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1st
appeared 12 April 1999
Fertility Experts Face New Life-and-Death
Ethical Issues
Three weeks ago, Gaby Vernoff became a mother for the first time, giving birth to a
daughter conceived with her dead husband's sperm. This is the first US case to come to
light in which a man fathered a child with sperm taken posthumously.
 Four years ago, Cappy Rothman, director of the Center for
Reproductive Medicine at Century City Hospital in Los Angeles, made an incision in Bruce
Vernoff's scrotum 30 hours after his death from a fatal reaction to a prescription
medication. Rothman extracted sperm from Vernoff's epididymis -- the coiled tubes that
surround the testes and store sperm. Three years later, after one failed in-vitro
fertilization attempt with the seed obtained from her deceased husband, Gaby Vernoff
conceived.
Her success was made possible in part by the participation of Paul Turek, a UCSF Stanford
Health Care urologist and male fertility expert. Turek, an assistant professor of urology
at UCSF, has developed a way to more easily select viable sperm from poor-quality samples.
The technique, called "hypo-osmotic swelling," can be used to identify sperm
that are alive, even when they don't appear to be able to move by propelling themselves
with their whip-like tails.
The basis for selecting sperm with the hypo-osmotic swelling technique is that living
sperm placed in a dilute sugar solution become swollen, but remain unharmed. Dead sperm
fail to swell under the same conditions. A microscope aids in selecting the best
candidates from among the tadpole-like cells. The technique was invented to aid infertile
couples in which the man has too few sperm or sperm of insufficient motility.
What remained of Bruce Vernoff's retrieved sperm after the first failed in-vitro
fertilization attempt was in worse condition than that of an average infertile man --
Vernoff had been dead for many hours when the sample was collected, extracted sperm is
immature compared to ejaculated sperm, and freezing and thawing took its toll. The
identification of viable sperm, which normally takes only minutes, in this case took
several hours, Turek said.
Once the sperm was selected, doctors used another recently developed technique,
single-sperm injection, to impregnate Gaby Vernoff. In single-sperm injection, a sperm is
introduced directly into the mother's egg, circumventing the possibility that sperm will
be too weak or otherwise incapable of penetrating the egg.
Thanks to new techniques such as these, perfected by fertility specialists over the past
decade, physicians can aid infertile couples in becoming parents even after years of
fruitless efforts using earlier in-vitro fertilization techniques. But with these new
methods, human reproductive capabilities have been pushed beyond old barriers. What was
until recently unthinkable is now possible, and physicians consulted by would-be parents
approach the new millennium torn by modern ethical dilemmas.
The ability to obtain sperm from dead men and use it to conceive children raises many
questions. For example, what are a man's reproductive rights? What is the nature of the
sanctity of death? Is a woman entitled to decide the fate of her diseased husband's sperm
as she sees fit, as if it were an organ? If the taking of sperm is justifiable in cases
where the widow wants to conceive, is it justifiable for other purposes? Is it okay to
extract sperm from the comatose? Would a man be similarly entitled to his comatose wife's
eggs?
In Britain, unless permission has been obtained from a man prior to his death, the
government prohibits extracting sperm posthumously, but in the United States there is no
case law to provide guidance. However, requests by loved ones to have sperm extracted from
the dearly departed occur frequently enough for the American Society for Reproductive
Medicine to have developed a protocol on what they call "posthumous
reproduction."
The number of requests by immediate family members for posthumous sperm procurement
appears to be rising. A telephone survey of personnel at 273 assisted reproductive
facilities in the United States and Canada, published in the June 1997 issue of the
Journal of Urology, revealed 82 such requests reported by staff at 40 facilities in 22
states from 1980 through 1995. More than half the requests (43) were reported between 1994
and 1995. Most requests were associated with trauma deaths. No requests were reported from
the Canadian sites surveyed, while the number reported from California (15) was
disproportionately high for the population. Of the 82 requests, 25 were honored at 14
facilities in 11 different states, including seven in California. Because they did not
survey hospitals, the authors concluded that their numbers might be low.
Thus far, Turek has agreed to assist in two cases in which a widow wanted sperm extracted
in order to conceive. In the Vernoff case, Turek says he spent several months deciding
whether or not to help. It is not surprising that most men who die suddenly have not left
behind written documentation regarding their desire to father children.
In this instance, after interviewing family members and convincing them to undergo
counseling, and after viewing a video in which Bruce Vernoff talked of having children,
Turek agreed to participate. In another case, he recently provided assistance in obtaining
sperm from a comatose man, but only after interviewing all close family members, and only
after the wife agreed to wait at least six months before attempting to conceive. Among his
other concerns about posthumous reproduction, Turek is worried that decisions to parent
will be colored by the intensity of grief in the immediate aftermath of losing a spouse.
As a physician who assists infertile couples, Turek is accustomed to simultaneously
considering the needs and concerns of both husband and wife, and he points out that the
spouse of the newly deceased already is entitled to make decisions regarding organ
donation. Nonetheless, the procreative power of sperm makes it unlike any organ, and Turek
would like to see laws on the books requiring prior written consent from a man before he
could be subjected to posthumous sperm extraction -- similar to British law and to
recently introduced state legislation in New York. Turek suggests that men then could fill
out donation cards and append them to their driver's licenses.
Turek notes that for decades, men have banked sperm prior to undergoing sterilizing
chemotherapy for cancer. He advises these patients to put in writing clear directions
about what to do with the preserved sperm in the event of death, telling each, "It is
the most important bank account you will ever have."
Links:
UCSF Department of Urology
Paul Turek biographical sketch
UCSF Stanford Health Care
American Society for Reproductive Medicine
Related Daybreak stories:
New Test Makes Fatherhood
Possible for Men With "Dead" Sperm
Sperm "Mapping"
Helps Men Overcome Infertility Problems
Source: Jeffrey Norris |
