Family and Child Psychology Research Centre, City University, Northampton Square, London EC1V 0HB, UK
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Abstract |
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Key words: oocyte donation/semen donation
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Introduction |
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The current policy of the HFEA is to move towards a situation whereby gamete donation is a gift, freely and voluntarily given, and thus to phase out payments to donors (Johnson, 1997; HFEA, 1998a). Currently, the HFEA allows UK donors to be paid up to £15 per donation, plus travelling expenses. However, following a consultation on the implementation of withdrawal of payments to donors, it was decided that the removal of payments at the present time would seriously jeopardise the supply of semen donors and that, in order to ensure a supply of safe, screened semen, payments may currently be maintained (HFEA, 1998b).
One consequence of the debate regarding the withdrawal of payments to gamete donors has been a consideration of the most effective and ethically acceptable ways of recruiting donors in future. With respect to semen donors, the concern that the withdrawal of payment would result in a sharp decline in the number of men coming forward to donateparticularly young single menhas prompted a discussion about targeting a different type of donor, namely older men with children and who are motivated by altruism. As has been pointed out correctly (Daniels and Hall, 1997), if recruitment is aimed at young men who are primarily motivated by payment, it is not surprising that these men report that they would not donate if payment was removed.
Whether or not it is possible to recruit altruistic semen donors in sufficient numbers remains a disputed issue. Unpaid donors are recruited in New Zealand, Sweden (Daniels and Haimes, 1997) and France (Guerin, 1998
), and it has been argued that recruitment strategies aimed specifically at such donors are what is required (Daniels and Hall, 1997
). Some evidence in support of this view comes from a comparison between a London clinic that paid donors and a London clinic that did not; the first clinic recruited the more traditional student donor, whereas the second clinic recruited older, altruistically motivated men with children (Daniels et al., 1996
). In contrast, other UK clinics have reported less successful attempts at recruiting donors who are not paid (Gazvani et al., 1997
; McLaughlin et al., 1998
).
Although the HFEA favours the recruitment of altruistic donors, there is mixed opinion about the appropriateness of such an approach. It has been suggested (Pennings, 1997) that altruism is not necessarily the best motive for semen donation in that the donor may be more likely to wish to be involved with the recipient familya situation that is thought to be undesirable by some clinicians and some parents of donor insemination (DI) children. This view contrasts sharply with that of others (Daniels and Hall, 1997
), who argue that marginalizing donors contributes to their negative image and thus mitigates against an increase in the number of men coming forward to donate. It has also been pointed out that the wish to be paid and the wish to help an infertile couple are not mutually exclusive, and that for many men both considerations are taken into account in their decision to donate (Golombok and Cook, 1994
; Cook and Golombok, 1995
; Fielding et al., 1998
).
Oocyte donation is rather different from semen donation in that the procedures involved are more unpleasant and intrusive, the risks are higher, and a greater degree of commitment is required. Although women who donate their oocytes in the UK are entitled to a payment of £15, this is unlikely to provide adequate compensation for the invasive nature of the donation procedure. Thus, these women are more likely to donate their oocytes for altruistic reasons rather than financial reward (Fielding et al., 1998). A further difference between oocyte and semen donation is that men who donate semen at licensed centres remain anonymous, whereas women who donate may be relatives or friends of the recipients of their oocytes.
The shortage of donated oocytes has been well documented in recent years (Price and Cook, 1995; Abdalla, 1996
; Ahuja and Simons, 1996
; HFEA, 1998a). One method of overcoming this problem has been to establish oocyte sharing schemes whereby patients undergoing IVF are offered free or reduced price treatment in return for donating some of their oocytes (Ahuja et al., 1996
). The HFEA has raised concerns about this practice, particularly in relation to the possibility of a childless woman donating oocytes in order to gain access to treatment which may be unsuccessful while another woman may give birth to her genetic child (HFEA, 1998a). Proponents of oocyte sharing have argued that such a scheme is preferable to persuading other women not requiring infertility treatment to take unknown risks (Ahuja et al., 1998
, 1999
). Following consultation, the HFEA decided to permit oocyte sharing on the grounds that such a scheme can be `enormously beneficial to both sharer and receiver' (HFEA, 1998b), and tight guidelines are soon to be introduced.
