A review of mathematical models used to determine sperm donor limits for infertility treatment

OBJECTIVE

To review mathematical models used to determine sperm donor limits for infertility treatment and to consider the need to develop a new, internationally recognized and applicable model for calculating limits.

DESIGN

Literature review.

SETTING

Models for determining sperm donor limits were identified through bibliographic databases.

PATIENT(S)

Published models.

INTERVENTION(S)

Variables used in the models were defined, evaluated, and assessed for relevancy and applicability.

MAIN OUTCOME MEASURE(S)

Relevance and applicability of model variables used to predict the number of consanguineous matings, probability of unwitting sibling mating and contribution to F (coefficient of inbreeding).

RESULT(S)

Models found to be outdated and inadequate for the present-day.

CONCLUSION(S)

Many countries have introduced limits to the number of offspring each anonymous sperm donor can father but these limits vary considerably. Published models for calculating sperm donor limits are in need of improvement and it is recommended that an enhanced, internationally applicable formula be developed for calculating acceptable limits. Moreover, it is recommended that further research be undertaken into the social and familial consequences of the revocation of sperm donor anonymity and the implications for the setting of sperm donor limits.

Parameters affecting the results in a program of artificial insemination with donor sperm. A 12-year retrospective review of more than 1800 cycles

PURPOSE

We aimed to establish the influence of the parameters affecting artificial insemination (AI) results in order to describe the ideal situations to achieve the best results as well as to adequately counsel the patients undergoing these treatments about their pregnancy chances.

METHODS

We performed a controlled retrospective clinical study over more than one decade in a total of 1858 cycles in 710 patients. Clinical histories and computer registers were systematically reviewed between January 1990 and June 2002. We analyzed the influence of diverse factors affecting AI results such as patient's age, ovarian stimulation, and seminal characteristics to offer a detailed description of the technique.

RESULTS

Less than 35-years-old, smooth ovarian stimulation and 5 million of progressive motile sperm inseminated two consecutive days are the optimum conditions for achieving good results. Also, period of time that sperm remained frozen do not affect the result. Furthermore, we present the likely or expected outcomes of these treatments depending on the male and female etiologies.

CONCLUSIONS

We discourage AI in aged patients, and strongly recommend undergoing ovarian stimulation. Nonetheless, we must reach an adequate amount of sperm with good motility in order to inseminate with maximum guaranties of success.

[Spreading of hereditary diseases through donor sperm: no reason for reducing the number of offspring per donor in the Netherlands]

In the Netherlands, a limit of 25 offspring per sperm donor has been applied for many years. This figure was based on the assumption that children from sperm donors are not at greater risk of having consanguineous relationships than a random individual of the Dutch population. After the report in 2002 that a donor, whose sperm was used to father 18 children by artificial insemination, had developed a serious hereditary brain disease, the question of whether the limit of 25 should be reduced was raised. From a population genetics point of view, reducing the number of children per donor will only result in greater genetic diversity being transmitted to the offspring of sperm donors. Moreover, the number of children from sperm donors is a negligibly small proportion of the general population (0.5% of the total number of newly-borns). Since no knowledge of other offspring from one particular donor is available to individuals making use of donor insemination, only optimally guaranteed safety (both genetic and microbial) is important to these people and their offspring, given that the risk of inbreeding is acceptably low. Finally, the interests of the donor can be properly safeguarded through individual agreements. Therefore, to conclude, there are no reasons to reduce the limit of 25 offspring per sperm donor.

[For an ethics of medical-assisted reproduction]

The principal problems to the bioethic of reproduction are exposed. A distinction must be done between the therapy of sterility and the processes for artificial reproduction. The first treatments do not need special rules, being under the laws regarding the medical profession. The second on the contrary need a legal regulation by the Parliament in order to avoid the manipulation of human life at its origin. More attention to values and less emphasis to technical problems is now required.

