Patient Desire for Disposition of Cryopreserved Sperm upon Death as a Surrogate Marker for Likelihood of Consent for Posthumous Sperm Retrieval
Dylan M. Buller, BA1, Brooke A. Harnisch, MD1, Vikram Lyall, BS1, Michael E. Goltzman, MD1, Stanton C. Honig, MD2.
1University of Connecticut, Farmington, CT, 2Yale University School of Medicine, New Haven, CT.
BACKGROUND: Decision-making regarding posthumous sperm retrieval can be ethically and legally challenging. Most cases do not clearly delineate in writing whether the deceased would consent for sperm retrieval. Therefore, decision making is guided by hospital policy or on a case-by-case basis. Patients who cryopreserve sperm are required to decide on disposition of their cryopreserved sperm should death occur while their sperm is in storage. Patients must decide between whether sperm should be “discarded per ASRM ethical guidelines” or “transferred to partner for his or her own family building efforts.” The objective of this study is to evaluate patient preference on consents for sperm disposition in case of death based on age, etiology of infertility, race/ethnicity, marital status, prior paternity, occupation, or insurance status. METHODS: An IRB approved, retrospective chart review was conducted on patients who froze sperm from January, 2016 through October, 2019 at a single fertility center. We reviewed the disposition of cryopreserved sperm should death occur to a patient. Collected data included age, race/ethnicity, occupation, insurance status, marital status and duration of marriage, prior biological children, and cause of fertility. Patients were excluded if they were not trying to get pregnant at present, prior to cancer therapy, prior to starting gender affirming treatments, or not in a committed relationship. RESULTS: After review of 550 charts, 403 patients met criteria for inclusion. The mean age was 38.2 years +/- 6.7 (SD). Reasons for sperm cryopreservation were female factor (46.2%), male factor (34.7%), or combined factor (8.9%) infertility; a diagnosis was unknown or unspecified in 9.4% of patients. Overall, 84.9% of patients consented to transfer their sperm to their partner in case of death. Male-factor infertility and having commercial insurance were predictors of electing to transfer sperm; there was no difference in “transfer to partner” rates with age, race/ethnicity, marital status, duration of marriage, having prior children, or occupation (Table 1). CONCLUSIONS: 84.9% of patients who cryopreserved sperm consented to transfer their sperm to their partners if death should occur. There does not appear to be a clear factor that would impact this decision, based on demographic information, prior children, or occupation. Since there is rarely written consent to perform posthumous sperm retrieval, this information is valuable in assessing whether most men who are married or in a committed relationship would consider proceeding in this fashion. This data may be useful to guide physician-institution-patient decision making in these complex situations. 
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