The End of Anonymous Sperm Donation in Colorado: A Step Forward to a New Fertility Future in the US?

This Viewpoint discusses the new Colorado law prohibiting anonymous gamete donation and other debates over reproductive technologies and secrecy.

Adult offspring of lesbian parents: How do they relate to their sperm donors?

OBJECTIVE: To study how adult offspring in planned lesbian-parent families relate to their unknown or known donors. DESIGN: Qualitative analyses of the sixth wave of online surveys from a longitudinal study of adult offspring in planned lesbian families, enrolled at conception. SETTING: Community-based United States national study. PATIENT(S): The 76 participants were 25-year-old donor insemination (DI) offspring whose lesbian parent(s) enrolled in a prospective longitudinal study when these offspring were conceived. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Offspring were asked about donor type, feelings about permanently unknown donor, satisfaction with and role of known donor, whether relationship with known donor was ongoing, and age of meeting open-identity donor. RESULT(S): This cohort (n = 76) of DI offspring with lesbian parents was among the first generation to reach adulthood. Thirty participants had permanently unknown donors and most participants felt comfortable about not knowing them. Sixteen participants had open-identity donors they had not met. Thirty had currently known donors-met in childhood (n = 22) or after open-identity donor disclosure (n = 8)-of whom two thirds had ongoing relationships with donors, half considered their donors as acquaintances, and nearly half had good feelings about their relationship, although a minority expressed conflicted feelings. CONCLUSION(S): This study of adult DI offspring from planned lesbian families shows that those who knew their donors mainly felt positively about these relationships. Qualitative analyses offered insight into offspring-donor relationships, whose numbers are increasing due to historical and demographic trends.

Mater semper certa est: motherhood is always certain.

The development of oocyte donation has led to a reexamination of the facets of motherhood: the genetic, gestational, and psychosocial contributions. In addition, the practice of oocyte donation has prompted a consideration of the unique psychosocial and legal aspects of this form of family building. In this section of Views and Reviews a summary and discussion of the long-term psychosocial adjustment of oocyte donor-conceived children and their parents is presented. Next, the current permeability around donor anonymity is investigated and questions regarding whether donor anonymity can still exist is discussed. Third, the evolution of oocyte cryopreservation and banking is reviewed and the future of oocyte banking is explored. Finally, as oocyte donation continues to grow and evolve, so too does the legal landscape in which it is practiced. Seminal legal cases are presented to describe the legal landscape that has shaped the practice of oocyte donation.

O casal homossexual e a inseminação artificial heteróloga / The homosexual couple and the artificial heterologous insemination

Objetivos: Avaliar o perfil epidemiológico de pacientes submetidas à inseminação artificial heteróloga (IAH), estabelecer a taxa de gravidez e de gestação múltipla e reconhecer a prevalência dos casais homossexuais como elemento de indicação. Metodologia: Estudo descritivo, retrospectivo e quantitativo feito de janeiro de 2009 a outubro de 2014, na Clínica Fértile – Reprodução Humana, que avaliou os procedimentos de IAH. Resultados: Foram analisadas 67 pacientes submetidas a 156 ciclos de tratamento, média de 2,3 procedimentos por paciente. A faixa etária mais prevalente situou‐se entre 18 e 35 anos (55,2%). A principal indicação foi o fator masculino (70,1%). O padrão espermático mais prevalente foi entre 1 e 5 milhões de espermatozoides/mL (53,9%). A taxa de gravidez por ciclo foi de 17,3%. Foram obtidas 7 gestações múltiplas (4,48%). Das 67 pacientes, 9 procuraram a IAH por serem casais homossexuais (13,5%). Conclusão:O perfil epidemiológico foi idade entre 18 e 35 anos, indicação principal o fator masculino e padrão espermático entre 1 e 5 milhões. A taxa de gravidez por ciclo foi de 17,3% com uma taxa de gestações múltiplas de 4,48%. A prevalência de casais homossexuais durante o estudo foi de 13,5%.

