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definition - Sperm donation

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Sperm donation

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Sperm donation is the name of the provision (or 'donation') by a man, known as a sperm donor, of his semen with the intention that it be used to achieve a pregnancy and produce a baby in a woman who is not the man's sexual partner.

Sperm donated in this way is known as donor sperm.

Pregnancies are most commonly achieved via sperm donation by the use of artificial insemination (known as AI or, where a donor is used, as donor insemination or DI), and less commonly by IVF or another ART method, rather than by NI (or sexual intercourse). Sperm donation is a means of third party reproduction.

A sperm donor may donate his sperm directly to recipient women, at a clinic known as a sperm bank or through a third party which brokers arrangements between sperm donors and recipient women, known as a 'sperm agency'.

Sperm donation commonly assists heterosexual couples unable to produce children because of 'male factor' fertility problems, but it is increasingly used as a means to enable single women (termed choice mothers) and single and coupled lesbians to have children.[1] The sperm donor is the genetic or biological father of each child produced with the use of his sperm. When a donor's sperm is successfully used repeatedly for impregnation in the same, or different, women, numbers of siblings and half-siblings will be produced.

Donors may be either anonymous or non-anonymous, although laws may require donors to be one or the other, or restrict the number of children each donor may father. Although many donors choose to remain anonymous, new technologies such as the Internet and DNA technology has opened up new avenues for those wishing to know more about the biological father, siblings and half-siblings.

Contents

Provision

A man who provides sperm as a sperm donor generally gives up all legal and other rights over the biological children produced from his sperm. It is for this reason that the process is known as 'sperm donation'. Sperm banks and fertility clinics provide significant access to sperm from anonymous sperm donors. There may also be sperm agencies that, usually via the Internet, mediate sperm delivery directly from a donor to the recipient. Private donors (see types of donors) donate independently of banks or agencies. Donors may operate either as anonymous donors, or "directed" donors, who direct their sperm to be used by a specific person.

Sperm banks

In a sperm bank, the donor will usually enter into a contract to donate sperm for a specified contractual period of time generally ranging from six to twenty four months. To donate sperm a man must generally meet specific requirements regarding age and medical history. In the United States, sperm banks are regulated as Human Cell and Tissue or Cell and Tissue Bank Product (HCT/Ps) establishments by the FDA. Many states also have regulations in addition to those imposed by the FDA. In the UK sperm banks are regulated by the HFEA. A man donates sperm at a clinic or sperm bank by way of masturbation in a private room or cabin, known as a 'men's production room' (UK) or a masturbatorium (USA). Many of these facilities contain pornography such as videos, magazines, and/or photographs which may assist the donor in becoming stimulated in order to facilitate production of the ejaculate, also known as the 'semen sample'. The sample is then processed which may include 'washing' the sample so that sperm may be extracted from the rest of the material in the semen, an extender is added which also assists the freezing process, and the sample is then frozen in a number of small glass tubes known as 'vials'. One sample (or ejaculate) will be frozen into between six and twelve vials depending on the quantity of the ejaculate, and whether the sample is 'washed' or 'unwashed' . Following the necessary quarantine period, the samples will be thawed when required and used to impregnate women through artificial insemination or other ART treatments. 'Unwashed' samples are used in artificial insemination and in IVF treatments, and 'washed' samples are used in IUI and IVF procedures.

Medical screening

Sperm banks screen every potential donor for genetically inheritable diseases and infectious diseases that may be transmitted through sperm.

In the US, the screening procedures are regulated by the FDA, the ASRM, the American Association of Tissue Banks, and the CDC. [2] The screening regulations are more stringent today than they have been in the past. [3]

Screening includes:[2]

Donors of Jewish, Québécois, or Cajun descent may also get genetic testing for the carrier trait of Tay Sachs disease.

Sperm donors are required to be fit and healthy and generally their 'sperm count' will be well above average to ensure that pregnancies may be easily and swiftly achieved by the use of their sperm.

HIV

The samples are generally frozen and stored for at least 6 months after which the donor will be re-tested for the HIV virus. The reason for this is that the virus takes time to establish itself in the body and a further test is therefore necessary. Providing the result is negative, the sperm samples can be released from quarantine and used in treatments.

Washing techniques are developing that purify sperm from viral load of HIV and hepatitis C.[4]

Cytomegalovirus

Screening for cytomegalovirus is only carried out in the UK and USA, and positive donors may still donate at sperm banks.[5]

Donor screening for cytomegalovirus (CMV) is carried out by testing for IgG antibodies against CMV that are produced if the donor ever has contracted CMV, which is the case in between 50% and 80% of adults[6]. Such antibody-positive individuals may potentially shed virus that remain latent in the body in the semen, infecting the mother and, in turn, the embryo/fetus. Most babies will not be harmed by the virus, but a small percentage may develop neurological abnormalities.[7] However, the risk of acquiring CMV infection from an antibody-positive sperm donor is believed to be extremely low, at least where sperm banks perform follow-up tests on antibody-positive donors for type IgM antibodies that indicate current or recent CMV infection, and where sperm preparations are performed that decrease the amount of white blood cells in the samples, e.g. in samples prepared for IUI.[7] In uncertainty, recipient women may do a blood sample test on themselves for IgG antibodies at their health care provider, determining immunity against the virus.[8]

Preparations

Donated sperm may be prepared for use by artificial insemination in intrauterine insemination (IUI) or intra-cervical insemination (ICI), or, less commonly, it may be prepared for use in other assisted reproductive techniques (ART) such as IVF. Donated sperm may also be used in surrogacy arrangements either by artificially inseminating the surrogate with donor sperm (known as 'partial surrogacy') or by implanting in a surrogate embryos which have been created by using donor sperm together with eggs from a donor or from the 'commissioning woman' ( known as 'full surrogacy'). Spare embryos from this process may be donated to other women or surrogates. Donor sperm may also be used for producing embryos with donated eggs which are then donated to a woman who is not genetically related to the child she produces.

