Does gamete donation need an overhaul?

It is disappointing to read about the closure of the National Sperm Bank (NSB) as its success could have helped many more people have a family using UK-donated sperm (see BioNews 875).

As has been well documented, in the past it has not been easy to recruit either sperm or egg donors in this country. The failure of the NSB may lead people to believe that it is still difficult, and that consequently those needing donated gametes should be referred or encouraged to go abroad for treatment. This would be a great shame for several reasons, not least of which is that there are donors in the UK but also because the UK donation service is probably one of the best regulated in the world.

The NSB is not the only body recruiting sperm donors in the UK. Several licensed treatment centres recruit both sperm and egg donors, with varying degrees of success. As most recruiters will have found, the majority of applicants do not actually end up as donors, yet they all need to be processed, informed and assessed for suitability. This makes donor recruitment an extremely time-consuming process and, sadly, neither easy or cheap.

Gamete donation also requires a significant commitment of time and resolve. Donors need to be committed to the process itself and the logistical arrangements required to complete the course. They must come to understand the emotional and social implications for themselves, their families and any children that might be born from their donation. They also have to be apprised of the legal requirements, particularly concerning the disclosure of identifying information of donors to future children on reaching the age of 18. Given these potential obstacles and difficulties, which they have to manage and overcome to donate successfully, it is not surprising that so many drop out along the way.

As the UK's only independent egg-donor agency that specialises in recruiting altruistic egg donors, we at Altrui have collected a number of statistics that demonstrate the large drop-out rate. Over 6000 women have approached us about donating their eggs since we set up in 2010. We filtered out roughly 15 percent at an early stage, based on medical or genetic issues. A further six percent had too high a BMI and have been put on hold until they lose sufficient weight to go ahead. Finally, another 70 percent fell out for a range of other reasons. The remaining nine percent or so have gone on to donate successfully.

Raising awareness of the great need for altruistic donors in this country might eventually produce another UK sperm or egg bank, but it will require a good deal of joined-up thinking, careful planning and a credible business model to make it viable. Recruiting donors successfully requires dedication, focus, knowledge, understanding and perseverance from a full-time team.

The social, physical and psychological differences of egg and sperm donors must be taken into account when recruiting. We have found that making the overall journey easier for egg donors makes them more inclined to help, and we imagine that this would also be the case for sperm donors. Perhaps, therefore, it is time to review just whether the path for sperm donors is as easy as it could be. For instance, should men be expected to produce so many samples? Are the number of visits required set for their convenience or to make the system financially attractive to the clinics? Should we be exploring whether moderating the number of samples demanded from each donor might lessen the time commitment and result in a lower dropout rate? Perhaps questions need to be asked about what other factors are limiting the number of donors. Given the current tests and technologies available, are there ways which might make the donor experience easier and therefore more appealing?

The closure of the NSB could be a trigger to review whether gamete donation is sufficiently focused on donors to attract enough of them and to seriously review each stage of the donation process. Surely our collective aim is to enable recipients to get an egg or sperm from the UK, rather than seek help from abroad simply because we can't get the UK donation process right for donors?