Virginie Rozée, co-ordinator of the ESHRE’s SIG Socio-cultural aspects of (in)fertility, said in her opening remarks to this Campus meeting that there remain two key controversies in gamete donation: anonymity and commercialisation. Both were featured in the two half-day sessions of this May meeting.
Although many countries, notably in northern Europe, have adapted their legislation to remove anonymity from gamete donation, bioethicist Guido Pennings, from the Bioethics Institute of Ghent, proposed that some of the ‘harms’ associated with sperm donation – what Pennings identified as ‘stigma’ and ‘moral blame’ linked to the attribution of fatherhood – could be avoided if donors were allowed to remain anonymous. These harms, Pennnings explained, followed the importance attached to a genetic link with the donor, and thus indirectly the chance of ‘attributional fatherhood’. Thus, despite the perceived and legislative support for identity-release donation, Pennings argued that society should retain the option of anonymity: ‘An anonymous donor is a donor who does not want to be contacted in the future. Recipients who select him should respect this wish.’
This view, however, seems contrary to what now appears the norm in this ‘era of anonymous donation’ - in countries like the Netherlands, Sweden and the UK. In the Netherlands, for example, as explained by Sophie Bolt from the Dutch organisation FIOM, the greater acceptance of non-anonymous gamete donation has arisen over the past 20 years ‘from a growing awareness of the importance of contact for donor-conceived people’. Motivations among those registered as identifiable donors (in a survey of those who in the past had donated sperm anonymously) were for ‘child-oriented’ motivations, or both child and donor motivations. The survey also found a strong impetus from the media and from support and contact networks. Indeed, said Bolt, ‘more registrations lead to more matches’, but presently in the Netherlands donors matched with donor-conceived people are still in a minority (24%).
The ‘right to know’ and the ‘right not to know’ was cited by Bolt as one of the conflicts of identity matching among donors. This too was at the heart of a presentation by Swedish sociologist Sebastien Mohr, who described a rationale for responsibility in sperm donation in ‘biosocial relatedness’. This was evident in selected research quotations in which donors recognised the need for testing and ‘genetic safety’, and the possibility of meeting up with children at some future time. Thus, said Mohr, ‘sperm donors assume positions as responsible men, men who know how to honour the kinds of responsibilities that come with relating and being connected to other people through the use of reproductive technologies’. This, he explained, was what he meant by biosocial relatedness.
Of course, the obvious way in which donors avoid any of the pitfalls of ‘anonymity’ is by providing sperm through online contact. Vasanti Jadva from the Centre for Family Research in Cambridge reported a rise in the number of men looking to donate sperm via connection websites, which – in the UK at least – ‘have made informal sperm donation more accessible’. A survey of men registering with one such website identified three motivations: to help others; to ‘pass on my genes’; and in recognition of infertility among family or friends. Financial payment was rated lowest.(1)
However, when the Campus proceedings moved on to the commercialisation of gametes, especially among egg donors, there was clearly an important element of compensation present, reflected in the recruitment of donors via clinics themselves and online agencies. Amrita Pande, in describing her close work with South African egg donors, even identified travel (hotels, tickets) as an important motivation. Such incentives, she added, were also apparent among ‘egg providers’ from Romania, Czech Republic, Ukraine and Cyprus – though she did add that these findings emerged well before the covid pandemic. Most of the travelling providers she journeyed with were white, single and educated. So altruism or something else? Her findings suggested that most of the donors had done their homework to avoid ‘complications’ and trafficking - in what she described as ‘responsible repro-preneurship’. As one of her providers said: ‘Women are using their reproductive matter to make money. But at the same time, they are using their participation in the industry to consume, and to get consumed, to avoid maternity, and to find another way of life.’
In Europe Spain had by far the largest egg donation services before the lockdowns – handling some 50% of all procedures. But, said Consuelo Alvarez Plaza from the University of Madrid, collecting accurate data is and always was difficult. The various programmes, which are all regulated, are characterised by anonymity (one attraction for overseas patients), financial compensation, patient or clinic recruitment of donors, high demand, and cross-border treatment. But despite the common features, a lack of clarity seems more the rule than the exception in Spain, although, said Plaza, there remains a cultural tradition of altruism and moral enforcement, which does at least seem to offer some homogeneity, even if hard data cannot.
After eight presentations at this Campus it seemed apparent that there were more unanswered questions than definitive statements related to the two subjects of anonymity and inducement in gamete donation. Guido Pennings even questioned the applicable definition of ‘anonymity’, describing it as a ‘multifaceted’ term subject to time, selection and condition. Anonymity is rarely ‘absolute or eternal’, he said, and its preserve, of course – in gamete donation especially – is now increasingly under threat through online databases. But, said Pennings, just because anonymity can no longer be guaranteed does not mean that every donor can be identified or that donors should not seek anonymity from their clinics. ‘Most harms are connected to being known as a donor,’ he added, ‘rather than to being identifiable.’ Which, he said, was one good reason for retaining the option of anonymity.
1. Graham S, Freeman T, Jadva V. A comparison of the characteristics, motivations, preferences and expectations of men donating sperm online or through a sperm bank. Hum Reprod 2019; 34: 2208-2218.