In medical terms, using donor sperm to achieve a pregnancy is no different from using sperm from a woman's partner, and the resulting pregnancy will be the same as a pregnancy achieved through sexual intercourse.

Information about donor

Sperm banks maintain lists or catalogues of donors which provide basic information about the donor such as racial origin, skin color, height, weight, colour of eyes, and blood group.[9] Some of these catalogues are available for browsing via the Internet, whilst others are only made available to patients when they apply to a sperm bank for treatment. Some sperm banks make additional information about each donor available for an additional fee, and others make additional basic information known to children produced from donors when those children reach the age of eighteen. Some clinics offer "exclusive donors" whose sperm is only used to produce pregnancies for one recipient woman. How accurate this is, or can be, is not known, and neither is it known whether the information produced by sperm banks, or by the donors themselves, is true. Many sperm banks will, however, carry out whatever checks they can to verify the information they request, such as checking the identity of the donor and contacting his own doctor to verify medical details. Simply because such information is not verifiable does not imply that it is in any way inaccurate, and a sperm bank will rely upon its reputation which, in turn, will be based upon its success rate and upon the accuracy of the information about its donors which it makes available.

Other screening criteria

Sexually active gay men are prohibited or discouraged from donating in some countries, including the United States.[10] Some sperm banks also screen out some potential donors based on height, baldness, and family medical history.[11]

Sperm donation and reduced birth defects

Children conceived through sperm donation have a birth defect rate of almost a fifth compared with the general population.[12] This may be explained by the fact that sperm banks only accept donors who have good semen quality, and because of the rigorous screening procedures which they adopt. In addition, sperm banks may try to ensure that the sperm used in a particular recipient woman comes from a donor whose blood group and genetic profile is compatible with those of the woman.

Sperm donation and rhesus incompatibility

Sperm donation is also used in cases of rhesus incompatibility. This particularly occurs where a woman is rhesus negative, and her partner is rhesus positive. The woman's body may reject a foetus if it has rhesus positive blood. Anti D injections have been developed and may be used to attempt to avoid this, and these are usually automatically given to rhesus negative women immediately after they give birth to their first child. However, in the past this was either not possible or was not always routinely undertaken where a woman had gave birth or had an abortion and she may have trouble carrying a child later in life. Furthermore, for some women, the anti D injection does not provide the entire solution, particularly where there is a medical history of complications during pregnancy which risk the woman's blood and that of the foetus becoming mixed. In such cases, sperm from a rhesus negative donor can provide the solution and a woman may be able to conceive and carry a pregnancy to full term when otherwise this would not be possible. For this reason, sperm from rhesus negative sperm donors is often in great demand, particularly those with the O negative blood group who are universal donors.

Sperm agencies

Sperm may also be donated through an agency rather than through a sperm bank. The agency recruits sperm donors, usually via the Internet, and it also advertises its services on the Internet. Donors may undergo the same kind of checks and tests required by a sperm bank, although clinics and agencies are not necessarily subject to the same regulatory regimes. In the case of an agency, the sperm will be supplied to the recipient woman fresh rather than frozen. A woman chooses a donor and notifies the agency when she requires donations. The agency notifies the donor who must supply his sperm on the appropriate days nominated by the recipient women. The agency will usually provide the sperm donor with a male collection kit and a container for shipping the sperm. This is collected and delivered by courier and the woman uses the donor's sperm to perform her own artificial insemination, typically without medical supervision. The whole process preserves the anonymity of the parties and it enables a donor to produce sperm in the privacy of his own home. A donor will generally produce samples once or twice during a recipients fertile period, but a second sample each time may not have the same fecundity of the first sample because it is produced too soon after the first one. Pregnancy rates by this method of sperm donation may vary more than those achieved by sperm banks or fertility clinics. Transit times may vary and these have a significant effect on sperm viability so that if a donor is not located near to a recipient woman the sperm may deteriorate. However, the use of fresh, as opposed to frozen semen will mean that a sample has a greater fecundity and this can produce higher pregnancy rates.

Sperm agencies may impose limits on the number of pregnancies achieved from each donor but in practice this is more difficult to achieve than for sperm banks where the whole process may be more regulated. Most sperm donors only donate for a limited period however, and since sperm supplied by a sperm agency is not proceesed into a number of different vials, there is a practical limit on the number of pregnancies which are usually produced in this way. A sperm agency will, for the same reason, be less likely than a sperm bank to enable a woman to have subsequent children by the same donor.

Sperm agencies are largely unregulated and, because the sperm is not quarantined, it may carry sexually transmitted diseases. Agencies typically insist on STI testing for donors, but such tests cannot detect recently-acquired infections. Donors providing sperm in this way may not be protected by laws which apply to donations through a sperm bank or fertility clinic and will, if traced, be regarded as the legal father of each child produced by their sperm, (but see below, Private donors).