In view of the difficulties encountered by licensed clinics in the recruitment of gamete donors, and the potential implications for the recruitment of gamete donors of policy changes proposed by the HFEA, the National Gamete Donation Trust (NGDT) was established in 1998 to facilitate the recruitment of oocyte and sperm donors. The present survey was commissioned by the Trust to provide systematic information on current practice as a basis for the planning of future recruitment strategies. It builds on the earlier survey (Golombok and Cook, 1994; Cook and Golombok, 1995
) by obtaining data from all licensed clinics that recruit semen and/or oocyte donors in the UK. This paper provides a summary of the main findings. The full report is available from the NGDT.
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Materials and methods |
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Procedure
All licensed clinics that recruited semen and/or oocyte donors were asked to participate in the survey. Among 64 clinics which participated, 55 recruited oocyte donors, 30 recruited semen donors, and 24 recruited both oocyte and sperm donors. All clinics agreed to take part, although three were excluded from the statistical analysis as they were not involved in the active recruitment of sperm and/or oocyte donors. One clinic that recruited both semen and oocyte donors responded with respect to semen donation only. Each clinic was contacted by letter in the first instance to provide information about the survey, and then by telephone to arrange an appointment with the person(s) most closely involved with the recruitment of semen and/or oocyte donors. The interview was carried out by one of the authors (C.M.). With the majority of clinics (85%), the interview was conducted face-to-face, but where this was not possible (due to time constraints or distance) a telephone interview was carried out.
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Results |
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Recruitment strategies
A variety of recruitment methods had been employed by clinics during the 12-month period preceding the survey. The most widely used method was advertising in universities and colleges; 50% of clinics reported that potential donors approached them after seeing an advert in a university or college, with almost two-thirds of these clinics obtaining more than 70% of their potential donors in this way. In contrast, advertising in hospitals and in male-oriented work settings was not found to be productive by any of the clinics, and only one clinic reported that a substantial proportion of potential donors (>30%) came to them as a result of work-place advertising.
The use of the media in recruitment was also popular. Some 23% of clinics estimated that they had been contacted by potential donors as a result of advertising in local newspapers, and 20% found that articles in local newspapers produced potential donors, with half of these clinics finding at least 30% of their donor candidates in this way. Although only a small proportion of clinics used local radio, one clinic found advertising on local radio to be somewhat helpful, and two clinics reported that being interviewed on local radio programmes brought in more than 30% of their potential donors.
Indirect advertising appeared to be a powerful method of recruitment in that two-thirds of clinics (67%) had been approached by men who had read an article about the need for donors, or had seen an advert for another clinic, and had subsequently contacted them. Furthermore, 57% of clinics reported that potential donors had contacted them through word of mouth from existing donors. In 40% of clinics, existing donors were asked to recruit other donors. However, only 7% of clinics reported that potential donors had contacted them after being specifically asked by an existing donor.
The recruitment process
For all of the clinics combined, it was estimated that approximately 2400 men approached a clinic about the possibility of donating semen in the year preceding the survey. In approximately three-quarters of clinics (73%), informal screening takes place at the time the man first makes contact with the clinic. For example, 60% of clinics screen at this stage for age, 23% screen for general health, 23% ask about sexual orientation, 20% check availability, and 17% ask whether the man is adopted.
In order to examine donor attrition from the time of entering the formal screening process to completing the donation programme, the total number of donors at each stage of the donation process was calculated. These calculations were based where possible on actual figures provided by individual clinics. Where these data were not available, informed estimates were made by clinic staff. The following figures are thus approximations rather than exact figures. They are useful in highlighting the extent to which donors are lost at each stage of the process.
In the year preceding the survey, approximately 1000 potential donors entered the formal screening process. Of these, approximately 660 were deemed unsuitable as donors after completing the screening process and approximately 40 did not return following the 6-month waiting period. Thus, only ~300 donors were accepted from the original pool of 1000, representing a loss of 70%. Of the 300 accepted, ~270 donated on at least one occasion, and ~230 completed the donation programme [i.e. donated up to twice a week for a period of between 6 and 9 months, and then returned 6 months later for a final human immunodeficiency virus (HIV) test]. Thus, less than one-quarter (23%) of the potential donors who formally entered the screening process completed the donation programme. The greatest attrition resulted from being deemed unsuitable as a donor as a result of the screening process.
