31 October 2011
ByAppeared in BioNews 631
The decision made by the Human Fertilisation and Embryology Authority (HFEA) to introduce fixed payments to donors has put the current shortage of donated gametes in the headlines. The shortfall in donated sperm, we are told, has pushed potential recipients onto websites where private sperm donors hawk their reproductive wares. If only the officially sanctioned sperm banks were well stocked, the thinking goes, women would not have to venture into that murky world.
But is that correct? What if sperm donation outside the official channels actually carried certain advantages over the clinic system? Here, Andrew Proven Donor, who has donated sperm both privately and in the clinic, argues the case for private donation.
Private donors are men who donate sperm directly to women. They're typically sourced through social contacts or donor websites. Donations are conducted at home using artificial insemination or intercourse.
We need to consider a range of issues to decide whether women who use private sperm donors are really engaging in a riskier undertaking than those who use a clinic. Firstly, consider sexually transmitted diseases (STDs). It makes sense that there will be lower risks for common STDs when using clinic sperm. Yet most people don't become celibate to avoid STDs, and they therefore accept some level of risk.
Is donation any different? STD testing is free, convenient and confidential – so private donors can be easily tested. Modern STD tests can give instant results and detect the early stages of infection. If private donors get regularly tested, they will be at lower risk than the general population. Therefore, recipients are not likely to be bearing any increased risk than that which they may encounter during the course of a normal sex life. Further, there's no guarantee that every possible infection will be picked up in screening at the clinic because not all are tested for.
There is a perceived risk that a private donor will turn out to be an axe murderer. But by taking some basic precautions and using common sense, there's no more risk than would be the case in everyday situations. Internet donor communities may seem to be unregulated, but this is inaccurate. Website owners have an incentive to police their sites. Furthermore, donors typically leave a trail of data which ensures they are far more traceable than a woman's offline contacts.
We can now examine subtler issues and here, I think, it all comes undone for the clinics. Firstly, consider treatment types. Private donations use home insemination, whether via intravaginal insemination or naturally. There are no medical risks from the insemination itself. Not so for the clinic recipient: IVF, for example, results in a higher risk of birth defects and the necessary ovarian stimulation also carries risks. Then there's the matter of sperm selection. The female body has a range of defences to ensure that bad sperm are kept away. Invasive fertility treatments, from intrauterine insemination to ICSI (intracytoplasmic sperm injection), strip away layers of evolutionary armour and expose the egg to additional risks.
The issue of DNA is the private donor's trump card. Women might be offered a handful of donors in a clinic, but with little information to facilitate their choice. By contrast, women can meet scores of private donors.
This richness of information resulting from personal contact and the range of choice available clearly favours private donation. You can't form a judgment about who you do or do not fancy by reading a cursory profile. Sperm is about a whole person. It cannot be summarised into height, weight and eye colour, and it cannot be measured by count or motility. It is for that reason that many women turn their backs on clinics; they wish to know the man behind the process, as it is the man and not the sperm that matters. The subtlety of this selection process is backed up by hard science, with a wealth of literature on the subtlety of choice. Partner choice is not something which can be shortcut by the 'pick a card, any card' approach of clinics. This is the main reason to reject clinics.
Alongside positive traits, we must also consider genetic risks. Few UK clinics have any in-depth genetic testing skills. Presently, much of donor selection is based on an arbitrary pass/fail assessment by a GP, together with some limited chromosomal and DNA tests. This is flawed. Donor selection is not a one-size-fits-all process. The private donation process has the potential to delve into medical details not only of the individuals, but also of their match. A better clinic process could also do much of this work, but this rarely happens.
There are, in most cases, no 'good' or 'bad' donors. Even when traits are 'undesirable' there is no valid way to determine the 'right' mate selection on behalf of a recipient. Should we have sought to reject Winston Churchill's genes on the grounds of his depression, or Van Gogh's for his bipolar? Are these people not fit to donate? Should we allow the state's agents to 'weed out' the genius and talent which is so often accompanied by an unusual mind or body? Diversity is the making of the human race, and we tamper with it at our peril. Let us continue to rely on personal choice and sexual chemistry to produce children. Until clinics can offer a proper analogue to real-life sexual selection, we should respect the fact that recipients are far better off choosing a private donor for themselves.
Then there are the psychological risks for the children. Many studies have shown that awareness of origins among donor-conceived children is healthy. With private donors, there is no state-enforced separation until 18. As and when children wish to enquire about their origins, the channels of communication can be opened. Through this, they have a chance at achieving a sense of place in a wider extended family. This helps psychologically, and it also helps reduce the risk of intermarriage.
Without the ability to maintain contact, there is a risk that a donor-conceived adult will end up in a consanguineous marriage. I appreciate the HFEA's efforts at creating a central register, but this is often rendered useless by stale data which is never refreshed. The 10-family limit is a drop in the ocean on a national level, but when the sperm is redistributed in a small city, risks are amplified. Ten families in London is a strong dilution, but ten families concentrated around Norwich would have statisticians reaching for their calculators.
There are both physical and psychological risks. Thoughtful children may grow up wondering about their classmates' heritage. They may hesitate when forming relationships. It is entirely unacceptable that clinic-conceived teens are not permitted to find out their partners' origins. For responsible private donors, the situation is different – and good records are always available, even for teens in underage relationships.
Finally, there exists a degree of legal risk. For private donor recipients who conceive naturally or who are unmarried, the donor is technically the legal parent. In practice, adoption by the recipient's partner is usually fairly easy. However, there is no such protection for single women. There therefore remains an uncomfortable legal limbo for these mothers and their donors. It need not be this way, and the government could easily solve the problem.
To summarise, clinics have their place but it's time to stop pretending that they're inherently safe. The medical process of clinic donation is usually more invasive and less safe than the private equivalent. Whilst clinics typically give better protection against STDs, the risks are still low with a responsible private donor. In the particular case of single recipients, clinics currently give better legal protection – but this could be changed. However the killer arguments in favour of private donations are diversity of donors, and the wealth of information available. Clinic recipients take a genetic gamble that is not justified. It is for this reason that it is genuinely safer to use a responsible private donor.