Private or "directed" donors

Some donors and recipients choose to arrange donations privately and directly. Recipients may approach a friend, or may obtain a "private" or "directed" donor by advertising. A number of Web sites seek to link such donors and recipients, while advertisements in gay and lesbian publications are common.[citation needed] Although artificial insemination is usually used, the parties may sometimes agree to inseminate by NI (see 'NI and sperm donation below'). Where a private or directed donor is used, sperm need not be frozen. Such donors may already know the recipients, or if arranged through a broker, may meet the recipients and may therefore become known to the recipient. Some brokerage services facilitate contact that maintains semi-anonymous identities for legal reasons.

Private donations may be free of charge - avoiding the significant costs of a more medicalised insemination - and fresh rather than frozen semen is generally deemed to increase the chances of pregnancy. However, they also carry the higher risks associated with any unscreened sexual or body fluid contact. Legal treatment of donors varies across jurisdictions, and in most jurisdictions, e.g., Sweden[13], personal and directed donors lack legal safeguards that may be available to anonymous donors. However, the laws of some nations (e.g., New Zealand), recognize written agreements between donors and recipients in a similar way to institutional donations.

Donor payment

The majority of sperm donors who donate their sperm through a sperm bank receive some kind of payment. This varies from the situation in the United Kingdom where donors are only entitled to their expenses in connection with the donation, to the situation with some US sperm banks where a donor receives a set fee for each donation plus an additional amount for each vial stored. Whilst the amounts concerned in each case are not excessive, some donors are known to donate to more than one sperm bank every week and they are thus able to secure a reasonable monthly income.

Some private donors may seek remuneration although others donate for altruistic reasons. Equipment to collect, freeze and store sperm is available to the public notably through certain US outlets, and some donors process and store their own sperm which they then sell via the Internet.

The selling price of processed and stored sperm is considerably more than the sums which are received by donors. Treatments with donor sperm are generally expensive and are seldom available free of charge through national health services. Sperm banks often package treatments into eg three cycles, and in cases of IVF or other ART treatments, they may reduce the charge if a patient donates any spare embryos which are produced through the treatment. There is often more demand for fertility treatment with donor sperm than there is donor sperm available, and this has the effect of keeping the cost of such treatments reasonably high.

Samples per child

How many donor samples (ejaculates) that are required to help giving rise to a child varies substantially from donor to donor, as well as from clinic to clinic.

However, the following equations generalize the main factors involved:

For intracervical insemination:

N = \frac{V_s \times c \times r_s}{n_r}
Approximate pregnancy rate (rs) varies with amount of sperm used in a cycle (nr). Values are for intrauterine insemination, with sperm number in total sperm count, which may be approximately twice the total motile sperm count. (Old data, rates are likely higher today)
N is how many children a single sample can help giving rise to.
Vs is the volume of a sample (ejaculate), usually between 1.0 mL and 6.5 mL [14]
c is the concentration of motile sperm in a sample after freezing and thawing, approximately 5-20 million per ml but varies substantially
rs is the pregnancy rate per cycle, approximately 10% to 15% [15]
nr is the total motile sperm count recommended for use in a cycle, approximately 20 million.[16] The pregnancy rate increases with increasing number of motile sperm used, but only up to a certain degree, when other factors become limiting instead.

With these numbers, one sample would on average help giving rise to 0.1-0.6 children, that is, it actually takes on average 2-5 samples to make a child.

For intrauterine insemination, a centrifugation fraction (fc) may be added to the equation:

fc is the fraction of the volume that remains after centrifugation of the sample, which may be about half (0.5) to a third (0.33).
N = \frac{V_s \times f_c \times c \times r_s}{n_r}

On the other hand, only 5 million motile sperm may be needed per cycle with IUI (nr=5 million) [16]

Thus, only 1-3 samples may be needed for a child if used for IUI.

Using ART treatments such as IVF can result in one donor sample (or ejaculate) producing on average considerably more than one birth. However, the actual number of births per sample will depend on the actual ART method used, the age and medical condition of the woman bearing the child, and the quality of the embryos produced by fertilization. Donor sperm is less commonly used for IVF treatments than for artificial insemination. This is because IVF treatments are usually required only when there is a problem with the female conceiving, or where there is a 'male factor problem' involving the woman's partner. Donor sperm is also used for IVF in surrogacy arrangements where an embryo may be created in an IVF procedure using donor sperm and this is then implanted in a surrogate. In a case where IVF treatments are employed using donor sperm, surplus embryos may be donated to other women or couples and used in embryo transfer procedures. When donor sperm is used for IVF treatments, there is a risk that large numbers of children will be born from a single donor, and many sperm banks therefore limit the amount of semen from each donor which is prepared for IVF use, or they may restrict the period of time for which such a donor donates his sperm to perhaps as little as three months (about nine or ten ejaculates).

Anonymity

Anonymous or non-anonymous

Anonymous sperm donation is where the child and/or receiving couple will never get to know the identity of the donor, and non-anonymous when they will.

A donor who makes a non-anonymous sperm donation is termed a known donor, open identity or identity release donor.

Non-anonymous sperm donors are, to a substantially higher degree, driven by altruistic motives for their donations. [17]

In any case, some information about the donor may be released to the woman/couple at the time of treatment. A limited donor information at most includes height, weight, eye, skin and hair colour. In Sweden, this is all the information a receiver gets. In the US, on the other hand, additional information may be given, such as a comprehensive biography and sound/video samples.

