Should sperm donors be paid? a survey of the attitudes of the general public

Transcription

1 Human Reproduction vol.13 no.3 pp , 1998 Should sperm donors be paid? a survey of the attitudes of the general public Helen Lyall 1,4, Gwyn W.Gould 2 and Iain T.Cameron 3 1 Department of Obstetrics and Gynaecology, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, 2 Division of Biochemistry and Molecular Biology, Institute of Biomedical and Life Sciences, University of Glasgow, Glasgow G12 8QQ and 3 Department of Obstetrics and Gynaecology, University of Glasgow, The Queen Mother s Hospital, Yorkhill, Glasgow G3 8SJ, UK 4 To whom correspondence should be addressed at: Department of Obstetrics and Gynaecology, The Queen Mother s Hospital, Yorkhill, Glasgow G3 8SJ, UK Gamete donation in assisted reproduction is an accepted treatment option for certain infertile couples. Traditionally, men donating spermatozoa have been paid a nominal fee, whilst women donating oocytes have not. The issue of payment for sperm donors has recently attracted attention following the Human Fertilisation and Embryology Authority s (HFEA) suggestion that such payment may be withdrawn. Prior to the final meeting of the HFEA working party which is examining this issue, here we report the results of a survey designed to solicit opinion on whether sperm donors should be paid, to identify social or other factors which influence this opinion, and to examine the influence of financial incentive on potential donors. We surveyed 717 individuals in three distinct groups: the general public, students (potential donors), and infertility patients (potential recipients). The majority of the potential donor group (students) was in favour of paying sperm donors, as were infertility patients. In contrast the general public was not. The opinion of the general public on this issue was influenced by their prior knowledge of whether donors were paid: those of the general public favouring the payment of sperm donors had a prior awareness that such payments were made. Although not in favour of paying sperm donors, the general public overwhelmingly approved of the use of donated spermatozoa for the treatment of infertile couples, and thought that ways should be sought to increase the availability of donor spermatozoa for the treatment of infertility and for research purposes. Within the potential donor group (students), the majority indicated that financial reward was an important factor which would influence their decision to donate spermatozoa. As the majority of both the potential recipients and potential donors feels that sperm donors should be paid, perhaps the views of these groups should carry significant weight when the decision whether or not to withdraw payment is taken. This is especially the case in view of the fact that the majority of the general public is in favour of the use of donated spermatozoa for the treatment of infertile couples. Key words: attitudes/gamete donation/payment/sperm donors Introduction Gamete donation in assisted reproduction has been a long accepted treatment option for certain couples. Tens of thousands of babies are born each year as a result of donor insemination (Barratt et al., 1990). Traditionally in the UK, men donating spermatozoa have been paid a nominal fee, while women donating oocytes have not. The issue of payment for sperm donors has recently attracted attention following the Human Fertilisation and Embryology Authority s (HFEA) suggestion that such payment may be withdrawn (HFEA 5th Annual Report, 1996; Johnson, 1997). Following the examination of various aspects of payment for donors, the HFEA agreed that donation should be something entered into freely and voluntarily. Regarding payment for donors, the authority felt that any risk that the decision to donate might be influenced by financial inducement was not desirable (Johnson, 1997). This issue has been (e.g., Shenfield and Steele, 1995), and continues to be, widely debated (e.g., Gazvani et al., 1997; Johnson, 1997; Pennings, 1997; Sauer, 1997). A HFEA working party is presently considering this matter. We therefore thought it pertinent to canvas public opinion on this important issue. The largest group from which sperm donors are recruited is students (Barratt et al. 1989). We therefore chose to solicit the opinion of a student group as potential sperm donors, of infertility patients as potential recipients, and of a broad crosssection of the general public who did not necessarily fall into either of these groups but who were drawn from the same geographical area. To our knowledge, this is the first attempt to study the attitudes of potential donors, recipients and the general public drawn from the same geographical location on this issue. Materials and methods For 2 weeks in February 1997, a questionnaire designed to determine attitudes towards the issue of payment for sperm donation was distributed to three groups of individuals: the general public, students and individuals attending an infertility clinic. These groups were chosen as representative of potential donors (students), potential recipients (infertility patients) and a broad cross-section of the general public. The student group was comprised of third and fourth year science undergraduates at the University of Glasgow, and all postgraduate students in the University Biochemistry Department. The infertility group comprised patients attending the Assisted Conception European Society for Human Reproduction and Embryology 771

