La majorité des couples procréant par don de sperme envisagent d’informer l’enfant de son mode de conception, mais la plupart souhaitent le maintien de l’anonymat du donneur

Semen donation is anonymous by law since 1994 in France but has been abolished in various countries. We present the results of a study that has been conducted in 14 Cecos in 2006, including 534 couples who were waiting for the assisted procreation, were under treatment, or had already at least one child with donor semen. The results were very similar between men and women and in the various groups. Over 90% of the men and the women are in agreement with donors’ anonymity and less than 10% would like the law to be changed on this point. Approximately 25% of them would give up their parental project if the law was going to change. Almost one-third would like information on the semen donor, mainly on his health, to be transmitted to themselves and to the children. The couples who plan to become parents through semen donation make a clear distinction between donor anonymity and child disclosure on its conception circumstances.     

Le don de sperme en Israël, son secret et son anonymat

Secrecy of donation and donor anonymity are extremely tight in Israel. For infertile couples, this appears to be the preferred mode of operation apparently facilitating long-term adaptation to parenthood. In orthodox Jewish communities, donor insemination is at best tolerated, if and only if the donor is of non-Jewish ancestry, so as to prevent a future incestuous or consanguineous marriage. Since the introduction of intracytoplasmic sperm injection, the proportion of infertile couples who require sperm donation keeps dropping, currently comprising a mere 20–25% of the recipient population. The rest of the recipients consists of single women, many of whom would like the child to know his or her biological father when he or she has grown up. The longterm success of donor insemination requires doctors’ awareness of the recipients’ sensitivities. Additionally, just as the importation of “non-Jewish sperm” is authorized, it would be advisable to allow recruitment of donors under two distinct modes: “anonymous” and “visible,” thereby accommodating the diverse preferences that various recipients seem to have.     

L’anonymat dans l’insémination avec don de sperme: un regard éthique

Which is the link between secret and anonymity in the case of donor insemination? Do we need to know the name of our donor in order to understand our own personal history? What does the term origin mean? This article aims to analyze such questions from a philosophical point of view, in order to show the difference existing between secret — which concerns conception — and anonymity, which deals with the name of the sperm donor.     

Don de sperme: le lien entre l’anonymat et le bénévolat

France has been the first country to introduce a new policy in matter of semen donation, based on anonymity and unpaid donation. The aim was to put sperm and more largely gametes into the category of human tissues that are, according to the law, out of the market. Nowadays there are trends in the opinion to abolish sperm donors’ anonymity. But, numerous sociological studies show that anonymity and unpaid donation are closely linked with the social intrinsic power to strengthen a joint solidarity based on unselfish altruism. Dissociating anonymity and no payment would open the way to the marketing business in semen donation.     

Le principe de l’anonymat du don de sperme: remarques sur son histoire et son application

Introduction

This article, based on sociological research on the activity of donor insemination and semen cryopreservation, addresses four questions concerning the present policy of donor anonymity: What is the principle of anonymous semen donation? Where does it come from? What is its purpose in the organization of donor insemination (DI)? How is the anonymity principle applied in daily practice?

Material and methods

Analysis of the origins and transformations of this policy is based on documents, published in the 70s and the 80s, which provide a history of the practice of donor insemination, in particular within the framework of rules devised by Centre for the Study and Cryopreservation of Semen (Cecos).

Results

This history shows that donor anonymity has been a de facto policy for over two centuries, whereas the notion of an anonymity principle is relatively recent.

Conclusion

Present challenges to this principle have brought to the fore long-standing queries about what establishes fatherhood in cases where paternity is dissociated from impregnation.     

En France, la majorité des donneurs de spermatozoïdes souhaite le maintien de leur anonymat

So far in France, sperm donor anonymity, which was a fundamental principle and has been twice confirmed in the law in 1994 and 2004, is debated nowadays. In this context, the Cecos wanted to know the donors opinion on anonymity. In 2006, 193 semen donors recruited in 14 Cecos answered anonymously a questionnaire: 73% were in agreement with the principle of anonymity and less than 30% agreed that the future law should change to allow the children to know the donor identity. In case of anonymity disclosure, 60% would give up their sperm donation. The same proportion of donors would accept that non identifying information on them could be given on request to the parents and the child.     