For most sperm recipients, anonymity of the donor is not of major importance at the obtainment or tryer-stage,[17]. The main reason for anonymity is that recipients think it would be easiest if the donor was completely out of the picture. However, some recipients regret not having chosen non-anonymous donor years later, for instance when the child desperately wants to know more about the donor anyway.[18]

One in three of donor conceived children want information about their biological father. [19]

There is a risk of bias in the information given by clinics or sperm banks regarding anonymity, making anonymous sperm donation seem more favorable than it may actually be, resulting from that anonymous sperm donations are easier for them to handle in the long term, because anonymity does not put the clinic or sperm bank responsible for safely storing donor information for a long period of time. In addition, a majority of donors are anonymous, causing a relative deficit in non-anonymous sperm supply.

In the United States, the trend of wanting to know the identity of donors has resulted in some sperm banks offering exclusively non-anonymous donors.[20]

In law

The law usually protects sperm donors from being responsible for children produced from their donations, and the law also usually provides that sperm donors have no rights over the children which they produce.[21]. An exception is Ireland, where the Supreme Court, in the case of McD v. L (2009), granted visitation rights to a sperm donor and suggested that it would do so in future cases.[22] Recent court cases have been eroding this protection, finding several private sperm-donors financially responsible for their offspring [23][24][25]. The widely publicised case of Andy Bathie highlights the developing area of fertility law.

Several countries, e.g. Sweden, Norway, the Netherlands, Britain, Switzerland, Australia[26] and New Zealand only allow non-anonymous sperm donation. The child may, when grown up (15–18 years old), get contact information from the sperm bank about his/her biological father. In Denmark, however, a sperm donor may choose to be either anonymous or non-anonymous. Nevertheless, the initial information which the receiving woman/couple will receive is the same. In the United States, sperm banks are permitted to disclose the identity of a non-anonymous donor to any children brought to the world by that donor, once the child turns 18.[27]

Desire to know

For most sperm recipients, anonymity is not of major importance. [17] For the donor conceived children, on the other hand, it may be psychologically burdensome not having the possibility of contacting or knowing almost nothing about the biological father.[28] One in three of donor conceived children want information about their biological father. [19] In case of non-anonymous sperm donation, most of the donor conceived people contact the clinic as soon as they reach the required age.[29]

Approximately 60% of requesters are female. [30] Approximately 40% of requests are from people raised by single women, 30% from those raised by lesbian couples, and 20% from those raised by heterosexual couples.[30] Approximately 60% of them are of the opinion that all sperm donations should include identity release. [30]

Limitation

Where a sperm donor donates sperm through a sperm bank, the sperm bank will generally undertake a number of medical and scientific checks to ensure that the donor produces sperm of sufficient quantity and quality and that the donor is healthy and will not pass diseases through the use of his sperm. The donor's sperm must also withstand the freezing and thawing process necessary to store and quarantine the sperm. The cost to the sperm bank for such tests is considerable. This normally means that clinics may use the same donor to produce a number of pregnancies in a number of different women.

The number of children permitted to be born from a single donor varies according to law and practice. These laws are designed to protect the children produced by sperm donation from consanguinity in later life: they are not intended to protect the sperm donor himself and those donating sperm will be aware that their donations may give rise to numerous pregnancies in different jurisdictions. Such laws, where they exist, vary from state to state, and a sperm bank may also impose its own limits. The latter will be based on the reports of pregnancies which the sperm bank receives, although this relies upon the accuracy of the returns and the actual number of pregnancies may therefore be somewhat higher. Nevertheless, sperm banks frequently impose a lower limit on geographical numbers than some US states and may also limit the overall number of pregnancies which are permitted from a single donor. When calculating the numbers of children born from each donor, the number of siblings produced in any 'family' as a result of sperm donation from the same donor are almost always excluded (but see below for the provisions in various states). There is, of course, no limit to the number of offspring which may be produced from a single donor where he supplies his sperm privately.

Despite the laws limiting the number of offspring, some donors may produce substantial numbers of children, particularly where they donate through different clinics, where sperm is onsold or is exported to different jurisdictions, and where countries or states do not have a central register of donors.

Sperm agencies, in contrast to sperm banks, rarely impose or enforce limits on the numbers of children which may be produced by a particular donor partly because they are not empowered to demand a report of a pregnancy from recipients and they are rarely, if ever, able to guarantee that a woman may have a subsequent sibling by the donor who was the biological father of her first or earlier children.

Sperm shortage

Countries that have banned anonymous sperm donation have a substantial sperm shortage, because only a fraction of sperm donors want to continue their contributions if they know that the donor conceived children may contact them one day. Banning of payment to donors has also caused shortages. This has caused fertility tourism to other countries to get the treatment.

For instance, when Sweden banned anonymous sperm donation in 1980, the number of active sperm donors dropped from approximately 200 to 30.[31] Sweden now has an 18 month long waiting list for donor sperm.[17] At least 250[17] Swedish sperm recipients travel to Denmark annually for insemination. Some of this is also due to the fact that Denmark also allows single women to be inseminated.[32]

After the United Kingdom ended anonymous sperm donation in 2005, the numbers of sperm donors went up, reversing a three-year decline.[33][34] However, there is still a shortage[35], and some doctors have suggested raising the limit of children per donor.[36] Sperm exports from Britain are legal (subject to the EU Directive on Tissue Exports) and donors may remain anonymous in this context. Some UK clinics export sperm which may in turn be used in treatments for fertility tourists in other countries. UK clinics also import sperm from Scandinavia. In 2009 one Danish clinic secure the approval of the HFEA to import sperm via registered clinics for use in the UK. The sperm must have been processed, stored and quarantined in compliance with UK regulations. The donors have agreed to be identified when the children produced with their sperm reach the age of eighteen. The number of children produced from such donors in the UK will, of course, be subject to HFEA rules (ie currently a limit of ten families,) but the donors' sperm may be used worldwide in accordance with the clinic's own limit of one child per 200.000 of population, subject to national or local limits which apply.

