A mandatory 6–12-month waiting period is recommended before proceeding with posthumous reproduction [9, 31, 39, 40]. Grief counseling should be considered for the surviving spouse during this bereavement period [6, 32, 40].

When available, involvement of a hospital ethics committee is prudent. Hospitals may stipulate that they release their responsibility for the sperm following its procurement. No hospital employee should be forced to participate in PMSR.

PMSR has been performed successfully using several techniques including electroejaculation (EEJ), testis biopsy, vasal or epididymal aspiration, and simple orchiectomy [6, 13]. All procedures can be carried out antemortem or postmortem with the exception of EEJ, which relies on an intact ejaculatory reflex, so it can only be performed prior to the cessation of cardiac activity [8, 13, 40]. The authors recommend obtaining a generous tissue sample since the decedent’s fertility status is usually unknown, there is no risk of causing hypogonadism or infertility in the future, multiple cycles of IVF/ICSI are often required to achieve a pregnancy, and there will only be one opportunity to retrieve sperm.

PMSR is a controversial practice which raises a myriad of ethical questions, yet it is being requested with increasing frequency worldwide [2, 39]. Successful PMSR requires swiftly navigating the logistical issues summarized in this chapter and has been described using a variety of retrieval procedures. No ethical calculus or system of judgement could conclusively resolve the ethical questions surrounding PMSR given the intense circumstances under which requests arise and when the interests of all involved parties are considered. The legal precedent for PMSR is highly variable and in many places nonexistent. In the absence of any official international or national guidelines, experts have called on medical centers to develop their own institutional policies to help guide physicians and hospital ethics committees considering requests for PMSR.