Posthumous sperm retrieval in the context of armed conflict.

STUDY QUESTION: What are the clinical and logistical predictors of sperm viability in posthumous sperm retrieval (PHSR), and how do post-mortem interval (PMI), body refrigeration, and mechanism of death affect outcomes?

SUMMARY ANSWER: Shorter PMI and body refrigeration significantly enhance post-mortem sperm viability, with the mechanism of death modulating viability patterns in a time-dependent manner.

WHAT IS KNOWN ALREADY: PHSR has gained increasing prominence in reproductive medicine, yet technical aspects remain under-researched. Key questions regarding optimal timing, storage conditions, and cause of death effects on sperm quality lack systematic investigation.

STUDY DESIGN, SIZE, DURATION: Retrospective observational study of 28 PHSR procedures performed between October 2023 and December 2024 at a tertiary academic medical center.

PARTICIPANTS/MATERIALS, SETTING,

METHODS

Twenty-eight deceased men aged 19-37 years whose families requested PHSR. Unilateral testicular biopsy was performed, followed by sperm viability assessment and cryopreservation. Fresh and post-thaw sperm viability were analyzed as functions of PMI, body refrigeration, and mechanism of death using linear regression and multivariate analysis.

MAIN RESULTS AND THE ROLE OF CHANCE: Viable sperm were successfully retrieved in 25 of 28 cases (89%) up to 37 h post-mortem under optimal conditions. Median fresh sperm viability was 42.0% (quartile 1-quartile 3 [Q1-Q3] 38.0-52.0%), declining to 27.0% (Q1-Q3: 20.0-32.0%) following cryopreservation, representing a median reduction of 39% (Q1-Q3: 32-48%). Linear regression showed a time-dependent viability decline of ∼2% per hour post-mortem. Refrigeration was associated with preserved viability at extended PMIs, with all successful retrievals beyond 14 h occurring in refrigerated bodies. Blast injuries showed higher initial viability than gunshot wounds but a more rapid decline over time. A multivariate model incorporating PMI, refrigeration, and mechanism of death explained 59.2% of the variance in sperm viability.

LIMITATIONS, REASONS FOR CAUTION: Limited sample size (n = 28) and unique wartime circumstances may limit generalizability. Documentation of intermediate storage conditions was challenging under combat conditions. Long-term outcomes and fertilization success require further investigation.

WIDER IMPLICATIONS OF THE FINDINGS: These findings provide evidence-based benchmarks for PHSR protocols and practical guidance for clinical decision-making and family counseling. The quantitative relationships identified can inform timing decisions and optimize retrieval success rates.

STUDY FUNDING/COMPETING INTEREST(S): This study received no external funding. All authors declare no competing interests.

TRIAL REGISTRATION NUMBER: N/A.