The real impact of the removal of donor anonymity

Legislation removing donor anonymity came into force in the UK in April 2005. Transitional arrangements, to allow the opportunity to use up reserves of anonymously donated sperm, were short; only one year. After that, the use of anonymously donated sperm was illegal.

Since then, there have been a number of reports that have suggested that the impact of this change on the provision of donor insemination (DI) treatment has been minimal.

These have included two Commentaries in Bionews which have reported the approach in two large clinics (Adams et al, Bionews 16 October 2006 and, most recently, Ahuja et al, Bionews 13 January 2008). Whilst these clinics should be commended, they do not seem to reflect the experience in the majority of fertility clinics in the UK, where the removal of donor anonymity has had a profound impact on DI treatment services.

There are currently 87 HFEA-licensed DI clinics in the UK. A BBC survey in September 2006 found that 90 per cent of UK sperm donors were recruited in just 10 of these clinics. The remaining smaller clinics have mainly relied on purchasing donor sperm from larger units over the past 10 years.

Initially, after the removal of donor anonymity, this was still possible but the cost of purchasing sperm rose very substantially; about an eight-fold increase.

Data from the HFEA long term analysis (2007) shows a 17 per cent reduction in the number of DI patients and an identical reduction in the number of DI treatment cycles between 2000 and 2004. However, between 2004 and 2006 there was a 30 per cent reduction in DI patients but a much larger 41 per cent - reduction in the number of DI treatment cycles. This suggests fewer DI cycles are being undertaken for the number of couples requesting this treatment.

A recent survey of DI services by the British Fertility Society found that:

1) 37 per cent of clinics are finding it harder to recruit donors

2) 94 per cent of clinics are finding it harder to buy in donor sperm

3) 74 per cent of clinics have increased their waiting lists for DI treatment

4) 86 per cent of clinics are able to offer less choice of donor. Most are now only able to match for racial group alone.

5) 60 per cent have introduced rationing of treatment cycles.

6) 9 per cent have closed their DI service

7) 89 per cent charge more for treatment because of the increased cost of the sperm they are able to purchase.

In addition, many clinics have closed their waiting lists for DI treatment. This became necessary in the clinic where we work last year, to avoid falsely raising the expectations of patients. The DI service had started in 1975 and had never had a waiting time of more than four months until the removal of donor anonymity. The clinic now has 23 patients on its waiting list and has closed this, having only been able to undertake six cycles of DI in the last year. The clinic had previously been undertaking 80 - 100 cycles each year. If, as widely predicted, the 18-week waiting target for NHS treatment is to be applied, for the first time, to fertility treatments in the near future, how many DI services will need to close because they are unable to achieve this target, through a shortage of donor sperm which is beyond their control?

Bionews is very widely read and the Commentary from Manchester in October 2006 has been quoted frequently by politicians, the National Gamete Donation Trust and others to support their view that the removal of donor anonymity has not had a significant impact on treatment services. I am sure the recent Commentary by Ahuja et al from the London Women's Clinic will be used in the same way. This positive view is the experience in only a small number of large DI clinics. The income they derive from the provision of services and from selling sperm allows these clinics to invest in the staff and resources to continue their advertising and recruitment services in a way which would not be possible in most smaller units, particularly those which are NHS-based.

We are sure that the legislation to remove donor anonymity was well-intentioned and that the impact on DI treatment services was not intended, though many involved in providing these services expressed anxieties about the imposition of a blanket ban on anonymous donation. We believe there are two possible solutions to this problem. The first would be for central funding to establish a NHS network of regional gamete donation centres, who would then provide screening, counselling and storage facilities for the fertility clinics in their area. The second would be to review and amend the current legislation to give donors the choice of either retaining complete anonymity, or for the disclosure of non-identifying information only, or for them to be identifiable in the way the law currently requires. Couples needing DI treatment would then, at the very least, have the choice of deciding whether they really want sperm from a donor who is prepared to be identified in the future.