A survey of semen donor attitudes

Anonymous sperm donors' attitude towards donation and the release of identifying information

INTRODUCTION

Belgian legislation allows only strictly anonymous gamete donation and known donation (donation to a recipient known by the donor). Recently, an amendment of the legislation was proposed to grant donor offspring, as of 18 years old, the right to claim identifying information about their donor.

PURPOSE

The aim is to explore the attitude of actual sperm donors towards donation and the release of identifying information and to investigate which donors would be willing to donate when anonymity would be prohibited by law.

METHODS

All men who were accepted as sperm donors (n = 242) by AZ Jan Palfijn Hospital (Ghent, Belgium) were invited to complete an anonymous online survey. The response rate was 65.5%.

RESULTS

One in five (20.1%; n = 30) would continue sperm donation upon a legislation change towards identifiable donation. Three in four donors (75.2%) would agree to provide basic non-identifiable information about themselves and one in three (32.9%) would provide extra non-identifiable information such as a baby photo or a personal letter. Almost half of the donors (45.6%) would agree to donate in a system where the hospital can trace the donor at the child's request and contact the donor, leaving it to the donor to decide whether or not to have contact with the requesting donor child.

CONCLUSION

These findings show that only one in five current donors would continue to donate when identifiable. The study also demonstrates that current donors think more positive about alternative options and that nearly half of them are willing to be contacted by the hospital at the donor child's request, providing the donor can decide at that time whether or not to release his identity.

Donor insemination: Israel as a representative case of a competitive market examining the possibility of policy reform

AIM

To measure the private and social benefits of donor insemination (DI).

METHODS

An empirical model investigates the general public and DI clients' willingness to pay (WTP) for DI, and the willingness of potential donors to become altruistic or paid sperm donors.

RESULTS

The general public and DI clients value DI and have a positive WTP for it, whereas willingness to donate, altruistically or for payment, is either low or very low.

CONCLUSION

The general public's and DI clients' WTP for DI is in average above actual cost, so the government should consider funding or subsidizing DI. The government should encourage altruistic gamete donation through information and education of all parties involved directly and indirectly in the process of donation whose ultimate goal is the birth of a child.

First Pregnancy, Somatic and Psychological Status of a 4-Year-Old Child Born following Annexin V TESA Sperm Separation

Introduction Sperm DNA integrity is a crucial paternal factor affecting fertilization and pregnancy rates, as well as embryo development. Case The present case report describes the successful pregnancy after testicular sperm aspiration (TESA) combined with intracytoplasmic sperm injection (ICSI) (TESA-ICSI) in a couple where the male presented high sperm DNA fragmentation. In order to sort damaged sperm presenting DNA fragmentation, magnetic activated cell sorting (MACS) with annexin V microbeads (MACS Miltenyi Biotec, Teterow, Germany) was used. Conclusion The authors present the first description of a successful medical case using TESA-ICSI annexin V sperm sorting. Additionally, a follow-up of the child at the age of 4 years old was done.

Recipients' views on payment of sperm donors

The aim of this qualitative study was to explore how recipients viewed payment of sperm donors. The study was conducted in Belgium, where, as in many countries, sperm donors receive recompense for their time and expenses. Face-to-face semi-structured interviews were conducted with 34 heterosexual and lesbian couples who, at the time of data collection, had at least one donor-conceived child aged 7-10 years or who were undergoing donor conception treatment. Although participants commonly described the issue of financial compensation as something that did not really concern them, all supported the idea that some level of payment was acceptable or even necessary. The participants also identified several ways in which donor payment offered advantages to their own position as (future) parents. Although the idea is commonly rehearsed that sperm donation is a gift and that monetary transaction for conception is demeaning, the participants of this study did not generally share this view. To them, a small financial return served as a symbolic acknowledgement of the donor's contribution and helped secure the type of relationship they expected from their donor. There was clearly concern, however, over high payments and the risk of attracting the wrong kind of donor.

A taxonomy of possible reasons for and against sperm donation

OBJECTIVE

Various reasons may guide the decision of men to become a sperm donor. Our aim was to identify a comprehensive set of possible reasons for and against sperm donation.

