Hospital Rijnstate, Alysis zorggroep, Department of Clinical Chemistry/Semenbank, Postbus 9555, 6800 TA Arnhem, The Netherlands. e-mail: pjanssens{at}alysis.nl
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Abstract |
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Key words: consanguinity/genetic disorders/offspring/sperm donor/The Netherlands
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Introduction |
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Last Spring (February, 2002) a sperm donor in The Netherlands, having fathered 18 children by means of artificial insemination, developed a serious late-onset hereditary brain disease (Janssens, 2002; Sheldon, 2002
). This disease, autosomal dominant cerebellar ataxia, was neither evident at intake of the donor or from the donors family history, nor in the subsequent period of semen donation. The cerebellar ataxia manifested itself several years after the donor had stopped sperm donation (Janssens, 2002
; Sheldon, 2002
).
The danger of inbreeding, used to calculate the tolerable number of offspring for sperm donors, is directly related to the transmission of autosomal recessive hereditary traitsoffspring of related mates having a significant risk of homozygosity with resultant manifestation of defects. However, the aforementioned donor had a dominant hereditary disease of a late-onset type. The question raised with respect to the transmission of dominant hereditary traits (of late-onset type) is whether the limit should be lower than the 25 based on the transmission of recessive traits. This question is approached in this article from a genetic, psychological and legal point of view, taking into consideration the consequences of DI for the general population, for parents seeking help from DI plus their offspring, and semen donors.
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Genetic considerations |
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Psychological considerations |
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Still, it might be asked what it means for parents or DI-offspring to know the accepted maximum number of offspring per donor in general. Parents seeking help from DI may simply accept the general offspring-limit, knowing that this figure does not necessarily apply to their own donor. However, they may also feel uneasy about it. In Dutch practice it is not considered desirable that sperm banks enter into specific agreements with parents concerning the donors characteristics. This applies equally to the number of offspring from a particular sperm donor. Therefore, for parents feeling uneasy about the high level of the donor-offspring limit an alternative might be to seek a donor of their own.
In conclusion, considerations of a psychological nature provide no reason for a systematic reduction of the number of offspring per sperm donor below the limit of 25.
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Legal considerations |
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Formerly, with the anonymity of sperm donors strictly guaranteed, the number of offspring was only of theoretical relevance to donors. Now, however, these offspring may come to have practical significance. The implications of abandoning the anonymity-guarantee for the semen donors seem reasonably clear. Simply speaking, in our experience there exist two types of donors. Donors of the first type offer their services for DI because, for various reasons, they are interested in (or have at least no reluctance to) personal procreation. Such donors most probably would not have problems with meeting their grown up DI-offspring. It seems reasonable to assume that these donors would not have much problem with the conception of quite a number of children from their spermeven up to the limit of 25. Moreover, some of these donors, being interested in meeting their offspring (and taking into account that only a fraction of their offspring might try to get in contact with them), could even reason that a high number of offspring would result in the best chance of their getting to know some of their offspring. The second type of donor is not interested in personal procreation by means of DI at all (or may even be averse to personal procreation). This type of donor offers his services purely because of altruistic motives. Donors of this type have no wish to meet their DI-offspring. At best they tolerate such contact, being forced to do so by law. These donors will probably find it acceptable that only a reasonably low number of children are conceived with their sperm. Taken together, it will therefore depend on the attitude of the donor what possible future contact with offspring will mean to him. Some donors might consider contact with a rather great number of offspring to be a threat, others may find it a surprise or a challenge. The interest of the donor therefore provides no unambiguous measure for a preferred number of offspring per donor. Therefore, for sperm donors the best option appears to be that sperm banks explain the situation and make individual agreements on how many offspring they would find an acceptable maximum.
In principle, the abandonment of the anonymity guarantee could also mean that children from the same donor (or their families) might get to know each otheralthough such complicated associations would probably be rare. This would imply that the number of offspring per donor might also become relevant for donor children (and maybe others). The implications in these circumstances, although probably very exceptional, are difficult to comprehend. However, as previously stated, professionals in The Netherlands are reluctant to enter into specific agreements with parents concerning donor characteristics or the number of offspring a particular donor might have. Therefore the new Dutch law on disclosure of donor identity does not make the number of offspring from donors an issue for parents seeking help from DI.
In conclusion, legal considerations provide no reasons for a general reduction of the number of offspring per sperm donor in The Netherlands.
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Discussion |
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No arguments were found for limiting the number of donor offspring below the number guaranteeing no increase in inbreeding (de Boer et al., 1995), neither from a population-genetic point of view, nor because of psychological needs of the parents helped by DI, or their offspring. An obvious reason not to lower the number of children per sperm donor is that it would create greater shortage of donors, something that is not in the interest of those seeking help from DI. Thus, in the absence of compelling reasons for generally reducing the number of offspring from semen donors, it is most rational not to reduce the limit set for preventing increased inbreeding among DI-offspring.
A case for reduction of the number of donor offspring may exist, however, in individual situations. This does not arise from genetic or psychological arguments, but from consideration of the implications of the new Dutch law on disclosure of donor identity to DI-children, operative since 2002. As such a case would probably involve individual requests by particular donors for a reduction of the number of offspring, this could easily be mutually arranged between the sperm bank and the donors concerned.
It may be noted that compared with other countries the offspring-limit of 25 as practised in The Netherlands is rather high. For instance in the UK the maximum number of offspring per sperm donor is set at 10 and in France, five (Deech, 1998; Le Lannou et al., 1998
). It should be noted, however, that these limits seem to have been reached quite arbitrarily, apparently more or less based on social-psychological and cultural considerations (Deech, 1998
; Le Lannou et al., 1998
). Medical-genetic and/or demographic arguments and calculations, based on the transmission of autosomal recessive disorders, lead to higher offspring limit per sperm donor (de Boer et al., 1995
). There seem to be no reasons for lowering this limit because of the small, though never to be excluded possibility of transmission of late-onset autosomal dominant disorders to donor offspring, as discussed here. Mutual agreements by sperm banks with individual donors suffice to fulfil the wishes of individuals wanting to deviate from the generally accepted rules.
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Acknowledgements |
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References |
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Janssens, P.M.W. (2002) Verspreiding van erfelijke ziekten door donorsperma: geen reden voor verlaging van het aantal nakomelingen per donor in Nederland. Ned. Tijdschr. Geneeskd., 146, 12151218.[Medline]
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Gottlieb, C., Lalos, O. and Lindblad, F. (2000) Disclosure of donor insemination to the child: the impact of Swedish legislation on couples attitudes. Hum. Reprod., 15, 20522056.
Le Lannou, D., Thépot, F. and Jouannet, P. (1998) Multicentre approaches to donor insemination in the French CECOS Federation: nationwide evaluation, donor matching, screening for genetic diseases and consanguinity. Centre dÉtudes et de Conservation des Oeufs et du Sperme humain. Hum. Reprod., 13 (Suppl. 2), 3554.
Sheldon, T. (2002) Children at risk after sperm donor develops late onset genetic disease. Br. Med. J., 324, 631.
Wet Donorgegevens Kunstmatige Bevruchting (2002) Dutch law. Staatsblad, May 28.
Submitted on July 9, 2002; resubmitted on September 12, 2002; accepted on November 28, 2002.