In accordance with findings from previous studies, the overriding reasons for rejecting potential donors were problems with sperm quality and freezethaw problems (Golombok and Cook, 1994): 73% of clinics had rejected donor candidates due to unsatisfactory sperm quality; 33% rejected between one- and two-thirds of their potential donors, and 13% rejected >90% of their potential donors, for this reason. Some 66% of clinics had rejected donor candidates due to freezethaw problems; 33% rejected between one- and two-thirds of their potential donors, and 7% rejected >90% on these grounds. Other factors which caused >10% of potential donors at any clinic to be rejected were a family history of genetic disorder, a positive cystic fibrosis test, a sexually transmitted disease, cytomegalovirus (CMV), past or present physical illness, a family history of physical illness, past or present psychiatric illness, a family history of psychiatric illness, personality problems, and drug or alcohol abuse. No clinic reported rejecting donor candidates on the basis of poor educational level, physical unattractiveness, homosexuality, a positive HIV test, hepatitis or a personal history of genetic disorder.
Characteristics and motivations of donors
As with previous surveys (Golombok and Cook, 1994), the majority of donors were found to be students; 43% of clinics recruited students, 27% recruited older men, and the remaining 30% recruited a mixture of the two. Whereas approximately half of the clinics (53%) used donors who did not have children, 30% recruited fathers, and 17% recruited childless men as well as fathers. Students constituted at least half of the current donors in almost two-thirds (63%) of clinics, whereas this was true of men with children in only one-quarter (27%) of clinics.
All clinics but one paid the donors, with approximately half paying per donation, and the other half paying per clinic visit. Most clinics (86%) retained a proportion of the payment until the end of the 6-month follow-up period when the potential donor was required to return for an HIV test. The majority of respondents (86%) believed that payment was the primary motivation of students to donate. In contrast, 89% believed that altruism was the primary motivation of older men. This pattern of results is in keeping with the views of actual donors, as demonstrated by other published studies (Cook and Golombok, 1995).
Demand for semen
The figures presented regarding the demand for semen are derived from the responses of all clinics in the survey. Some 93% of clinics had obtained semen from other clinics during the 12 months preceding the survey; 30% obtained fewer than 20 samples, 30% obtained between 20 and 100 samples, and 30% obtained between 100 and 350 samples.
The total number of patients treated with donated semen in the previous year was estimated to be ~4500 for all of the clinics combined. Of the 42 clinics that treated patients with donated semen in this period, six treated <20 patients, 23 treated between 20 and 100 patients, and 13 treated between 100 and 600 patients. When asked whether they had experienced difficulty in obtaining a sufficient supply of semen during the past 12 months, 13% reported a definite difficulty and a further 14% reported an occasional difficulty. Very few clinics (7%) had patients on a waiting list due to the unavailability of semen. When patients did have to wait for semen to become available, the waiting time was usually less than 6 months.
However, there appeared to be particular difficulties associated with obtaining a sufficient supply of semen from donors of a particular type, with 53% clinics reporting this to be a problem. With respect to donors from different ethnic groups, Asian donors were the most difficult to find, with the percentage of clinics reporting difficulties in obtaining semen from Indian, Pakistani and Bangladeshi donors respectively being 39%, 37% and 31%. Very few clinics specifically targeted potential Asian donors in their recruitment drive. Three clinics tried specifically to recruit Indian donors, and two tried to recruit Pakistani donors. None targeted Bangladeshi donors.
Maintaining a supply of semen from Black African, Black Caribbean and other Black donors was also problematic, with 21%, 19% and 19% of clinics reporting a problem for each of these ethnic groups respectively. Some 11% of clinics also reported a problem in obtaining a sufficient supply of semen from Chinese donors, and 7% reported a problem in relation to other ethnic groups, including Middle Eastern donors. Again, very few clinics specifically targeted these ethnic groups as part of their recruitment programme. Only three clinics specifically tried to recruit Black Caribbean donors, and two tried to recruit Black African or other Black donors. None targeted Chinese donors.
With regard to different religious groups, the percentage of clinics reporting a difficulty in obtaining a sufficient supply of semen for Muslim, Sikh, Hindu and Jewish patients was 26%, 19%, 13% and 7% respectively. However, no clinic reported that patients were currently on the waiting list due to a lack of semen from a donor of their religion.
Views of clinic staff
When asked what they considered to be the main difficulties in recruiting semen donors, the most common response, given by 43% of interviewees, was the lack of public awareness of the need for donors. It was also felt by 27% of the respondents that publicity about the need for donors was not being targeted at those who might donate. In addition, information was obtained on the factors that clinic staff believed discourage potential donors from contacting their clinic. A number of factors were thought to be important, including concern about not wanting a future child finding out (77%), the low level of payment (70%), concern about friends or family finding out (53%), objection or discouragement by a partner (57%), the amount of time involved (53%), embarrassment (43%), the discomfort of screening (33%) and the potential effect on future relationships (30%).
