A systematic review of assisted and third-party reproduction guidelines regarding management and care of donors

BACKGROUND

Gamete and embryo donors face complex challenges affecting their health and quality of life. Healthcare providers need access to well-structured, evidence-based, and needs-based guidance to care for gamete and embryo donors. Therefore, this systematic review aimed to synthesize current assisted and third-party reproduction guidelines regarding management and care of donors.

METHODS

The databases of ISI, PubMed, Scopus, and websites of organizations related to the assisted reproduction were searched using the keywords of "third party reproduction", "gamete donation", "embryo donation", "guidelines", "committee opinion", and "best practice", without time limit up to July 2023. All the clinical or ethical guidelines and best practice statements regarding management and care for gamete and embryo donors written in the English language were included in the study. Quality assessment was carried using AGREE II tool. Included documents were reviewed and extracted data were narratively synthesized.

RESULTS

In this systematic review 14 related documents were reviewed of which eight were guidelines, three were practice codes and three were committee opinions. Five documents were developed in the United States, three in Canada, two in the United Kingdom, one in Australia, and one in Australia and New Zealand. Also, two guidelines developed by the European Society of Human Reproduction and Embryology were found. Management and care provided for donors were classified into four categories including screening, counseling, information provision, and ethical considerations.

CONCLUSION

While the current guidelines include some recommendations regarding the management and care of gamete/embryo donors in screening, counseling, information provision, and ethical considerations, nevertheless some shortcomings need to be addressed including donors' psychosocial needs, long-term effects of donation, donors' follow-up cares, and legal and human rights aspects of donation. Therefore, it is needed to conduct robust and well-designed research studies to fill the knowledge gap about gamete and embryo donors' needs, to inform current practices by developing evidence-based guidelines.

Acceptance and rejection of "morally challenging" behaviour in online sperm donation communities: narrative interviews with recipients and donors

Introduction

Online sperm donation allows those hoping to conceive a baby ("recipients") to meet prospective sperm donors online, via "connection" websites or social media. These sites offer some advantages to clinical donation (including lower costs and greater choice over donation arrangements) but previous research has suggested that these sites may also pose risks and challenges to those who use them. Therefore, the aim of this exploratory research was to better understand online sperm donation communities and the experiences of both recipients and donors, particularly with respect to situations that could be "morally challenging" or involve harm.

Methods

Three prolific donors and five recipients were interviewed using an in-depth narrative approach. Carol Gilligan's Listening Guide was employed to analyse the data.

Results

The findings demonstrated that the donors sought to find ways to maintain autonomy in their donating practices and were concerned about the character and parenting abilities of recipients, as well as the potential for recipients to make unwarranted complaints. The recipients were concerned about their safety and finding a donor they could trust, discussing issues relating to donor "dishonesty", online abuse, and a lack of support from connection sites and related authorities. Both donors and recipients identified "morally challenging" behaviour relating to donor anonymity (donor use of fake online profiles or aliases) and the sexual motivations or (mis)conduct of some donors. The participants each discussed the ways in which they managed perceived risks.

Discussion

The degree to which the participants voiced their acceptance or rejection of challenging behaviour in online sperm donation communities varied across and within participants, highlighting the complexity of the way in which people interact in this environment. Further research is required to understand how this form of sperm donation can be as safe and supportive as possible, while also respecting the importance to donors and recipients of autonomy and choice when making donation arrangements.

Israeli students' perceptions regarding sperm donation: dilemmas reflections with dominant demographic effect

BACKGROUND

Sperm donation has undergone significant medical and social transformations in recent decades. This study aimed to explore Israeli students' perceptions towards sperm donation and investigate the potential influence of demographic characteristics on these perceptions.

DESIGN

The study encompassed 254 students from Tel-Aviv University, who completed an anonymous online survey in January-February 2021. This cross-sectional quantitative online survey, comprised 35 questions categorized into three sections: demographic data, assessment of prior knowledge, and perceptions of sperm donation (general perceptions related to both positive and negative stigmas associated with sperm donation, the roles and activities of sperm banks, and considerations surrounding identity disclosure versus the anonymity of sperm donors and their offspring).

RESULTS

Participants exhibited a relatively low level of prior knowledge (mean 31.2 ± 19 of 100). Scores for positive and negative stigmas ranged from 1.3 to 2.2. Notably, the statement "Donors' anonymity preservation is crucial to maintain sperm donation" received a mean of 3.7. Seeking for anonymous sperm donation identity both by recipients and offspring was ranked with low means (1.5 and 1.7, respectively). However, the pursuit of half-siblings by mothers or siblings themselves received higher ratings ranging from 2.7 to 3. Women's stigma ranking were notably lower, while men emphasized the importance of donor anonymity.

CONCLUSIONS

Sperm Banks hold a position of medical authority rather than being perceived as being commercial entity. The preservation of donor anonymity is widely accepted as a crucial element, prioritized over the requests for identity disclosure from recipients and offspring. Demographic parameters exhibit a strong and precise effects on participants' perceptions.

A low total motile sperm count in donor sperm obtained from commercial banks does not affect pregnancy rates from intrauterine insemination

Objective

Women are often concerned about the absolute quantity and quality of sperm in a thawed donor sample at the time of intrauterine insemination (IUI). The aim of this study was to determine how the total motile sperm count (TMSC) of donor sperm obtained from commercial sperm banks affects the pregnancy rate after IUI.

Study design

We performed a retrospective cohort study including single women and women in same-sex relationships undergoing IUI at a single academic fertility center between January 2011 and March 2018. Our primary outcome was pregnancy rates per IUI cycle, stratified by post-washed TMSC. The data was analyzed according to TMSC and included three different groups: samples with a TMSC less than 5 million; TMSC of 5-10 million; and a TMSC greater than 10 million. Pregnancies were defined by a serum Beta-human chorionic gonadotropin (Beta-HCG) of greater than 5 mIU/mL. Chi-squared analyses and correlation coefficients were performed.

