Giving or giving back: new psychosocial insights from sperm donors in France

Fertility stakeholders' concerns regarding payment for egg and sperm donation in New Zealand and Australia

New Zealand and Australia are countries which currently prohibit donor payment and require open-identity forms of donation. This study explored the concerns of fertility stakeholders regarding payment which would constitute financial reward for gamete donation, and factors predicting such concerns. A total of 434 participants from across New Zealand and Australia completed an online survey anonymously. Participants included those with infertility and treatment experience, donors, recipients, donor-conceived people and clinic professionals. Results indicated that participants' concerns related to their assumptions about the type of donor motivated by financial reward, and the possibility that, if paid, donors might conceal information relevant to treatment and the donor-conceived person. Furthermore, participants were concerned about increasing recipient costs. Participants with personal experience of infertility held stronger concerns overall. Professionals expressed concerns of clinical relevance, such as the withholding of donor information relevant to treatment outcomes. The lowest levels of concern were expressed in relation to payment devaluing the meaning of human life. Qualitatively, themes highlighted concerns regarding payment enticing the 'wrong' type of donor, increased cost to recipients, and concern about the wellbeing of donor-offspring. Collectively, such concerns must be understood against the New Zealand and Australia open-identity donation context which enables the possibility of contact between donors and offspring. These findings indicate that donor recruitment campaigns need to account for different stakeholder concerns, and consider ways to address donor shortages effectively while remaining compliant with legislative requirements.

Motivations and Attitudes of Men Towards Sperm Donation: Whom to Donate and Why?

BACKGROUND

The widespread access to medically assisted reproduction (MAR) techniques for all women, regardless of any infertility diagnosis, has led to an increased, but as yet unmet, demand for sperm donors in Portugal. For this study, we deployed an online survey to explore men's motivations for donating and their attitudes toward anonymity and donating for specific groups.

METHOD

The study's sample comprised men who were eligible to donate sperm (N = 282). The relationships between these factors and participants' psychological and sociodemographic characteristics were also explored.

RESULTS

The results mostly indicated altruistic reasons for donating, positive attitudes toward anonymity, and a greater willingness to donate to infertile women. Overall, sexual orientation was not associated with the participants' attitudes and motivations. Age, education level, conscientiousness, empathic concern, and conservative and religious values were associated with the participants' motivations and attitudes toward sperm donation.

CONCLUSION

Recruitment campaigns should therefore consider the specific motivations, attitudes, and psychosocial characteristics of potential sperm donors. Indeed, parenthood is a universal right, so sperm donation should be encouraged, regardless of recipients' fertility status. Clear information about the identifiability of sperm donors should also be provided.

[Citizens who volunteer as participants for cancer research-results of the Seintinelles Barometer 2018]

INTRODUCTION

Health researchers often face difficulties related to participants' recruitment for their research. However, a new strategy emerges: offering patients-but also citizens who are not ill-the possibility to volunteer as participants to hasten research processes. The French platform "Seintinelles" aims to fulfill this goal and bring together citizens who volunteered to participate to cancer related research. The "Seintinelles Barometer" aims to describe these volunteers' profile.

METHODS

The Seintinelles Barometer data were collected through a web-based auto-questionnaire proposed to the "Seintinelles" members from June 2017 to November 2018.

RESULTS

The sample presents a high level of overrepresentation of women. Participants are characterized by a high level of education. About a third of the participants had suffered from cancer. Two profile of volunteers emerged: the « patients » and the « supportive citizens ».

DISCUSSION

The Seintinelles Barometer participants manifest a strong wish to be involved in cancer related research. Therefore, this platform seems to be a promising tool for the development of community-based research in the field of cancer.

Support for recognition and payment options for egg and sperm donation in New Zealand and Australia

STUDY QUESTION

To what extent do infertility clinic patients, fertility industry professionals and members of the public support different forms of payment and recognition for egg and sperm donation?

SUMMARY ANSWER

While participants expressed support for reimbursement of expenses for both egg and sperm donation, payment constituting explicit financial advantage was regarded less favourably although potentially necessary to address donor gamete shortages.

WHAT IS KNOWN ALREADY

In both New Zealand and Australia, commercial inducement for the supply of gametes is prohibited. This prohibition has been argued to contribute to limited availability of donor gametes with the effect of increasing waiting lists and/or the pursuit of potentially unregulated cross-border reproductive care by domestic patients requiring donor gametes.