Korea has a sperm shortage because their Bioethics Law prohibits selling and buying of sperm between clinics, and a donor may only help giving rise to a child to one single couple. [37]

Canada also has a shortage because it has been made unlawful to pay people for donating it, requiring recipients who wish to purchase it to import it from the United States.[38]

The United States, on the other hand, has had an increase in sperm donors during the late 2000s recession, with donors finding the monetary compensation more favorable. [39]

Siblings

Where a woman wishes to have additional children by sperm donation, she will often wish to have these by the same donor. The advantage of having subsequent children by the same donor is that these will be full biological siblings, having the same biological father and mother. Many sperm banks offer a service of storing sperm for future pregnancies, but few will otherwise guarantee that sperm from the original donor will be available in the future.

Sperm banks rarely impose limits on the numbers of second or subsequent siblings. Even where there are limits on the use of sperm by a particular donor to a defined number of families (as in the UK) the actual number of children produced from each donor will often be far greater.

Onselling

There is a market for vials of processed sperm and for various reasons a sperm bank may sell-on stocks of vials which it holds (known as 'onselling'). Onselling therefore enables a sperm bank to maximize the sale and disposal of sperm samples which it has processed. The reasons for onselling may be where part of, or even the main business of, a particular sperm bank is to process and store sperm rather than to use it in fertility treatments, or where a sperm bank is able to collect and store more sperm than it can use within nationally set limits. In the latter case a sperm bank may sell on sperm from a particular donor for use in another jurisdiction after the number of pregnancies achieved from that donor has reached its national maximum..

A UK sperm bank however, may only onsell sperm before the national limit of ten families has been achieved from one donor within the UK. This means, for example, that a sperm bank may recruit a donor and prepare samples for ICI, IUI and ART use from his donations. After 9 months it is able to release the 10 or so samples donated within the first 3 months, from 6 month quarantine ( approximately 100 vials) and it uses these to achieve 6 pregnancies (although more pregnancies could, of course, be achieved from the number of vials prepared as illustrated). The sperm bank is then able to onsell sperm from that donor to sperm banks and clinics outside the UK and it can illustrate the fecundity of the various types of samples it sells from the pregnancy rates it has achieved. The donor may continue to donate for several years (usually 3 or 4) and may provide as many as 150 donations (or even more). The UK clinic will be able to achieve a further 4 pregnancies in the UK at the end of that period within the UK rules. It will also continue to hold stocks of that donor's sperm for sibling use after that time. The donor must however, have agreed to the export and to the use of his donations abroad, and he must be told that reguations for use outside the UK will vary. He must not have put a limit on the number of births which may be achieved from his donations. The HFEA must be notified of exports of sperm from the UK but it does not limit these since it is only concerned with the storage and use of sperm within the UK.

Emrbyos may also be onsold. These are usually spare embryos which are created through IVF treatment where a woman achieves the number of pregnancies she requires and the resulting embryos may therefore be disposed of. Donor sperm (and donor eggs) may be used in IVF treatments, and as many as eighteen eggs may be fertilized using one vial of donor sperm, although only the most viable of these will be subsequently implanted in a woman in an attempt to achieve a pregnancy. In the case of the UK, because an embryo wll have been created in the UK under a regulated process, the consent of the HFEA must be obtained if these are to be exported.

Onselling is normally only appropriate where the donor remains anonymous. Sperm banks purchasing sperm samples may in turn onsell these to other sperm banks. Onselling may therefore give rise to numerous pregnancies being produced from individual donors which can sometimes total 100 or more (see above 'Limitation' and the associated link) particularly where a sperm donor donates his sperm for a period of two years or more and where his samples are prepared for IVF use. Sperm from certain donors, such as those with particular blood groups, physical features or intellect, may also be more in demand than sperm from other donors. However, in every case rules as to use and the limitation on the number of pregnancies which apply locally will reduce the risk of consanguinity. The lack of overall records as to use and success will mean that the numbers of pregnancies achieved from the samples of an individual donor will not exist and the donor will not be at risk of knowing the large number of births that were produced from the samples he donated.

Sperm may also be sold on for research or educational purposes, usually after the number of births from the donor concerned has reached its maximum. Sperm is used for genetic and fertility testing, and also for research into birth control.

Donor tracking

Even when the donor had chosen to be anonymous, there are still opportunities for children to find their biological father. Registries and DNA-databases are useful for this purpose.

Tracking by registries

Some donors are non-anonymous, but most are anonymous, i.e. the donor conceived person does not know the true identity of the donor. Still, he/she may get the donor number from the fertility clinic. If that donor had donated before, then other donor conceived people with the same donor number are thus genetic half-siblings. In short, donor registries matches people who type in the same donor number.

