Does Cryos have a global limit on how many children a sperm donor may help conceive?

For many years, there has been a strong focus on limiting how many children can be conceived with the help of the same sperm donor. This is primarily driven by the desire to reduce the risk of consanguinity (inbreeding), i.e. that two people who are unknowingly half-siblings meet and have children together. Some have also pointed to possible psychological aspects for children, families, and donors.

Many countries have therefore introduced national quotas for sperm donors. These vary considerably and may be defined in terms of the number of pregnancies, children, or families, and may depend on the recipient’s nationality or country of residence. Cryos complies with all national regulations and administers them through country-specific quota mechanisms.

Cryos does not have a fixed global limit on the total number of children per donor. This is based on genetic health logic: what matters is not the total number of children worldwide, but their geographical distribution. Genetic diseases should not be considered a relevant factor when determining donor offspring limits. From a public health perspective, there is also no relation between the number of offspring per donor and the overall prevalence of genetic conditions in the population. The risk of consanguinity depends on whether children conceived with the same donor live within the same communities. Cryos manages this risk through geographical distribution and compliance with national quotas. ESHRE also states: “Several studies have modelled the risk of consanguinity between donor-conceived offspring and identified very low risk levels, especially in the context of international use of gametes, where there is a wide geographical spread of donor siblings.” They further write: “The risk of inbreeding is likely to be further reduced by parents increasingly being open about telling their children that they are donor conceived, and by donors increasingly being open about telling their own children about their donations, as well as by increased access to genetic testing. Therefore, inbreeding is no longer a pressing problem.” (3)

The debate on global quotas has arisen, among other things, in response to a few cases in which hereditary diseases have been transmitted via donor sperm (1, 2). This has prompted political and professional discussions about the need for international or global quotas, including recommendations from professional organizations such as ESHRE (3). However, it is important to emphasize that global quotas cannot eliminate the risk of hereditary diseases. All people carry genetic variations and potentially disease-causing mutations. The more diseases one tests for, the fewer donors will be eligible, and a very low quota does not reduce the total number of children born with genetic diseases, but may instead lead to a greater variety of rare diseases (4). The number of affected children is not reduced by the introduction of global quotas, which may therefore create a false sense of security.

There are differing experiences regarding the psychological aspects of having many donor half-siblings. For some, this can be a burden (5, 6), while others experience it as a resource (7, 8). For the donors themselves, research does not indicate that a high number of children in itself constitutes a psychological burden (9, 10, 11). Cryos acknowledges that the need for information and transparency varies among donors, recipients, and donor-conceived persons, and balances this in respect of all parties’ rights in accordance with Article 10 of the European Bioethics Convention.

Finally, many countries face a shortage of sperm donors at the same time as demand is increasing. Strict global quota limitations would likely lead to reduced availability, longer waiting times, higher prices, and increased reliance on unregulated markets. Ultimately, this could undermine safety for all parties involved and reduce the number of people who are able to fulfill their wish to become parents.

Cryos is therefore working to offer donors with global quotas of 50 and 15 families in accordance with ESHRE’s recommendations (3). These options can provide families with an informed choice, but will affect price and availability differently depending on the size of the quota.

Links

1 Danish sperm donor passed neurofibromatosis on to five children | The BMJ
2 Sperm from donor with cancer-causing gene was used to conceive almost 200 children
3 Draft position paper available from: Stakeholder review
4 No reason for a reduction in the number of offspring per sperm donor because of possible transmission of autosomal dominant diseases - PubMed
5 Finding people like me: contact among young adults who share an open-identity sperm donor | Human Reproduction Open | Oxford Academic
6 The ongoing work of kinship among donor half-siblings in The Netherlands | BioSocieties
7 Searching for ‘relations’ using a DNA linking register by adults conceived following sperm donation | BioSocieties
8 Adolescents Conceived through Donor Insemination in Mother‐Headed Families: A Qualitative Study of Motivations and Experiences of Contacting and Meeting Same‐donor Offspring - Persaud - 2017 - Children & Society - Wiley Online Library
9 Oocyte and sperm donors' opinions on the acceptable number of offspring - Sydsjö - 2014 - Acta Obstetricia et Gynecologica Scandinavica - Wiley Online Library
10 Egg donors’ attitudes toward identifiability, offspring information, and genetic testing | Reproductive Biology and Endocrinology
11 Experiences and attitudes of Danish men who were sperm donors more than 10 years ago; a qualitative interview study | PLOS One