K, Magnus D. A content analysis of posthumous sperm procurement protocols with considerations for developing an institutional policy. Fertil Steril 2013:839–43.
37
Tash J, Applegarth L, Kerr S, Fins J, Rosenwaks Z, Schlegel P. Postmortem sperm retrieval: the effect of instituting guidelines. J Urol 2003:1922–5.
38
Finnerty J, Karns L, Thomas T, West R. Pinkerton JV. Gamete retrieval in terminal conditions: is it practical? What are the consequences? Curr Womens. Health Rep 2002:174–8.
39
Law 40/2004, enacted by the Italian Parliament on 19 th February 2004.
40
Spielman B. Pushing the dead into the next reproductive frontier: post mortem gamete retrieval under the uniform anatomical gift act. J Law Med Ethics 2009:331–43.
41
Ethics Committee of the American Society for Reproductive Medicine. Posthumous reproduction. Fertil Steril 2004.
42
Landau R. Posthumous sperm retrieval for the purpose of later insemination or IVF in Israel: an ethical and psychosocial critique. Hum Reprod 2004:1952–6.
43
Goulding E, Lim B. Life after death: posthumous sperm procurement. Whose right to decide? BJOG 2015:394.
44
Jones S, Gillett G. Posthumous reproduction: consent and its limitations. J Law Med Ethics 2008:279–87.
45
Negro F, Varone M, Rio D, A. Advances in medically-assisted procreation technologies: can malpractice claims and “reproductive damage” be identified. Clin Ter 2020:225–8.
46
Robertson J, Kempers R, Cohen J, Haney A, Younger J. Posthumous Reproduction Fertility and Reproduction Medicine 1998.
47
Freeman T. Gamete donation, information sharing and the best interests of the child: an overview of the psychosocial evidence. Monash Bioeth Rev 2015:45–63.
48
Jequier A, Zhang M. Practical problems in the posthumous retrieval of sperm. Hum Reprod 2014:2615–9.
49
Hurwitz J, Macdonald J, Lifshitz L, Batzer F, Caplan A. Posthumous sperm procurement: an update. Fertil Steril 2002;(1):2–42.
50
Kerr S, Caplan A, Polin G, Smugar S, Neill O, Urowitz K, et al. Postmortem sperm procurement. J Urol 1997:2154–8.
51
Rothman C. A method for obtaining viable sperm in the postmortem state. Fertil Steril 1980:512.
52
Batzer F, Hurwitz J, Caplan A. Postmortem parenthood and the need for a protocol with posthumous sperm procurement. Fertil Steril 2003:1263–9.
53
Collins R. Posthumous reproduction and the presumption against consent in cases of death caused by sudden trauma. J Med Philos 2005:431–42.
54
Shenfield F. Consent and intent in assisted reproduction. Law Med 2000:317–25.
55
Planchon S. Comment the application of the dead man’s statutes in family law. Journal of American Academy of Matrimonial Lawyers 2001:561–77.
56
Check M, Summers-Chase D, Check J, Choe J, Nazari A. Sperm extracted and cryopreserved from testes several hours after death results in pregnancy following frozen embryo transfer: case report. Arch Androl 1999:235–7.
57
Belker A, Swanson M, Cook C, Carrillo A, Yoffe S. Live birth after sperm retrieval from a moribund man. Fertil Steril 2001:841–3.
58
Zaami S, Busardò F. Elective egg freezing: can you really turn back the clock? Eur Rev Med Pharmacol Sci 2015:3537–8.
59
Wang A, Kumsa F, Kaan I, Li Z, Sullivan E. Farquhar CM. Effectiveness of social egg freezing: protocol for systematic review and meta-analyses. BMJ Open 2019:30700.
60
Zaami S, Stark M, Malvasi A, Marinelli E. Eggs Retrieval. Adverse Events, Complications, and Malpractice: A Medicolegal Perspective 2020:347–59.
61
Ethics Committee of the American Society for Reproductive Medicine. Posthumous retrieval and use of gametes or embryos: an Ethics Committee opinion. Fertil Steril 2018:45–9.
62
Orr R, Siegler M. Is posthumous semen retrieval ethically permissible. J Med Ethics 2002:299–302.
63
Panagiotopoulou N, Karavolos S. Let Me Keep My Dead Husband’s Sperm": Ethical Issues in Posthumous Reproduction. J Clin Ethics 2015:143–51.
64
Disposizioni in materia di prelievi e di trapianti di organi e di tessuti 1AD.
65
Italian Ministry of Health statement n. 110, issued on 20 th August 2019:2–4.
66
Napoletano S, Rio D, A. Reproductive medicine between advancement and ethics. Clin Ter 2018:108–9.
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