The large majority of clinics (86%) reported that they spent a maximum of one hour per week on the recruitment of semen donors. There was much variation in the amount of money spent on recruitment, with 37% of clinics reporting no expenditure, 21% spending up to £100, and 42% spending between £100 and £3000 per year. When questioned about the best ways of recruiting donors in the future, approximately two-thirds of the clinic staff interviewed (67%) thought that a public awareness campaign involving well-informed press coverage would be the most effective approach. Removing the stigma commonly associated with semen donation was seen as an important part of this process (Daniels et al., 1996). Some clinic staff suggested that a national sperm bank would be useful for tracking the number of offspring born to each donor and thus ensuring that the legal limit was maintained, and for facilitating the use of semen from the same donor when a couple wished to have another child.
Oocyte donation
Of the 64 clinics that participated in the survey, 55 (86%) were involved in oocyte donation and the recruitment of oocyte donors. Fifteen were NHS clinics, 30 were private, and 10 treated both NHS and private patients. The following analyses were carried out using data obtained from all 55 clinics.
Recruitment strategies
By far the most common recruitment strategy was to involve patients in the recruitment process, with 71% of clinics asking patients to help with recruitment. This often involved patients and placing adverts for anonymous donors in the local press asking potential donors to contact the clinic directly. Some 64% of clinics reported that potential donors had come to them through this route in the 12 months preceding the survey, and one-quarter (27%) stated that >70% of their donors had come to them in this way.
In addition, the majority of clinics (76%) treated patients using the oocytes of donors who were known to them, either members of their family or friends. In 13% of clinics, oocyte sharing was carried out. This involved women who were undergoing IVF in donating some of their oocytes in return for a free or reduced-price IVF cycle. Asking women undergoing sterilization to donate oocytes was practised in only 7% of clinics.
Whereas 36% of clinics had contributed to articles in local newspapers in the preceding year and 16% had taken part in local radio programmes, only 11% and 7% respectively had advertised in local newspapers or on local radio stations. With respect to national media coverage, 11% of clinics had participated in television programmes about the need for oocyte donors, 9% of clinics had contributed towards articles in women's magazines, 4% had contributed towards articles in national newspapers and 2% had advertised in the national press. Only 5% or fewer clinics reported that donors had contacted them as a direct result of adverts or articles in the national or local press, radio or television, and 7% of clinics had obtained potential donors through articles in women's magazines.
In addition to these direct methods of recruiting, word of mouth is used in the recruitment of oocyte donors. The percentage of clinics reporting that donors had contacted them after hearing about the need for oocyte donors from patients and existing donors respectively was 11% and 10%. Furthermore, 80% of clinics had donors approach them as a result of indirect advertising, e.g. reading an article about infertility and contacting their nearest clinic.
For the 12 months preceding the survey, 76% of clinics reported no expenditure on the recruitment of oocyte donors, 12% spent between £10 and £300, and a further 12% spent between £1000 and £3000. In terms of time spent on recruitment, 67% spent no time, 24% spent 12 h per week, and 10% spent >4 h per week.
The recruitment process
The total number of oocyte donors at each stage of the recruitment process was calculated. As for semen donation, these calculations were based where possible on actual figures provided by individual clinics, and where these data were not available, informed estimates were made by clinic staff. The following figures are thus approximations rather than exact figures, and show the extent to which donors are lost at each stage of the process.
During the year preceding the survey, ~6000 potential donors contacted a clinic, and ~1400 women formally entered screening. Of these, ~200 were regarded as unsuitable as donors as a result of the screening process. Thus, ~1200 donors were accepted from the pool of 1400. Of those donors accepted, ~1100 donated; therefore, 79% of the potential donors who formally entered the screening process completed the donation programme. The greatest attrition resulted from potential donors deciding against donating after receiving information about the procedures involved.
The most common reasons for rejecting donor candidates were a positive cystic fibrosis test, physical illness, and hormonal problems with 24%, 22% and 20% of clinics respectively rejecting women for these reasons. In 13% of clinics, more than two-thirds of women failed the screening process due to hormonal problems. The only other factor that caused >10% of donor candidates to be rejected was a family history of genetic disorder, and 13% of potential donors withdrew from the screening process.