Tracking by DNA-databases

However, even sperm donors who have not initiated contact through a registry are now increasingly being traced by their children. In the current era there can be no such thing as guaranteed anonymity. Through the advent of DNA testing and Internet access to extensive databases of information, one sperm donor has recently been traced. In 2005 it was revealed in New Scientist magazine[40] that an enterprising 15-year-old used information from a DNA test and the Internet to identify and contact his father, who was a sperm donor. This has brought into question the ability of sperm donors to stay anonymous.

International comparison

On the global market, Denmark has a well developed system of sperm export. This success mainly comes from the reputation of Danish sperm donors for being of high quality[41] and, in contrast with the law in the other Nordic countries, gives donors the choice of being either anonymous or non-anonymous to the receiving couple.[41] Furthermore, Nordic sperm donors tend to be tall and highly educated[42] and have altruistic motives for their donations[42], partly due to the relatively low monetary compensation in Nordic countries. More than 50 countries worldwide are importers of Danish sperm, including Paraguay, Canada, Kenya, and Hong Kong.[41] Several UK clinics also export donor sperm and no restriction is placed on the number of times this may be used to achieve a pregnancy provided that the maximum number of permitted births has not been achieved in the UK at the time of the export. The use of the sperm outside the UK will be subject to local rules but no overall limit is imposed by the exporting clinic. Within the EU there are now regulations governing the transfer of human tissue including sperm between member states to ensure that these take place between registered sperm banks. However, the Food and Drug Administration (FDA) of the US has banned import of any sperm, motivated by a risk of mad cow disease, although such a risk is insignificant, since artificial insemination is very different from the route of transmission of mad cow disease.[43] The prevalence of mad cow disease is one in a million, probably less for donors. If prevalence was the case, the infectious proteins would then have to cross the blood-testis barrier to make transmission possible.[43] Transmission of the disease by an insemination is approximately equal to the risk of getting killed by lightning. [44]

Psychological and social issues

Common reasons to donate are to help childless couples, and, for some, the monetary compensation. Reluctance to donate may be caused by a sense of ownership and responsibility for the well-being of the offspring. [45]

Telling the child

Many donees do not tell the child that they were conceived as a result of sperm donation, or, when non-anonymous donor sperm has been used, they do not tell the child until it is old enough for the clinic to provide the contact information about the donor.

For children who find out after a long period of secrecy, their main grief is usually not the fact that they are not the genetic child of the couple who have raised them, but the fact that the parent or parents have kept information from or lied to them, causing loss of trust.[46] Furthermore, the overturn of the sense of who were the parents through the whole life may cause a lasting sense of imbalance and loss of control.[47]

However, there are certain circumstances where the child very likely should be told:

  • When many relatives know about the insemination, so that the child might find it out from somebody else. [46]
  • When the husband carries a significant genetic disease, relieving the child from fear of being a carrier.[46]
  • Where the child is found to suffer from a genetically-transmitted disorder and it is necessary to take legal action which then identifies the donor.

Families sharing same donor

Having contact and meeting among families sharing the same donor generally has positive effects. [48][49]. It gives the child an extended family and helps give the child a sense of identity[49] by answering questions about the donor.[48] It is more common among open identity-families headed by single women.[48] Less than 1% of those seeking donor-siblings find it a negative experience, and in such cases it is mostly where the parents have disagreed with each other about how the relationship should proceed.[50]

Other family members

Parents of donors, who are the grandparents of donor offspring and may therefore be the oldest surviving progenitors, may regard the donated genetic contribution as a family asset, and may regard the donor conceived people as their grandchildren.[51]

Ethical considerations

Sperm donation and sexuality

Sperm donation can be a morally contentious issue. Couples in heterosexual relationships considering the use of donor sperm through an ART method as a solution to childlessness may view it as preserving the sexual integrity of their relationship. However, sperm donation does not maintain the reproductive integrity of a relationship in that the woman's sexual partner is not the biological father of her child, and it is the sperm donor, not the partner, who has reproduced himself.

However, others point out that the process is essentially a sexual one: a woman's innate sexuality may be the reason why a child is wanted, the donor has to be screened for sexually transmitted diseases which could be passed on through the use of his sperm, and the donor has to sexually stimulate himself in order to produce the sperm samples which are used for achieving pregnancies in women to whom he is not related. Some would argue that it is impossible to distinguish sexuality from reproduction, and that the very reason for preserving sexual integrity is to preserve reproductive integrity.

NI and sperm donation

For many donors and recipient women, the lack of physical sexual contact between the parties is one of the essential advantages of sperm donation. Whether the donor is anonymous or not, and whether or not the parties meet, the fact that the reproductive process takes place without genital contact serves to place the procedure on a level which is not readily identified as 'sexual' within the generally understood meaning (see 'Sperm donation and sexuality' above).

However, the very fact that sperm donation involves the placing of a man's gamete in the reproductive tract of a woman for the sole reason of enabling the woman to have that man's child does, for some, mean that the process is an intensely personal one which involves the highest degree of intimate contact. In this context, personal, physical intimacy may be seen as secondary to the reproductive process which is taking place. In addition, NI almost invariably produces higher pregnancy rates than ICI, which is the usual method of artificial insemination deployed in private donor arrangements, since it involves the fresh and immediate deposit of the donor's sperm in the woman's reproductive tract. Consequently, an increasing number of private sperm donors now offer NI as an alternative to the use of artificial means, or they will do so after attempts to achieve a conception by artificial insemination using their donations have failed. [52] Some fertility clinics, notably in India and China are also offering donors and surrogate women who will attempt to achieve pregnancies by NI as a more effective and cheaper alternative to ART methods. Some women also favour a 'natural' conception rather than subject themselves to mechanical procedures which may or may not involve the intervention of third parties. However, in all such circumstances, the ethical considerations may be seen to be on entirely different ground, even though NI involving someone other than the woman's partner has been used as a way of dealing with childlessness from time immemorial.

