Researchers find sharp fall requires urgent new recruitment strategies
A study by a leading UK fertility centre has found that the numbers of men – especially students – coming forward as potential sperm donors fell sharply after 2000, almost certainly due to growing awareness that changes in the law would be removing the right to anonymity.
The fall in applications, leading to a significant decline in the numbers recruited, has prompted researchers from the Newcastle Fertility Centre at LIFE to call for urgent action to attract more volunteers – particularly from among older men – and for fears over the release of donor information to be allayed.
The results of the study of over 1,100 potential donors who applied between 1994 and 2003 to the Newcastle centre are published on-line (Thursday 10 November) in Europe's leading reproductive medicine journal Human Reproduction.
They reveal that 88% of applicants were aged under 36, more than half were students without a partner, 85% were unmarried and over three-quarters had no children. Nearly a third had defaulted along the way and almost two-thirds were rejected (85% of those because of sub-optimal semen quality). At the end of the recruitment and testing process fewer than four in a hundred (3.63%) were accepted as suitable donors.
Overall, there was a downward trend in the annual number of applicants from around 175 in 1994 to about 25 in 2003, with the sharpest fall occurring from 2000 onwards. From 1999, the numbers who changed their mind during the application and testing process rose. The acceptability rate of donors (donor release rate) also declined over the study period because of the introduction of stringent criteria aimed at improving standards of recruitment.
Lead author Dr Sudipta Paul, who is now locum consultant obstetrician and gynaecologist at Whitehaven Hospital in Cumbria, said the study showed that the number of men interested in donating sperm had declined significantly, with a consequent reduction in the number recruited. This fall could continue due to the removal of anonymity for men recruited since April 2005.
He said: "The proposed changes in the Human Fertilisation and Embryology Authority (HFEA) review (SEED report) and the EU directive on standards relating to the handling and use of human tissues and cells may also lead to further reductions in donor treatment activity. On the other hand, the demand for donor sperm is likely to increase because of a possible decline in the semen quality in the general UK population."
The potential gap between supply and demand has led senior author Dr Jane Stewart, consultant gynaecologist and specialist in reproductive medicine at the Newcastle Fertility Centre at LIFE, to call for a change of tactics in recruiting donors.
"It is difficult and costly to recruit sperm donors. With the change in the anonymity rules coming we saw a sharp fall in numbers and a change in the profile of the applicants, perhaps reflecting the attitudes of different groups to anonymity. There was a significant increase in the number of men who had partners and, after the Department of Health announcement that anonymity would be removed, there was a substantial fall in the numbers of students."
The unit has been reviewing how it reaches potential donors. "We need to get to the right groups, including minority ethic groups, and inspire them to act," said Dr Stewart, who is also an honorary lecturer at the University of Newcastle-upon-Tyne.
She said that the SEED report, with little change in the criteria for acceptance or exclusion and little to offer in the way of extra remuneration, had not really changed the issue of recruitment.
"It is clear now that we can recruit only donors willing to be identified that we need to change our strategies to target older men in established relationships. Since it appears they are likely to offer help for altruistic purposes, we must continue to work to increase public knowledge of the need for donors up to the age of 40."
Dr Stewart said named donations had been practised in several countries for some years and the UK is having to learn how to make the transition from anonymity. It would help recruitment, she believed, if uncertainties about the eventual release of identifiable information could be clarified and fears allayed. "As yet there is no published policy from the HFEA regarding the plans for information release. Although it is effectively 18 years from now, current donors ought to have at least some idea of how that is to be managed."
She added that it was also important to make clear the level of commitment required as this had possibly contributed to the 30% drop-out rate over the decade of the study, particularly in the early days when fertility issues were less well known to the public.
The unit is also reviewing its high cut-off rate for semen quality. However, to achieve good freeze-thaw sperm quality and, hence, good success rates, the starting sample needs to be substantially better than the WHO criteria for sperm quality. Reducing these criteria may also reduce success rates, which is not appropriate, as this will not only compound the problem but also disappoint patients. Testing two samples may increase acceptability rates, but a man who has variable samples may not always produce samples suitable for freezing. This will increase the number of ejaculates he needs to donate and the time involved, making the whole process more costly.
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