Aims: To evaluate the epidemiological profile of patients undergoing heterologous artificial insemination (HAI), establish the rate of pregnancy and multiple pregnancy and recognize the prevalence of homosexual couples as an indication element for the procedure. Methods: A descriptive, retrospective and quantitative study conducted from January 2009 to October 2014, in the Fertile Clinic ‐ Human Reproduction assessing the HAI procedures. Results: We analyzed 67 patients who underwent 156 cycles of treatment with an average of 2.3 procedures per patient. The most prevalent age group was among 18 and 35 representing 55.2%. The main indication for the procedure was the male factor (70.1%). In most prevalent standard sperm concentration was between 1 and 5 million sperm/ml (53.9%) The cycle for pregnancy rate was 17.3%. Seven obtained multiple pregnancies (4.48%) and 5 of these were twins (3.2%) and 2 triplets (1.28%). Of the 67 patients, nine sought to HAI for being homosexual couples representing a rate of 13.5% of patients. Conclusion: The epidemiological profile was represented as follows: age among 18 and 35, the main indication was the male factor and the spermatic standard donated semen was between 1 and 5 million. The cycle for pregnancy rate was 17.3% with a rate of multiple pregnancies of 4.48%, 3.2% were twins and 1.28% triplets. The prevalence of homosexual couples during the study was 13.5%.

[Artificial insemination with donor sperm in the Netherlands: future-proof?]. / Kunstmatige inseminatie met donorsperma in Nederland: toekomstbestendig?

In recent years much has changed in care for artificial insemination with donor sperm (AID). Since new laws and regulations were implemented, a large number of sperm banks have closed and the total number of sperm donors and their availability have decreased. Long waiting times and the use of sperm donors recruited by foreign commercial sperm banks can indicate a shortage of sperm donors. The fact that the internet offers women the possibility of ordering donor sperm and starting treatment without the intervention of a sperm bank means that future donor-conceived children may be prevented from obtaining the identity of their sperm donor as stipulated in the Dutch law on donor information in the context of artificial insemination. In order to comply with this law, an active recruitment policy is needed for Dutch sperm donors, to prevent waiting lists and treatments outside Dutch sperm banks. Only then can current AID care be guaranteed in the Netherlands in the future.

The sperm donor programme over 11 years at Newcastle Fertility Centre.

The UK national sperm donor shortage is well known. We aimed to analyse the trends in various aspects of the sperm donor programme at Newcastle Fertility Centre (NFC) between 2000 and 2010. A retrospective review of the assisted conception treatments with donor sperm was performed. A decline in the numbers of donors recruited alongside a declining trend in the number of patients treated with donor sperm and donor insemination (DI) treatment cycles carried out was apparent. There was an accompanying rising trend in donor IVF cycles and in same-sex couples and single women coming for treatment. The transfer of sperm to local peripheral centres ceased during this time and an increasing number of patients imported sperm from overseas commercial sperm banks. A waiting list for treatment was set up in 2007 with a gradual increase in waiting time to 18 months in 2010. Overall, there was a significant change in the sperm donor programme at NFC with fewer donors recruited, fewer patients receiving treatment, increasing sperm import and longer waiting times for treatment over the study period.

Donor conception, secrecy and the search for information.

Donor conception has historically been shrouded in secrecy. Such secrecy has been underpinned by social views and legal issues concemrning the adults involved in the process--the donor, the recipient parent(s), and, at times, the doctor. However, there is increasing recognition of the need to focus upon donor-conceived people's interests and rights to have identifying and non-identifying information about their donors. This editorial examines issues raised in relation to information release, while also introducing some of the arguments presented by other authors in this Special Issue of the JLM. It also considers recent Australian federal and State government inquiries that have favoured information release and the former Victorian Infertility Treatment Authority's service model to support people in the process of information access and release. While there has been a clear shift to favouring openness and honesty, legislative action is still required to ensure the balancing and realisation of people's interests.

