Manhood
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Anonymous sperm donation is where the child and/or receiving couple will never get to know the identity of the donor, and non-anonymous when they will. A donor who makes a non-anonymous sperm donation is termed a known donor, open-identity or identity-release donor. Non-anonymous sperm donors are, to a substantially higher degree, driven by altruistic motives for their donations.
In any case, some information about the donor may be released to the woman/couple at the time of treatment. A limited donor information at most includes height, weight, eye, skin and hair colour. In Sweden, this is all the information a receiver gets. In the us, on the other hand, additional information may be given, such as a compre-hensive biography and sound/video samples.
For most sperm recipients, anonymity of the donor is not of major importance at the obtainment or tryer-stage. The main reason for anonymity is that recipients think it would be easiest if the donor was completely out of the picture. However, some recipients regret not having chosen a non-anonymous donor years later, for instance when the child desperately wants to know more about the donor anyway.
There is a risk of bias in the information given by clinics or sperm banks regarding anonymity, making anonymous sperm donation seem more favourable than it may actually be, resulting from the fact that anonymous sperm donations are easier for the clinic or sperm bank to handle in the long term, because anonymity doesn’t make them responsible for safely storing donor information for a long period of time. In addition, a majority of donors are anonymous, causing a relative deficit in non-anonymous sperm supply.
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vo l u n ta ry a n d i n vo l u n ta ry s t e r i l i t y The law usually protects sperm donors from being responsible for children produced from their donations, and the law also usually provides that sperm donors have no rights over the children which they produce. Several countries, e.g. Sweden, Norway, the Netherlands, Britain, Switzerland, Australia and New Zealand only allow non-anonymous sperm donation. The child may, when grown up (15–18
years old), get contact information from the sperm bank about his/her biological father. In Denmark, however, a sperm donor may choose to be either anonymous or non-anonymous. Nevertheless, the initial information which the receiving woman/couple will receive is the same.
In the United States, sperm banks are permitted to disclose the identity of a non-anonymous donor to any children brought to the world by that donor, once the child turns eighteen.
Where a sperm donor donates sperm through a sperm bank, the sperm bank will generally undertake a number of medical and scientific checks to ensure that the donor produces sperm of sufficient quantity and quality and that the donor is healthy and will not pass diseases through the use of his sperm. The donor’s sperm must also withstand the freezing and thawing process necessary to store and quarantine the sperm. The cost to the sperm bank for such tests is not inconsiderable.
This normally means that clinics may use the same donor to produce a number of pregnancies in a number of different women.
The number of children permitted to be born from a single donor varies according to law and practice. These laws are designed to protect the children produced by sperm donation from consanguinity in later life: they are not intended to protect the sperm donor himself and those donating sperm will be aware that their donations may give rise to numerous pregnancies in different jurisdictions. Such laws, where they exist, vary from state to state, and a sperm bank may also impose its own limits. The latter will be based on the reports of pregnancies which the sperm bank receives, although this relies upon the accuracy of the returns and the actual number of pregnancies may therefore be somewhat higher. Nevertheless, sperm banks frequently impose a lower limit on geographical numbers than some us states and may also limit the overall number of pregnancies which are permitted from a single donor. When calculating the numbers of children born from each donor, the number of siblings produced in any ‘family’ as a result of sperm donation from the same donor are almost always excluded (but see below for the provisions in various states). There is, of course, no limit to the number of offspring which may be produced from a single donor where he supplies his sperm privately.
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donate through different clinics, where sperm is onsold or is exported to different jurisdictions, and where countries or states do not have a central register of donors.
Sperm agencies, in contrast to sperm banks, rarely impose or en-force limits on the numbers of children which may be produced by a particular donor partly because they are not empowered to demand a report of a pregnancy from recipients and they are rarely, if ever, able to guarantee that a woman may have a subsequent sibling by the donor who was the biological father of her first or earlier children.
Countries that have banned anonymous sperm donation have a substantial sperm shortage, because only a fraction of sperm donors want to continue their contributions if they know that the donor-conceived children may contact them one day. Banning of payment to donors has also caused shortages. This has prompted fertility tourism to other countries to get the treatment.
For instance, when Sweden banned anonymous sperm donation in 1980, the number of active sperm donors dropped from approximately 200 to 30. Sweden now has an eighteen-month-long waiting list for donor sperm. After the United Kingdom ended anonymous sperm donation in 2005, the numbers of sperm donors went up, reversing a three-year decline. However, there is still a shortage, and some doctors have suggested raising the limit of children per donor. Sperm exports from Britain are legal (subject to the eu Directive on Tissue Exports) and donors may remain anonymous in this context. Some uk clinics export sperm which may in turn be used in treatments for fertility tourists in other countries. uk clinics also import sperm from Scandinavia.
Canada also has a shortage because it has been made unlawful to pay people for donating it, requiring recipients who wish to purchase it to import it from the United States. The United States, on the other hand, has had an increase in sperm donors during the late 2000s recession, with donors finding the monetary compensation more favorable.