Characteristics and motivations of donors
Three-quarters of the clinics (78%) recruit women with children, 20% recruit a mixture of women with and without children, and only 2% recruit women who do not have children. Whereas the large majority of clinics only recruit women who have partners (89%), 11% recruit a mixture of partnered and single women. In a few clinics (14%) only women aged >30 years are recruited, and 2% of clinics only recruit women aged <30 years. Most clinics (84%), however, recruit donors above and below 30 years of age.
During the 12 months preceding the survey, the majority of clinics (71%) recruited a mixture of anonymous donors and donors who were known to the recipient, 22% recruited anonymous donors only, 5% recruited known donors only, and 2% recruited donors who were known to a recipient of oocyte donation but donated to someone else. Some 32% of clinics reported that around half of the known donors were relatives, and around half were friends of the recipient. There was a higher proportion of relatives than friends in 16% of clinics, and a higher proportion of friends than relatives in 26% of clinics. Of those who recruited known donors, 82% felt that some donors had been under pressure to donate.
An oocyte sharing scheme was practised in 13% of clinics. Of the clinics that had obtained oocytes from women undergoing IVF during the previous 12 months, two clinics had obtained oocytes from <10 women, three clinics had obtained oocytes from between 10 and 35 women, and one clinic had obtained oocytes from ~100 women. In 20% of clinics, a donation of oocytes had been obtained from women undergoing sterilization (some of whom had contacted the clinic spontaneously), and 16% of clinics had received a donation from women undergoing a hysterectomy.
The respondents were asked what they believed to be the primary motivation of oocyte donors. Without exception, it was thought that women donated for altruistic reasons, a finding which is in accordance with previously published views of oocyte donors themselves (Power et al., 1999). Like semen donors, oocyte donors are paid up to £15 for their donation. Some 90% also received expenses to cover travelling and, in some cases, childcare and accommodation costs. In almost half of the clinics (48%), these expenses were between £20 and £100, and in 35% of clinics they ranged from £100 to £500. In clinics that practised oocyte sharing, the donors received payment in kind amounting to the cost of an IVF cycle.
Demand for oocytes
Based on actual figures andwhere these were unavailableinformed estimates, it was calculated that the total number of patients treated with donated oocytes during the 12 months preceding the survey was 1370. In 34% of clinics, <10 patients were treated, in a further 34% between 10 and 20 patients were treated, in 24% of clinics between 20 and 100 patients were treated, and in 8% of clinics 100 or more patients were treated.
Three-quarters of the clinics (73%) had experienced a definite difficulty in obtaining a sufficient supply of oocytes in the previous year, and a further 16% reported an occasional difficulty. Most clinics (87%) reported that they had patients on a waiting list for treatment due to the unavailability of oocytes. In 56% of clinics, between 10 and 100 patients were on a waiting list, and in 20% of clinics this was true of between 100 and 400 patients. The average time on the waiting list was estimated to be a least 1 year in 78% of clinics, with 31% of these clinics reporting average waiting times of 3 years or more.
As found with sperm donors, clinics experience particular difficulties in finding specific types of donors; 66% of clinics reported this to be a problem. Regarding donors from different ethnic groups, Asian donors were the most difficult to recruit. The percentage of clinics reporting difficulties in obtaining oocytes from Indian, Pakistani and Bangladeshi donors respectively were 62%, 49% and 42%. Some 11% of clinics had tried to address this problem by specifically targeting Asian donors as part of their recruitment drive.
Substantial difficulties were also reported with respect to Black Caribbean, Black African and other Black donors, with 44%, 40% and 29% of clinics reporting a problem for each of these ethnic groups respectively. In addition, 15% of clinics had difficulty in recruiting Chinese oocyte donors, and 13% reported a problem in relation to other ethnic groups, including Middle Eastern donors. Approximately 10% of clinics had made a specific attempt to recruit Black Caribbean, Black African and other Black oocyte donors. None had specifically targeted recruitment at Chinese donors.
The total number of ethnic minority patients treated with donor oocytes during the 12 months preceding the survey for all clinics combined was estimated to be ~100. Of the 29 clinics that reported treating ethnic minority patients in this period, only two had treated >10 patients. The total number of ethnic minority patients on the waiting list due to the unavailability of oocytes for all clinics combined, was estimated to be ~440, with 20% of clinics reporting at least 10 patients on the waiting list for this reason, and a further 4% of clinics reporting >50 patients on the waiting list.
