Human Fertility, 2014; 17(1): 21–27 © 2014 The British Fertility Society ISSN 1464-7273 print/ISSN 1742-8149 online DOI: 10.3109/14647273.2014.881561
ORIGINAL ARTICLE
An inventory of reasons for sperm donation in formal versus informal settings ERCOLIE R. BOSSEMA1, PIM M. W. JANSSENS2, ROSWITHA G. L. TREUCKER1, FRIEDA LANDWEHR1, KOR VAN DUINEN3, ANNEMIEK W. NAP4 & RINIE GEENEN1 1
Department of Clinical and Health Psychology, Utrecht University, Utrecht, the Netherlands, 2Department of Clinical Chemistry and Haematology/Semenbank, Rijnstate Hospital, Arnhem, the Netherlands, 3Department of Medical Psychology, Rijnstate Hospital, Arnhem, the Netherlands, and 4Department of Gynaecology, Rijnstate Hospital, Arnhem, the Netherlands
Abstract The shortage of sperm donors in formal settings (i.e., assisted reproduction clinics) and the availability of sperm donors in informal settings (such as through contacts on the internet) motivated us to investigate why men may prefer either a formal or an informal setting for sperm donation. Interviews with ten sperm donors and non-sperm donors yielded 55 reasons for sperm donation in the two settings. These reasons were categorized according to similarity by 14 sperm donors and non-sperm donors. These categorizations were then structured by means of hierarchical cluster analysis. Reasons favouring formal settings included being legally and physically protected, evading paternal feelings or social consequences, and having a simple, standardized procedure in terms of effort and finances. Reasons favouring informal settings related to engagement, the possibility to choose a recipient, lack of rules and regulations, having contact with the donor child, and having an (intimate) bond with the recipient. The overview of reasons identified may help potential sperm donors decide on whether to donate in a formal or informal setting, and may fuel discussions by professionals about the most appropriate conditions and legislation for sperm donation in formal settings.
Keywords: Assisted reproduction clinics, internet, motives, sperm banks, sperm donation
Introduction
settings. In a previous study (Bossema et al., 2012), we used a concept-mapping technique to derive three main categories of possible reasons for and against sperm donation: selfishness (including narcissism and procreation), psychosocial drives (including altruism, detached procreation, and sexual/financial satisfaction), and psychosocial barriers (including moral barriers related to oneself, one’s spouse, the donor child, and society). Reasons for sperm donation previously cited by other studies are financial compensation and altruism, including empathy and knowing infertile couples, procreation, including having as many children as possible and passing on genes, evaluating one’s own fertility, having a physical and biochemical examination, helping clinical staff, the desire to parent, the desire not to parent, and curiosity (Pedersen et al., 1994; Lui et al., 1995; Daniels et al., 1996; Lui & Weaver, 1996; Emond & Scheib, 1998; Lalos et al., 2003; Almeling, 2006; Ernst et al., 2007; Ekerhovd et al., 2008; Ripper, 2008; Thorn et al., 2008; Riggs & Russell, 2011). Some of the reasons identified
Since 1985, in an increasing number of countries, the debate on the right of a child conceived by donor insemination to know their donor has led to legislation abolishing donor anonymity when the child reaches a certain age, although without actually obliging the donor to have contact with the child. This legislation may have decreased the number of sperm donors in formal settings, that is, in assisted reproduction clinics (Janssens et al., 2006; Hamilton, 2010; Tomlinson et al., 2010), and may have increased the number of sperm donors in informal settings, such as through contacts on the internet (Ripper, 2008). The shortage of sperm donors in formal settings (Janssens et al., 2006; Hamilton, 2010) and the availability of sperm donors in informal settings (Ripper, 2008; Riggs & Russell, 2011) motivated us to investigate why men may prefer a formal or an informal setting for sperm donation. Reasons for sperm donation have only been examined without distinguishing between formal and informal
Correspondence: Rinie Geenen, Department of Clinical and Health Psychology, Utrecht University, P.O. Box 80.140, 3508 TC Utrecht, the Netherlands. Tel: ⫹31 30 253 4916, Fax: ⫹31 30 253 4718 E-mail: [email protected] (Received 16 December 2012; revised 8 July 2013; accepted 7 October 2013)
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22 E. R. Bossema et al. by previous studies only apply to sperm donation in formal settings, such as receiving a physical and biochemical examination and helping clinical staff, whereas other reasons may apply more to sperm donation in informal settings, such as the desire to parent. However, neither our study nor others provided reasons that may be used by potential sperm donors to weigh the pros and cons of sperm donation in formal versus informal settings. The individuals in our previous study (Bossema et al., 2012) participated in a second study which aimed to identify possible reasons for sperm donation in formal settings (i.e., assisted reproduction clinics) versus informal settings (such as through contacts on the internet). First, an inductive, open-minded interview approach was used to obtain a large number of reasons to donate in either setting. Second, a concept-mapping technique (Trochim, 1989), consisting of a card-sorting task and hierarchical cluster analysis, was used to structure these reasons.