Sperm donation and social issues

The use of sperm donation is increasingly popular among unmarried women and single or coupled lesbians. Indeed, some sperm banks and fertility clinics, particularly in the US, Denmark and the UK have a predominance of women being treated with donor sperm who come within these groups and their publicity is aimed at them. This produces many ethical issues around the ideals of conventional parenting and has wider issues for society as a whole, including the issues of the role of men as parents, the issue of family support for children, and the issue of financial support for women with children.

Some donor children grow up wishing to find out who their fathers were, but others may be wary of embarking on such a search since they fear they may find scores of half-siblings who have been produced from the same sperm donor. Even though local laws or rules may restrict the numbers of offspring from a single donor, there are no worldwide limitations or controls and most sperm banks will onsell and export all their remaining stocks of vials of sperm when local maxima have been attained (see 'onselling' above).

However, others would argue that sperm donation has liberated the way in which women can control their reproductive lives and that it has enabled many men as sperm donors to father children which they would not want or wish to support but which they know will fulfill a desperate biological and social need for the women who bear them.

History

In the past, sperm donation was rather a hush-hush business, used mainly by private doctors to treat infertile couples. During the last two decades[18] it has grown into becoming more commercial, with sperm banks offering sperm in an increasing amount to single mothers and lesbian couples.

The first recorded sperm donation that took place on a medical center was carried out with few of the ethical considerations that are mandated in clinics today: It was performed in 1884 by professor William Pencoast at Philadelphia's Jefferson Medical College on the wife of a sterile Quaker merchant.[53] Instead of taking the sperm from the husband, the professor chloroformed the woman, then let his medical students vote which one of among them was "best looking", with that elected one providing the sperm for the insemination. After talking to the husband, they decided it was best not to let the woman know.[54]

In the United States, Manhattan Family Court Judge Edward Kaufman ruled against sperm donor Thomas Steel in 1993, the first case in which a sperm donor was denied any paternal rights in his biological offspring.[55] This proved to be a watershed ruling that established this principle as a fundamental tenet of American family law.[56]

Fictional representation

Movie plots involving artificial insemination by donor are seen in Made in America and in upcoming films such as The Back-Up Plan and The Baster, and follow in the wake of Baby Mama which involved surrogacy.[57]

Films and other fiction depicting emotional struggles of assisted reproductive technology have had an upswing first in the latter part of the 2000s decade, although the techniques have been available for decades.[57] Yet, the amount of people that can relate to it by personal experience in one way or another is ever growing, and the variety of trials and struggles is huge.[57]