Le principe de l’anonymat du donneur de gamètes à l’épreuve de son contexte. Analyse des conceptions juridiques de l’identité

This study clarifies the lively debate surrounding the anonymity of gamete donors. This principle, which has not been challenged since 1994, is currently criticized by a number of people, who were conceived through medically assisted procreation technologies with donor and who now have reached adulthood. Their testimony has a very significant impact on French public opinion. Several official reports have already suggested that the anonymity of gamete donors may well be removed under certain circumstances. To understand why public opinion has evolved so dramatically, we must revisit the legal position of gamete donors in the specific context of less visible changes in the law. Indeed, the legal concepts of parenthood and identity have been reshuffled over time, and such changes have deeply affected the legal issues relating to the anonymity of gamete donors. Formerly, the law governing the identification of individuals was shaped by political and social objectives. Now it is more concerned with the sense of identity and personal fulfilment of people. This change, based on modern western notions of egalitarianism and individuality, has dramatically affected the outcome of parenthood trials. Moreover, biological tests have made the truth available like never before. The possibility of finding out the truth has shocked the practice of many areas of family law and has created a new set of challenges, especially when the secrecy of the genetic parents has been legally established. In France, women have traditionally been able to deliver their children anonymously. A deadlock has resulted, which may now be overcome by introducing a new concept of personal origins. Now the law is evolving to permit the children to demand their biological mothers’ identity under certain circumstances, but without affecting anyone’s rights. The concept of personal origins has been quite successful on the European scene and has also charged the debate. It is now recognized under French and European laws that individuals must have privileged access to their personal origins. Can the principle of anonymity of gamete donors remain immune from such a (r)evolution ?     

Don anonyme, secret du don et symbolique

Based on the psychological interviews we had at CECOS with sperm donors and with requesting couples, and following the analysis of testimonials of children born through donations, we seek to outline that it is not mainly the anonymous donors who raise an issue, but the secret on the nature of the donation itself. It all becomes a family secret as the donation is not well received by the parents. This causes negative effects when the announcement is made lately and it is forbidden to talk about it.     

L’entretien psychologique systématique pour les couples optant pour l’IAD: huit ans d’expérience clinique dans une législation prévoyant la levée de l’anonymat du donneur

A law on medically assisted procreation was implemented in Switzerland in 2001. This law is subordinate to the well-being of the child and stipulates that only married couples can benefit from donor insemination (DI). Furthermore, a child who was conceived with donor sperm may obtain access to information including the identity of the donor on reaching adulthood, at age 18. The law also specifies that psychological assistance must be offered before, during, and after treatment. For the past 12 years, the Unit of Reproductive Medicine and the Center of Medically Assisted Procreation in Lausanne employ a concept of psychological assistance adjusted to each couple’s needs, called “ressource counselling”. In preparation for DI, specific questions are examined, such as “Should the child be informed about the donor insemination, should others be informed, if so, how and when?” These questions may also be discussed in a group setting specific for couples concerned with DI. Our experience shows that systematic counselling helps couples in finding their own path through the delicate subjects of secrecy, attachment, and the rights of a child to be informed of his/her genetic links.     

Should We Formulate an Incentivized Model Facilitating Kidney Donation from Living Donors? A Focus on Turkey's Current System

Kidney transplantation is a lifesaving medical treatment. However, very high demand for kidneys with low kidney donation causes a black market that exploits patients’ desperation and donors’ vulnerability. The current kidney donation programs fail to produce promising results to avoid illegal and unethical kidney trafficking and commercialism. Even though the primary goal of kidney donation is to increase the number of deceased organ donations, in some countries, like Turkey, due to religious or cultural concerns, it is impossible to supply adequate deceased kidney donations. In this view, the aim of this paper is to examine kidney trafficking in the scope of Turkey's current organ donation system and propose a new model, named the Incentivized Kidney Donation Model (IKDM), to increase kidney donation from living donors. The model encompasses the following benefits offered to kidney donors; lifetime health insurance, exemptions from copayments/contribution shares, priority when receiving an organ, priority when finding a job, income tax exemptions for salaried employees, and free or discounted public utilities. This normative model has the potential to promote donors’ altruistic acts as well as the solidarity and loyalty among members of a society without violating ethical values and internationally accepted principles.     

Données descriptives de l’activité d’Assistance médicale à la procréation avec don de spermatozoïdes au sein des CECOS de 1973 à 2006 en France

Introduction

The first CECOS (Centre for study and conservation of human eggs and sperm) was created in 1973 by Georges David and till today, most of the activity of sperm donation in France is managed by the CECOS. This work presents a detailed report of the activity of sperm donation between 1973 and 2006 in this French CECOS network.

