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Rachel V Thomas

Delhi HC Allows Sperm Extraction of Soldier in Coma: Doctors Call For Clearer IVF Guidelines

India needs clearer guidelines on reproductive rights, consent, and medical ethics, said doctors after the <span>Delhi High Court</span>, in a highly complex and sensitive case, granted permission for the extraction and <span>cryopreservation</span> of sperm of an Indian Army soldier in a persistent vegetative state. 

As per the guidelines laid under the Assisted Reproductive Technology (ART) (Regulation) Act, 2021, it is important to have the written consent of both partners. 

However, calling it “the right to reproductive autonomy,” Justice Purushaindra Kumar Kaurav allowed for sperm retrieval. The Court also cited the soldier's prior consent to undergo <span>IVF</span> treatment with his wife. "It constituted valid consent under the ART Act," LiveLaw reported. 

The wife of an Indian Army soldier had approached the Court seeking directions to allow the retrieval and preservation of her husband's genetic material to enable her to undergo IVF. 

Her husband, an Indian Army soldier, suffered a severe traumatic brain injury during deployment in Jammu and Kashmir in July last year and has since remained in a persistent vegetative state. 

Before the incident, the couple had already opted for IVF and initiated procedures. However, the process was halted due to the husband's inability to provide fresh written consent as required under Section 22 of the ART Act, Live Law reported. 

“While ...as on date there is no express indication of consent from the petitioner's husband, however, under the facts and circumstances of the present case, it is found to be fair, reasonable, and just for the respondents to undertake the necessary procedure/steps which are required to take the IVF treatment to its logical conclusion. But for this, the original consent given by the petitioner's husband shall stand vitiated, and the very purpose for acceding to the IVF treatment shall be rendered otiose,” said Justice Kaurav, in the Court's ruling. 

 “It is further directed that the petitioner's consent be considered as valid consent for her husband for the purposes of IVF procedure, if the same is required for any other step/procedure. The respondents shall not disentitle the petitioner on the sole ground that the petitioner's husband's written consent is absent,” the Court said. 

HealthandMe spoke to IVF specialists to understand the procedure and implications around reproductive rights, consent, and medical ethics. 

<h2>How Is Sperm Retrieval Performed in a Comatose Patient? </h2>

Dr Rachita Munjal, Director and Senior Consultant - Department of Fertility at Cloudnine Group of Hospitals, Gurugram, said that sperm retrieval and cryopreservation are possible in coma/vegetative patients, but success depends on timing and medical condition. 

<strong>Also read: </strong><a href="https://www.healthandme.com/health-wellness/explained-what-is-posthumous-reproduction-article-151046800" data-type="tilCustomLink">Explained: What Is Posthumous Reproduction?</a>

In such conditions, sperm quality may be compromised, but assisted reproductive techniques can still make conception possible.

"Cryopreservation of sperm in men who are in a vegetative state or coma is medically complex but technically feasible in many cases, depending on the underlying condition and timing," the doctor told HealthandMe. 

Since the person cannot ejaculate voluntarily, doctors use assisted techniques, such as 

<ul><li>Penile vibratory stimulation (PVS): Non-invasive; works if spinal reflexes are intact </li><li>Electroejaculation (EEJ): Electrical stimulation under anesthesia to induce ejaculation </li><li>Surgical sperm retrieval: If the above fail. Testicular sperm aspiration (TESA), Testicular <span rel="noindex">sperm extraction</span> (TESE) </li><li>Percutaneous epididymal sperm aspiration (PESA) </li></ul>

These are typically performed by urologists or fertility specialists with consent from legal guardians or prior consent of the patient. Once sperm is obtained: 

<ul><li>Sperm is analyzed (count, motility, morphology) </li><li>Mixed with a cryoprotectant to prevent cell damage </li><li>Gradually cooled and stored in liquid nitrogen at –196°C </li><li>Can be preserved for years without significant degradation</li></ul>The feasibility depends on: 

<ul><li>Cause of coma (trauma vs neurological disease) </li><li>Time since coma onset (earlier is better) </li><li>Baseline fertility health</li></ul> Dr Munjal said that in acute cases (e.g., an accident), sperm retrieval is often more successful than in prolonged illness. For people in coma, the sperm quality can vary. The sperm's motility and count often gets reduced due to: 

<ul><li>prolonged immobility </li><li>infections </li><li>medications (sedatives, antibiotics) </li><li>hormonal disruption </li></ul>However, even low motility sperm can be used with advanced techniques like ICSI (Intracytoplasmic Sperm Injection), the doctor noted.

<h2>Are There Any Ethical Considerations </h2>

There are many ethical considerations in such cases, said Dr Munjal, noting that this requires explicit prior consent or legal authorization. 

“Ethical concerns include reproductive rights and future child welfare,” she added. 

Dr. Sabine Kapasi, IVF Specialist &amp; Public Health Strategist, called it “an emotionally sensitive case where law, ethics, and reproductive rights intersect”. 

“While prior IVF consent may indicate shared intent to build a family, it does not always automatically equal consent for gamete retrieval during permanent incapacity. Such decisions should ideally involve explicit consent, ethics review, and psychological counseling for the family,” the expert said. 

This is not the first time that sperm have been retrieved from a comatose patient.