A high sensitivity-nested PCR assay for BHV-1 detection in semen of naturally infected bulls

Several different PCR protocols for the detection of Bovine herpesvirus-1 (BHV-1) in bovine semen, are available in the literature. Most of them are rather laborious and the majority were performed on laboratory samples, artificially contaminated semen or semen provided from experimentally inoculated animals. Furthermore, to obtain higher levels of sensitivity, additional dot-blot procedures are frequently necessary. We describe the detection of BHV-1 in bovine semen and the supernatant of cell cultures with titres of 0.001 TCID50/50 microliter by a nested PCR assay, with no further hybridization procedures. The high sensitivity was achieved by filtering the semen samples on chromatography columns before DNA extraction, by using two pairs of primers in a nested PCR and by evaluating the amplification products on silver-stained polyacrylamide gels. Specificity of the amplified fragments was confirmed by RFLP and sequence analysis of the PCR products. This nested PCR procedure was performed in parallel with viral isolation (VI) on 101 semen samples provided from naturally infected bulls housed at an artificial insemination centre. The nested PCR was shown to be more sensitive, faster and easier to perform than the standard VI test. To our knowledge, it is the most sensitive PCR test for BHV-1 detection in bovine semen and could be easily used for routine diagnosis.

[The value of donor sperm in intra-cytoplasmic sperm injections? The French Centers for Semen Preservation policy]

Some IVF laboratories ask for donor's semen during an ICS attempt if retrieval of husband's sperm is unsuccessful. The French Centers for Semen preservation (CECOS) consider that this request is not acceptable for legal, psychological and ethical considerations. Legal consent may not be ambiguous. The psychological lost of biological fatherhood should be totally assumed before undertaking conception with donor's semen. ICSI should be started only if it is most likely to succeed. For all these reasons, CECOS refuse to modify the strategy of procreatione during the course of an attempt.

FDA approved? A critique of the artificial insemination industry in the United States

Artificial insemination by donor is becoming an increasingly popular means to achieving parenthood. While the majority of couples use artificial insemination to overcome fertility problems, many recipients use artificial insemination to avoid passing a genetic disease to their children. However, case studies reveal the inherent dangers of artificial insemination, namely the lack of proper screening methods to avoid passing genetic diseases to children born by artificial insemination. State-by-state regulation, federal guidelines, and private adjudication have all proven to be inadequate methods of regulating the artificial insemination industry. Ginsberg proposes federal regulation as the only means of achieving a safe artificial insemination industry. The proposed federal regulation would include better genetic screening, a more efficient national sperm donor system, and limited disclosure to recipients of artificial insemination and their children. These measures would help to ensure that couples using artificial insemination get what they expect--healthy sperm, a safe artificial insemination process, and ultimately, a healthy child.

[Prevention of viral infections transmitted by semen in volunteer donors for assisted reproduction. 2 years' experience]

During a 2 years period the serological markers of viral infections were evaluated in the semen of 24 donors who were involved in assisted reproduction techniques. The presence of cytomegalovirus, hepatitis B virus and human immunodeficiency virus were investigated. The results were as expected, no data of viral infection at the time of donation being found because the study population was a highly selected one. Taking into account all the known microorganisms that can be transmitted through semen, a protocol for the prevention of infections in the mother and in the prospective newborn is suggested.

The screening of donors enrolled in an artificial insemination program

Artificial insemination is currently offered in Ontario to couples when infertility arises from a male factor. The majority of practitioners are using fresh sperm, but because of the threat of transmitted infection, a change to the use of frozen semen, which can be screened concurrently, is anticipated. Screening can prevent the transmission of both genetic and infectious disease and the principles of a possible program are outlined below. Elements of screening include a genetic history, blood count, selected biochemical and serological assays, and a semen analysis and culture. Because of the high cost and the few cases of genetic disease that will be prevented, routine karyotyping is not recommended. It remains to be seen whether changing the donor pool from an unscreened group of medical personnel to a screened sperm bank derived from the general population will provide increased protection for the mother and child.

Surrogate motherhood: unacceptable answer to infertility

Although many see surrogate motherhood as a solution to female sterility, it produces problems with the marriage relationship, parental responsibility, and parent-child bonding. Pope Pius XII condemned artificial insemination from a donor (surrogate fatherhood) because it separates procreation from marriage. This condemnation would extend to surrogate motherhood for the same reasons: Human procreation is reduced simply to transmitting biological life rather than a Christian way of living, which is a task that requires parents' commitment to each other and the child. Many other problems make this procedure unacceptable. These include commercialization, the child's possible anxiety because of its ambiguous parentage, and the surrogate's wanting to keep the child.