DESIGN

Concept mapping.

SETTING

Assisted reproduction clinics.

SAMPLE

Nine sperm donors and seven non-sperm donors.

METHODS

Interviews to obtain statements for and against sperm donation, card-sorting tasks to categorize these statements according to similarity, and hierarchical cluster analysis to structure these categorizations.

MAIN OUTCOME MEASURES

Hierarchical structure with reasons for and against sperm donation.

RESULTS

The hierarchical structure with 91 reasons comprised selfishness (including narcissism and procreation), psychosocial drives (including altruism, detached procreation, and sexual/financial satisfaction), and psychosocial barriers (including normative and moral barriers related to oneself, one's spouse, the donor child, and society).

CONCLUSIONS

The identified hierarchical overview of reasons for and against sperm donation may help potential sperm donors when considering becoming a sperm donor, enable more systematic counseling of potential sperm donors, and guide further research on reasons for and against sperm donation.

Attitude to sperm donation among medical students in Enugu, South-eastern Nigeria

This study investigated the knowledge, attitude and practices of a sample of Nigerian medical students towards sperm donation. It was a self-administered semi-structured questionnaire survey of fifth and final year medical students of the College of Medicine, University of Nigeria, Enugu campus, South-eastern Nigeria. Out of 205 eligible medical students in both classes, 180 (87.8%) responded. There were 99 male and 81 female respondents. Their ages ranged from 20 to 30 years with a mean of 24.0 +/- 2.0 years. All the participants were Christians. A total of 177 (98.3%) of the respondents were aware of the practice of sperm donation for the treatment of infertility, while three students had never heard of it. A total of 15 (15.2%) of the male respondents reported their willingness to donate their sperm for infertile couples. The main motivation for wanting to donate sperm was a desire to help infertile couples. A total of 24 (30%) of the female respondents were willing to accept donor semen should the need arise. The leading factors which discouraged the male respondents from donating semen were that the practice was either against their religious belief (41.7%) or in their opinion, was morally wrong (22.6%). Some 10.7% were afraid of a possible adverse effect on future fertility, while 9.5% were afraid of being screened for sexually transmitted infections; 20 (35%) of the female respondents would not accept donor semen because of the psychological and emotional effects of having to bring up a child that is not their husband's; 13 (23%) said it was against their religious faith, while 10 (18%) believed that adopting a child was better than accepting donor semen. Eight (14%) were afraid of contracting HIV infection through donor semen, while six (11%) declined because they would not want the paternity of their child to be questioned later. With respect to the participants' views on identity disclosure, 35 (90%) of the 39 respondents willing to donate or accept sperm objected to their identities being disclosed to the recipient couples or the donor, while four (10%) did not mind. It was concluded that, despite the high level of awareness of sperm donation among medical students in Enugu, the majority of them were unfavourably disposed to it and none had ever practiced it. Public enlightenment through the mass media and correction of false notions about infertility treatment will go a long way in addressing this problem.

Donor gametes and embryos: who wants to know what about whom, and why?

Many treatments for infertility require the use of donated gametes or embryos. Arguments have been made that all parties involved (donors, recipients, and children) should have open access to information about one another. The present article reports a survey of attitudes of 77 donors and 327 recipients in the state of Western Australia. Donors and recipients endorsed a register of nonidentifying information, but were less keen on a register of identifying information. They believed that medical personnel should have access to such registers, and that donors and recipients (but not children) should have access to nonidentifying, but not identifying, information. Typically, the sort of information respondents wanted to access pertained to health status and physical characteristics. Overwhelmingly, both donors and recipients saw gamete and embryo donation as more like blood donation than like adoption.

Potential sperm donors’, recipients’ and their partners’ opinions towards the release of identifying information in Western Australia

BACKGROUND

The aim of this study was to examine Western Australian potential sperm donors' and recipients' opinions towards the release of identifying information and their intentions to disclose.

