Several different types of medically assisted reproduction (MAR) techniques exist to help people to become parents. These include donor insemination, in vitro fertilization (IVF) using donor sperm, and insemination for heterosexual couples with severe male factor infertility, and for single women or women in same-sex relationships. All these procedures rely on successful recruitment of sperm donors and, although much is made of the screening and assessment of donors from a safety perspective, little research has been done on the ease of the recruiting process itself.
There is a constant need for sperm banks to replenish their stocks with sperm from new donors because national legislation usually limits the number of children that can be born from a single donor. Thus, the process of becoming a new donor should be as streamlined and simple as possible, to ensure ongoing supplies of sperm for MAR.
In a new study, published in the journal Human Reproduction, scientists have tracked the progress of potential sperm donors through the recruitment process, and have identified the reasons that many men do not get to the stage of having their sperm frozen and released for use. A research team led by the University of Sheffield found that, of a sample of 11,712 men who initially applied to become sperm donors, only 3.9 percent were ultimately accepted and donated sperm for use in reproductive procedures.
The researchers used data from all male applicants at Cryos International, one of the world’s largest sperm banks, during 2018 and 2019. This organization has sperm banks in several countries, and data from the U.S. and Denmark were accessed as these are the main sources of donor sperm for MAR procedures in the U.K.
“To our knowledge this is the largest study of sperm donor applicants outside China and, given that the U.K. relies so heavily on imported sperm from the U.S.A. and Denmark, it is important for us to understand the recruitment processes there and reassure ourselves that they are safe, as well as see if there is anything we can do to improve them,” said study lead author Professor Allan Pacey.
Potential donors have to go through a number of steps during the selection process. Initially, a potential donor completes an application form online. If the details are acceptable, he is asked to submit a sperm sample for a quality check. At least 5 million swimming sperm must be present per milliliter of semen after freezing and defrosting, in order for the sample to be acceptable. If the donor passes this stage, he must complete a questionnaire about lifestyle, which can also result in his subsequent rejection. Lastly, the applicant must give information about any diseases or genetic issues present in himself or his close family members.
The results of the analysis revealed that most candidate donors were lost during recruitment because they: withdrew, failed to respond, did not attend an appointment, or did not return a questionnaire (54.91 percent); reported a disqualifying health issue or failed a screening test (17.41 percent); did not meet the eligibility criteria at the outset (11.71 percent); or did not have sperm samples of sufficient quality (11.20 percent).
There were statistically significant differences between the figures for Denmark and for the U.S.; more applicants were successfully recruited in Denmark (6.53 percent) than in the U.S.A. (1.03 percent). In addition, the chances of becoming a successful donor were also influenced by the donor’s choice of whether to allow himself to be identified to future offspring or to remain anonymous. Those who had chose to allow their initial identity (ID) to be released to any donor-conceived people (ID release) were more likely to have sperm samples frozen and released for use than those who chose not to release their identity (non-ID release).
A total of 40 percent of donor candidates initially agreed to be identifiable, and this approach was more common in applicants from Denmark than from the U.S. This has relevance for U.K. recipients because more than half of the new sperm donors registered in the U.K. are from foreign sperm banks, like Cryos in the U.S. and Denmark. Since 2006 it has been illegal in the U.K. to use sperm from donors who are unwilling to be identified to any people born from their donations.
The researchers found that, once men had been accepted as donors and had begun to make regular donations, many of them decided to change their initial identity choice. Although changes were made in both directions, it was more common for men who had chosen non-ID release to change their registration to ID release.
“The study with Cryos highlights how hard it is to become a sperm donor. It’s not like blood donation where once it’s done you can have a cup of tea and go home. Sperm donation is a regular commitment with lots of screening and regular testing as well as life-long implications for the donor if any children are born from their sample,” said Professor Pacey.
“What’s particularly fascinating is that more donors, who initially wanted to remain anonymous, were willing to be identifiable as the screening and donation process continued. This is particularly good news for patients in the UK undergoing fertility treatment, as it is a legal requirement for sperm donors to be identifiable to any children born from their donations.”
Dr. Anne-Bine Skytte, Medical Director at Cryos International said: “We are very grateful to Professor Pacey and the team for their in-depth analysis of sperm donors which has already been very valuable in helping Cryos look at its recruitment process and try to make it more efficient.”
“If we can recruit donors more easily then this will help keep costs down for patients in the UK and elsewhere who often buy donor sperm with their own money because it’s not funded by the NHS.”
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By Alison Bosman, Earth.com Staff Writer