Results

Overall, 9341 IUIs were conducted during the study period. Of these, 1080 (11.56%) were performed for single women and women in a same-sex relationship using commercially available donor sperm. We found that there were no differences in the pregnancy rates per insemination based on TMSC. The pregnancy rates per cycle were 15/114 (13.3%) for the group with a TMSC of less than 5 million; 34/351(9.5%) with a TMSC of 5-10 million; and 61/609 (10.0%) for samples with a TMSC greater than 10 million (p = 0.52). We found an insignificant correlation (r = -0.072) between donor sperm TMSC and pregnancy after IUI (p = 0.46). Furthermore, a reassuring beta-HCG level (>100IU/L) drawn 16 days after IUI was unrelated to TMSC (r = 0.0071, p = 0.94).

Conclusion

The pregnancy rate following IUI is unaffected by the TMSC of commercially available donor sperm. This result is useful in reassuring patients when freshly thawed donor sperm is found to have a lower TMSC. Frozen sperm samples from commercial banks typically represent just a portion of an ejaculate produced by a donor who meets the banks' standards for age, health and sperm quality. As such, exaggerated sperm death caused by freezing does not result in worse outcomes with donor sperm.

Student views on recognition and payment options for gamete donation in New Zealand

BACKGROUND

Demand for donor gametes in New Zealand significantly outweighs the number of willing donors. Payment for donation has been suggested as a viable solution to increase the supply and attract more donors in acknowledging the time, effort and inconvenience associated with donation.

AIMS

Internationally, university students are a commonly targeted group for paid gamete donation. This study aims to explore the views of university students in New Zealand to gauge their support and concerns relating to a range of options to recognise donors, including payment.

METHODS

Two hundred and three tertiary students completed a questionnaire exploring their views on various forms of recognition for donation and concerns relating to payment.

RESULTS

Participants indicated the greatest support for reimbursement for expenses directly related to the donation process. Payment constituting explicit financial advantage was regarded least favourably. Participants held concerns that payment would attract people donating for the 'wrong' reasons and lead to donors concealing relevant histories. Further concerns included payment increasing costs for recipients and causing disparities in access to gametes.

CONCLUSIONS

The findings of this study suggest that within a New Zealand context a culture of gift-giving and altruism are strongly held principles towards reproductive donation, including among the student population. This highlights the need to consider alternative strategies to commercial models to overcome donor shortages which are in line with the cultural and legislative context of New Zealand.

Long-term follow-up of mental health and satisfaction in a Swedish sample of sperm and egg donors after open-identity donation

RESEARCH QUESTION

How is the mental health of open-identity gamete donors and their satisfaction with their contributions 14-17 years after acceptance as a donor?

DESIGN

The Swedish Study on Gamete Donation is a longitudinal study comprising women and men who were accepted as donors at seven Swedish university clinics between 2005 and 2008. The latest (fifth) follow-up included 215 open-identity donors (response rate 87%): 123 oocyte donors and 92 sperm donors. The donors answered a questionnaire regarding their perceptions, experiences and expectations after gamete donation 14-17 years previously.

RESULTS

The donors were satisfied with the experience of donating, and no differences were detected between sperm and oocyte donors. Oocyte donors were more than twice as likely to feel that family and friends were proud of their donation compared with sperm donors (51% versus 23%, P < 0.001). In total, six donors regretted their donation: four oocyte donors and two sperm donors. Sperm donors were more frequently satisfied with the financial compensation compared with oocyte donors (P = 0.005). No difference in the development of symptoms of anxiety or depression was detected 14-17 years post-donation.

CONCLUSION

Long-term follow-up studies on donors are important for recruiting donors, and for recipients and the children who will be conceived with donated gametes. The results from the current study indicate that donors, generally, have good mental health and do not regret their decision to donate gametes. These findings are reassuring for all parties involved.

Motivational stimuli to donate sperm among non-donor students

BACKGROUND

Sperm banks face a continuously evolving gap between the increasing demand for sperm donation (SD) vs. limited available reserve. To improve donors' recruitment and increase supply, motivations towards SD should be investigated specifically among young men who have the potential to become donors. Our aim was to evaluate factors which increase and decrease predisposition to donate sperm among non-donor students, who represent a "potential pool" for possible donors' recruitment.

RESULTS

Ninety-three men fulfilled the questionnaire with mean age of 28.2 ± 4.5 years. The most powerful incentive to donate sperm was financial reward followed by a willingness to help others to build a family (3.8 and 3.4, respectively). The most dominant consideration to decline donation was the fear of anonymity loss and future regret (4 and 3.8). While participants' willingness for anonymous SD was fair (2.8), the open-identity donation was rated significantly lower (1.75, p < 0.01). Familiarity with recipients and offspring had lower scores (1.9-2.2) as well.

CONCLUSIONS

Young single men represent a suitable cohort for anonymous donation. Financial reward and willingness to help others are important positive incentives while anonymity preservation is crucial to maintain their willingness towards SD. Regulatory shifting towards open-identity SD necessitates the establishment of an alternative "potential pool" population as a reliable source to recruit donors.

Who's your daddy? An ethical argument for disclosure to donor conceived children

To our knowledge, there have been few discussions in the andrology literature regarding the ethics of disclosure to donor conceived children. Our goal in this paper is to summarize the main reasons in favor of disclosure to engender more conversations about the ethics of donor conception in andrology circles. Specifically, we argue (1) transparency regarding gamete donation upholds the ethical principle of beneficence by improving the psychological health of donor conceived children; and (2) based on the ethical principle of autonomy, donor conceived children should have the right to know their donor status.