METHODS

Forty-five potential sperm donors, 33 recipients and 12 partners completed an anonymous questionnaire regarding their opinions on the release of identifying information, whether a child should be told about the manner of their conception, the level of expected contact of donor with future donor offspring and the importance of anonymity in their decision to donate.

RESULTS

Slightly less than one-half (48.9%) of potential donors indicated that they would still donate if their identity was revealed to future offspring. When asked whether they would consider contact with offspring, 80% responded positively, with 42% favouring one-off contact. The majority of recipients (82%) and partners (92%) were planning to inform their offspring about the manner of their conception, with 69% of recipients believing that the offspring should receive identifying information about the donor. Recipients were ambivalent about the level of contact between their offspring and the donor.

CONCLUSION

These results suggest that the move to an open-identity donor system in Western Australia will benefit the majority of recipient parents who are intending to disclose; however, it also suggests a 50% decline in the number of potential sperm donors.

Sperm Donation: Implications of Canada’s Assisted Human Reproduction Act 2004 for Recipients, Donors, Health Professionals, and Institutions

BACKGROUND

On April 22, 2004, the Assisted Human Reproduction Act came into force, prohibiting the purchase of sperm or eggs from donors in Canada. In response to the concerns of medical professionals and some consumers that prohibiting payment would lead to a decline in the number of gamete donors, Health Canada commissioned research on altruistic donor recruitment and recruitment strategies.

METHODS

Twenty-two studies of sperm donors were located and their findings reviewed. The studies spanned 23 years (1980-2003), were undertaken in a range of countries, and were chosen on the merit of their relevance to the development of recruitment strategies within a policy of altruistic sperm donation. Observations were derived from assessing and comparing the purposes, findings, and implications of the 22 studies.

RESULTS

Payment for providing sperm was made in all but three studies, although participants in 15 studies indicated clearly that their motivations were primarily altruistic. Observations indicate that men who are more willing to be identified to offspring in the future share demographic characteristics, such as age and parental status, with those who are prepared to donate altruistically. These characteristics appear to be a factor in motivation to donate altruistically.

CONCLUSION

The studies show that there are men who are prepared to donate sperm without financial payment. The findings suggest that a change is required in the culture of sperm donation, specifically the adoption of a new approach to donor recruitment.

Recruitment of sperm donors: the Newcastle-upon-Tyne experience 1994–2003

BACKGROUND

The demand for sperm donors has continued despite the introduction of ICSI. This study was undertaken in the light of impending changes in donor anonymity laws to evaluate the recruitment process of sperm donors.

METHODS

Retrospective analysis of 1101 potential sperm donors in a tertiary referral centre between January 1994 and August 2003. The main outcome measures were to determine the demographic details, recruitment rate and reasons for rejection of donors.

RESULTS

The majority of the applicants were aged <36 years (88.07%), students (54.88%), without a partner (53.47%), unmarried (85.38%) and without proven fecundity (78.67%). Only 3.63% of the applicants were released as donors, 30.79% defaulted, whilst 64.48% were rejected. The most common reason for rejection was suboptimal semen quality (85.07%). Over the years, the numbers of the applicants and released donors have declined significantly. The overall clinical pregnancy rate from donor sperm during this period was 23.52%.

CONCLUSIONS

In this successful anonymous sperm donor programme only a small proportion of the applicants are released as donors. The significant decline in released sperm donors coupled with the potential effects of loss of donor anonymity means that new strategies for sperm donor recruitment are urgently required.

Short Communication: Previous semen donors and their views regarding the sharing of information with offspring

BACKGROUND

The UK government has decided to introduce, from 2005, rules that will allow donor-conceived persons to have access to identifying information concerning their donor. This has led to many concerns regarding future gamete donor recruitment.

METHODS

Semen donors who had been recruited between 1988 and 2002 were invited to take part in a telephone interview. The interview sought these previous donors' views on issues associated with recruitment, attitudes regarding information sharing and views concerning the offspring. Responses regarding information sharing were compared with their views recorded at the time of recruitment.