In 2024, a Kerala High Court permitted the extraction of the sperm of a childless couple where the husband was in a brain-dead condition and kept alive with ventilator support. The Court allowed the extraction and cryopreservation of the gametes, without the written consent of the husband. 

"India now needs clearer ART guidelines for coma, posthumous, and incapacity-related reproduction to avoid future disputes. Compassion is important, but medical ethics and long-term child welfare must remain central,” Dr Kapasi noted.

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Delhi High Court

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Soldier in Coma

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India needs clearer guidelines on reproductive rights, consent, and medical ethics, said doctors after the Delhi High Court, in a highly complex and sensitive case, granted permission for the extraction and cryopreservation of sperm of an Indian Army soldier in a persistent vegetative state. As per the guidelines laid under the Assisted Reproductive Technology (ART) (Regulation) Act, 2021, it is important to have the written consent of both partners. However, calling it “the right to reproductive autonomy,” Justice Purushaindra Kumar Kaurav allowed for sperm retrieval. The Court also cited the soldier's prior consent to undergo IVF treatment with his wife. "It constituted valid consent under the ART Act," LiveLaw reported.  What Is the Case All About?The wife of an Indian Army soldier had approached the Court seeking directions to allow the retrieval and preservation of her husband's genetic material to enable her to undergo IVF. Her husband, an Indian Army soldier, suffered a severe traumatic brain injury during deployment in Jammu and Kashmir in July last year and has since remained in a persistent vegetative state.  Before the incident, the couple had already opted for IVF and initiated procedures. However, the process was halted due to the husband's inability to provide fresh written consent as required under Section 22 of the ART Act, Live Law reported. “While ...as on date there is no express indication of consent from the petitioner's husband, however, under the facts and circumstances of the present case, it is found to be fair, reasonable, and just for the respondents to undertake the necessary procedure/steps which are required to take the IVF treatment to its logical conclusion. But for this, the original consent given by the petitioner's husband shall stand vitiated, and the very purpose for acceding to the IVF treatment shall be rendered otiose,” said Justice Kaurav, in the Court's ruling.  “It is further directed that the petitioner's consent be considered as valid consent for her husband for the purposes of IVF procedure, if the same is required for any other step/procedure. The respondents shall not disentitle the petitioner on the sole ground that the petitioner's husband's written consent is absent,” the Court said. HealthandMe spoke to IVF specialists to understand the procedure and implications around reproductive rights, consent, and medical ethics.  How Is Sperm Retrieval Performed in a Comatose Patient?  Dr Rachita Munjal, Director and Senior Consultant - Department of Fertility at Cloudnine Group of Hospitals, Gurugram, said that sperm retrieval and cryopreservation are possible in coma/vegetative patients, but success depends on timing and medical condition. Also read: Explained: What Is Posthumous Reproduction?In such conditions, sperm quality may be compromised, but assisted reproductive techniques can still make conception possible. "Cryopreservation of sperm in men who are in a vegetative state or coma is medically complex but technically feasible in many cases, depending on the underlying condition and timing," the doctor told HealthandMe. How sperm is retrieved Since the person cannot ejaculate voluntarily, doctors use assisted techniques, such as Penile vibratory stimulation (PVS): Non-invasive; works if spinal reflexes are intact Electroejaculation (EEJ): Electrical stimulation under anesthesia to induce ejaculation Surgical sperm retrieval: If the above fail. Testicular sperm aspiration (TESA), Testicular sperm extraction (TESE) Percutaneous epididymal sperm aspiration (PESA) These are typically performed by urologists or fertility specialists with consent from legal guardians or prior consent of the patient. Once sperm is obtained: Sperm is analyzed (count, motility, morphology) Mixed with a cryoprotectant to prevent cell damage Gradually cooled and stored in liquid nitrogen at –196°C Can be preserved for years without significant degradationThe feasibility depends on: Cause of coma (trauma vs neurological disease) Time since coma onset (earlier is better) Baseline fertility health Dr Munjal said that in acute cases (e.g., an accident), sperm retrieval is often more successful than in prolonged illness. For people in coma, the sperm quality can vary. The sperm's motility and count often gets reduced due to: prolonged immobility infections medications (sedatives, antibiotics) hormonal disruption However, even low motility sperm can be used with advanced techniques like ICSI (Intracytoplasmic Sperm Injection), the doctor noted.Are There Any Ethical Considerations There are many ethical considerations in such cases, said Dr Munjal, noting that this requires explicit prior consent or legal authorization. “Ethical concerns include reproductive rights and future child welfare,” she added. Dr. Sabine Kapasi, IVF Specialist & Public Health Strategist, called it “an emotionally sensitive case where law, ethics, and reproductive rights intersect”. “While prior IVF consent may indicate shared intent to build a family, it does not always automatically equal consent for gamete retrieval during permanent incapacity. Such decisions should ideally involve explicit consent, ethics review, and psychological counseling for the family,” the expert said. This is not the first time that sperm have been retrieved from a comatose patient.In 2024, a Kerala High Court permitted the extraction of the sperm of a childless couple where the husband was in a brain-dead condition and kept alive with ventilator support. The Court allowed the extraction and cryopreservation of the gametes, without the written consent of the husband. "India now needs clearer ART guidelines for coma, posthumous, and incapacity-related reproduction to avoid future disputes. Compassion is important, but medical ethics and long-term child welfare must remain central,” Dr Kapasi noted.