Exploring the Landscape of Social Egg Freezing: Navigating Medical Advancements, Ethical Dilemmas, and Societal Impacts

This narrative review article comprehensively explores the multifaceted landscape of social egg freezing, delving into its medical, ethical, societal, psychological, legal, and cultural dimensions. Oocyte cryopreservation, a developing procedure, gives women the chance to match their life goals with fertility goals. Informed decision-making, morally sound guidance, and open communication are all stressed by ethical considerations. Family planning practices, workplace cultures, and gender equality all have an impact on societal dynamics. The process's emotional toll and associated coping mechanisms are highlighted by psychological elements. Legal and policy frameworks need constant ethical reflection and understanding of the regulatory environment. Religious and cultural views highlight the variety of perspectives that influence attitudes toward this practice. For responsible practice to ensure individual liberty while navigating the evolving landscape of reproductive options, it is essential to comprehend how these aspects interact.

An Ethical Examination of Donor Anonymity and a Defence of a Legal Ban on Anonymous Donation and the Establishment of a Central Register

Many if not most sperm donors in the early years of IVF donated under conditions of anonymity. There is, however, a growing awareness of the ethical cost of withholding identifying parental information from donor children. Today, anonymous donation is illegal in many jurisdictions, and some jurisdictions have gone as far as retrospectively invalidating contracts whereby donors were guaranteed anonymity. This article provides a critical evaluation of the ethics and legality of anonymous donation. We defend Australian and British legislation that has outlawed donor anonymity, and we argue for the establishment of a central registry that provides donor children with the ability to easily and reliably access identifying information about their donor parents.

Experiences and attitudes of Danish men who were sperm donors more than 10 years ago; a qualitative interview study

BACKGROUND

More knowledge about the long-term impact of sperm donation is essential as the donor's attitude towards donation may change over time. Personal and social developments may prompt a rethinking of previous actions and decisions, or even regret. Thus, the aim of this study was to explore the experiences and attitudes of men who were sperm donors more than 10 years ago.

METHODS

From May to September 2021, semi-structured, qualitative interviews were conducted with 23 former donors (> 10 years since last donation) from Cryos International sperm bank. Two participants were non-anonymous donors and 21 were anonymous. The interviews were conducted by phone or via video (mean 24 minutes). All interviews were recorded, transcribed verbatim and rendered anonymous. Data were analyzed using thematic analysis.

RESULTS

The analysis showed that most men had been donors for monetary and altruistic purposes, and now considered sperm donation as a closed chapter that was 'unproblematic and in the past'. Most men valued anonymity and emphasized the non-relatedness between donor and donor conceived offspring. Knowledge about recipients and donor offspring was seen as 'damaging' as it could create unwanted feelings of relatedness and responsibility towards them. All men acknowledged donor conceived persons' potential interests in knowing about their genetic heritage in order to understand appearance and personal traits, but also emphasized the donors' rights to anonymity. Potential breach of anonymity was generally considered 'highly problematic' as it was expected to disturb their families and force a relationship on them.

CONCLUSION

This study reports on former donors who might not have volunteered for research due to lack of interest or protection of privacy. The majority of men valued anonymity and clearly demarcated a line between sperm donation and fatherhood, which was enforced by not knowing about the donor offspring or recipients.

Adolescent Development and the Parent-Adolescent Relationship in Diverse Family Forms Created by Assisted Reproduction

Assisted reproduction techniques (ARTs) are employed by single individuals and couples who are not otherwise able to conceive spontaneously. While the use of ARTs is increasing, research is lacking on the attempts made by adolescent offspring conceived via ARTs to integrate their ART conception into their identity and negotiate a connection with, and autonomy from, their parents. The present article reviews studies investigating adolescent development and the parent-adolescent relationship in diverse family forms created by ARTs (mainly heterosexual and lesbian parent families), and discusses the results in light of attachment, identity development, and emotional distance regulation theories. Overall, the results indicate that the psychological adjustment of adolescents conceived via ARTs is not undermined by the manner of their conception, and that they enjoy positive relationships with their parents with no difference from those enjoyed by spontaneously conceived adolescents. However, it remains unknown whether the development of a reproductive identity in adolescence is likely to influence adolescents' interest in searching for or contacting their donors, surrogates, and/or donor siblings. The results suggest the relevance of considering the parent-adolescent relationship, disclosure, and identity formation issues when planning psychological counseling and support interventions with ART parents and their adolescent offspring, and emphasize the need to further investigate these aspects in diverse ART families, including single-, gay-, bisexual-, and trans*-parent families.

Understanding the Reasons Why Men and Women Do Not Donate Gametes

The global under-supply of sperm and oocyte donors is a serious concern for assisted reproductive medicine. Research has explored self-selected populations of gamete donors and their ex-post rationalisations of why they chose to donate. However, such studies may not provide the necessary insight into why the majority of people do not donate. Utilising the unique open form responses of a large sample (n = 1035) of online survey respondents, we examine the reasons participants cite when asked: “Why haven’t you donated your sperm/eggs?.” We categorise these responses into four core themes (conditional willingness, barriers, unconsidered, and conscientious objector) and eleven lower-order themes. We find that, on average, women are more conditionally willing (8.2% difference; p = 0.008) to participate in gamete donation than men. We also find that women are more likely than men to justify their non-donation based on their reproductive history (21.3% difference; p = 0.000) or kin selection and inclusive fitness (5.7% difference; p = 0.008). However, compared to women, men are more likely to validate their non-donation based on sociocultural or social norms (6% difference; p = 0.000) or religion (1.7% difference; p = 0.030). That so many of our study participants report in-principal willingness for future participation in gamete donation speaks to the need for increased research on understanding non-donor population preferences, motivations, and behaviours.