Naturally, waiting times have gone up, and as a result more and more patients look for a donor by themselves: brothers, brothers-in-law, cousins, close friends, etc. In addition donors advertise, though this raises questions about the quality and safety of the sperm. Waiting times of almost two years also drive patients abroad to countries like Belgium, where there is still complete anonymity.
Do parents tell their children that they have been conceived with the help of a donor? With single people and lesbian couples the question doesn’t arise. The greatest dilemma is whether children and sperm donor actually want to get to know each other. Suppose someone in late adolescence is told that his father is not his biological father, what will their reaction be? It’s hard to imagine. Very probably few sixteen-236
vo l u n ta ry a n d i n vo l u n ta ry s t e r i l i t y year-olds are dying to trace their ‘roots’. It would seem more obvious for them to do that when genealogical factors like birth, death, marriage or divorce come into the picture.
In my hospital donors are recruited through adverts in the regional daily newspaper. Men of 55 and over are excluded, since their generally poor sperm quality entails a higher risk of a child being born with a chromosomal abnormality. More than 80 per cent of volunteers are rejected, usually for the same reason, though occasionally a hereditary problem is grounds for rejection. Traceability and potential pressure have led to the number of families a donor may help to create being limited to five. This means that the number of times he may be approached in future is limited. The recipient of the sperm is promised that she may also have a second or subsequent child from the same donor, so that her children are true brothers and sisters. The restriction on the number of women per donor also has the advantage that the period of donorship ne
ed only be short. The men come for a period of between one and two years, every two or three weeks, in order to build up a large quantity of sperm. Of course some basic information is recorded, including height, weight, skin, eye and hair colour and certain personality features.
The sperm is released only after it has been in quarantine for six months. Meanwhile the donor has been screened again for hepatitis b and c, syphilis, chlamydia, cytomegalia and hiv. Experience has shown that the chance of a full-term pregnancy for each artificial donor insemination is approximately one in eight.
Sick sperm and original sin
‘Babies Made with Sperm from Sick Donor’ read the front-page headlines in the Dutch daily Trouw at the end of February 2002. The report that followed these striking headlines was shocking enough! Eighteen children were found to have been artificially conceived with sperm from a donor suffering from a congenital muscular disease, which had only manifested itself in the donor later in life. The chance of this being passed on was 50 per cent for each child. A nasty fright, and not just for the (foster-)parents. The report confronted the newspaper reader, just out of bed, with the alienating effects of reproductive medicine.
The headline chosen only reinforced this and at any rate stayed with me, and kept buzzing through my head all that week. And certainly, the headline was ‘provocative, polemical and piquant’, as the editor said in justification, after extensive reader comment. ‘It is a radical shock to be confronted with the downside of the “messing about” with modern reproductive techniques’, wrote the editor.
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‘Yet that wasn’t what concerned me most’, wrote a very interesting magazine with a Christian perspective on faith and culture. The writer expressed his view as follows:
I have long disliked the downside of the ‘messing about’.
There’s no need for the paper to define me with this headline.
It’s a little late, it seems to me. It disturbs me too. There’s something hypocritical about wanting suddenly to focus in the light of this unpleasant incident on the messing-about with nature’s reproductive techniques. As if when they are supposedly successful, they raise no questions. Apart from that, it is all so relative. The messing about and manipulation surrounding conception is only a special variant of the universally accepted messing and manipulation surrounding contraception. It may provoke its own moral questions, questions which are real, but to act as if natural conception in a period when contraceptives are deliberately not used is not messing about, goes too far for me. Children are not only made in laboratories, nowadays.
The headline ‘Babies Made with Sperm from Sick Donor’
approved by a conscientious editor concerned me because I found it an almost poetic line, reflecting as it does both modern life (‘made’) and the classical Calvinist teaching of man’s mortal condition, or original sin (‘sperm from sick donor’).
And a little further:
The article casts an unusual light on something as everyday as the desire for children. It seems as if the scope and depth of the desire for children is realized precisely where this desire is not immediately fulfilled in a natural way. The fact that the desire proves to have undreamed-of highs and lows, becomes clear in the lengths people go to in order to realize their wish after all.
Nether the medical route nor the adoption route are pleasant, but they are demanding, both mentally and physically. The desire is such that some people are prepared to make do with a child that is not fruit of both members of a couple.
This is in no way new. On the eve of writing I read precisely the stories of Sarah and Hannah in Genesis and Samuel.
The story of Sarah in particular displays many parallels with the newspaper article. In the absence of a well-trained gynaecologist Sarah took the route of the surrogate mother. The
‘fuss’ casts an unusual light on such people’s desire for chil-238
vo l u n ta ry a n d i n vo l u n ta ry s t e r i l i t y dren: honour must be saved. Without wishing to argue that the desire for children is inspired only by the desire for honour –
general values (virtues) like care and love are also at issue – I would not wish to play down its importance for our age. In our children we finally transcend the finiteness and futility of our existence, perpetuate ourselves, retain our grip on the world after our death.
