Hollywood Fertility Centre, Hollywood Private Hospital, Monash Avenue, Nedlands, Western Australia 6009
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Abstract |
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Key words: cytomegalovirus/litigation/patient choice/semen donors
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Introduction |
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Although I have not been party to any of the discussions leading up to the formulation of the new British Andrology Society guidelines, I am sure that the authors took great care to seek appropriate consultation and that they did not draft the guidelines without much soul searching. They are good people. However, the missing piece of the jigsaw seems to me to be the input and choice of the recipient, and the element of risk that the recipient would be willing to accept. Why not let the ultimate decision about accepting a particular donor be made by the recipient, providing they are given all the information and appropriate help in interpreting results?
So where do I stand? After oscillating between the extreme stance of putting recipients at no risk (i.e. exclude donors testing positive, as in the case of seropositive CMV donors) and a lax position of not interfering, I would ultimately prefer to choose a place somewhere between where: (i) Guidelines drawn up by the professional bodies dictate the minimum amount of screening that should be done on a donor. This would help standardize the screening process and provide the recipients with a defined panel of tests and characteristics. It would appear from guidelines already in existence that there is reasonable agreement on the main tests that should be done; and (ii) The recipient be allowed to decide whether to use that donor or not and to take some responsibility. However, for any consent for usage of semen to be valid then comprehensive information must be provided and that information must be fully understood by the recipient. When done in advance, the recipient could then seek other documented advice (e.g. general practitioner, pathologist, etc.) to help them put the risk of transmission of the infection or genetic trait in perspective. In the case of CMV, the recipients would have the opportunity to accept a seropositive donor if they were seropositive as has been the recommendation with the original British Andrology Society guidelines (Barratt et al., 1993) and thought a feasible option by others (Liesnard et al., 1998
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In adopting a more flexible approach based upon discussion between clinic and patient, our duty of care would then be to ensure that we were equipped to offer a satisfactory level of information and advice to enable a truly informed consent to be given, rather than simply restrict the availability of donors. The existence of such counselling facilities could be enforced in many countries through the various regulatory authorities.
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References |
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British Andrology Society (1999) British Andrology Society guidelines for the screening of semen donors for donor insemination. Hum. Reprod., 14, 18231826.
Liesnard, C.A., Revelard, P. and Englert, Y. (1998) Is matching between women and donors feasible to avoid cytomegalovirus infection in artificial insemination with donor semen? Hum. Reprod., 13, (Suppl. 2), 2531.[Medline]