Working Party on Sperm Donation Services in the UK: report and recommendations

An analysis of the outcome of 11 712 men applying to be sperm donors in Denmark and the USA

STUDY QUESTION

Is the outcome of donor recruitment influenced by the country in which recruitment took place or the initial identity (ID)-release choice of applicants?

SUMMARY ANSWER

More applicants are accepted as donors in Denmark than in the USA and those who choose ID release are more frequently accepted than those who do not.

WHAT IS KNOWN ALREADY

The successful recruitment of sperm donors is essential to provide a range of medically assisted reproduction (MAR) procedures, which rely upon donor sperm. However, while much has been written about the medical screening and assessment of sperm donors from a safety perspective, relatively little has been written about the process of recruiting donors and how it works in practice. There are differences in demographic characteristics between donors who choose to allow their identity to be released to their donor offspring (ID release) compared to those who do not (non-ID release). These characteristics may also influence the likelihood of them being recruited.

STUDY DESIGN, SIZE, DURATION

A total of 11 712 men applied to be sperm donors at a sperm bank in Denmark and the USA during 2018 and 2019.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Anonymized records of all donor applicants were examined to assess the number passing through (or lost) at each stage of the recruitment process. Statistical analysis was carried out to examine differences between location (Denmark or USA) and/or donor type (ID release versus non-ID release).

MAIN RESULTS AND THE ROLE OF CHANCE

Few applicants (3.79%) were accepted as donors and had samples frozen and released for use; this was higher in Denmark (6.53%) than in the USA (1.03%) (χ2 = 243.2; 1 degree of freedom (df); z = 15.60; P < 0.0001) and was higher in donors who opted at the outset to be ID release (4.70%) compared to those who did not (3.15%) (χ2 = 18.51; 1 df; z = 4.303; P < 0.0001). Most candidate donors were lost during recruitment because they: withdrew, failed to respond, did not attend an appointment, or did not return a questionnaire (54.91%); reported a disqualifying health issue or failed a screening test (17.41%); did not meet the eligibility criteria at the outset (11.71%); or did not have >5 × 106 motile sperm/ml in their post-thaw samples (11.20%). At each stage, there were statistically significant differences between countries and the donor's initial ID choice. During recruitment, some donors decided to change ID type. There were no country differences in the frequency in which this occurred (χ2 = 0.2852; 1 df; z = 0.5340; P = 0.5933), but it was more common for donors to change from non-ID release to ID release (27.19%) than the other way around (11.45%) (χ2 = 17.75; 1 df; z = 4.213; P < 0.0001), although movements in both directions did occur in both countries.

LIMITATIONS, REASONS FOR CAUTION

No information was available about the demographic characteristics of the applicants, which may also have influenced their chances of being accepted as a donor (e.g. ethnicity and age). Donor recruitment procedures may differ in other locations according to local laws or guidelines.

WIDER IMPLICATIONS OF THE FINDINGS

A better understanding of when and why candidate donors are lost in the recruitment process may help develop leaner and more efficient pathways for interested donors and sperm banks. This could ultimately increase the number of donors recruited (through enhanced information, support, and reassurance during the recruitment process) or it may reduce the financial cost to the recipients of donor sperm, thus making it more affordable to those who are ineligible for state-funded treatment.

STUDY FUNDING/COMPETING INTEREST(S)

The study received no funding from external sources. All authors are Cryos employees or members of the Cryos External Scientific Advisory Committee.

TRIAL REGISTRATION NUMBER

N/A.

Independent and combined effects of diethylhexyl phthalate and polychlorinated biphenyl 153 on sperm quality in the human and dog

A temporal decline in human and dog sperm quality is thought to reflect a common environmental aetiology. This may reflect direct effects of seminal chemicals on sperm function and quality. Here we report the effects of diethylhexyl phthalate (DEHP) and polychlorinated biphenyl 153 (PCB153) on DNA fragmentation and motility in human and dog sperm. Human and dog semen was collected from registered donors (n = 9) and from stud dogs (n = 11) and incubated with PCB153 and DEHP, independently and combined, at 0x, 2x, 10x and 100x dog testis concentrations. A total of 16 treatments reflected a 4 × 4 factorial experimental design. Although exposure to DEHP and/or PCB153 alone increased DNA fragmentation and decreased motility, the scale of dose-related effects varied with the presence and relative concentrations of each chemical (DEHP.PCB interaction for: DNA fragmentation; human p < 0.001, dog p < 0.001; Motility; human p < 0.001, dog p < 0.05). In both human and dog sperm, progressive motility negatively correlated with DNA fragmentation regardless of chemical presence (Human: P < 0.0001, r = −0.36; dog P < 0.0001, r = −0.29). We conclude that DEHP and PCB153, at known tissue concentrations, induce similar effects on human and dog sperm supporting the contention of the dog as a sentinel species for human exposure.

Jewish Law, Scarcity of Sperm Donors and the Consequent Private Import of Sperm of Non-Jews by Israeli Women

AIM

The objective of this article is to explore how Israeli Jewish women cope with the religious prohibition on sperm donation and the scarcity of Israeli donors, and to estimate the number of available sperm donors in Israel.