2 H.Lyall, G.W.Gould and I.T.Cameron Service at Glasgow Royal Infirmary. In order to obtain as large a cross-section of educational and socio-economic status as possible for a general public group, we approached individuals at two sources: those attending the Physiotherapy and X-Ray Departments of Glasgow Royal Infirmary, and workers of all grades in two University Departments containing a broad cross-section of educational ability and social class (lecturing staff, secretaries, ancillary workers, cleaners etc.). Clearly, these groups will differ in age and education, and also possibly in social class (see Results and Discussion). However, we felt that these three groups offered a means by which to evaluate the attitudes and views of potential donors and recipients, and the view of a range of the general public from the same geographical area. The questionnaire solicited views on: the awareness of the use of donor spermatozoa; the use of donated spermatozoa for assisted reproduction and research; the payment of sperm donors; questions designed to identify factors which correlate with the issue of payment for donors; a series of hypothetical questions regarding the issue of payment for donors; a series of biographical questions. Given the polarization of beliefs in the West of Scotland, we did not determine religious views in this survey. χ 2 -Tests or t-tests were employed for the identification of statistically significant differences between the three groups and the total cohort, or between individual groups as indicated. Statistical analysis was performed on a Macintosh computer using StatView 4.0 (Abacus Software, Berkeley, CA, USA). Results Characteristics of the groups We distributed questionnaires to 219 students, 260 members of the general public and 238 infertility patients. Completion was voluntary and anonymous. The characteristics of the three groups revealed the expected differences in ages (mean values SD: students years; infertility patients years; general public years). All three groups exhibited high completion rates (84% overall, no significant differences between the groups). Attitudes to sperm donation Over 85% of the respondents indicated that they were aware that donor spermatozoa were used in the treatment of infertility. Within the three sub-groups, this figure was lowest in the general public (75%), but there were no statistically significant differences between the three sub-groups. We then sought to determine attitudes regarding the use of donor spermatozoa. Only 29% of the total cohort indicated they would be prepared to use donor spermatozoa for treatment of themselves, and 26% for treatment of their partner. Interestingly, the majority of people were in favour of the use of donor spermatozoa for both treatment of others (66% of the total cohort) and research (76% of the total cohort). Within the three sub-groups, the student group exhibited the highest proportion directly in favour of use of spermatozoa for treatment of others and research (80 and 94% respectively), and also exhibited a slightly increased tendency to favour the use of donor spermatozoa for treatment of partners (36 versus 26% in the total cohort, P 0.04). Despite some reservations regarding the use of donor spermatozoa for the treatment of themselves or partners, the majority of each group felt that ways should be sought to 772 increase the availability of donor spermatozoa for use in the treatment of infertility and research (78 and 80% of the total cohort in favour respectively). There were no significant deviations from these values in any of the three sub-groups. Thus in the total cohort there appeared to be strong support for the use of donor spermatozoa. Should sperm donors be paid? We asked whether, prior to reading an information sheet supplied with the questionnaire, individuals were aware that sperm donors were paid. Overall, only 45% of the total group were aware that sperm donors were paid prior to reading the information sheet. Interestingly, within the infertility patients, these ratios were essentially unchanged. However, the students exhibited a much greater prior awareness of the payment of donors (64% were aware of such payments), whereas the general public was less likely to be aware of this (only 28% were aware of such payments). When asked directly if sperm donors should be paid, the majority of the total cohort responding was in favour of this (52% YES, 43% NO). Within the infertility subgroup, there was no significant deviation from these figures. However, the student sub-group was notably in favour of the payment of donors (67% YES, 29% NO; P 0.01) but the general public sub-group was not (39% YES, 58% NO; P 0.01). This difference between the infertility and general public groups was statistically significant (P 0.05). Factors dictating views on the payment of sperm donors We wished to identify factors which might be associated with either a positive or negative response to the question should sperm donors be paid? Within the general public group, one significant correlation was identified. A much smaller fraction of those answering NO to the question should sperm donors be paid? had prior awareness that sperm donors were paid than those answering YES (17 versus 43% respectively, P 0.01). Within the infertility patient cohort, those who indicated that sperm donors should be paid were much more likely to favour the use of donor spermatozoa for their own treatment (42% in YES group compared to 16% in NO group; P 0.01) or that of their partners (26% in YES group, 13% in NO group, P 0.05). Prior awareness of the payment of sperm donors was again well correlated with the likelihood to favour this payment (60 versus 25%, P 0.05). When the student group was analysed on the basis of YES or NO responses to the question should sperm donors be paid?, there was no significant difference between the groups. Patients in a group drawn from the general public indicated that they had had experience of infertility treatment (n 24). Analysis of the responses of this group compared to the rest of the general public cohort did not reveal any significant differences in attitudes (data not shown). Would you donate spermatozoa? And if so, would you wish to be paid? We asked the men in the cohort whether they would consider donating spermatozoa for the treatment of others or research.

