Posthumous sperm retrieval in the context of armed conflict

Abstract 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.