Medical ethics when moving towards non-anonymous gamete donation: the views of donors and recipients

Drawing on the views of donors and recipients about anonymity in a country that is experiencing a transition towards non-anonymous gamete donation mandated by the Constitutional Court, we explore how the intersection between rights-based approaches and an empirical framework enhances recommendations for ethical policy and healthcare. Between July 2017 and April 2018, 69 donors and 147 recipients, recruited at the Portuguese Public Bank of Gametes, participated in this cross-sectional study. Position towards anonymity was assessed through an open-ended question in a self-report questionnaire, which was subject to content analysis. Preference for an anonymous donation regime was mentioned by 82.6% of donors and 89.8% of recipients; and all those with children. Instead of the rights-based reasoning used by the Constitutional Court, donors highlighted concerns over future relationships and recipients focused on socioethical values linked with the safeguard of safety, privacy and confidentiality. The remaining participants advocated the choice between anonymity or non-anonymity (double-track policy), invoking respect for their autonomy. The complex, diverse ethical views and reasoning of donors and recipients expand a traditionally dichotomous discussion. Their perspectives challenge the transition towards non-anonymity and international guidelines, raising awareness to the need for their involvement in the design of policies to enable choice according to their values and preferences, and of psychosocial counselling responsive to their socioethical concerns and sensitive to their parental status. Empirical frameworks complement rights-based approaches to uphold justice, fairness and equal respect, and to incorporate utility, beneficence and non-maleficence in policymaking and healthcare in the transition towards non-anonymity.

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.

OUP accepted manuscript

STUDY QUESTION

What information and support should be offered to donors, intended parents and donor-conceived people, in general and in consideration of the availability of direct-to-consumer genetic testing and matching services?

SUMMARY ANSWER

For donors, intended parents and donor-conceived offspring, recommendations are made that cover information needs and informed consent, psychosocial implications and disclosure.

WHAT IS KNOWN ALREADY

Trends indicate that the use of donor-assisted conception is growing and guidance is needed to help these recipients/intended parents, the donors and offspring, navigate the rapidly changing environment in which donor-assisted conception takes place.

STUDY DESIGN, SIZE, DURATION

A working group (WG) collaborated on writing recommendations based, where available, on evidence collected from a literature search and expert opinion. Draft recommendations were published for stakeholder review and adapted where relevant based on the comments received.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Papers retrieved from PUBMED were included from 1 January 2014 up to 31 August 2020, focusing on studies published since direct-to-consumer genetic testing has become more widespread and accessible. The current paper is limited to reproductive donation performed in medically assisted reproduction (MAR) centres (and gamete banks): donation outside the medical context was not considered.

MAIN RESULTS AND THE ROLE OF CHANCE

In total, 32 recommendations were made for information provision and support to donors, 32 for intended parents and 27 for donor-conceived offspring requesting information/support.

LIMITATIONS, REASONS FOR CAUTION

The available evidence in the area of reproductive donation is limited and diverse with regards to the context and types of donation. General conclusions and recommendations are largely based on expert opinion and may need to be adapted in light of future research.

WIDER IMPLICATIONS OF THE FINDINGS

These recommendations provide guidance to MAR centres and gamete banks on good practice in information provision and support but should also be considered by regulatory bodies and policymakers at a national and international level to guide regulatory and legislative efforts towards the protection of donors and donor-conceived offspring.

STUDY FUNDING/COMPETING INTEREST(S)

The development of this good practice paper was funded by European Society of Human Reproduction and Embryology (ESHRE), covering expenses associated with the WG meetings, the literature searches and dissemination. The WG members did not receive any payment. The authors have no conflicts of interest to declare.

DISCLAIMER

This document represents the views of ESHRE, which are the result of consensus between the relevant ESHRE stakeholders and where relevant based on the scientific evidence available at the time of preparation.

The recommendations should be used for informational and educational purposes. They should not be interpreted as setting a standard of care, or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. They do not replace the need for application of clinical judgement to each individual presentation, nor variations based on locality and facility type.

^†ESHRE pages content is not externally peer reviewed. The manuscript has been approved by the Executive Committee of ESHRE.

Attitudes of sperm donors towards offspring, identity release and extended genetic screening

RESEARCH QUESTION

What is sperm donors' attitude towards offspring, anonymity and extended genetic screening?

DESIGN

An online questionnaire for sperm donors was administered at Cryos International in the USA and Denmark between 9 and 30 September 2020. A total of 233 donors (37 in the USA and 196 in Denmark) completed the questionnaire. This study is unique because it was performed in a setting that allows donors to choose to be either ID-release or non-ID-release donors.

RESULTS

Most donors had two motives to donate: helping childless people and/or financial compensation. ID-release donors differed significantly from non-ID-release donors in numerous aspects of the donation, including relationships with the offspring, information sharing with others and wanting information about offspring. In general, donors had a very positive attitude towards genetic testing and extended genetic screening.

CONCLUSIONS

Offering the possibility for donors to be either ID-release or non-ID-release allows more donors to be recruited than if only one option were available. The multiple differences between the two donor types suggests that these are groups with profoundly different attitudes towards donation. The general attitude of donors towards genetic testing and expanded genetic screening is very positive but further studies on the attitude of candidate donors are needed.

Donor-centred care: the facilitating and constraining factors experienced by gamete donors in a public bank

The provision of care that is responsive to the preferences, needs and values of gamete donors is key to improving their recruitment and ensuring the functioning of gamete banks. This qualitative study aimed to explore gamete donors' experiences about the facilitating and constraining human and system factors to donor-centred healthcare delivery in gamete banks. It is based on 20 semi-structured interviews with oocyte and sperm donors, recruited at the Portuguese Public Bank of Gametes, conducted from November 2017 to February 2019. Deductive content analysis was performed using the software NVivo12, following the patient-centred infertility care model. Interviewees identified facilitating factors mostly related with the human dimension of care (i.e. careful and available attitude and behaviours of health professionals, as well as their good communication skills and emotional support). Constraining factors were predominantly identified at the system level (i.e. insufficient information provision, poor coordination, and integration). Lack of privacy emerged simultaneously as a human and a system constraining factor (i.e. physical discomfort during medical-technical acts or gamete collection). There is room for improving clinical practice and the organisation of healthcare services within a context where the competence and attitude of, and relationship with, the staff are highly valued.