If in the practice of reproductive medicine you listen to what involuntarily childless couples have to say, you realize the extent to which the
‘death is final’ feeling can affect the ability to retain the unfulfilled desire for children. It makes everyone it affects doubly aware of human mortality. The line dies out, the name is lost. Looked at in this light, the often laborious journey through the medical circuit or the adoption mill, sometimes accompanied by moments of loss of decorum, takes on the character of a battle against the finiteness of existence. The childless couple want a share in what others regard as axiomatic.
But where awe at the mystery of procreation and sense of vulnerability are lost, or are even absent, the human soul is damaged. Parents who with the aid of assisted reproduction techniques want to ‘make’ a child as part of their life project, sooner or later run up against the boundaries of narcissism, certainly when a child demands a different kind of care and love than its parents had planned. Instead of blessing their child, they may come to curse it and such curses can extend a long way. If they cling to the ‘project’, sad self-pity is the lot they have chosen for themselves.
Vibro-ejaculation and electro-ejaculation
A spinal cord lesion is a traumatic injury to the spine. The consequences depend on the location and severity of the trauma. Fortunately it is a rare injury. It is estimated that the annual incidence of spinal cord injury (sci), not including those who die at the scene of the accident, is approximately 40 cases per million population in the usa or approximately 11,000 new cases each year. Since there have not been any overall incidence studies of sci in the usa since the 1970s it is not known if incidence has changed in recent years. Before the Second World War the prognosis for such people was poor, but thanks to the advance of medical science life expectancy has risen markedly and at present is only slightly a few years below the norm. The number of people in the United States who were alive in December 2003 who have sci has been estimated to be approximately 243,000 persons, with a range of 219,000 to 279,000 persons.
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Many people with a spinal cord lesion experience problems in their sex lives. Irrespective of the height of the lesion, experiencing a ‘normal’
orgasm is no longer possible. However a portion of spinal cord lesion patients are able to experience a form of orgasm. Often these are pleasant sensations in the transitional area between presence and absence of sensation. Possibly erratic nerve activity in the brain plays a part in this, since such activity bypasses the spinal cord.
The feeling of an orgasm is sometimes actually unpleasant, although patients turn out to experience a certain relaxation afterwards. The nerves that exit on a level with the spinal segments from the eleventh thoracic vertebra to the second lumbar vertebra (t11-l2) deal with the first part of ejaculation in men. If there is trauma above the tenth thoracic vertebra there is no more transportation of sperm, so that ejaculation is no longer possible. If there is a complete spinal lesion between t11 and l2 the results are unpredictable, depending on whether there are still impulses via this level to the epididymides, seminal ducts and seminal glands. In the case of a complete spinal cord lesion between the third lumbar vertebra and the first sacral vertebra (l3 and s1), sperm transportation and ejaculation generally remain intact.
In involuntary childlessness the poor quality of the sperm plays a role in addition to erection and ejaculation problems. The causes of this are ‘accumulation’ due to the lack of spontaneous ejaculation, epididymal inflammations and too high a temperature. In wheelchair patients the testicles hang more or less constan
tly in a warm environment.
There are various methods of treating fertility problems in cases of spinal cord lesion. If manual stimulation does not produce an ejaculation, an ordinary vibrator can be used, and if that doesn’t help, a more powerful vibrator. In 80 per cent of men with a spinal cord lesion an ejaculation can be produced in this way. In individuals with a spinal cord lesion above the sixth thoracic vertebra, though, it may cause raised blood pressure and even cerebral haemorrhaging. For that reason there must be a doctor on hand, at least the first time. A similar expensive vibrator can also be used in the case of anejaculation with different causes, including psychological ones. Both the vibration frequency and the amplitude can be adjusted. The optimum amplitude with spinal cord lesion is 2.8 mm and a frequency of 100 Hertz. If no ejaculation can be produced with this method, the next step is electrostimulation. This involves the giving of electrical impulses via a thick probe in the rectum, causing the release of sperm cells which can subsequently be removed from the bladder. If the quality is good, the sperm cells are frozen and are used at a later date for icsi.
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vo l u n ta ry a n d i n vo l u n ta ry s t e r i l i t y This equipment was developed by vets involved in breeding programmes in zoos. In the 1970s zoos stopped capturing animals straight from the wild. An out-and-out sex and sperm tourist business developed. The sperm was obtained, with the animals under anaesthetic, by electro-ejaculation. If necessary the males went travelling.
Coordinated breeding programmes monitor the reproduction of several hundred animal species of virtually all the zoos on earth. The experts look at the sex distribution, age structure and the degree of relatedness of all animals of the same type in the various parks and zoos. In this way a breeding plan is drawn up, laying down what animals may have descendants with what others.