See also

References

  1. ^ Single Mothers by Choice.com
  2. ^ a b The Sperm Bank of California - Comprehensive Donor Screening
  3. ^ dailymail.co.uk - The hidden health risks for children of sperm donors. By Anna Magee. Last updated at 1:32 AM on 07th October 2008
  4. ^ First report of the absence of viral load in testicular sperm samples obtained from men with hepatitis C and HIV after washing and their subsequent use Fertility and Sterility. Volume 92, Issue 3, Pages 1012-1015 (September 2009). Nicolás Garrido, Ph.D.a, Manuel Gil-Salom, M.D.ab, Jose M. Martínez-Jabaloyas, M.D.ac, Marcos Meseguer, Ph.D.ab
  5. ^ Cryos International --> Donor screening Retrieved on June 20, 2009
  6. ^ Ryan KJ, Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. pp. 556; 566–9. ISBN 0838585299. 
  7. ^ a b California Cryobank -> CMV Testing Retrieved on June 12, 2009
  8. ^ labtestsonline.org --> CMV - The Test This article was last reviewed on January 29, 2008.This page was last modified on April 8, 2009.
  9. ^ http://www.livescience.com/health/060523_bad_banks.html
  10. ^ FDA Recommends Barring Gay Men From Being Sperm Donors By Linda Orlando
  11. ^ http://www.livescience.com/health/060523_bad_banks.html
  12. ^ motherearthnews.com - THE SPERM CRISIS
  13. ^ Swedish Genetic Integrity Act
  14. ^ Essig, Maria G.; Edited by Susan Van Houten and Tracy Landauer, Reviewed by Martin Gabica and Avery L. Seifert (2007-02-20). "Semen Analysis". Healthwise. WebMD. http://www.webmd.com/infertility-and-reproduction/guide/semen-analysis?page=1. Retrieved 2007-08-05. 
  15. ^ Utrecht CS News Subject: Infertility FAQ (part 4/4)
  16. ^ a b Cryos FAQs - What is the recommended quantity and quality by ordering of donor semen?
  17. ^ a b c d e Ekerhovd E, Faurskov A, Werner C (2008). [Expression error: Missing operand for > "Swedish sperm donors are driven by altruism, but shortage of sperm donors leads to reproductive travelling"]. Ups. J. Med. Sci. 113 (3): 305–13. PMID 18991243. 
  18. ^ a b # Boston.com: The search for DGM 2598 By Carey Goldberg. Globe Staff / November 23, 2008
  19. ^ a b Telegraph.co.uk: Sperm donors should get cut-price IVF to tackle shortage By Rebecca Smith, Medical Editor in San Francisco. Last Updated: 4:12PM GMT 11 Nov 2008. This ref, in turn, cites Dr Joanna Sheib from the University of California Davis
  20. ^ European Sperm Bank USA
  21. ^ Revenge of the Sperm Donors
  22. ^ Jacob M. Appel, Revenge of the Sperm Donors, Dec. 27, 2009
  23. ^ Malvern, Jack (2007-12-04). "Sperm donor forced to pay child support after lesbian couple split". http://women.timesonline.co.uk/tol/life_and_style/women/families/article2994783.ece. Retrieved 2009-06-29. 
  24. ^ Neil, Martha (2007-05-10). "Court Says Sperm Donor Owes Child Support". http://abajournal.com/news/court-says-sperm-donor-owes-child-support/. Retrieved 2009-06-29. 
  25. ^ Carne, Lucy (2007-12-02). "$PERM WAIL BY DONOR MUST PAY SUPPORT 18 YRS. LATER". http://www.nypost.com/seven/12022007/news/regionalnews/perm_wail_by_donor_901096.htm. Retrieved 2009-06-29. 
  26. ^ the Economist
  27. ^ Cryos New York
  28. ^ Donor Babies Search for Their Anonymous Fathers. By Craig Malisow. Published on November 04, 2008 at 11:22am
  29. ^ Telegraph.co.uk: Sperm donors should get cut-price IVF to tackle shortage By Rebecca Smith, Medical Editor in San Francisco. Last Updated: 4:12PM GMT 11 Nov 2008.
  30. ^ a b c ASRM: Pressure Builds for Open-Identity Sperm Donation in the U.S. This ref, in turn, cites Dr Joanna Scheib from the University of California Davis
  31. ^ Sydsvenskan:[Här börjar livet för 100 svenska barn varje år (Google translate:Here begins the lives of 100 Swedish children each year).] By Karen Söderberg 17 april 2005 00:00
  32. ^ Single Women Head For Denmark For Guess What? The Impudent Observer. July 24th, 2009 by Fred Stopsky
  33. ^ http://www.hfea.gov.uk/en/1459.html
  34. ^ http://www.hfea.gov.uk/en/1523.html
  35. ^ http://www.hfea.gov.uk/en/956.html
  36. ^ http://www.bmj.com/cgi/content/extract/337/nov11_3/a2318
  37. ^ Digital Chosun Ilbo: Sperm Donations Drying Up. Updated Jan.7,2009 08:29 KST
  38. ^ Sperm donor shortage hits Canadian infertility clinics December 19, 2006. Retrieved February 4, 2009.
  39. ^ WCBD: Well-paid sperm donations up during slumping economy Published: April 6, 2009. Retrieved on April 7, 2009
  40. ^ New Scientist article about a 15-year-old who found his donor using a DNA test
  41. ^ a b c Assisted Reproduction in the Nordic Countries ncbio.org
  42. ^ a b FDA Rules Block Import of Prized Danish Sperm Posted Aug 13, 08 7:37 AM CDT in World, Science & Health
  43. ^ a b The God of Sperm By Steven Kotler
  44. ^ A 'BABY BJORN' SPERM CRISIS NEW YORK POST. September 16, 2007
  45. ^ McMahon CA, Saunders DM (November 2007). [Expression error: Missing operand for > "Attitudes of couples with stored frozen embryos toward conditional embryo donation"]. Fertil. Steril.. doi:10.1016/j.fertnstert.2007.08.004. PMID 18053994. 
  46. ^ a b c Donor insemination Edited by C.L.R. Barratt and I.D. Cooke. Cambridge (England): Cambridge University Press, 1993. 231 pages.
  47. ^ A generation of sperm donor children are discovering the father they know and love is NOT their father at all. By Alison Smith Squire in Daily Mail. Last updated at 11:18 AM on 19th March 2009
  48. ^ a b c Scheib JE, Ruby A (July 2008). [Expression error: Missing operand for > "Contact among families who share the same sperm donor"]. Fertil. Steril. 90 (1): 33–43. doi:10.1016/j.fertnstert.2007.05.058. PMID 18023432. 
  49. ^ a b T. Freeman, V. Jadva, W. Kramer, and S. Golombok. Gamete donation: parents' experiences of searching for their child's donor siblings and donor. Human Reproduction, 2008; 24 (3): 505 DOI: 10.1093/humrep/den469
  50. ^ Contact with donor siblings a good experience for most families By HAYLEY MICK. From Thursday's Globe and Mail. February 26, 2009 at 8:58 AM EDT
  51. ^ My scattered grandchildren The Globe and Mail. Alison Motluk. Sunday, Sep. 13, 2009 07:53PM EDT
  52. ^ http://news.bbc.co.uk/1/hi/uk/8261034.stm
  53. ^ Revenge of the Sperm Donors By Jacob M. Appel. Bioethicist and medical historian. Posted in huffingtonpost on December 27, 2009 07:38 PM
  54. ^ Donor Babies Search for the Anonymous Fathers From: Donorconceived Adult. Posted: Sunday, December 7th, 2008
  55. ^ Revenge of the Sperm Donors
  56. ^ Revenge of the Sperm Donors
  57. ^ a b c chicagotribune.com --> Heartache of infertility shared on stage, screen By Colleen Mastony, Tribune reporter. June 21, 2009

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