Psychosocial aspects of donor insemination. Sperm donors--their motivations and attitudes to artificial insemination

The Good-Enough Donor: Sperm as a Good, Not-Me Possession

Reproductive endocrinologists often recommend sperm donation to two groups of patients. The first are women with partners with azoospermia. The second are women who do not have a partner and yet desire to become a parent. This article focuses on a subset of women in these two groups who hesitate to accept this recommendation from their reproductive endocrinologist. Winnicott's writings on transitional phenomena, especially his description of how the infant creates good, not-me possessions, may be helpful in our understanding of some of these women's fantasies of sperm as a bad, not-me possession. Case material is used to highlight treatment recommendations that utilize a reframing of the understanding of the donor's motivation, which may create the possibility of an acceptance of sperm as a good, not-me possession. This moves the patient toward what Winnicott calls acknowledgement of indebtedness and toward what the patient may perceive as a good-enough donor.

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.

Gamete donors' reasons for, and expectations and experiences of, registration with a voluntary donor linking register

This paper reports on a study of the views and experiences of 21 sperm donors and five egg donors registered with UK DonorLink (UKDL), a voluntary DNA-based contact register established to facilitate contact between adults who wish to identify and locate others to whom they are genetically related following donor conception. Specifically, the paper examines donors' reasons for searching for, or making information about themselves available to donor-conceived offspring. Their expectations of registration with UKDL, experiences of being registered and finally, the experiences of those who had contacted donor-conceived offspring and other genetic relatives are investigated. While most respondents reported largely positive experiences of registration, the study found significant issues relating to concerns about donation, DNA testing, possible linking with offspring and expectations of any relationship that might be established with offspring that have implications for support, mediation and counselling. Research that puts the experiences, perceptions and interests of gamete donors as the central focus of study is a relatively recent phenomenon. This study contributes to this debate and highlights directions for future research in this area.

Feasibility of an altruistic sperm donation program in Canada: results from a population-based model

BACKGROUND

Stringent donor-screening criteria and legislation prohibiting payment for donor gametes have contributed to the radical decline of donor insemination (DI) using sperm provided by Canadian men. Thus, many individuals rely on imported sperm. This paper examines the feasibility of an altruistic sperm donation (ASD) program to meet the needs of Canadians.

METHODS

Using Canadian census data, published literature and expert opinions, two population-based, top-down mathematical models were developed to estimate the supply and demand for donor sperm and the feasibility of an ASD program.

RESULTS

It was estimated that 63 donors would pass Canadian screening criteria, which would provide 1,575 donations. The demand for DI by women was 7,866 samples (4,319 same sex couples, 1,287 single women and 2,260 heterosexual couples).

CONCLUSION

Considerable effort would be necessary to create the required increase in awareness of the program and change in societal behaviour towards sperm donation for an ASD program to be feasible in Canada.

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.

Beyond motivation: on what it means to be a sperm donor in Denmark

This paper, analyzing interviews with men that donate their semen in Denmark, explores what it means to be a sperm donor. Breaking with the assumption that men have a specific and clearly identifiable motivation to become sperm donors, this paper leaves the confinement of such an accountable actor model implied in asking for men's motivations to donate semen. Instead, the author describes the experiences of sperm donors to show how the moral, organizational, and biomedical-technological context of sperm donation in Denmark makes for enactments of moral selves as well as specific embodiments of masculinity. Instead of looking for motivations that can be accounted for, the author engages with the question of how donating semen affords men the experience of moral and gendered selves.

Gamete donors' satisfaction; gender differences and similarities among oocyte and sperm donors in a national sample

OBJECTIVE

To explore oocyte and sperm donors' emotional stress, experiences of care and satisfaction after donation.

DESIGN

Prospective multicenter study.

SETTINGS

All fertility clinics performing gamete donation in Sweden during the period 2005 to 2008.

POPULATION

Of 220 eligible oocyte donors who were approached, 181 agreed to complete the first questionnaire and 165 completed the second questionnaire 2 months after oocyte donation. Of 156 eligible sperm donors 119 accepted to complete the first questionnaire before donation. Eighty-nine participants completed the second questionnaire 2 months after sperm donation.

METHODS

Standardized and study-specific questionnaires.

MAIN OUTCOME MEASURES

Satisfaction with the donation, respondents' mental health and overall care.

RESULTS

A larger percentage of sperm donors (97.8%) were satisfied with their overall experience of being a donor than oocyte donors (85.9%, p = 0.003). Some oocyte and sperm donors did not receive sufficient information about practical issues (9.1% and 13.5%, respectively) and future consequences (12.8% and 3.4%, respectively, p = 0.014). The donors' symptoms of anxiety and depression did not show any differences in relation to negative or positive perceptions of satisfaction. The donors who did not indicate ambivalence before treatment were on average almost five times more satisfied compared with those who did indicate ambivalence (odds ratio 4.71; 95% CI 1.34-16.51).

CONCLUSIONS

Most donors were satisfied with their contribution after the donation. Oocyte and sperm donors who expressed ambivalence before donation were less satisfied after donation. In vitro fertilization staff fulfilled most of the donors' needs for information and care.

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.

Who becomes a sperm donor: personality characteristics in a national sample of identifiable donors

OBJECTIVE

To study the personality characteristics of identifiable sperm donors in a national sample in comparison with the same characteristics of a control group.

DESIGN

Descriptive study.

SETTING

All clinics (n=7) performing gamete donation in Sweden.

POPULATION

All Swedish sperm donors recruited during 2005-08. An age-matched group of Swedish men served as controls.

METHODS

Standardised questionnaires were used to measure personality.

MAIN OUTCOME MEASURES

Demographics and the Temperament and Character Inventory (TCI).

RESULTS

The mean age of the donors was 33.8±7.8 years (18-56 years). About one-third (36.5%) of the donors had biological children of their own. With regard to personality, significant differences were present on harm avoidance, with lower means for sperm donors (P=0.002, 95% CI -3.74 to -0.85), and on self-directedness and cooperativeness, with higher means for donors (P=0.002, 95% CI 0.97-4.19; P=0.001; 95% CI 0.75-2.95, respectively), compared with controls. This indicates that the donors in general feel less worried and suffer less from uncertainty, shyness and fatigability than controls. They also perceive themselves as being autonomous, with a capacity to take responsibility, to behave in a goal-directed manner, to be resourceful and self-acceptant, and to behave in a manner guided by meaningful values and goals. Furthermore, they describe themselves as being well integrated in humanity or society, and having a good capacity for identification with and acceptance of other people.

CONCLUSIONS

The screening process at the clinics seems to generate a group of stable, mature and well-integrated donors, and this is a promising result for the future.

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.

Saviours and satyrs: ambivalence in narrative meanings of sperm provision

This paper reports on the complex representations of sperm providers in the narratives of donors, recipients and offspring involved in donor-assisted conception. Eighty-seven volunteers from Australia, Canada, UK, USA and Argentina participated in qualitative narrative research. Sperm provision was perceived to be publicly represented as sexualized, provoking both disgust and hilarity; this is interpreted as arising from its association with masturbation and the metaphorical representation of the donor sperm as cuckolding the recipient's husband. Recipients' representations of providers were found to mix gratitude with resentment, embarrassment, and anxiety; their constructions are strongly influenced by the position of the social father. The complex representation of the provider as a genetic father is considered: providers can be seen as threatening the integrity of parents if they become involved in the life of their offspring and abandoning their offspring to confusion and despair if they do not. The research demonstrates that, in spite of its relative frequency and familiarity, donor insemination is still represented ambivalently, including by those who may be said to benefit from it.