Sperm donation has been around for several decades but is still raising ethical questions related to anonymity, financial compensation, and altruism. Developments in society and the evolution of regulation in some countries contribute to the constant change of characteristics of the sperm donor population. A significant change is the growing application of expanded carrier screening on gamete donors. These changes may have an impact both on past donors but and the recruitment of new donors. Most countries are struggling to cover the demand for donor sperm and the overall shortage of donors. With that in mind, it is important to seek the opinion of the sperm donor population on the different aspects of the procedure.
This recent study by Cryos investigated the attitudes of sperm donors towards offspring, anonymity, and extended genetic screening. The study was conducted by online questionnaire for sperm donors in Denmark and the United States in September 2020 and was set up to measure and psycho-social parameters and to compare anonymous (Non-ID Release) and non-anonymous (ID Release) donors. A total of 233 donors (37 in the US and 196 in Denmark) completed the questionnaire.
Demographic and psychosocial aspects
ID Release and Non-ID Release Donors were compared systematically for all characteristics and items. The majority of the donors (~78%) had no children of their own at the time of donation and their mean age was 28.6 years. About half of them had been donating for less than one year. The most frequent occupations of the donors were student, skilled worker, and academic worker.
An almost equal distribution was found between donors who had a partner and those who did not. ID-release Donors were significantly older than non-ID Release Donors and more likely to have a partner. Also, they had more frequently informed their partner about their donor status. However, the two groups were not different in the degree to which their partner had influenced their decision to become a donor nor about the feelings their partner had towards the fact that they were sperm donors: ~86% had told their partners about their donation, and the influence of the partner on their decision was limited. The majority of the partners (~84%) felt positive about the donation (as reported by the donor).
In line with informing the partner, ID Release Donors were significantly more likely to tell their own children about their donations, than reported by the Non-ID Release donors (~57% versus 21%). Regarding talking to others about being a sperm donor, ~51% mentioned it to selected others and ~32% were completely open about it. On these two questions, there was no significant difference between ID Release and Non-ID Release Donors.
Motivational factors to donate
On the question of motivation for sperm donation, respondents could select one or more of the following options: ‘curiosity’, ‘to earn money’, ‘to get a health check’, ‘to have my sperm quality tested’ and ‘to help childless people’. No significant difference was found between donor type and the reasons to donate. Nor was there any difference between these groups on the intention to stop donating if donors would no longer receive a financial compensation for their sperm donation: ~21% would continue to donate, ~45% would stop and ~34% did not know what they would do.
Attitude towards the children and anonymity
Most donors (~65%) would like to be informed if their donation resulted in a pregnancy. Regarding information about the children, most donors wanted to know the number of children and their health, including hereditary diseases. The information provision from donor to offspring depends on the donor profile. ID Release Donors were much more likely to have an extended donor profile (~79%), and they were significantly more likely to want information about potential donor children. Extended Profile Donors thereby demonstrated that they accepted that a lot of information about themselves would be shared with the recipients and the offspring.
About half of the of Non-ID Release Donors (~54%) would stop donating if their ID choice were no longer available, hence they could no longer be anonymous. From the ID Release Donors on the other hand, ~74% would continue as a Non-ID Release Donor and only ~9% would stop donating, thus indicating that ID Release was not a necessary condition to donate.
The possibility to identify donors through large genetic databases generates a number of problems with the concept of anonymity. When compared to ID Release Donors, the wish of Non-ID Release Donors to remain anonymous is supported by their rejection of the possibility of any children to find out about their donor conception e.g. through a genetic database (73.9% vs. 28.8%).
Positive mindset towards genetic testing
Sperm donors are being tested for the most common and severe hereditary diseases. In general, donors have a positive attitude towards genetic testing. Only 6% preferred no genetic testing. A very large majority (~87%) also agreed with extended carrier screening. The positivity regarding genetic testing is expressed in the acceptance of more testing in the future. Still, about one in six (14%) did not know what they would do if genetic testing would be expanded in the future. Most donors (~82%) wanted to know all results and less than 10% would put restrictions on the information they would like to receive. However, further studies on the attitude of candidate donors and in particular their understanding of implications of genetic screening results are needed.
Summary
This study is unique as there is no other study of its kind that we have identified in which donors can be compared, based on their given choice of anonymity and identifiability. The systematic comparison of donor types shows that there are two groups of donors with a very different attitude towards several aspects of the donation.
The results indicate that Non-ID Release Donors are unlikely to become ID Release Donors. The possibility to choose either ID Release or Non-ID Release thus allows the recruitment of more donors than if only one donor type would be accepted. This study shows that the majority of donors are very positive towards genetic testing in general. They are also very positive about the extended carrier screening as applied in this sperm bank.