RESULTS

All 32 donors were recruited altruistically. Eighteen (56%) held the same views concerning the provision of identifying information as they did at the time of recruitment. Of those who had changed their views, eight (25%) expressed a willingness to be more open and four (12%) now wished to be anonymous having previously been unsure. Half of the donors would still have donated if they had been required to be identified to offspring, one-quarter would not have and one-quarter were undecided, although the majority of these said they may have donated under an open system.

CONCLUSION

The study shows that it is possible to recruit identifiable donors at this clinic and this suggests that it may be possible for other clinics to do likewise.

Semen providers and their three families

BACKGROUND

In 1985 the Swedish government introduced legislation that required all semen providers to furnish identifying information on themselves which would then be made available to their biological/provider offspring when they are deemed to have 'sufficient maturity'. The purpose of the legislation was to protect the child's rights and needs. The aim of this paper is to examine the degree to which semen providers have considered the implications of their decision to donate upon their three families; their birth family, the family they form with their partner, and the recipient family.

METHODS

Thirty semen providers from two Swedish clinics were sent self-completion questionnaires collecting both quantitative and qualitative information. The initial response rate was 100%. Questions requested demographic information; the degree to which semen providers had consulted with or advised their partners, family, existing offspring and acquaintances about their semen donation; views and attitudes of semen providers towards donor offspring, anonymity, information sharing, payments to semen providers, community acceptance of DI and semen providers, experience of donation, recruitment/screening procedures.

RESULTS

Almost all respondents had told their partners that they were providing semen, however, a much smaller proportion had told their birth families. Almost two thirds of semen providers were positive or very positive about the prospect of meeting their offspring at some time in the future, with older men expressing more enthusiasm.

CONCLUSIONS

The findings suggest that semen providers have only partially considered and addressed the full implications of having semen provider offspring. The age of semen providers could be influential in determining some attitudes and views.

How would revealing the identity of gamete donors affect current practice?

The possibility of revealing the identity of gamete donors may change the decision of a donor to collaborate with infertility clinics and patients. Previous experiences with patients and donors, as well as different cultural viewpoints in northern and southern Europe, are presented.

A comparison of oocyte donors' and gestational carriers/surrogates' attitudes towards third party reproduction

PURPOSE

This study was designed to compare levels of satisfaction for ovum donors and gestational carriers/surrogates (GCS), investigate attitudes, and explore beliefs about the role genetics, gestation, and environment play in various characteristics.

DESIGN

An east coast IVF center and two California-based agencies recruited donor and GCS candidates.

METHODS

Participants received mailed questionnaires that included sections on demographics, attitudes, and beliefs.

RESULTS

Both groups were highly satisfied with their participation. Donors were not willing to be GCS, and GCS were not willing to be donors. GCS thought about and disclosed their participation, felt children should be told about GCS, and desired future contact with the child(ren) more than did donors (p < 0.002). Donors did not indicate a preference about disclosure. Contact with recipients did not correlate with satisfaction.

CONCLUSION

Women who chose to donate eggs or to be GCS hold distinct and different beliefs about the role of gestation and genetics.

Gamete donation: ethical implications for donors

The interests of gamete donors have only recently been recognized in assisted reproduction; traditionally, the interests of the patients (typically a couple) and the prospective child are paramount. However, assisted reproduction would not be possible without donors, and the simple utilitarian view would be to place their interests first to maximize the availability of the practice. There are several ethical issues on both sides of the donor--recipient equation, some of which are mutual and others are in conflict. For example, the word 'donation' implies there is no payment. Informed consent for donation is essential if the autonomy of the donor is to be respected, and includes information about the results of screening. This is a sensitive issue, especially when pathology is found in a donor who is not being screened for his or her own immediate benefit. Counselling may result in donors refusing to take part, but may also lead to selection by the person recruiting the donors, sometimes as a consequence of examining the motivation of the donor. In this case, the main problem is the ethical basis of the selection process. Other aspects of gamete donation may lead to a conflict of interests between the donor, the recipients and even the prospective child, particularly in terms of anonymity and the information that is made available about the specific circumstances of donation. Implications and support counselling are essential tools in achieving an acceptable balance for all parties involved.

