There is a current shortage of donor sperm in the UK. Recruitment of donors has always required marketing. Traditionally, students provided donor sperm for 'beer money'. Thirty years has seen little change in the remuneration. It is now referred to as 'travelling' costs. This is compatible with other forms of tissue donation, for which monetary remuneration is deemed illegal. The acute current shortage coincides with a change in the rules of anonymity such that donor-conceived children at 18 are now able to find out the identity of their donor.
Solutions to consider:
1. Readdress the cause of the problem
2. Look at other restrictions and see if those can be reconsidered
3. Accept the change
Readdressing the cause
Some donor-conceived individuals raised concerns. The rights of the many donors were sacrificed for the benefit of those few who wish to seek out their genetic origins. People resulting from gamete donation have a 'right' not available to those conceived naturally. Uncertain paternity is rated at an incidence of between 1:25 to 1:10 in the general population, who have no 'rights' to know their genetic paternity, unlike donor-conceived individuals. The prospect of the state having a genetic database to enable every individual to trace their genetic origin is an option that most would abhor.
When we are parents we make decisions for our children that they may later resent. There is no doubt that there is a group of offspring who wish to seek out their genetic origins. It is interesting to explore exactly what they are looking for when they seek out the donor who sired them. It certainly isn't a father. He is the man who brought them up. There is no doubt that the original problem which was universal anonymity required addressing. Would it have not have been better if donors were given three options?
ii) Declared - exposure of their identity when the child reaches eighteen
iii) Deferred - 'I don't know; ask me again when they are eighteen'.
When a couple are choosing donor sperm, they use the option that is chosen by the donor as part of the first decision they make for their children. In this way, the rights of the donor child have been addressed. After all it is still parental choice whether to inform the child that they are the offspring of donor gametes; a decision which clearly has a preferred choice of informing the child. Dare the legislators have the courage to re-debate this?
Look at other restrictions
The age limit on gamete donation is to ensure sperm quality; a chronological restriction on what is a biological deterioration. Surely restrictions would be better placed in the biological frame than the chronological. The only nationally fixed quality parameter is age. This, perhaps, should be taken out of the national equation and replaced by biological quality standards.
The numbers of families a donor may sire is set at ten by the Human Fertilisation and Embryology (HFE) Act, with no apparent basis in presented evidence to set this number. The HFE Authority (HFEA) seems in my experience reticent to readdress issues on which it has already decreed. However something such as this needs to be reconsidered in the light of the current problem that was created by the anonymity issue.
The fear, of course, is inadvertent half-sibling matings. Contrary to absence of evidence, there appears to be quite considerable data on which to make a value judgement. Australian population densities suggest that it is very unlikely (Six recipients 1:40,000). In the UK, if 2,000 donor conceived children are born per year with five children per donor, unwitting half-sibling matings would occur at a rate of 1 every 50-100 years.
The concern with half-sibling matings undoubtedly is that genetic abnormalities may be commoner, as with second cousin matings. However humans we have been exposed to half-sibling matings time and time again through history. Harems, popular in many cultures, do not seem to be associated with abnormal second generation infants.
Conquering armies may be typified by Genghis Khan, who is widely associated with the greatest number of paternities. Recent studies have shown that 8 per cent of the men in a large region of Asia today share the same Y chromosome. Closer to home is the second greatest of all paternities - Somerled. He was a military leader in the Scottish isles in the twelfth century. He twice defeated Goraidh, and rid the Scottish highlands and islands of the Vikings. Genetic studies conclude that Somerled has probably 500,000 current descendents, particularly amongst MacDonalds, MacDougalls and MacAllisters. It is clear therefore that Britain has been submitted to multiple paternities of orders of magnitude greater than ten families in the past. There is no record of an 'epidemic' of fetal abnormalities subsequent to this. An interesting footnote to the story of Somerled is that new evidence shows him to have had Norse ancestry; a Viking. In terms of uncertain paternity the question now arises as to whether the three clans mentioned above now have an identity crisis much as the children of donors claim to have by not being able to trace their ancestry.
Accept the change
Those who are strongly oppose erosion of the current situation urge us to adapt to the law as it stands. However a market place with a restricted commodity increases the value of that commodity. Pay higher prices or buy abroad.
Trans-border fertility treatment raises questions about lack of control of quality and safety. There is a threshold of restriction that drives people overseas. We are at that threshold now.
The issue of remuneration is a consequence of insistence on no change in other areas. Remuneration has not changed significantly for thirty years; we could be more generous. After all, gamete donation is not like other tissue donation, otherwise it would be anonymous. Gametes are distinctly different from kidneys, hearts and livers.
In 2004 a publication by Sukchareon presented us with data that men who had vasectomies/obstructive azoospermia quickly developed considerable sperm aneuploidy. Rates exceeded tenfold. This is often not presented to vasectomy patients. Perhaps there is an opportunity. The cost of back-up cryopreservation of sperm covers various screening tests plus an annual retention fee.
Could we not recruit sperm donors from people requesting sterilisation? Certainly Urologists would be reticent to refer for fear of losing a surgical fee. Would it not be reasonable for sperm banks to circulate vasectomists with a patient information leaflet offering back-up cryopreservation? A referral of, say £150, for referral of the patient would be followed by donation for a year, providing an agreed number of samples of which some are used for his long-term storage. We would then refer back to the original surgeon for the vasectomy. The surgeon stands to lose nothing because he would still get a fee for referring as well as potentially doubling his income if the patient returns for vasectomy. The patient would have stored sperm as well as thinking time surrounding the big decision as to whether or not to have a vasectomy. Finally it would boost recruitment of men with proven fertility.
'Sperm sharing' is already being offered. The difficulty is making it acceptable. Men and women are undoubtedly different. The acceptability of sperm sharing to the wife seems to be far less acceptable than the concept of egg sharing to the men. The economic returns are dwarfed by those of egg sharing. However it is certainly an option.
The lawmakers and regulators have created a legislative and restrictive environment. Driven, I hope, by a sense of serving the community rather than some covert plan to stop all gamete donations in this country, they would want to work with professionals and patient groups to serve the whole of society equally. The opportunities are there before us. We need to be open-minded and flexible from all sides.
Like reproductive fundamentalists, do we dig our heels in with a self righteous belief that ours is the only way, whilst happy in the belief that if patients go overseas it's their problem? Or do we try to find an acceptable middle ground on provision?