The stability of psychological adjustment among donor-conceived offspring in the U.S. National Longitudinal Lesbian Family Study from childhood to adulthood: differences by donor type

OBJECTIVE

To study differences by sperm donor type in the psychological adjustment of the U.S. National Longitudinal Lesbian Family Study (NLLFS) offspring across three time periods from childhood to adulthood.

DESIGN

U.S.-based prospective cohort study.

SETTING

Paper-and-pencil questionnaires and protected online surveys.

PATIENT(S)

A cohort of 74 offspring conceived by lesbian parents using an anonymous (n = 26), a known (n = 26), or an open-identity (n = 22) sperm donor. Data were reported when offspring were ages 10 (wave 4), 17 (wave 5), and 25 (wave 6).

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Achenbach Child Behavior Checklist administered to lesbian parents when offspring were ages 10 and 17 and the Achenbach Adult Self-Report administered to offspring at age 25.

RESULT(S)

In both relative and absolute stability, no differences were found in internalizing, externalizing, and total problem behaviors by donor type over 15 years. However, both externalizing and total problem behaviors significantly declined from age 10 to 17 and then increased from age 17 to 25. Irrespective of donor type, among the 74 offspring, the large majority scored continuously within the normal range on internalizing (n = 62, 83.8%), externalizing (n = 62, 83.8%), and total problem behaviors (n = 60, 81.1%).

CONCLUSION(S)

The results reassure prospective lesbian parents and provide policy makers and reproductive medicine practitioners with empirical evidence that psychological adjustment in offspring raised by lesbian parents is unrelated to donor type in the long term.

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.

A comparison of the characteristics, motivations, preferences and expectations of men donating sperm online or through a sperm bank

STUDY QUESTION

How do the demographic characteristics, motivations, experiences and expectations of unregulated sperm donors (men donating sperm online through a connection website) compare to sperm donors in the regulated sector (men donating through a registered UK sperm bank)?

SUMMARY ANSWER

Online donors were more likely to be older, married and have children of their own than sperm bank donors, were more varied in their preferences and expectations of sperm donation, and had more concerns about being a sperm donor.

WHAT IS KNOWN ALREADY

While studies have examined motivations and experiences of both regulated sperm bank, and unregulated online sperm donors, no study has directly compared these two groups of donors.

STUDY DESIGN, SIZE, DURATION

An email was sent to the 576 men who were registered sperm donors at the London Sperm Bank, the UK’s largest sperm bank regulated by the Human Fertilisation and Embryology Authority (HFEA), who had commenced donation between January 2010 and December 2016, and had consented to be contacted for research. The online survey, which contained multiple choice and open-ended questions, was completed by 168 men over a 7-week period. The responses were compared to those of sperm donors registered on Pride Angel, a large UK-based connection website for donors and recipients of sperm: our research team had already collected these data. In total, 5299 sperm donors were on Pride Angel at time of data capture and 400 men had completed a similar survey. The responses of 70 actual online sperm donors (i.e. those whose sperm had been used to conceive at least one child) were used for comparison with the sperm bank donors.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The survey obtained data on the sperm donors’ demographic characteristics, motivations, experiences and expectations of sperm donation. Data from sperm bank donors were compared to online donors to examine differences between the two groups. The study compared online and clinic donors who had all been accepted as sperm donors: online donors who had been ‘vetted’ by recipients and sperm bank donors who had passed the rigorous screening criteria set by the clinic.

MAIN RESULTS AND THE ROLE OF CHANCE

A response rate of 29% was obtained from the sperm bank donors. Online donors were significantly older than sperm bank donors (mean ± SD: 38.7 ± 8.4 versus 32.9 ± 6.8 years, respectively) and were more likely to have their own children (p < 0.001 for both characteristics). Both groups rated the motivation ‘I want to help others’ as very important. Online donors rated ‘I don’t want to have children myself’, ‘to have children/procreate’ and ‘to enable others to enjoy parenting as I have myself’ as more important than sperm bank donors, whereas sperm bank donors rated financial payment as more important than online donors, as well as confirmation of own fertility. Most (93.9%) online donors had donated their sperm elsewhere, through other connection sites, fertility clinics, sperm banks or friends and family, compared to only 2.4% of sperm bank donors (p < 0.001). There was a significant difference in how donors viewed their relationship to the child, with online donors much less likely than sperm bank donors to see their relationship as a ‘genetic relationship only’. Online donors had more concerns about being a donor (p < 0.001), for example, being concerned about ‘legal uncertainty and child financial support’ and ‘future contact and uncertainty about relationship with donor-conceived child’.

LIMITATIONS, REASONS FOR CAUTION

Findings may not be representative of all sperm donors as only one online connection site and one HFEA registered sperm bank were used for recruitment.

WIDER IMPLICATIONS OF THE FINDINGS

Despite concern regarding shortages of sperm donors in licensed clinics and unease regarding the growing popularity of unregulated connection websites, this is the first study to directly compare online and sperm bank donors. It highlights the importance of considering ways to incorporate unregulated online sperm donors into the regulated sector. With many online donors well aware of the legal risks they undertake when donating in the unregulated online market, this would both increase the number of sperm donors available at clinics but also provide legal protection and support for donors.

STUDY FUNDING/COMPETING INTEREST(S)

This study was supported by the Wellcome Trust Grants 104 385/Z/14/Z and 097857/Z/11/Z. The authors have no conflicts of interest.

Adult offspring of lesbian parents: How do they relate to their sperm donors?

OBJECTIVE

To study how adult offspring in planned lesbian-parent families relate to their unknown or known donors.

DESIGN

Qualitative analyses of the sixth wave of online surveys from a longitudinal study of adult offspring in planned lesbian families, enrolled at conception.

SETTING

Community-based United States national study.