A follow-up study with oocyte donors exploring their experiences, knowledge, and attitudes about the use of their oocytes and the outcome of the donation

OBJECTIVE To learn what information oocyte donors were given and wanted to have about the use of their oocytes and the outcome of the donation.

DESIGN

In-depth interviews.

SETTING

Participants recruited through IVF clinics, matching agency, the Internet, word of mouth, and newspaper ads.

PARTICIPANT(S)

Thirty-three former oocyte donors and six women preparing to donate.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

None.

RESULT(S)

Thirty-three former donors completed 66 donation cycles; 48 donation cycles were anonymous. Only 41% (16 of 39) of all participants were comfortable giving the recipient couple complete dispositional authority over the resulting embryos; the remainder wanted some control. One quarter did not want embryos used for research. Fifty-four percent (21 of 39) thought donation of excess embryos to another couple was acceptable, but one third wanted to be informed. Of the 25 anonymous donors, 6 learned the outcome of the donation; 14 others wanted to know. All hoped the donation was successful.

CONCLUSION(S)

Because oocyte donors' need for information varies, clinics should consider being more flexible in their disclosure policies. Disclosure about the possible uses of donor oocytes or embryos should be mandatory. Findings have implications for the informed consent and counseling processes.

Secrecy among Israeli recipients of donor insemination

Patterns of discretion and disclosure of fertility-related information among Israeli recipients of donor insemination (DI) are explored. Based on questionnaires completed by recipients in four sperm banks, we studied differences between married women and men. We found that most Israeli recipients conceal the treatment from their friends and relatives. Women and men, however, differ in their disclosure patterns: women are somewhat more open about the general fertility problem, but conceal the male factor; men are more discreet. However, men who disclose the fertility problem also tell about their own impairment. DI appears to be the most secretive issue in this context. Recipients who confided in anyone about their problem restricted it mostly to family relatives. The results are interpreted in terms of Israeli pronatalism, traditional concepts of the natural family, as well as elements of macho culture. Public education is highly recommended in order to open and "normalize" DI in Israel.

Motivation, attitudes and experience of donation: a follow-up of women donating eggs in assisted conception treatment

This paper reports a follow-up of 39 women who had donated eggs to an assisted conception unit. Their experience of donation and their motivation and attitudes were assessed. Comparisons were made with a group of semen donors who were attending a second unit. Female and male donors donated for altruistic reasons and neither group wished to have contact with recipients or donor offspring or have their identity revealed. Female donors were more involved in the donation process and more interested in the outcome of donation. They also appeared to be more motivated by 'helping' than male donors. The sample of female donors contained a small group of women who were donating to sisters and friends. In comparison with anonymous donors, these women reported more effects upon the family and issues of secrecy and openness were more apparent. The results are discussed in the light of previous studies and the legal framework for donation in the UK. Attention is drawn to the lack of social psychological analyses in this controversial medical area.

Disclosure issues and decisions of couples who conceived via donor insemination

Disclosing the use of donor insemination (DI) to family, friends, and offspring poses a quandary for many DI patients. A cross-sectional survey was conducted to determine whether couples opted to share information about conception via donor sperm with their children, as well as the issues and concerns that arose for parents once infertility treatment was completed. Twenty-seven married heterosexual infertile husbands and wives who had used DI to conceive completed a follow-up questionnaire asking them about disclosure decisions as well as thoughts about DI as a reproductive option. Results revealed that nearly three-quarters of the sample had not disclosed to their child and did not plan to, although 85% had told at least one other person about conception via DI. With few exceptions, husbands and wives agreed about how to handle disclosure. Notably, 32% of the mothers reported not knowing when or how to disclose. However, the majority of couples were not offered psychological counseling prior or subsequent to DI. It is suggested that mental health professionals should be aware of the divergence of opinion between what they believe about the benefits of disclosure/counseling, the beliefs of infertile couples about disclosure and what is actually known about the benefits of full disclosure among all involved parties.