Material and methods

Annual activity reports have been compiled by the French CECOS network since 1973. We have collected and analysed these annual reports in order to establish a general estimation of the activity of sperm donation in France during the period of more than 30 years.

Results

Sixty-nine thousand nine hundred forty-five couples asked for assisted reproductive techniques with sperm donation (mainly artificial insemination) to conceive their first child. About 20% of these couples tried to conceive a second or third child. A total of 44,045 children were thus conceived with the effective contribution of 10,347 donors of spermatozoa (out of 16,971 donors who came in the centres for a donation). This report of activity is the largest ever published.     

Anonymity versus Privacy in the Dictator Game: Revealing Donor Decisions to Recipients Does Not Substantially Impact Donor Behavior

Anonymity is often offered in economic experiments in order to eliminate observer effects and induce behavior that would be exhibited under private circumstances. However, anonymity differs from privacy in that interactants are only unaware of each others'' identities, while having full knowledge of each others'' actions. Such situations are rare outside the laboratory and anonymity might not meet the requirements of some participants to psychologically engage as if their actions were private. In order to explore the impact of a lack of privacy on prosocial behaviors, I expand on a study reported in Dana et al. (2006) in which recipients were left unaware of the Dictator Game and given donations as “bonuses” to their show-up fees for other tasks. In the current study, I explore whether differences between a private Dictator Game (sensu Dana et al. (2006)) and a standard anonymous one are due to a desire by dictators to avoid shame or to pursue prestige. Participants of a Dictator Game were randomly assigned to one of four categories—one in which the recipient knew of (1) any donation by an anonymous donor (including zero donations), (2) nothing at all, (3) only zero donations, and (4) and only non-zero donations. The results suggest that a lack of privacy increases the shame that selfish-acting participants experience, but that removing such a cost has only minimal effects on actual behavior.     

Guidelines for drug donations.

Drug donations are usually given in response to acute emergencies, but they can also be part of development aid. Donations may be given directly by governments, by non-governmental organisations, as corporate donations (direct or through private voluntary organisations), or as private donations to single health facilities. Although there are legitimate differences between these donations, basic rules should apply to them all. This common core of "good donation practice" is the basis for new guidelines which have recently been issued by the World Health Organisation after consultation with all relevant United Nations agencies, the Red Cross, and other major international agencies active in humanitarian emergency relief. This article summarises the need for such guidelines, the development process, the core principles, and the guidelines themselves and gives practical advice to recipients and donor agencies.     

Anonymat et compensation financière du don de gamètes et d’embryons en Belgique

Belgian law concerning medically assisted procreation (MAP) and use of gametes and supernumerary embryos was adopted in 2007 and entered into force at the end of July 2007. It has only a limited impact on routine clinical practice, but dramatically limits the number of pregnancies that can be achieved by gamete donation. In Belgium, sperm donation is theoretically anonymous, but anonymity is not mandatory: when the donor and recipient attend the clinic together, request direct donation and sign an agreement, this procedure is acceptable. Sperm donation is free but it is permitted to provide reasonable compensation to the donor for any expenses and loss of income. Ooocyte donation is also free and theoretically anonymous, but directed (non-anonymous) donation is not prohibited when all parties sign an agreement. In this case, the donor and recipient attend the clinic together. It is also permitted to provide compensation to the donor, but no agreement has been reached concerning the acceptable amount. By taking into account the need for treatment, it would be reasonable to provide for 10 to 15 days off work and therefore an equivalent loss of income that could be compensated by 500 to 1000 euros, travel expenses, or even accommodation close to the MAP clinic during this period, which could also represent 500 to 1000 euros. Justified compensation would therefore represent 1000 or even 2000 euros. This amount appeared to be excessive up until now, but opinions tend to change. It is nevertheless true that spontaneous volunteer donors for free and anonymous oocyte donation are rare. Some centres perform donor randomisation to ensure anonymity. Embryo donation is anonymous. Embryos cannot be sold, but the MAP clinic must ensure the health security of these embryos and their management after the 5-year legal storage period, which also has a certain cost.     

Le don de sperme en Belgique: entre loi et pratique

As well as the other assisted reproductive technologies, insemination with donor sperm has received an abundant legislative framework in Belgium providing the context in which this activity is allowed. According to a law of 2007, we know an access to donor sperm is also open for lesbian and single women. Even if they have to be declined in the multiple points of view of the Belgian society, the National Advisory Ethical Committee proposed in 2004 recommendations for the use of donor sperm. Based on an unusual consensus, it appears that anonymity of the sperm donor must be preserved as long as possible, even if some think that an access to non identifying information (concerning position, philosophy, etc.) should remain accessible if the donor agrees and if it is requested by the patients, mainly if they are lesbian or single.     