PATIENT(S)

The 76 participants were 25-year-old donor insemination (DI) offspring whose lesbian parent(s) enrolled in a prospective longitudinal study when these offspring were conceived.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Offspring were asked about donor type, feelings about permanently unknown donor, satisfaction with and role of known donor, whether relationship with known donor was ongoing, and age of meeting open-identity donor.

RESULT(S)

This cohort (n = 76) of DI offspring with lesbian parents was among the first generation to reach adulthood. Thirty participants had permanently unknown donors and most participants felt comfortable about not knowing them. Sixteen participants had open-identity donors they had not met. Thirty had currently known donors-met in childhood (n = 22) or after open-identity donor disclosure (n = 8)-of whom two thirds had ongoing relationships with donors, half considered their donors as acquaintances, and nearly half had good feelings about their relationship, although a minority expressed conflicted feelings.

CONCLUSION(S)

This study of adult DI offspring from planned lesbian families shows that those who knew their donors mainly felt positively about these relationships. Qualitative analyses offered insight into offspring-donor relationships, whose numbers are increasing due to historical and demographic trends.

The ethical case for non-directed postmortem sperm donation

In this article we outline and defend the concept of voluntary non-directed postmortem sperm donation. This approach offers a potential means of increasing the quantity and heterogeneity of donor sperm. This is pertinent given the present context of a donor sperm shortage in the UK. Beyond making the case that it is technically feasible for dead men to donate their sperm for use in reproduction, we argue that this is ethically permissible. The inability to access donor sperm and the suffering this causes, we argue, justifies allowing access to sperm donated after death. Moreover, it is known that individuals and couples have desires for certain sperm donor characteristics which may not be fulfilled when numbers of sperm donors are low. Enacting these preferences contributes significantly to the well-being of intended parents, so we argue that this provides a pro tanto reason for respecting them. Finally, we explore the benefits and possible disadvantages of such a system for the various parties affected.

Psychosocial aspects of identity-release gamete donation - perspectives of donors, recipients, and offspring

Donor conception creates families with varying genetic linkage between family members. This may have short-term as well as lifelong psychosocial consequences for all involved. Gamete donors have traditionally been anonymous to recipients and offspring, but there is a growing trend towards identity-release donor programmes that give offspring the right to obtain the donor's identity. This review aims to provide an overview of the perspectives of donors and recipients and offspring involved in identity-release donation. The results show that both oocyte and sperm donors have primarily altruistic motives, and recipients, in particular lesbian and single women, are generally open about the donation to their offspring. The few existing studies on offspring perspectives indicate that those who are aware of their donor conception appear to be interested in contact with the donor, and most donors are open to such contact. Investigations of donors and recipients indicate a need for more counselling and support to manage family life with varying genetic linkage within and outside the family unit. This includes preparing for and managing future contact between the donor and his/her family and donor offspring and their family, as well as between donor siblings and their respective families.

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 &gt; 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.

Worlds apart or two sides of the same coin? Attitudes, meanings, and motives of potential oocyte and sperm donors in Austria

Purpose

Gamete donors and recipients of such donations have been explored by previous studies, which mostly focus on post-donation scenarios. Our study analyses the general willingness to donate oocytes or sperm and focuses on differences between potential female and male donors in attitudes, meanings, and motives in a pre-donation setting.

Methods

An electronic survey (n = 555 students) was used in this anonymous observational study. To enable comparisons between men and women regarding their attitudes, meanings, and motives and their willingness to donate gametes, we designed two separate questionnaires.

Results

The sample was divided into three groups based on the willingness to donate: potential donors (n = 133; women: 48.1%, men: 51.9%); doubtful donors (n = 207; women: 75.8%, men: 24.2%); and non-donors (n = 215; women: 68.3%, men: 31.7%). The group of potential male donors (39.2%) was significantly larger than the group of potential female donors (16.9%). Significant differences regarding altruism, the meaning of one’s self-worth, and passing on the own genes were found between doubtful and potential donors. Potential donors attached less value to altruism but more value to the enhancement of one’s self-worth and passing on one’s genes than doubtful donors. The motive of passing on one’s genes and altruistic motives were more important to men than to women.

Conclusion

This study helps to create a better understanding of potential donors in the existing donation framework and supports the evaluation of the given regimes in the context of designing an improved framework.

Applications to statutory donor registers in Victoria, Australia: information sought and expectations of contact

Knowledge of genetic origins is widely believed to have consequences for health, family belonging and personal identity. Donor linking is the process by which donors, recipient parents (RP) and donor-conceived people (DCP) gain access to identifying information about each other. This paper reports on the information and contact sought by donor-linking applicants to the central and voluntary registers in the state of Victoria, Australia, which has one of the most comprehensive donor-linking legislative frameworks in the world. Applicants to the Victorian registers complete a statement of reasons (SOR), a written document that is given to the subject of the application, outlining their reasons for applying and their short- and long-term goals. SOR written by applicants between 29 June 2015 and 28 February 2017 who had agreed to be recontacted for research were analysed. Forty-two of 93 eligible applicants took part (45%). All applications pertained to donor sperm. RP were the largest applicant group (n = 19) followed by DCP (n = 17) and donors (n = 6). All applicants wanted personal information and most expressed a desire for contact. Single mothers of young children used the registers more than any other parent group, indicating that family structure may influence application patterns. While it is apparent that all applicants are eager for information and some form of interpersonal contact, further research is needed on how the legal and policy landscape of different jurisdictions influences expectations, as well as what happens after parties are linked.

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.

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.

