Fertility experts suggest reforms to overcome sperm shortage
Progress Educational Trust17 November 2008
Sperm donation services require infrastructural reorganisation, 'sperm-sharing' incentive schemes and regulatory reforms to overcome the severe shortage presently causing 'anguish' to thousands of infertile couples in the UK each year and to the health professionals unable to provide treatment to their patients, according to fertility experts writing in the British Medical Journal (BMJ). An estimated 10 per cent of UK clinics have had to cease offering treatments using donated sperm, driving infertile couples abroad or to join lengthy waiting-lists at British clinics, according to Dr Mark Hamilton and Dr Allan Pacey, chairman and secretary respectively of the British Fertility Society (BFS).
One in seven UK couples have problems conceiving with half attributable to male infertility. Around 4,000 UK patients request donor sperm each year, yet in 2006 there were only 307 sperm donors. The authors estimate that a minimum of 500 donors per year would be needed to meet the demand.
Currently, regulation allows for a maximum limit of 10 families to receive sperm from the same donor as a precaution against children from the same donor parent unwittingly reproducing together. The authors criticise the limit as an 'arbitrary' reflection of generalised societal bias of how many children an individual should father rather than 'evidence-based' on any real risk, genetic or otherwise. Hamilton compares the Netherlands, where the population is a quarter of Britain's and where a donor's limit is 25 families. Despite the high limit, the Dutch also have a sperm donor shortage, which some experts blame on the removal of donor anonymity in 2004. In France, where the population is similar to the UK and donors retain anonymity, only five women may receive sperm from the same donor and there too exists a donor shortage.
The BFS argues that given Britain's population size, this limit should be removed and a more flexible approach adopted through agreement between donors and recipients. The US does not limit sperm donations, according to Eleanor Nicoll, spokeswoman for the American Society for Reproductive Medicine. Instead, guidance recommends that a single donor be limited to 25 births in a population of 800,000. The Human Fertilisation and Embryology Authority (HFEA) has said it will review the regulation.
Another suggestion was to allow 'sperm-sharing' schemes which would offer infertile couples discounted IVF treatment in return for sperm donation, in a similar way to controversial egg-sharing schemes. Critics oppose these initiatives as tantamount to selling gametes and exploiting emotionally vulnerable couples desperate to conceive who are coerced into donating their gametes for a bargain price as the only way they can afford treatment. Supporters view it as a mutual benefit for all involved in shared circumstances.
According to the BFS article, 35 per cent of initial interest expressed by potential donors is not followed-up for assessment. The authors feel that efficiency and accessibility must be improved to capture this lost opportunity. They suggest a structural re-organisation whereby large regional centres recruit and manage donors with smaller local centres providing services for recipients.
The authors cited the removal of donor anonymity in April 2005 - allowing children to trace their donor parent once eighteen - as a key causal factor for the shortage. Donor anonymity is optional in the US and many experts there believe this is why they do not have a sperm donation shortage.
However, donor numbers were declining before the UK removed donor anonymity - dropping by 40 per cent in 15 years (a third in the last decade). In 1991 there were 503 recorded sperm donors but by 2000 there were only 325, according to official records. A spokesperson for the Department of Health denied that changes in anonymity law are responsible for the shortage but said the Government welcomes consideration of the BFS recommendations to boost sperm donations.
Dr Hamilton said that donor anonymity has been debated for years by Parliament and he accepts the decision as a 'non-negotiable stance'. He suggests that other options should be explored that 'work within these constraints'. The BFS doctors did not support raising the donor age-limit above 40 or relaxing semen quality standards. Furthermore, Dr Pacey who runs a clinic in Sheffield, stated that imported sperm donations have not proven to be a solution to the shortage.
Reproduced with permission from BioNews, an email and online sources of news, information and comment on assisted reproduction and genetics.