STUDY DESIGN, SIZE, DURATION

The study was a mixed methods study drawing on data from a questionnaire completed by 434 participants from across New Zealand and Australia between November 2018 and March 2019.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Stakeholders involved in donor-assisted conception (past and present infertility patients, gamete recipients and donors), fertility industry professionals and members of the public were recruited following online advertisement of the study. All participants spoke English and primarily identified as Caucasian. Participants anonymously completed an online questionnaire gauging their support for a range of recognition and payment options. Dependent samples t-tests were used to probe for differences in support of recognition and payment options in relation to egg and sperm donation. Linear regression models were used to determine factors predicting support for the different options for both egg and sperm donation. Thematic analysis was used to identify main themes in free text question responses.

MAIN RESULTS AND THE ROLE OF CHANCE

Broadly, there was agreement that donors be reimbursed for medical expenses, travel time, unpaid time away from work relating to treatments and out-of-pocket expenses directly related to the gamete donation process, with greater support suggested for egg versus sperm donors. Items gauging support for non-material recognition and tokens of thanks for donations were not significantly different between egg and sperm donation programmes (P > 0.05) nor rated as highly as reimbursement alternatives. Lowest ratings of support were indicated for the outright payment or reward of donors for the supply of their gametes, options that would leave donors in better financial positions. Qualitatively, themes valuing gamete donation as ideally relating to gifting were identified, although counterbalanced in opinion by concepts of fairness in reimbursing gamete donors for their costs. Where payment over and above the reimbursement of costs was supported, this was related to pragmatic considerations of limited supply of donor gametes.

LIMITATIONS, REASONS FOR CAUTION

This study used a cross-sectional design and consequently causal inferences cannot be made. Additionally, participants particularly professional fertility staff, were required to self-report on politically sensitive and legal issues with the potential for social desirability response bias. Snowball sampling may have led to participation of like-minded individuals, thus limiting generalizations of findings.

WIDER IMPLICATIONS OF THE FINDINGS

In a climate of global commercialization of reproductive medicine, limited donor gamete availability and rising incidences of cross-border reproductive care, the findings of this study can be used as a basis for further discussion between regulators and professional industry stakeholders with respect to shaping ethical policy and practice relating to donor conception.

STUDY FUNDING/COMPETING INTEREST(S)

No external funds were sought for this work. None of the authors have any competing interests to declare.

TRIAL REGISTRATION NUMBER

N/A.

Payment to gamete donors: equality, gender equity, or solidarity?

PURPOSE

Regulation of payment to gamete donors varies substantially across countries. The development of an ethically sustainable governance system of payments in gamete donation demands that the preferences of different stakeholders be heard. This study intends to contribute to improving the understanding of payment to gamete donors by analysing the views of donors and recipients about the preferred form of payment and its associations with their sociodemographic characteristics.

METHODS

This cross-sectional study included 70 donors and 172 recipients recruited at the Portuguese Public Bank of Gametes (July 2017-June 2018). Participants completed a self-reported questionnaire. Views about the preferred form of payment were collected through a multiple-choice question and an open-ended item. Associations were quantified through χ2 tests; content analysis was conducted with the open-ended answers.

RESULTS

Both donors (48.6%) and recipients (40.7%) considered that reimbursement is the preferred form of payment to ensure solidarity-based motivations to donate. This option was followed by compensation for non-financial losses (41.4% of donors; 33.7% of recipients) based on gender equity. Preference for a fixed reward (22.7% of recipients; 8.6% of donors) was less frequent among younger donors and married/living with a partner or employed recipients, being based on the promotion of equality.

CONCLUSION

In the context of the search for cross-border reproductive care and gamete circulation across countries, the findings from this study claim for the need to create solutions for payment to gamete donors that take into account gender equity and are simultaneously sensitive to donor's actual expenses and further health complications.

The attitude of female students towards sperm donation by their partner

PURPOSE

The aim of this study is to assess the attitude of heterosexual female students towards sperm donation by their partners and towards sperm donation in general.

METHODS

The method is an online anonymous survey of 1525 female students.

