Challenges persist in the recruitment of sperm donors

Published 17 January 2023

A study of sperm donor applicants at a Danish and US sperm bank with the same recruitment protocols found continuing low levels of acceptance, with some explanations for the high rates of attrition apparently country-dependent; applicants who opted for ID-release were more frequently accepted than those who did not.

The atlas of fertility treatment policies published by Fertility Europe in 2021 revealed statutory inconsistencies throughout Europe, but none more so than in gamete, especially sperm, donation. Many countries (including Czech Republic, Greece, Italy) were still listed as not allowing sperm donation for the treatment of same-sex female couples or single women.(1) France, with a long tradition of public sperm banks in its CECOS network, only allowed treatment in lesbian and single women in its bioethical overhaul of ART in 2021. There are similar legal inconsistencies in donor anonymity regulations, with some countries requiring strictly anonymous donation (Spain, for example) and others operating different schemes of identity release (or both).

Despite the complexities, the demand for donor sperm seems greater than ever, explained in some countries by the increasing treatment of single women and lesbian couples. A review of gamete donation in the UK published in November 2022 reported that the number of children born from donor sperm more than tripled in recent years - from under 900 in 2006 to over 2800 in 2019.(2) This increase was driven by single patients and those in female same-sex relationships, said the HFEA.

But despite the demand, a new report on sperm donors recruited in 2018-19 by a sperm bank offering ‘the world’s largest selection of sperm’ has found that very few of its donor applicants – just 3.79% - actually progressed to have samples frozen and released for use.(3) The low figure was derived from analyses at two of the group’s clinics, in the USA, where just 1.03% of 5834 donor applicants went on to be donors, and in Denmark where 6.53% of 5878 applicants were accepted.

While the number of successful applicants in both countries is low, the study results suggest that national characteristics – in methods of recruitment, attitude, general health, financial compensation, and legislative background – may also make a difference to a country’s provision of donor sperm. Although this study sought to answer some of these questions, the more general answers about sperm donor recruitment are complicated by a lack of data, even at the local level. An ESHRE survey published in 2020 found that IUI (whether with partner or donor sperm) is considered an ART treatment in only 35 of 43 European countries surveyed, and a registry of donors exists in only 16 of them.(4) It’s not easy – even possible – to follow trends in sperm donor numbers, although the UK’s HFEA reported in November that new sperm donor registrations had doubled from around 400 in the early 1990s to around 800 in the late 2010s.(2) Since then, the proportion of imported sperm donations increased (with samples from Denmark and USA) and ‘typically fewer sperm donors per year’ as sperm donors tend to provide multiple donations. The Covid pandemic, of course, affected the recruitment of donors throughout the world. In Australia, one of few countries to have a specific policy for men’s sexual health and where sperm donation must be altruistic, it’s been reported that the number of men donating sperm has decreased by 23% over the last five years.(5)

This latest study found that most donor applicants were lost during recruitment because they simply withdrew from the programme, did not attend an appointment, or did not return a questionnaire (54.91%); others reported a disqualifying health problem or failed a screening test (17.41%); others did not meet the initial eligibility criteria (11.71%) or did not have the minimum motile sperm concentration (>5 X 106 motile sperm/ml) in their post-thaw samples (11.20%).

However, these were combined rates of attrition in both Denmark and the USA, and individual country patterns differed. For example, it was more common in the USA than in Denmark (61.19% vs 48.67%) for candidate donors to be lost from recruitment because they withdrew or did not respond. The study authors speculate why, even suggesting that US men are only interested in a free semen analysis. It was also found that more applicants in the USA were rejected because of health problems – evident from the recruitment questionnaire, a genetic test or screening. And candidate donors in Denmark were 2.5 times more likely to be rejected because their semen samples failed to achieve the required >5 X 106 motile sperm/ml in their post-thaw sample than those in the USA. Against a background of identical recruitment protocols, these were described by the authors as ‘genuine country differences’.

These were distinct national variations, but the study also found – in both countries - that acceptance rates were higher in applicants who at the outset opted for ID-release (4.70%) than in those who did not (3.15%). Despite the marginal difference, this may suggest, write the authors, that those who chose ID-release have a greater motivation to be a donor at the outset and, having applied, are less likely to walk away. A study from bioethicist Guido Pennings and colleagues in 2021 found that offering potential donors a choice of either ID-release or non-ID-release ‘allows more donors to be recruited than if only one option were available’ – and that the two groups have ‘profoundly different attitudes to donation’.(6) However, this same study did note that donors willing to be identifiable at the same sperm bank were entitled to extra financial compensation.

So what more do we now know about sperm donors? First, as ever, they’re a rare and valued group whose recruitment and retention remain ‘challenging’. However, it seems clear that successful recruitment does depend on national characteristics and legal requirements, particularly as the greatest rate of attrition occurs early in the recruitment pathway. Perhaps, they suggest, better ‘information, support, and reassurance’ during the process might encourage more progress, while of course maintaining safety and clinical efficacy.

As the latest HFEA data also showed, the actual total number of new donors may decline as well established donors continue to provide acceptable samples. However, the ESHRE survey of IUI made it clear that a free-for-all of sperm donation is not usually possible, despite the anecdotes of sperm donor fathers to multiple children. Limitations (recommended or statutory) on the number of children originating from the same donor are in place in most European countries, ranging from one in Cyprus to 25 in the Netherlands.(4)

Commenting on the results, one of the study authors, Allan Pacey from the University of Sheffield, said: ‘The study highlights how hard it is to become a sperm donor. It’s not like blood donation where once it’s done you can have a cup of tea and go home. Sperm donation is a regular commitment with lots of screening and regular testing as well as life-long implications for the donor if any children are born from their sample.’

1. https://fertilityeurope.eu/european-atlas-of-fertility-treatment-policies/
2. https://www.hfea.gov.uk/about-us/publications/research-and-data/trends-in-egg-sperm-and-embryo-donation-2020/
3. Pacey AA, Pennings G, Mocanu E, et al. An analysis of the outcome of 11 712 men applying to be sperm donors in Denmark and the USA. Hum Reprod 2023; doi.org/10.1093/humrep/deac264
4. Calhaz-Jorge C, De Geyter CH, Kupka MS, et al. Survey on ART and IUI: legislation, regulation, funding and registries in European countries: The European IVF-monitoring Consortium (EIM) for the European Society of Human Reproduction and Embryology (ESHRE). Hum Reprod Open 2020; hoz044. doi.org/10.1093/hropen/hoz044
5. https://www.healthymale.org.au/news/your-guide-to-sperm-donation-in-australia
6. Pennings G, Mocanu E, Herrmann JR, et al. Attitudes of sperm donors towards offspring, identity release and extended genetic screening, Reprod Biomed Online 2021; 43: 700-707. doi.org/10.1016/j.rbmo.2021.06.025

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