A police officer's widow gave birth to his daughter this week, three years after he was killed in the line of duty. Here's the procedure doctors used to conceive his child.

July 26, 2017

 

 

When NYPD officer Wenjian Liu was shot and killed while sitting in his patrol car in December 2014, he was 32 years old and had been married for three months. Yet just this week, his baby, a girl, was born. How? The night of the shooting, Liu's widow, new mom Pei Xia Chen, asked for her husband’s sperm to be extracted and frozen, so she could use it later to conceive a child.

The bittersweet occasion may seem like a miracle, but it’s not unheard of for sperm to be retrieved from a dying or even a deceased man. In fact, the first documented posthumous sperm retrieval (PSR) was reported in 1980, and the first baby conceived as the result of PSR was born in 1999.

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PSR is still rare procedure, but it’s become much more common in recent years, according to a 2016 article in the British science magazine Mosaic. Not all hospitals and fertility clinics will perform the procedure, and those that do have varying guidelines as to when and how it can be done, and who can request it.

To learn more about how the procedure is done—and the medical and ethical issues that go along with it—Health spoke with Jesse Mills, MD, urologist and director of the Men’s Clinic at UCLA. Dr. Mills was not involved in Liu and Chen’s case, but he has performed sperm retrieval on other patients, both living and deceased.

According to Dr. Mills, sperm can generally be extracted from a patient who is brain dead, or shortly after he’s declared deceased. (In medical literature, the recommended time frame is typically 24 hours to 36 hours after death.)

“The sperm is only viable for a brief period of time, so most times the patient has to be already on his way to the hospital when he dies, or placed on life support, in order for this to even be possible,” says Dr. Mills.

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To perform the retrieval, a surgeon or urologist may conduct an epididymal aspiration (extraction of sperm with a needle through the skin), a testicular biopsy, or a complete removal of the testicles.

Once the sperm is extracted, it can be frozen and stored the same way fertility clinics freeze a living donor’s semen. When the deceased's partner is ready to get pregnant, doctors can attempt to fertilize one of her eggs with the sperm in a lab setting using in-vitro fertilization. If the sperm was not ejaculated as semen, says Dr. Mills, a woman can't get pregnant through intrauterine insemination—a technique that places sperm directly into the uterus via a catheter.

The success rate of pregnancies using posthumously acquired sperm has not been widely studied, and neither has the health of children conceived this way. But one 2015 paper in Human Reproduction reported on four women undergoing IVF using sperm from their deceased partners, all of whom eventually got pregnant. One baby was born premature, but all four children “were shown to have normal health and developmental outcomes” at follow-up visits over the next seven years.

And although the actual retrieval of sperm is relatively simple, a 2015 paper in BJOG: An International Journal of Obstetrics and Gynecology points out that it “raises numerous ethical questions and medico-legal issues, including the rights of the deceased, the question of informed consent, the best interest of the child, and the motivation of the applicant.”

Unlike some other countries, the United States has no government regulations for when and how PSR can be performed; the decision is up to individual hospitals and fertility clinics. Whether or not a facility will agree to do PSR will also depend on if it has the specialists, equipment, and storage capabilities required for such a procedure.

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The American Society for Reproductive Medicine (ASRM) issued guidelines on posthumous collection of reproduction tissue in 2013, stating that sperm or egg collection after death use is “ethically justifiable” if written documentation from the deceased authorizes it. In the absence of such documentation, programs should consider requests only from “the surviving spouse or life partner,” the opinion states.

The ASRM’s guidelines also state that “adequate time for grieving and counseling” should be allowed before a woman uses her partner’s sperm to try to get pregnant, and that clinics and hospitals should develop written policies if they do choose to offer the procedure.

Dr. Mills says that most clinics, including his own, require some sort of advanced directive from the man—or indication from his married partner—that the couple wanted children or was actively trying to get pregnant. “I’ve been called about the procedure more times than I’ve followed through, because often the cases do not meet those ethical guidelines,” he says.

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But for the cases that do, Dr. Mills says that giving grieving partners and families the chance to preserve a loved one’s reproductive tissue—and possibly bring his offspring into the world—“makes perfect sense” and can provide some hope and comfort during a very painful time.

“They’re able to establish a family, and even though the father won’t be around physically, that doesn’t seem like any worse reason to bring life into this world,” he says. “To me, it gives a tragic story a bit of an upbeat ending, for the wife, the grandparents, and everyone involved.”