RESULTS

The majority of the women had a positive attitude towards sperm donation in general, but only 37% would support their partner if he would want to donate. The highest barriers to accepting donation by their partner were the fact that he would have one or more children that she would not know (55.8%) and the chance that he would be traced by his donor offspring (58.9%). There was a significant difference between the general attitude towards sperm donation as a fertility treatment and the attitude towards sperm donation by the partner.

CONCLUSIONS

Men rightly worry about their partner or future partner when they donated or consider donating sperm. Only about one in three women would support their partner if he would want to donate. The majority of women perceived sperm donation by their partner as an act that also concerns them and believed that they should be heard in this decision. To promote full informed consent, the relational component should be included in counselling donors, not only regarding the present but also regarding the (possible) future partner.

Sperm donor regulation and disclosure intentions: Results from a nationwide multi-centre study in France

Gamete donation in Europe is not regulated by a common legal framework. Different laws regarding donor anonymity and remuneration exist in different countries. In France, gamete donation is characterized by a stable legal framework - the existing system of anonymous and non-remunerated donation remained unchanged following a period of public and parliamentary debate in 2011 - but little evidence is available concerning recipients' views and experiences of gamete donation. This article describes findings from a questionnaire completed individually by 714 heterosexual couple members undergoing a donor conception procedure at one of 20 national fertility centres in France. Participants were invited to report their attitudes towards the French legal framework, their perceptions of the anonymous donor, and their intentions to disclose donor conception to their child and to other people. The majority of respondents (93%) approved of the current legal framework. Participants indicated that they thought about the sperm donor in ways that emphasized his act of donation without describing him as a specific individual. A majority (71%) also stated that they intended to tell their child about their donor conception. Given that this is the largest nationwide study of French recipients of donor sperm, the findings make an important contribution to the research evidence currently available about prospective parents' perspectives in the increasingly uncommon context of donor anonymity in Europe.

Preferences and needs regarding future contact with donation offspring among identity-release gamete donors: results from the Swedish Study on Gamete Donation

OBJECTIVE

To investigate the attitudes and preferences regarding future contact with donation offspring among identity-release donors of oocytes or sperm.

DESIGN

Longitudinal cohort study.

SETTING

University-based fertility clinics in Sweden.

PATIENT(S)

A total of 210 women and men were questioned 5-8 years after their donation of oocytes or sperm.

INTERVENTION(S)

Questionnaires given to donors prior to their donation and 5-8 years after donation.

MAIN OUTCOME MEASURE(S)

Donors' attitudes and preferences regarding future contact with their donation offspring.

RESULT(S)

A majority of identity-release oocyte (65%) and sperm (70%) donors were positive toward being contacted by an offspring of mature age. More than half wanted to be notified by the clinic when an offspring requested information about them, but about a third were negative toward receiving this information. One in four reported a need for counseling regarding future contact with an offspring.

CONCLUSION(S)

Several years after donation, a majority of identity-release oocyte and sperm donors show positive attitudes toward future contact with their offspring. Donors appear to have different preferences for information and support regarding such contact. Fertility clinics and health-care services should provide counseling regarding contact with an offspring to the donors who express a need for this.

Cryoconservation de spermatozoïdes avant vasectomie: utilité et paradoxes à travers l’activité des CECOS

Le recours à la vasectomie demeure largement moins utilisé en France que dans d’autres pays comme le montrent les données présentées dans cet article. Par ailleurs, environ 12 % des hommes qui ont recours à ce moyen de stérilisation volontaire vont dans le même temps procéder à une congélation de spermatozoïdes. Proposer de préserver la fertilité d’hommes qui n’envisagent pas ou plus de projet de paternité peut apparaître paradoxal. Nous reprenons dans cet article les éléments de réglementation, réflexion et évolution au cours du temps de la pratique de la vasectomie combinée à la congélation de spermatozoïdes. Les données montrent qu’environ 5 % des hommes qui ont préservé leur fertilité avant la chirurgie demanderont ultérieurement une utilisation de ces spermatozoïdes, le plus souvent lors d’une nouvelle union. L’analyse de l’évolution des pratiques montre également qu’actuellement, le recours aux inséminations artificielles a été largement supplanté par l’utilisation des techniques de fécondation in vitro avec des chances de grossesse nettement supérieures. Enfin, au regard de l’évolution de la réglementation et de l’évolution des pratiques, nous posons la question de l’utilité de continuer à proposer une préservation de fertilité préalablement à la vasectomie et présentons des pistes de réflexion sur ce point.