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.     

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.     

Enjeux psychosociaux du don de sperme: le point de vue des couples

The French national debate, which took place during the review of bioethical laws, concerns the issue of anonymity of gametes donations, among other questions. More specifically, the debate was focused on sperm donations in which numerous arguments have advocated for a partial opening of sperm donor’s anonymity. But what about couples who are implicated in donation programs? What do they want? What sort of practical changes occur for receiving couples in countries which take away the donor’s anonymity? Our article presents some results of recent social psychological research conducted on a significant sample of French receiving couples. Results focus as much on their experience and their intention to share the secret of conception through sperm donation, as on specific aspects of this type of donation and its defining legislative principles in France. Finally, we question the organizing principles of their stand regarding donator’s anonymity and the convergence of parental strategies in dissident legal frameworks, through the lens of international scientific literature.     

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.     

Le prelevement de sperme deferentiel couple a une Fecondation In Vitro dans les troubles de l’ejaculation

Surgical recovery of spermatozoa from the vas deferens is a simple and reproductible treatment for men with ejaculatory failure. After washing on a Percoll gradient spermatozoa can be used for in vitro fertilization (IVF). Also, when sperm recovery is good, surplus spermatozoa may be frozen. The indications for this treatment include retrograde ejaculation and anejaculation after classic treatments have failed and after failed vasovasostomy. During a one year period five patients were treated in this way (three with retrograde ejaculation and two with anejaculation). The five IVF attemps were performed with aspirates containing 30 to 55 × 106 spermatozoa/ml (mean=42 × 10⁶/ml), 25 to 55% motile spermatozoa (mean=43%). An average of 8.4 ovocytes were inseminated (range=8 to 21) with a fertilization rate of 67% and a success rate of 80% (one term pregnancy, two third trimester pregnancies and one second trimester pregnancy). Surgical sperm aspiration from the vas deferens in cases of ejaculatory failure is a simple, efficacious method by which sufficient mature spermatozoa for an IVF attempt (and/or cryopreservation) can be obtained     

Importance de la qualité du sperme

The semen quality and sperm chromatin alteration have added a new dimension to the evaluation of male factors in repeated spontaneous abortion (RSA). The aim of the study was to evaluate the importance of the sperm quality in RSA conjugal partners. In RSA group, when husbands sperm having more 50% of normal forms and more 50% of native DNA, the paternal lymphocytes injection may lead to a positive immunization. However, no benefit of immunotherapy between conjugal partners if the conventional semen parameters and chromatin quality were altered. Our data indicates that among the vast array of male factors, sperm morphology and chromatin quality seems to be an important criterion to conceive or maintain pregnancy of women with a RSA.     

Cancer du testicule et autoconservation de sperme

Testis cancer, chemotherapy and radiation can induce temporary or permanent infertility in men. Cryopreservation of spermatozoa seems an absolute prerequisite in such situation for male patients who are old enough to procreate. We propose a national retrospective study carried out in 17 CECOS. This survey demonstrates a regular increase for semen preservation in testis cancer and analyses the modalities of gametes preservation and their possible use. In view of this activity, we propose a discussion of the attitude of the various CECOS and of particular cases involving ethical issues.     

Autoconservation de sperme avant traitement anti-cancéreux

Cryopreservation of spermatozoa before treatement is the only proven effective method available to circumvent the sterilizing effect of therapy in young patients with malignant diseases. Sperm disturbances are more important in testicular cancer than in Hodgkin disease. Sperm cryopreservation results depend on sperm initial quality but the advances in Assisted reproduction methods make sperm banking more helpful. Psychological impact of sperm cryopreservation is very strong. It should be proposed even semen quality is poor before oncologic treatement.     

Testicule et sperme dans le Syndrome de Klinefelter chez l'adulte

Klinefelter's syndrome is characterised by azoospermia, gynecomastia and hypogonadotropic hypogonadism. The testes are reduced in volume. Microscopically, seminiferous tubules show a reduced diameter and a thickening of peritubular sheath. The seminiferous epithelium contains Sertoli cells with a clear typical nucleus and a heterogeneous nucleolus. Usually there are no germ cells. When present they degenerate at the spermatocyte stage. Very few achieve a complete maturation until the spermatozoon form. The interstitial gland appears relatively hypertrophied, due to the decrease in volume in the other components of the testis. Sometimes Leydig cells display an adenomatous morphology. Therefore the steroidogenic function is impaired. Azoospermia is a major event in Klinefelter's syndrome but sometimes restricted to severe oligozoospermia. In that cases, fertility may be somewhat preserved, and the caryotype usually reveals a mosaicism, 47,XY/47,XXY with a better prognosis than in pure syndrome.     

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.     

Influence de la cure chirurgicale de la varicocele sur la qualite du sperme

The aim of this study was to assess the efficacy of surgical varicocèle repair in terms of sperm quality. We have performed a retrospective study including 62 patients. All of them underwent clinical evaluation. A sperm analysis has been done before and after surgical repair. Before sugery, the spermogram was normal in only 11.3%. Oligospermia was found in 62.1 % of cases while 6.5% of patients had azoospermia. Abnormalities like microcephalia were encountered in 36.8% of cases. All patients underwent surgical varicocele repair. They were followed up every three months up to 18 months. A significant improvement of sperm count was found in 18 cases, with a pregnancy rate of 6.45%. Alterations of sperm quality was most severe in older patients. We think that as far as natural history of varicocele is not well established, the duration of its evolution is well correlated with the severity of sperm alterations. So, need for precocious diagnosis in order to lessen the risk of infertility.