Sperm donation in the UKBMJ 2008; 337 doi: http://dx.doi.org/10.1136/bmj.a2318 (Published 12 November 2008) Cite this as: BMJ 2008;337:a2318
- Mark Hamilton, consultant obstetrician and gynaecologist1,
- Allan Pacey, senior lecturer in andrology2
- 1Department of Obstetrics and Gynaecology, University of Aberdeen, Aberdeen AB25 2ZD
- 2Academic Unit of Reproductive and Developmental Medicine, School of Medicine and Biomedical Sciences, University of Sheffield, Sheffield S10 2SF
For some years, providers of assisted conception services in the United Kingdom have highlighted difficulties in maintaining the infrastructure needed to recruit sperm donors. In 2006, the number of donors registered with the Human Fertilisation and Embryology Authority (HFEA) was 60% of that in 1991.1 Controversially, the removal of donor anonymity in 2005 may have contributed to this problem. Currently, many clinics struggle to recruit donors, have long waiting lists for those needing treatment, have high costs, and in some areas have ceased to provide treatment services altogether.2 To propose solutions to this problem, a working party of the British Fertility Society has published a report on how the UK recruits donors and uses their donations in assisted reproduction.1
The numbers of women using donor sperm in the UK have decreased by 40% since 2000 to around 3000 each year.3 The introduction of intracytoplasmic sperm injection in the mid-1990s may account for some of this reduction,4 but it is unlikely to be wholly responsible because this technique was well established in most fertility clinics by 2000. Any recent increase in intracytoplasmic sperm injection cycles is almost certainly the result of increased access to treatment generally,3 rather than a switch in medical management.
It is difficult to estimate the unmet demand for donor sperm in the UK because of local differences in availability, waiting times, costs, and rationing. The proliferation of internet based sperm supply services (until recently beyond the regulatory control of the HFEA) shows that such a demand exists. This is mainly from single women and lesbian couples—in 2006 nearly 40% of women receiving donor insemination in licensed centres fell into this category.3 At least 4000 UK patients each year are estimated to require donor sperm.1
Because UK law limits the number of families that can be created from a single donor, a constant supply of new donors is needed.5 If we accept that patients should be offered a choice of donor and that not all donors used will achieve (or consent to) pregnancies in 10 families (the current legal maximum5), a minimum of 500 new donors are needed each year.1 Current new donor registrations by the HFEA fall well short of this number, with only 307 new donors registered in 2006.6
The British Fertility Society report concludes that major changes could be made in the mechanics and organisation of donor recruitment services. Currently, men can donate sperm only in centres licensed by the HFEA, and in some areas donors have to travel considerable distances. Moreover, not all licensed centres are equipped to accept donors, which exacerbates the problem. A national service framework, with strategically located regional (hub) centres providing the bulk of donor management and local (spoke) centres providing services for recipients, might help alleviate the problem. Focusing resources on early donor care in hub centres is important because up to 35% of potential donors are lost after first contact and are never assessed.7 In addition, coordinated regional advertising, improved efficiency of dealing with first enquiries, and more convenient opening hours that enable men to donate outside working hours might encourage more men to participate. These changes would need to be supported by adequate funding, perhaps along the lines of resource allocation for national blood services.
Other measures could improve the supply and distribution of donor sperm but are controversial. For example, increasing the age limit for donors (currently 40 years8) or lowering the threshold for acceptable semen quality would enable more men to donate. But new mutations occur in the genome as men age,9 and higher than normal levels of DNA damage are seen in semen of suboptimal quality,10 so the report did not recommend such changes.1 However, it did recommend an examination of sperm sharing schemes, whereby fertile male partners of women who need in vitro fertilisation could become donors and have their fertility treatment partly funded, along the lines currently allowed for egg sharing.11 Furthermore, if the law were modified to allow more than 10 families to use sperm from existing donors (if the donor consented), then fewer donors would be needed, although the risk of inadvertent consanguinity would increase.
The current limit of 10 families is arbitrary and not evidence based, and a large safety margin probably exists given the size of the UK population and dispersal patterns.12 Interestingly in the Netherlands, which has a smaller population than the UK, the upper limit is 25, while in France it is five. A more flexible approach that allows donors and recipients to determine their preference on family numbers could be facilitated. However, what is acceptable to donors, families, people conceived from donors, and society as a whole needs to be evaluated because evidence on which to base a decision is lacking.
Cite this as: BMJ 2008;337:a2318
Competing interests: MH is the current chair of the British Fertility Society and AP is the honorary secretary. Both are involved in the recruitment of sperm donors.
Provenance and peer review: Not commissioned; externally peer reviewed.