Anonymous Dutch sperm donors releasing their identity

This study examined the motivations of anonymous Dutch sperm donors to release their identity. It aimed to increase knowledge and encourage donors to become identifiable through a more informed decision, allowing more donor-conceived persons to contact their donors. Since 2010, anonymous sperm donors in the Netherlands can register in the Fiom KID-DNA Database developed by Fiom and Canisius Wilhelmina Hospital (CWZ). An online survey was sent to donors who registered in the database (May 2015-August 2017). A total of 179 male respondents participated in this study. The motives of most donors to register in the database were child-oriented: donors believe that their offspring are entitled to their physical and social details and/or they want to give their offspring the chance to contact them. Other motives are donor-oriented, such as the curiosity about the number of offspring, their well-being and the desire to establish contact. This research showed that, to encourage anonymous donors to release their identity, one should focus on providing information about the existence of DNA databases. As well as increasing the donor's awareness of problems donor-conceived persons can experience by the lack of knowledge about their descent, answering questions and concerns from donors, and exploring the curiosity about their offspring.

'Is blood thicker than water?' Donor conceived offspring's subjective experiences of the donor: a systematic narrative review

The aim of this study was to provide a systematic narrative review of the published research articles on donor conceived offspring's subjective experiences of their donor. A systematic search of electronic databases (PsycINFO and PubMed) provided 29 published quantitative and qualitative studies matching the inclusion criteria. The analysis of the studies outcomes led to the identification of four main themes: (i) views/representations of the donor; (ii) desire to contact the donor (in terms of desire to meet the donor, reasons for wanting to contact the donor, type and frequency of contact); (iii) reactions to discovering the donor's identity and contacting the donor; (iv) identity issues. The findings revealed that genetic ties do matter to donor conceived people, especially during adolescence or adulthood. Many donor conceived people were interested in contacting the donor and all of them needed to make meaning of the role of the donor, as well as to integrate it into their family life and self-concept. Besides curiosity and medical reasons, many people reported wanting to contact the donor to see what he/she looked like, and to have access to their own ancestry and genetic history.

"I want us to be a normal family": Toward an understanding of the functions of anonymity among U.S. oocyte donors and recipients

BACKGROUND

Anonymity remains the more common practice in gamete donations, but legislation prohibiting anonymity with a goal of protecting donor-conceived children's right to know their genetic origins is becoming more common. However, given the dearth of research investigating the function of anonymity for donors and recipients, it is unclear whether these policies will accomplish their goals. The aim of this study was to explore experiences with anonymity among oocyte donors and recipients who participated in an anonymous donor oocyte program and to understand the ways in which anonymity functions for them.

METHODS

Semistructured interviews were conducted with 50 women: 28 oocyte donors and 22 recipients who were recruited from an academic center for reproductive medicine in the United States.

RESULTS

Donors and recipients view anonymity both as a mechanism to protect the interests of all parties (recipients, donors, and donor-conceived children) and as a point of conflict. Specifically, three key areas were identified where both donors and recipients saw anonymity as having an important role: relieving anxieties about family structures and obligations; protecting their interests and those of donor-conceived children (while acknowledging where interests conflict); and managing the future.

CONCLUSION

As gamete donation increasingly moves away from the practice of anonymity, examining why anonymity matters to stakeholders will be helpful in devising strategies to successfully implement identity-release options.

Clinical vs. exclusively online sperm donors: what's the difference?

BACKGROUND/OBJECTIVES

As the growth of the internet and commercial connection websites increasingly facilitates sperm donation outside of clinical (formal) settings, studies looking into informal (online) donor psychology and behaviour are both extremely warranted and currently under-researched. This study's aim was to identify key differences between informal donor males with a history of clinical donation, and those who exclusively participate in the informal market.

METHODS

The study utilises (N = 112) current informal sperm donors' demographics and personality traits taken from registered members of the connection website PrideAngel (Nov-Dec 2016). This study conducts probit multivariate and interaction analysis of socioeconomic and personality factors to explore key differences in males who have chosen to exclusively donate through connection websites and those with a clinical history.

RESULTS

Results from this sample show that exclusively informal donors are more likely to be in some form of committed relationship. Exclusively informal males are also more likely to identify as a sexuality other than heterosexual (e.g. gay, bisexual or asexual). Also, exclusively informal participants exhibit higher average scores for the personality trait agreeableness.

CONCLUSIONS

Overall, this study demonstrates key differences in the relationship status, sexuality and personality traits of a new and burgeoning group of males and their reproductive psychology and behaviour.

Non-donors' attitudes towards sperm donation and their willingness to donate

PURPOSE

The aim of this article is to study attitudes about sperm donation and willingness to donate sperm in students who have never shown an interest in sperm donation.

METHODS

The method used in this study is an electronic survey of 1012 male students.

RESULTS

Only one third of the respondents (34.3%) would consider donating sperm. Overall, 85.7% indicated a positive attitude towards sperm donation while 14.3% indicated a neutral or negative attitude. The highest scored barriers to donating were the lack of practical information and the fear that the partner would not agree. Almost 40% of the respondents feared that the donation might have a negative impact on their current or future relationship. The majority (83.6%) of those who considered donating thought donors should receive a financial compensation. Money was also one of the main motivators.

CONCLUSIONS

About 85% of the students thought positively about sperm donation but several factors such as perceived negative views by the social environment, especially the partner, may deter students from donating. This study indicates that the effect of strong incentives, for instance in monetary terms, on a donor pool consisting of students could be limited and that relational factors and donor's perceptions of the views of the wider social network should be taken into account when recruiting donors.

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.

What women want in their sperm donor: A study of more than 1000 women's sperm donor selections

Reproductive medicine and commercial sperm banking have facilitated an evolutionary shift in how women are able to choose who fathers their offspring, by notionally expanding women's opportunity set beyond former constraints. This study analyses 1546 individual reservations of semen by women from a private Australian assisted reproductive health facility across a ten year period from 2006 to 2015. Using the time that each sample was available at the facility until reservation, we explore women's preference for particular male characteristics. We find that younger donors, and those who hold a higher formal education compared to those with no academic qualifications are more quickly selected for reservation by women. Both age and education as proxies for resources are at the centre of Parental Investment theory, and our findings further build on this standard evolutionary construct in relation to female mate preferences. Reproductive medicine not only provides women the opportunity to become a parent, where previously they would not have been able to, it also reveals that female preference for resources of their potential mate (sperm donor) remain, even when the notion of paternal investment becomes redundant. These findings build on behavioural science's understanding of large-scale decisions and human behaviour in reproductive medical settings.