3 Should sperm donors be paid? Table I. Attitudes of potential donors: the financial issue. Individuals who indicated they would be prepared to donate sperm for either treatment of infertile couples or for research purposes were subsequently asked for their opinion on payment for donation in a multiple-choice format On the subject of donation for infertility treatment: If you were not paid for donation, would you be more likely, less likely or neither to donate sperm for treatment of infertility? Total group Students 47* 5** Public Infertility 14* If you were paid, would you be more likely, less likely or neither to donate sperm for treatment of infertility? Total group Students 0 70* Public 21* 33* Infertility On the subject of donation for research: If you were not paid for donation, would you be more likely, less likely or neither to donate sperm for research purposes? Total group Students 62* 2** Public 21 34* Infertility 15* If you were paid, would you be more likely, less likely or neither to donate sperm for research purposes? Total group Students 0 68** Public 17* 34* Infertility Significant differences in a sub-group compared to the total cohort were determined as described, and significant differences are indicated by *P 0.05, **P n number of individuals responding to each question. Within the total cohort, 58% would donate for treatment of others and 72% would donate for research purposes. However, notable differences were observed within the three sub-groups when compared to the total cohort. Male infertility patients were much more likely to be prepared to donate spermatozoa for treatment than was the case for the general public or the students (74% infertility group, 42% general public group and 60% of the student group indicated they would donate spermatozoa for treatment of infertile couples). Similar trends were reported when the study population was asked for views regarding donation for research purposes, but slightly increased numbers indicated they would donate spermatozoa under such circumstances (72% of the total cohort). We also sought to determine views regarding the issue of payment for donation. Of the total cohort, 28% indicated that non-payment of donors would make them less likely to donate (Table I). They reinforced this view by indicating that a greater proportion would be more likely to donate if they were paid (Table I). Broadly similar figures were evident when donation for research was considered (see Table I). Within the three sub-groups, students again had the most polarized view: 47% indicated they would be less likely to donate spermatozoa for treatment and 62% said they would be less likely to donate for research if they were not paid. Similarly, an overwhelming majority of students indicated that payment for such donation would make them more likely to donate (Table I). Forty-one percent of men in the general public group who would be prepared to donate spermatozoa indicated that they would be more likely to donate spermatozoa if they were not paid, compared to only 26% in the total cohort and only 5% of the student group. When the same question was asked in reverse (i.e. would you be less likely to donate if you were paid? ), again a relatively high proportion of the general public indicated that this was the case (21% of the general public group compared to 11% in the total cohort and 0% in the student group). Such data suggest that the general public may be more altruistic in their views. Similar responses were noted when the issue of payment for spermatozoa donated for research was considered (Table I). Gender differences in attitudes to sperm donation We next separated the sub-groups and total cohort into men and women to determine whether gender affected responses to specific questions. We observed no differences between male and female members of each sub-group in responses to any questions, with the exception of responses to questions concerning the use of spermatozoa donated from an anonymous donor for treatment of yourself or your partner. A greater proportion of male students would be willing to use donor spermatozoa for treatment of their partner than was the case for females (47 compared to 27%, P 0.05). A similar trend was observed in the infertility patient cohort (31 versus 10%, P 0.05), but the public did not exhibit this gender difference (28 versus 21%, not significant). Men in the public group however were less willing to consider using donor spermatozoa (17 versus 32%, P 0.04), an opinion which was not shared by the student or infertility patient groups. Discussion Many clinics have reported a shortage of spermatozoa for donor insemination (Liu et al. 1995) and several groups have looked at the motivation of sperm donors (Kovacs et al., 1983; Pedersen et al., 1994; Cook and Golombok, 1995; Liu et al., 1995). For example, Liu et al. (1995) reported that 69% of potential sperm donors expect financial reward. Pedersen and co-workers found that 8% of sperm donors in their