Obtaining a sufficient supply of oocytes from different religious groups appeared to pose much less of a problem, possibly because there was less of a demand. Some 7% of clinics reported difficulty in obtaining Muslim oocyte donors, and 6% had difficulty in relation to Jewish oocyte donors. At the time of the survey, only one clinic had patients on a waiting list due to the unavailability of donors of the same religion. With the exception of one clinic that targeted potential Hindu oocyte donors, none had aimed their recruitment procedures at specific religious groups.
Views of clinic staff
When asked what they believed discourages potential donors from donating oocytes, the most common reasons given were lack of public awareness of the need for oocyte donors and concern about medical risks. A total of 82% of respondents believed each of these factors discouraged potential donors from coming forward. Other reasons thought to be important by respondents were the discomfort of oocyte retrieval (73%), objection by a partner (67%), the amount of time involved (53%), and concern about the feelings of a future child (38%). Practical constraints such as distance to the clinic and incompatible clinic opening hours were mentioned by <10% of clinics, and concern about anonymity was not considered to be an important issue for oocyte donors.
In response to questioning regarding the most effective way of recruiting oocyte donors in future, 42% suggested a public awareness campaign. Presenting an accurate portrayal of the kinds of women who require donated oocytes was felt to be important.
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Discussion |
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The most pressing need appears to be for oocyte donors. Almost all of the clinics had experienced difficulty in obtaining a sufficient supply of donated oocytes, and most had placed patients requiring treatment with donated oocytes on a waiting list for this reason.
Many patients had to wait for more than 1 year for treatment, with waiting times of more than 3 years being reported. Finding donors from the same ethnic group as the patients proved to be particularly difficult, especially Asian, Black Caribbean and Black African donors.
The most productive method of recruiting anonymous oocyte donors was to involve patients in the recruitment process, for example, by placing adverts in the local press. Less success was achieved from media publicity by the clinics themselves, although this is difficult to evaluate as few clinics had actively pursued that route. The majority of clinics also treated patients with the oocytes of women who were known to them, either relatives or friends, and in some clinics oocyte sharing was carried out.
Although a substantial number of women had approached a clinic to enquire about the possibility of becoming an oocyte donor, most changed their minds after receiving information about the procedures involved. It was estimated that three-quarters of potential oocyte donors were lost in this way.
The difficulties in recruiting semen donors were generally less acute, with only one-quarter of clinics reporting problems, and very few patients being kept on a waiting list due to a shortage of semen. Nevertheless, one-third of clinics experienced difficulties in recruiting a sufficient number of Asian donors, and one-fifth of clinics reported a shortage of Black African, Black Caribbean and other Black donors. Problems were also encountered in the recruitment of Chinese and Middle Eastern donors in some clinics.
The majority of men who contacted a clinic with a view to becoming a donor had been prompted to do so by a local advert for semen donors, often in their university or college, or had heard about the need for semen donors through word of mouth. Adverts or articles in the local press were also found to be successful by two-thirds of clinics that used this approach. As with the recruitment of oocyte donors, very few clinics operated at a national level.
When clinic staff were asked what aspects of semen donation were most likely to discourage potential donors from coming forward, the most commonly reported deterrents were the possible withdrawal of payment, and fear of being traced by offspring born as a result of their donation if the law changed. These factors have also been reported by donors themselves to be important deterrents (Cook and Golombok, 1995). According to clinic staff, the possible withdrawal of payment and fear of being traced by their future offspring were of less concern to older men with children than to young students, and the latter type of donor remains in the majority at the present time. Interestingly, however, one-quarter of clinics recruited older men.
Although a substantial proportion of men who enquire about the possibility of donating semen do not proceed any further, the greatest problem in the recruitment of semen donors is the high proportion of potential donors who are deemed unsuitable after completing the screening process. This is largely due to unsatisfactory sperm quality and deterioration in sperm quality following freezing. Some clinics reported a preference for younger donors in order to maximize sperm quality.
In the consultation document on the withdrawal of payment to gamete donors issued by the Human Fertilisation and Embryology Authority (HFEA, 1998a), a case was made for a national donor service, or several regional donor services, to raise awareness of gamete donation and manage recruitment procedures. The findings of the present survey show that there is support for such a development in so far as national or regional campaigns designed to increase public awareness about the need for donors, and to reduce the stigma associated with gamete donation, were thought by clinic staff to be the best way forward in the pursuit of future oocyte and semen donors.
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Acknowledgments |
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Notes |
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References |
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Submitted on January 28, 2000; accepted on June 12, 2000.