METHODS

A key word search was employed to retrieve relevant Hebrew and English sources; additional information was collected via interviews with two sperm donors and twelve donor insemination patients.

RESULTS

Rabbinical instructions focus on married women and refrain from acknowledging the growing number of non-married donor insemination patients. Non-married women follow the restrictions relevant to married women and hence refrain from purchasing Jewish sperm. Israeli sperm banks offer donations of Jewish donors whose number is estimated at a maximum of 140 and a minimum of 50 for the entire Jewish population of 6.2 million. In order to abide by American Society for Reproductive Medicine recommendations, the number of available donors should optimally be six times larger. The scarcity of sperm donors drives the private import of American sperm donations.

CONCLUSION

Reconsideration of the rabbinical prohibition to allow collecting sperm for donating to women who wish to have a baby is needed for the sake of increasing the donor pool, along with measures to ensure donors' privacy and dignity. © 2015 S. Karger AG, Basel.

Central role of altruism in the recruitment of gamete donors

This paper explores problems associated with using altruism as the central value in gamete donation, and in doing so draws on empirical data that sheds light on why gamete donors choose to donate. Donation of bodily material is, arguably, supposed to be motivated by altruism, and this is the view taken by many European governments. Other values are often ignored or rejected as morally inappropriate. This paper analyses some conceptual and practical problems with the use of altruism as the motivation to determine moral acceptability-drawing on empirical data that suggests gamete donors are not motivated purely by altruism, and that motivations are in fact quite complex. Two problems are first analysed: (1) how do we distinguish altruistic from non-altruistic donations and (2) how do we distinguish between removing barriers and providing incentives. A final question, triggered by the Nuffield Council on Bioethics' report, is whether the meaning of the payment should be decided on the basis of an a priori definition or on the basis of the donors' subjective experience. It is concluded that there are different legitimate core values in donation, which should be balanced. In order to value the good generated by donation, donors with mixed motives should be accepted, as long as helping others is an important motive and also features in their motivation.

Global decline in semen quality: ignoring the developing world introduces selection bias

Multiple studies from around the world have suggested that semen quality is declining globally. However, all studies suffer from variable semen sampling criteria, selection bias with respect to the types of men volunteering to participate, and a bias with respect to a tendency to examine only samples from high-income countries. This heterogeneity in approaches, especially given the undersampling of rural and less affluent men from low-income countries, calls into question researchers’ claims of universally declining semen norms.

A decade of the sperm-washing programme: where are we now?

Since 1999, we have treated HIV-positive men with sperm washing as part of a risk-reduction programme with a year-on-year increase in total infectious cycles performed to over 200 in 2008. Four hundred and thirty nine cycles of IUI, 114 cycles of IVF and 117 cycles of ICSI have been performed in HIV positive men over the decade and of the 259 couples treated, a pregnancy rate and ongoing pregnancy rate per couple of 45.4% and 36.3% have been achieved with over 100 children born with no seroconversions. We outline the continued importance of such risk-reduction measures with 9.7% of samples from men with 'stable' disease on anti-retroviral treatment and undetectable viral load demonstrating detectable viral particles in seminal fluid and discuss measures to improve outcome in this patient group.

En France, la majorité des donneurs de spermatozoïdes souhaite le maintien de leur anonymat

En France, l’anonymat du donneur de sperme, principe jusqu’alors jugé essentiel et qui avait été réaffirmé par deux fois dans les lois de bioéthique, se trouve aujourd’hui remis en question. Dans ce contexte, il est apparu utile aux Centres d’étude et de conservation des œufs et du sperme (Cecos) de connaître l’avis de ceux qui sont à l’origine de ces dons. En 2006, 193 donneurs de sperme recrutés dans 14 Cecos ont accepté de répondre anonymement à un questionnaire sur le sujet: 73 % étaient en accord avec le principe de l’anonymat, et moins de 30 % pensaient que la future législation devrait offrir aux enfants la possibilité de connaître l’identité du donneur. Si l’anonymat était levé, 60 % des hommes renonceraient à donner leur sperme. En revanche, la même proportion serait d’accord pour communiquer des informations non identifiantes les concernant aux parents et aux enfants.

UK guidelines for the medical and laboratory screening of sperm, egg and embryo donors (2008)

This article updates the 1999 British Andrology Society (BAS) guidelines for the screening of sperm donors and the 2000 British Fertility Society (BFS) guidelines for the screening of egg and embryo donors and combines the new recommendations into a single document. This was achieved by a multidisciplinary working group composed of representatives from the Association of Biomedical Andrologists, the Association of Clinical Embryologists, the BAS, the BFS and the Royal College of Obstetricians and Gynecologists. The major changes to the guidelines include a requirement to consider a donor's risk of transmissible spongiform encephalopathies and the recommendation to screen for human T cell lymphotropic viruses 1 and 2. The role of nucleic amplification tests for the detection of blood borne viruses such as HIV is discussed, but it remains the recommendation that this be achieved by serological testing to detect antibody or antigen as appropriate with a quarantine period of 180 days.