Online sperm donation: a survey of the demographic characteristics, motivations, preferences and experiences of sperm donors on a connection website

STUDY QUESTION

What are the demographic characteristics, motivations, preferences and experiences of heterosexual, gay and bisexual sperm donors on a connection website (i.e. a website that facilitates direct contact between donors and recipients of gametes)?

SUMMARY ANSWER

This demographically diverse group of men was donating for altruistic reasons and perceived the website as providing greater choice over donation arrangements: approximately one third favoured anonymous donation, most of whom were heterosexual, whilst gay and bisexual donors were more likely to be in contact with children conceived with their sperm.

WHAT IS KNOWN ALREADY

Despite substantially more sperm donors being registered on connection websites than with clinics, there has been very little research on this population. Current understanding of the impact of sexual orientation on donors' attitudes is also limited.

STUDY DESIGN, SIZE, DURATION

An online survey was conducted over 7 weeks with 383 men registered as sperm donors with Pride Angel, a large UK-based connection website for donors and recipients of sperm.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The survey obtained data on participants' demographic characteristics and their motivations, preferences and experiences regarding online sperm donation, including attitudes towards contact with offspring. Differences according to participants' sexual orientation were examined.

MAIN RESULTS AND THE ROLE OF CHANCE

Most participants (80.4%, 308) were heterosexual, 10.5% (40) were gay and 9.1% (35) were bisexual; ages ranged from 18 to 69 years (median = 36, mean = 37.3, SD = 9.7). A greater proportion of gay and bisexual men desired open-identity donation (P < 0.005) and contact with offspring (P <0.005) than heterosexual men. Approximately one third (28.7%, 110) had donated sperm; 18.3% (70) had conceived at least one child, of whom a minority (25.7%, 18) were currently in contact with the child, comprising significantly more gay and bisexual than heterosexual men (P = 0.001). Heterosexual men were most likely to state a preference for natural insemination, although the large majority (94.3%, 66) of donors who had conceived children had used artificial insemination.

LIMITATIONS, REASONS FOR CAUTION

Findings may not be representative of all sperm donors using connection websites because members of only one website participated and participants were, by necessity, a self-selected sample.

WIDER IMPLICATIONS OF THE FINDINGS

This is the first comprehensive study of donors who connect with recipients via the internet, including a substantial number who have donated and conceived children. The findings indicate that sexual orientation may influence men's donation preferences and raise policy issues concerning donor recruitment and the incorporation of online sperm donation into clinical practice.

STUDY FUNDING/COMPETING INTERESTS

This study was supported by the Wellcome Trust (097857/Z/11/Z). E.T. is the co-founder of Pride Angel; the remaining authors have no conflicts of interest.

Industry is not the dark side, but an essential partner to make progress in reproductive health

For the last 20 years, Thomas D'Hooghe has been coordinator of the Leuven University Fertility Center at Leuven University Hospitals, Belgium, one of the largest teaching hospitals in Europe. Since 1995, he has also been Professor of Reproductive Medicine and Biology at KU Leuven (University of Leuven) and Adjunct Professor at Yale University, USA. Since 1 October 2015, he has been the Vice President and Head of Global Medical Affairs Fertility at Merck's headquarters in Darmstadt, Germany. He has published nearly 300 papers in internationally peer-reviewed journals and has contributed to reproductive health serving major international organizations such as the WHO, the European Society of Human Reproduction and Embryology, the Society of Reproductive Investigation and the World Endometriosis Research Foundation.

What motivates men to offer sperm donation via the internet?

To investigate why men offer sperm donation via the internet, a questionnaire was disseminated via 39 Dutch-language websites thought to be visited by potential sperm donors. Nine internet donors completed the survey, men who typically knew the women they were donating to. Their responses were compared with those of a control group of 35 general sperm bank donors who were recruited using flyers in Dutch sperm banks, and who were typically unaware of the identity of the eventual recipients. The findings shed light on the motives and attitudes of internet donors. Both groups of donors indicated that their primary motivation for donating was altruism (>80% of all respondents). However, internet donors had a more pronounced desire to procreate than sperm bank donors (6 out of 9, i.e. 66 vs. 22%, respectively) and more often felt that they had good genes they wished to pass on (5 out of 9, i.e. 55 vs. 31%, respectively). The main reason internet donors gave for donating via the internet was that they wanted to know the prospective parents and be kept up to date on the progress of the offspring conceived from their donations. This distinguishes them significantly from sperm bank donors. A further finding was that they were not prompted to avoid the formal donation circuit for which, by law in the Netherlands, pregnancies resulting from donations have to be registered in a central database. This study is subject to several, in some cases inevitable, limitations, but it provides an interesting starting point that future studies can seek to confirm and extend.

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.

Evolving minimum standards in responsible international sperm donor offspring quota

An international working group was established with the aim of making recommendations on the number of offspring for a sperm donor that should be allowable in cases of international use of his sperm. Considerations from genetic, psychosocial, operational and ethical points of view were debated. For these considerations, it was assumed that current developments in genetic testing and Internet possibilities mean that, now, all donors are potentially identifiable by their offspring, so no distinction was made between anonymous and non-anonymous donation. Genetic considerations did not lead to restrictive limits (indicating that up to 200 offspring or more per donor may be acceptable except in isolated social-minority situations). Psychosocial considerations on the other hand led to proposals of rather restrictive limits (10 families per donor or less). Operational and ethical considerations did not lead to more or less concrete limits per donor, but seemed to lie in-between those resulting from the aforementioned ways of viewing the issue. In the end, no unifying agreed figure could be reached; however the consensus was that the number should never exceed 100 families. The conclusions of the group are summarized in three recommendations.