Choreographies of sperm donations: dilemmas of intimacy in lesbian couple donor conception.

Assisted conception involving donor insemination challenges cultural idioms of parenthood and family; there is now a growing body of work exploring how women and couples negotiate becoming a family in this way. But sperm donation also raises questions on the more intimate levels of sex, sexuality and sexual bodies, and these have received little sustained attention in the literature. Lesbian couples in the U.K. increasingly negotiate access to medicalised donor insemination, but many also conceive in informal arrangements with donors where they themselves negotiate proximity and contact with donors when retrieving donor sperm. I explore in this paper how lesbian couples manage and perceive sperm donations, how they seek to negotiate their intimate, sexual and bodily overtones, and how the medical and non-medical settings enable them to do this in different ways. I draw on empirical data from an interview study conducted from 2006 to 2009 in England and Wales comprising 25 lesbian couples. I suggest that sperm donation raises dilemmas of intimacy for lesbian couples, and that couples try to resolve such dilemmas by carefully and intentionally choreographing donation events through managing patterns of movement and action. The different institutional, medical and regulatory frameworks governing clinical and non-clinical sperm donation shape that management in significant and different ways. I argue that sperm donation choreographies enable couples to negotiate the private, sexual and intimate tensions surrounding sperm donations, and also the subjectivity of the sperm donor.

Donor insemination and infertility: what general urologists need to know.

Therapeutic donor insemination (TDI), also known as artificial insemination by donor, is one of the oldest forms of male infertility treatment. With the advent of assisted reproductive technologies and in vitro fertilization techniques over the past few decades, the use of TDI in male infertility treatment has decreased dramatically. Knowledge of its use, indications, efficacy, and related psychosocial issues has also declined among urologists treating male infertility. Despite the change in popularity of the procedure, though, TDI remains an appropriate therapeutic option for certain cases of male infertility, particularly in patients who have failed multiple cycles of in vitro fertilization/intracytoplasmic sperm injection or in men with no available sperm even after attempted microdissection testicular sperm extraction. Further consideration and research should be focused on the potential uses and indications for TDI.

Open-identity donor insemination in the United States: is it on the rise?

Information about US donor insemination programs was reviewed to determine whether an increasing number are offering open-identity donation. Results indicate that indeed, numbers are rising and that the ratio of open-identity to anonymous sperm donors in a program increases the longer that the program has offered an open-identity option.

Changes in American A.I.D. practice during the past decade.

We conducted a survey of donor artificial insemination (AID) practices within the United States. The survey document was sent to 360 practitioners listed by national infertility organizations as performing AID. In addition, we queried 100 practices that had responded to a similar survey in 1978. AID was actually performed during the survey year by 167 of the 282 respondents. Relatively few practices (23%) inseminated more than 10 patients per month. Donor payments increased from a mean of $25 to $40 over that period. A significant increase in the use of frozen semen was found. A majority of practices (52%) used a combination of basal body temperature and urinary LH to time inseminations. The fraction of practitioners who inseminated unmarried women increased substantially since the previous survey. The maximum number of pregnancies resulting from a single donor has not changed over the decade. However, on the average, a single donor is fathering fewer children. The percentage (39%) of practices that inseminate women because of genetic disease in the husband's family has remained about the same. Records of donors and AID children were maintained by 40% of the respondents, representing no change from the previous survey. Our data suggest that as many as 23,400 infants may have resulted from AID conceptions during the survey year. Further changes in the practice of AID can be expected as a result of the 1988 federal recommendations that all donor inseminations be undertaken with cryopreserved, quarantined semen.

Whither human donor insemination in Britain?

KIE: There has been an apparent upsurge in the practice of AID in Great Britain as elsewhere. Although a recent study in Denmark found few untoward effects among participating couples, much more research into the psychosocial implications of AID will be required in order to establish policy guidelines for British physicians.^ieng