How good are we at recruiting sperm donors?
Sudipta Paul, Steve Harbottle and Jane A Stewart
Progress Educational Trust
21 May 2004
One in six couples have fertility problems. Male factors are known to be responsible for about 30 per cent of these cases, and are associated with another 30 per cent in combination with female factors. Despite the advent of artificial reproductive techniques - intra-cytoplasmic sperm injection (ICSI) in particular - the demand for sperm donors has continued.
Studies of sperm donors have tended to report a poor recruitment rate. Decline in overall semen quality, as suggested by some researchers, and the removal of donor anonymity after April 2005, may have an impact on both the demand for and the recruitment of sperm donors. We undertook a study to evaluate the current recruitment rate of sperm donors at Newcastle Fertility Centre at Life.
Over a period of 10 years, between January 1994 and August 2003, 1101 men applied to be sperm donors at the centre. The majority were less than 36 years old (88%), and were unmarried (85%). Over half were students (55%), or without a partner (53%) and most had no proven fecundity status (79%). The most common sources of information about sperm donation were the media (36.5%), student sources (35%) and word of mouth or friends (21%).
Only 40 (less than four per cent) of the applicants were accepted as sperm donors, five others are under investigation and seven are in quarantine. Of the others, 339 (over 30%) defaulted and 710 (64.5%) were rejected.
The most common reason for rejection was found to be suboptimal semen quality (85%), followed by applicants having a history of sexually transmitted disease (7%). The main determinant of suboptimal semen quality was a combination of suboptimal sperm concentration and motility (51%), followed by suboptimal motility alone (17%), concentration (13%), then post-thaw motility (8%).
All but one of the accepted donors were less than 40 years old. The majority of them were students (67.5%), unmarried (87.5%) or without partner (62.5%). Eighty-five per cent had unproven fecundity status.
The average number of applicants per year showed a significant declining trend, with a sharp fall after 2000. The number of potential donors defaulting also increased sharply after 1999. This may be related to concern about the possible removal of donor anonymity. The number of accepted sperm donors and the acceptance rate per year also showed a declining trend.
Generally, the use of donor sperm declined after 1997, probably in relation to the increase in use of ICSI. However, it began to rise again after 2001, possibly due to an accumulation of cases of failed ICSI, and probably also because of a greater number of same-sex couples requesting donor treatment. The demand for DI treatment has been rising consistently in contrast to that for donor IUI (intra-uterine insemination) and IVF.
At the Newscastle centre, a total of 22,640 straws of semen were stored in the 10-year period studied. These contained an average of 45 ejaculations per donor. The overall clinical pregnancy rate, during this period, was 330 pregnancies in 1403 cycles (23.5%): 30% for donor IUI, 30% for donor IVF and 19% for DI; these figures are comparable with the national standard.
This study shows that in a successful sperm donor programme only a small proportion of applicants are accepted as donors. The numbers of applicants and, consequently, sperm donors have been declining, and may decrease further in future due to the removal of donor anonymity and possible overall decline in semen quality. This may have serious resource implications for future donor treatment and we conclude that interventionist strategies to improve sperm donor recruitment are urgently required.
Dr Sudipta Paul, Specialist Registrar; Mr Steve Harbottle, Embryologist; Dr Jane A Stewart, Consultant, Newcastle Fertility Centre at Life, Newcastle-upon-Tyne, UK.
© Copyright Progress Educational Trust
Reproduced with permission from BioNews, an email and online sources of news, information and comment on assisted reproduction and genetics.
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