L’insémination artificielle avec donneur: les enfants donnent leur avis

Abstract

A study has recently been carried out in France on adults (both men and women) conceived by donor insemination.

Method

Twenty-one subjects were interviewed about shared aspects of their experience by a psychologist (the present author) working for CECOS (Centre d’étude et de conservation des ?ufs et du sperme humains).

Results

It was found that the subjects had much in common, while remaining individually distinctive in terms of their relationships with their parents.

Conclusion

Most of the subjects felt that, by and large, their parents had been right to choose this method. The majority also considered that the anonymity of sperm donation was a good thing.     

Evolutionary genetics and ecology of sperm-dependent parthenogenesis

Sperm-dependent (or pseudogamous) forms of parthenogenetic reproduction occur in a wide variety of animals. Inheritance is typically clonal and matroclinous (of female descent), but sperm are needed to initiate normal development. As opposed to true parthenogenesis (i.e., sperm-independent reproduction), pseudogamous parthenogenetic lineages must coexist with a ‘sperm donor’— e.g., males from a conspecific sexual lineage, conspecific hermaphrodites, or males from a closely related sexual species. Such sperm donors do not contribute genetically to the next generation. The parasitic nature of sperm-dependent parthenogenesis raises numerous ecological and evolutionary questions. How do they arise? What factors help stabilize coexistence between the pseudogamous parthenogens and their sperm donors (i.e., ‘sexual hosts’)? Why do males waste sperm on the asexual females? Why does true parthenogenesis not evolve in pseudogamous lineages and free them from their dependency on sperm donors? Does pseudogamous parthenogenesis provide compensatory benefits that outweigh the constraints of sperm-dependence? Herein, we consider some genetic, ecological, and geographical consequences of sperm-dependent parthenogenesis in animals.     

Baisse de la production et de la qualite spermatique chez l’homme: Facteurs de variation et problemes méthodologiques

In the last few years, the possible decline of human semen quality as well as the important geographical variations of semen quality have been discussed in several scientific articles. In a meta-analysis of 61 publications worldwide, Carlsen et al. found a trend of decreasing sperm count over the past 50 years. This work has been at the origin of many commentaries and controversy. Two kinds of questions were mainly raised: Is the phenomenon real? what could be the reason(s) for such a decline? Many sceptical attitudes facing the conclusions of Carlsen et al. came from the fact that the studies included in the meta-analysis were done in various countries at different times, that the men studied could be very heterogeneous in term of fertility status and that the sample sizes of many studies were very low. It was also advocated that the results could be influenced by cofactors as the man’s age or the duration of sexual abstinence before semen collection or by differences in the methodologies used to analyse the semen samples in the various centers. Interestingly, several retrospective studies from a single centre were published after the meta-analysis of Carlsen reporting data from different groups of men recruited during more than 10 years periods in the last decades. Some of these studies found a decline of sperm concentration while for others, no secular modification of sperm concentration could be observed. It was also noticed important differences between values of semen characteristics in these various studies raising the question of geographical or regional differences besides the secular trend observed. Most of the published studies were very imprecis or poor of information concerning the men included in the study, the technical conditions used for semen analysis, the statistical methods used and the interpretation of the data. We discuss here some of the data of these studies in the context of the actual debate on the modifications of semen quality with the aim to pin-point the methodological bias contributing to the variation in the evaluation of semen quality. Moreover we also discuss the current data on the factors related to the men and their environment which could modulate sperm production and quality. It is mandatory to determine if the man’s reproductive function is influenced by environmental factors and if yes how they act. May be one of the main interest of the ongoing debate will be to develop basic and prospective epidemiological research in the field.     

Le don de sperme

Since its creation, the recruitment of donors has been a constant difficulty of the CECOS. Donors have to be sollicited directly or indirectly. The limited number of pregnancies from the same donor obliges the CECOS to recruit constantly new ones. They cannot call for the same donors periodically. Sperm donation, like other human products, should be done with the free consent of the donors. Its aim is to allow the conception of children outside the family organization of the donor. This motivates some men to accept donation and at the same time démotivates many of them. Hence the necessity of advertisment for sperm donation to favor recruitment among a large population.