International policies on posthumous reproduction: a pilot survey study

Objective

Posthumous assisted reproduction (PAR) is a form of assisted reproductive technology (ART) that includes the use of sperm, eggs, or embryos that have been cryopreserved before or immediately following the death of an individual [1]. While the first recorded case of conception after death occurred in 1977, the phenomenon of posthumous reproduction has increased in recent years [2, 4, 5]. Historically, posthumous reproduction has referred to the birth of children after the death of a biological parent—more specifically, birth by a pregnant person after the death of their partner [3]. However, the expansion of ART has transformed posthumous reproduction into a practice intentionally utilized in family building.

PAR can be divided into three subcategories: postmortem birth, postmortem conception, and postmortem gamete acquisition [2]. Postmortem birth refers to the historical phenomenon of posthumous reproduction, while the latter two categories refer to PAR. As PAR becomes more widespread, policies toward PAR in clinics become increasingly necessary. While studies surrounding PAR policies in clinics across the USA suggest poor institutional policies toward PAR, international institutional policies toward PAR remain unclear [3]. Thus, the objective of this study was to assess the prevalence, policies, and requirements of PAR internationally.

Study design

This pilot study used a cross-sectional survey. The survey was comprised of 23 multiple choice and 3 open-ended questions that assessed practice characteristics (such as practice type, location, and IVF cycle volume), the presence of clinic policies toward PAR, and the content of such policies. The survey was emailed to listservs of members of the Oncofertility Consortium and International Society for Fertility Preservation.

Results

A total of 156 surveys were received from 46 different countries (Table 1). Less than half of respondents (41%) reported that posthumous reproduction was not allowed in their country, and of those respondents, more than half (51%) reported not being favor of allowing posthumous reproduction in their country (Fig. 1). A total of 45% of respondents reported that there were no policies in place for perimortem oocyte retrieval in their respective countries, while 46% of respondents reported that there was a policy in place for perimortem sperm retrieval. The need for prior patient consent was the most prevalent consideration in allowing perimortem retrieval of oocytes (26%). Similarly, prior patient consent was reported as the paramount factor for allowing perimortem sperm retrieval (38%), use of posthumous gametes (68%), and posthumous cryopreserved embryos (38%). The majority of respondents (53%) reported having no bereavement or waiting period for the use of stored embryos or gametes by a surviving partner specified in their clinic’s policy.

Table 1.

Survey results

Has a policy for perimortem oocyte retrieval
No	45%
Not sure	10%
Yes	12%
Missing/prefer not to answer	33%
Would allow perimortem oocyte retrieval
With parents/partner consent	10%
Prior patient consent	26%
Under no circumstances	10%
Not sure	10%
Missing/prefer not to answer	44%
Have a policy for perimortem sperm retrieval
Yes			46%
No			54%
Would allow perimortem sperm retrieval
With parent/partner consent			24%
Prior patient consent			38%
Under no circumstances			7%
No policy			29%
Not sure			2%
Consent needed for use of posthumous gametes (oocytes and sperm) (respondents could select multiple options)
Prior patient verbal consent		68%
Listed as organ donor		0
Court order		37%
Patient prior indication to be parent		24%
Not sure		7%
Consent needed for use of posthumous cryopreserved embryos
Consent surviving partner				32%
Prior patient consent				38%
Under no circumstances				7%
No policy				29%
Not sure				2%
Bereavement waiting period required
Yes					40%
No					53%
Not sure					7%
Missing/prefer not to answer					10%
Time of bereavement waiting period
Not sure						45%
1 year or more						26%
6 months–1 yr						23%
Less than 6 months						6%

Fig. 1.

Countries participating in the survey

Conclusion

Results suggest that many countries do not have policies regulating PAR. Most respondents noted that no policies existed for perimortem retrieval of gametes or the use of previously stored gametes. Among those with a policy, prior consent of patients was most important when considering the future use of gametes or embryos. Future research is needed to understand barriers to the creation and implementation of these increasingly needed policies in countries where PAR is permitted.

Declarations

Conflict of interest

The authors declare no competing interests.