cohort stated purely altruistic motives for donation, 32% purely financial, and 60% a combination of both (Pedersen et al., 1994). These studies, and other studies of UK sperm donors (e.g. Cook and Golombok, 1995) have shown clearly that the majority of men who donate spermatozoa in the UK are young single students who are motivated predominantly by payment. This is at odds with the HFEA s stated recommendation that attempts should be made to recruit older donors from stable relationships who already have children. Studies both in the UK and abroad have clearly indicated that payment for sperm donation is an important consideration, particularly among younger (student) donor groups (Cook and Golombok, 1995), although the co-existence of altruistic motives together with 773

4 H.Lyall, G.W.Gould and I.T.Cameron financial considerations is well documented (reviewed in Daniels and Lewis, 1996). Moreover, a recent survey of UK centres licensed for infertility treatment involving donated spermatozoa showed that almost all centres (97%) paid donors, and that 88% of centres surveyed believed that they would lose at least 80% of donors if payment was to be withdrawn (Golombok and Cook, 1995). It has been recognized that the social and ethical issues imposed by assisted reproduction techniques are both complex and controversial (Schafer et al. 1995). These issues have been shown to vary between countries, and also between religious groups among donors and recipients (MorJosef and Schenker, 1995). Surprisingly, although there are numerous studies of the attitudes of donors, there is little or no information regarding attitudes to payment among donors, recipients and the general public drawn from the same geographical area. We therefore set out to examine this contentious issue in potential donor and recipient populations and the general public drawn from the same geographical location. The majority of individuals in our total cohort were in favour of the payment of sperm donors. However, examination of the three categories (potential donors, potential recipients and the general public) showed clear polarization of views, with the potential donors indicating their preference for financial incentive. A similar trend was observed in the infertility patients, the majority of whom were in favour of the payment of sperm donors. On the other hand, the general public group was not in favour of payment. Interestingly, the opinion of the general public on this issue was positively correlated with their prior knowledge of whether sperm donors were paid. Thus, the majority of the public who indicated that they thought sperm donors should not be paid, were unaware that such donors were presently paid, prior to reading the information sheet. This highlights the danger of interpreting questionnaires if basal knowledge is not known, and suggests that a public education campaign could have the potential to influence public opinion. Although in general the public group would not countenance the use of donor spermatozoa for treatment of themselves or their partners, like the potential donor and recipient groups, they were overwhelmingly in favour of the use of donor spermatozoa for the treatment of others or for research. Extrapolation from hypothetical questions in groups without first hand experience of infertility has to be interpreted with caution. For example, in a study in the USA, Braverman and Corson (1995) noted that infertile men were more accepting of the use of donated spermatozoa than men with no direct experience of infertility. Nevertheless, the general public in our survey were fully supportive of the use of donated spermatozoa for the treatment of others, suggesting in our particular sample public acceptance of this practice. Furthermore, all three groups also indicated that they favoured ways to increase the supply of spermatozoa for both treatment or research. Male infertility is an important issue, and donor insemination is an established and cost-effective form of treatment. The availability of donor spermatozoa is a limiting factor (Golombok and Cook, 1995). We have found that financial 774 incentives have a bearing on whether men will donate spermatozoa. If such payments are withdrawn, there is a possibility that the availability of spermatozoa for treatment may decline. In this regard, we show that students strongly favour the payment of donors (67% in favour, 29% against). Since in the UK students represent the main source of donors, our data add weight to the concern already voiced by infertility centres that withdrawal of payment could have significant implications (Golombok and Cook, 1995). While the potential recipient group also favoured the payment of donors (53 versus 39%), the general public were strongly against payment (39 versus 58%). This raises an interesting question not only from an ethical, but also from a social and religious perspective: if the majority of both donors and recipients is in favour of such payment, but