Abstract and Introduction
Abstract
Study Question: Is the outcome of donor recruitment influenced by the country in which recruitment took place or the initial identity (ID)-release choice of applicants?
Summary Answer: More applicants are accepted as donors in Denmark than in the USA and those who choose ID release are more frequently accepted than those who do not.
What is Known Already: The successful recruitment of sperm donors is essential to provide a range of medically assisted reproduction (MAR) procedures, which rely upon donor sperm. However, while much has been written about the medical screening and assessment of sperm donors from a safety perspective, relatively little has been written about the process of recruiting donors and how it works in practice. There are differences in demographic characteristics between donors who choose to allow their identity to be released to their donor offspring (ID release) compared to those who do not (non-ID release). These characteristics may also influence the likelihood of them being recruited.
Study Design, Size, Duration: A total of 11 712 men applied to be sperm donors at a sperm bank in Denmark and the USA during 2018 and 2019.
Participants/Materials, Setting, Methods: Anonymized records of all donor applicants were examined to assess the number passing through (or lost) at each stage of the recruitment process. Statistical analysis was carried out to examine differences between location (Denmark or USA) and/or donor type (ID release versus non-ID release).
Main Results and the Role of Chance: Few applicants (3.79%) were accepted as donors and had samples frozen and released for use; this was higher in Denmark (6.53%) than in the USA (1.03%) (χ2 = 243.2; 1 degree of freedom (df); z = 15.60; P < 0.0001) and was higher in donors who opted at the outset to be ID release (4.70%) compared to those who did not (3.15%) (χ2 = 18.51; 1 df; z = 4.303; P < 0.0001). 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%); reported a disqualifying health issue or failed a screening test (17.41%); did not meet the eligibility criteria at the outset (11.71%); or did not have >5 × 10[6] motile sperm/ml in their post-thaw samples (11.20%). At each stage, there were statistically significant differences between countries and the donor's initial ID choice. During recruitment, some donors decided to change ID type. There were no country differences in the frequency in which this occurred (χ 2 = 0.2852; 1 df; z = 0.5340; P = 0.5933), but it was more common for donors to change from non-ID release to ID release (27.19%) than the other way around (11.45%) (χ 2 = 17.75; 1 df; z = 4.213; P < 0.0001), although movements in both directions did occur in both countries.
Limitations, Reasons for Caution: No information was available about the demographic characteristics of the applicants, which may also have influenced their chances of being accepted as a donor (e.g. ethnicity and age). Donor recruitment procedures may differ in other locations according to local laws or guidelines.
Wider Implications of the Findings: A better understanding of when and why candidate donors are lost in the recruitment process may help develop leaner and more efficient pathways for interested donors and sperm banks. This could ultimately increase the number of donors recruited (through enhanced information, support, and reassurance during the recruitment process) or it may reduce the financial cost to the recipients of donor sperm, thus making it more affordable to those who are ineligible for state-funded treatment.
Study Funding/Competing Interest(S): The study received no funding from external sources. All authors are Cryos employees or members of the Cryos External Scientific Advisory Committee.
Trial Registration Number: N/A.
Introduction
The successful recruitment of sperm donors is essential to provide a range of medically assisted reproduction (MAR) procedures, which rely upon donor sperm. Typically, these include donor insemination, or IVF using donor sperm by heterosexual couples with severe male factor infertility, and increasingly by single women or women in same-sex relationships (National Institute for Health and Care Excellence (NICE), 2013). Although MAR using donor sperm is highly effective, national legislation typically limits the number of children that can be born from a single donor (Janssens et al., 2011, 2015; Calhaz-Jorge et al., 2020). Therefore, there is a constant requirement for sperm banks to replenish their stocks with sperm from new donors. For example, it has been calculated that at least 400 new donors are required to be recruited each year to meet the need for donor sperm used in MAR in the UK (Hamilton et al., 2008).
While much has been written about the medical screening and assessment of sperm donors from a safety perspective (Clarke et al., 2021; Practice Committee of the American Society for Reproductive Medicine and the Practice Committee for the Society for Assisted Reproductive Technology, 2021), relatively little has been written about the process of recruiting donors and how recruitment processes work in practice. One exception is the paper by Paul et al. (2006) who reported on the outcome of 1101 candidate sperm donors at a single clinic in the northeast of England. They found that only 3.63% of the initial applicants had samples that were frozen and subsequently released for use, with the most common reason for rejection being suboptimal semen quality (85.07%). More recently, Liu et al. (2021) reported on the screening results of 24 040 candidate sperm donors over a 14-year period at a single centre in China and found that 23.38% of candidate donors were accepted. Moreover, they found that acceptance rates were significantly higher for men who were married, with children of their own and who had higher levels of education. They suggested that this was because these men pay more attention to reproductive health and have a lower incidence of sexually transmitted infections.
In a recent study of accepted sperm donors at Cryos in Denmark and the USA (Pennings et al., 2021), some notable differences in demographics and attitudes were found between donors who had chosen to allow their initial identity (ID) to be released to any donor conceived people (ID release) compared to those who had not (non-ID release). For example, ID-release donors were generally older and more likely to have a partner compared to donors who had chosen to be non-ID release. With this in mind, the present study aimed to compare the donor recruitment process in Denmark and the USA and reasoned that the initial ID-release choice of candidate donors may influence the likelihood of them being recruited, either by virtue of the decisions they make as individuals or as a consequence of the biological and demographic differences between them. It also explores whether the outcome of recruitment was influenced by the country in which recruitment took place and at what step the candidate donor journey ended by choice or by selection.
Hum Reprod. 2023;38(3):352-358. © 2023 Oxford University Press
