Unregulated sperm donation – not that bad?

More and more people worldwide are avoiding regular sperm banks and fertility clinics and searching for a solution elsewhere.

Elsewhere includes a large variety of different venues including so-called connection websites, Facebook groups, and social media networks. This unregulated circuit is growing constantly and at increasing speed, judging by the number of people registering. How much activity there really is, is difficult to determine since good quality studies of this phenomenon are, not surprisingly, difficult to perform. Nevertheless, based on numbers across several sites, a recent study published in Frontiers in Global Women's Health counted tens of thousands of men presenting as candidate sperm donors and more than 350,000 potential recipients.

The phenomenon is comparable to the better-known trend of cross-border reproductive care. People go to another country for a multitude of reasons: treatment is not available in their home country or it is too expensive, not adapted to their wishes, or conditions are imposed that do not suit donors and/or recipients. However, some of the same reasons to avoid a regulated domestic system may also apply abroad. Many women, for instance, mention high cost as one of the prime reasons for bypassing clinics overall. In countries without public funding for treatment, multiple expensive sperm samples plus several cycles of clinic-based insemination amount to an expensive treatment. Going to a clinic abroad will rarely be cheaper.

A similar reason for travelling abroad is adopted by women who want to select their donor. In many countries, women are barely given any information on the donor and are not allowed to choose their donor based on their preferred criteria. Unless they find a clinic abroad that allows donor selection, the internet may again provide the solution.

Horror stories have long been spread about how things can go awfully wrong when people seek what they need 'off the internet'. However, people would not find themselves looking there unless they believed that it offered them something they cannot get from mainstream providers.

Moving to the internet to seek sperm donors has both advantages and disadvantages, as I outlined in a paper published in Reproductive BioMedicine Online. Recipients feel that they are more in control, they can meet and select the donor, and negotiate the level of involvement of the donor in the family. Moreover, it is cheaper and they do not have to justify their plans to anyone.

Internet donors have fairly similar reasons: meeting and selecting the recipient, the possibility to have contact with the child, and generally to have control over the process. However, there are also downsides for both parties. For the recipients, the main issues are lack of sexually transmitted disease testing (although many internet donors report undergoing these tests) or genetic disease testing, and the possibility of some form of abuse. A significant percentage of internet donors want to donate through sexual intercourse and insist on this method. There is evidence of a continuum of violence going from coercion, through to intimidation, over stalking to sexual harassment. Moreover, the selection can be a tedious process that requires a lot of time, mental effort, and emotional investment.

Still, the same applies to dating apps like Tinder and few people argue that people should not visit at all. Nevertheless, there are clearly good reasons to be cautious during all interactions on the internet. In addition, when they step away from the regulated system, the parties cannot enjoy the legal protection that the law provides. In that regard, the many court cases in the context of known donation do not bode well.

How should we evaluate the unregulated system? Most commentators take the regular system as their reference point. The unregulated system is wrong when the practices or rules deviate from how things are done in the regulated system. However, one could also look at the practice as a form of natural reproduction. When people choose a reproductive or sexual partner, they do not normally test them for sexually transmitted or genetic diseases or demand certificates to verify the information they provided. There is always a level of trust required.

Moreover, many people seem to overestimate the regulated system. A critical look at this gold standard may bring them to reconsider this evaluation. Most clinics and sperm banks cannot control the number of offspring per donor (either because there is no central register or because sperm is imported), do not verify the information shared by the donor, do not perform extensive genetic testing (apart from taking an elaborate family history) and legal protection is not guaranteed for everyone in all countries.

People looking for a donor or recipient on the internet can be separated into two categories. The first category has no other solution such as people belonging to groups that are denied access to treatment or who do not have the financial resources for pursuing treatments in clinics. Rather than blaming them for trying to find an alternative route, one should do something about the causes. Reviewing the law (such as France has done recently for lesbian couples and single women) to allow access for everyone and/or providing reimbursement for donor insemination would be a good start. For this category, the unregulated system (like cross-border care) increases their reproductive freedom and autonomy.

The other category consists of people who have specific wishes that are excluded from the protocol in the clinic or that are forbidden by law in their jurisdiction, such as having the option to choose the donor or the recipient, or choosing to be anonymous or identifiable. It would be impossible for clinics to cater to all clients' wishes but a critical review of the existing rules in the clinic or legislation might already help.

In conclusion, the unregulated system is here to stay. Regulators are still adding extra rules and restrictions that increase costs for the users and make participation less attractive for both donors and recipients. Many users of the unregulated system do not go there out of their own free will but are pushed away by the regulated system. Although this move also brings many disadvantages with it, it ultimately increases women's reproductive autonomy by allowing them to bypass societal restrictions.

The future of sperm and egg donation will be discussed at two free-to-attend online PET events in September:

• Small Change: Is It Time to Reconsider Compensation for Gamete Donors? (20 September 2023)
• Opening the Register: How to Handle Disclosure of Gamete Donor Information (27 September 2023)