the general public is not, whose view should prevail? Payment for donation encompasses a broad range of views. For working men, the potential for donating spermatozoa may be influenced by the need to take time off work (and thus lose income) as much as by the desire to receive payment for the donation (see Daniels and Lewis, 1996). However, a recent series of studies at two London donor insemination clinics argues that both the attitudes and characteristics of donors can be influenced by the recruitment procedure (Daniels et al., 1996, 1997). In one centre, payment was made for semen. The majority of donors were young single men in their midtwenties. These individuals expressed financial gain as the main reason for donation, but in common with many other studies expressed an altruistic reason as a second important incentive. In the second clinic, donors were neither paid for donation nor were they reimbursed for expenses. These donors were older (30s to 40s), almost all were married with children, and the majority expressed a desire to help infertile couples conceive. Almost 50% of this group had direct experience of infertility. Thus, specific targeting of certain groups (such as students) may influence profoundly the motivation for donation. Examination of the data in Table I shows that within both the general public and infertility patient cohorts, a significant number of individuals expressed a (hypothetical) willingness to donate spermatozoa regardless of payment. Such observations, together with the strong correlation between prior knowledge of payment of sperm donors positively correlating with the view that sperm donors should be paid, suggests that a public awareness campaign might influence public opinion on this issue. Such proactive measures have been effective in other countries (notably Sweden and New Zealand) in influencing the potential donor pool (Daniels and Lalos, 1995; Daniels and Lewis, 1996). Studies from two London clinics indicate that such mechanisms might be equally effective in the UK (Daniels et al., 1996, 1997). In conclusion, our study showed that the majority of the public were in favour of the use of donated spermatozoa for the treatment of infertile couples. Given that a majority of both the potential recipients and potential donors felt that sperm donors should be paid, perhaps the views of these groups should carry significant weight when the decision whether or not to withdraw payment is taken.

5 Should sperm donors be paid? References Barratt, C.L.R., Monteiro, E.F., Chauhan, M. et al. (1989) Screening donors for sexually transmitted disease in donor insemination clinics in the UK. A survey. Br. J. Obstet. Gynaecol., 96, Barratt, C.L.R., Chauhan, M. and Cooke, I.D. (1990) Donor insemination a look to the future. Fertil. Steril., 54, Braverman, A.M. and Corson S.L. (1995) Factors related to preferences in gamete donor sources. Fertil. Steril., 63, Cook, R. and Golombok, S. (1995) A survey of semen donation: phase II the view of the donors. Hum. Reprod., 10, Daniels, K.R. and Lalos, O. (1995) The Swedish insemination act and the availability of donors. Hum. Reprod., 10, Daniels, K.R. and Lewis, G.M. (1996) Donor insemination: the gifting and selling of semen. Soc. Sci. Med., 42, Daniels, K.R., Curson, R. and Lewis, G.M. (1996) Semen donor recruitment: a study of donors in two clinics. Hum. Reprod., 11, Daniels, K.R., Lewis, G.M. and Curson, R. (1997) Information sharing in semen donation: the views of donors. Soc. Sci. Med., 44, Gazvani, M.R., Wood, S.J., Thomson, A.J.M. et al. (1997) Payment or altruism? The motivation behind gamete donation. Hum. Reprod., 12, Golombok, S. and Cook, R. (1995) A survey of semen donation: phase I the view of UK licensed centres. Hum. Reprod., 10, Human Fertilisation and Embryology Authority (1996) Fifth Annual Report. HFEA, London. Johnson, M. (1997) Payments to gamete donors: position of the Human Fertilisation and Embryology Authority. Hum. Reprod., 12, Kovacs, G.T., Clayton, C.E. and McGowan, P. (1983) The attitudes of semen donors. Clin. Reprod. Fertil., 2, Liu, S.C., Weaver, S.M., Robinson, J. et al. (1995) A survey of semen donor attitudes. Hum. Reprod., 10, MorJosef, S. and Schenker, J.G. (1995) Sperm donation in Israel. Hum. Reprod., 10, Pedersen, B., Neilsen, A.F. and Lauritsen, J.G. (1994) Psychosocial aspects of donor insemination. Sperm donors their motivations and attitudes to artificial insemination. Acta Obstet. Gynaecol. Scand., 73, Pennings, G. (1997) The internal coherence of donor insemination practice: attracting the right type of donor without paying. Hum. Reprod., 12, Sauer, M.V. (1997) Reproductive prohibition: restricting donor payment will lead to medical tourism. Hum. Reprod., 12, Schäfer, D., Arnemann, J., Brude, E. et al. (1995) Society must decide about prenatal diagnosis. Hum. Reprod., 10, Shenfield, F. and Steele, S.J. (1995) Why gamete donors should not be paid. Hum. Reprod., 10, Received on August 18, 1997; accepted on November 7,