Materials and methods Setting As society and the legal framework of a country may affect views regarding sperm donation, a description is given of the situation in the Netherlands, where this study was performed. Fulfilment of a wish to have child by means of gamete donation is not a strong taboo in the Netherlands, neither for heterosexual parents nor for lesbian couples or single women. Currently, there are eight officially registered sperm banks, united in the Dutch-Belgian Society for Artificial Insemination. Registration of a sperm bank is required according to the Safety and Quality of Bodily Material Law [Wet veiligheid en kwaliteit lichaamsmateriaal], in force since 2005 (http://www.wetten.overheid.nl/BWBR0014682). This law implies that the sperm bank has to comply with all legal and professional regulations related to gamete donation and practised by the medical profession. The rights of donor children are described in the Artificial Insemination Donor Information Act [Wet donorgegevens kunstmatige bevruchting], in force since 2004 (http://www.wetten.overheid.nl/BWBR0013642). According to this law, a donor offspring has the right to obtain identifying information of their donors from the Dutch national donor registry on reaching the age of 16. The ‘general donors’ in formal settings whose sperm is used to help multiple women, do not get to know the recipients of their gametes and the conceived donor children. This, however, may change when their identity is revealed to the children conceived by their gametes in case these children seek contact with them. Nevertheless, a donor in such a situation has no obligations to the child or the recipients and is even free to refuse contact with the donor child. The situation is different for the ‘private donor’ in formal settings who is personally requested by a specific recipient, and for donors in informal settings. Both kinds of donors
have been in contact with the recipient; they know each other’s identity and may keep in touch with each other, if they want. Via the recipient, the private donor and donor in informal settings may possibly come into contact with their offspring, or be denied this, in line with the wish of the recipients. While general donors in formal settings will never have obligations towards their offspring, private donors and donors in informal settings may have such obligations, depending on the arrangements the donors and recipients made and on the kind of personal relationship akin to parenthood between the donor, recipient, and offspring. The latter is suggested by legal rules of the Court on issues relating to donor responsibilities and obligations (Nuytinck, 2008). Participants Sperm donors were recruited through letters given to sperm donors at the assisted reproduction clinic of Rijnstate Hospital in Arnhem, the Netherlands, and through announcements for finding sperm donors on Dutch websites. This resulted in five sperm donors agreeing to be interviewed. One of them had donated in a formal setting (10 times), two in informal settings (up to 30 times), and one in both a formal and informal settings (up to 19 times). Two of these five sperm donors did not wish to participate in the subsequent cardsorting task. A new recruitment resulted in four new sperm donors, and a total of seven sperm donors participating in the card-sorting task. Two of them had donated in formal settings (up to ⱖ 20 times), four in informal settings (up to 30 times), and one in both formal and informal settings (ⱖ 20 times). To balance the number of sperm donors and non-sperm donors, a similar number of non-sperm donors (five in the interviews and an additional two in the card-sorting tasks) were recruited among the acquaintances of the researchers. Demographic characteristics of the participants are given in Table I. The number of 14 participants in the cardsorting task is considered appropriate to obtain a variety of categorizations (Trochim, 1989). Procedure The interviews took place at Utrecht University and were performed by one member of the research team, while another member wrote down the answers. For reasons of privacy, interviews were held individually and answers not tape-recorded. Two open questions asked the participants to consider reasons to donate sperm in informal settings compared with formal settings: ‘What reasons could men have to donate their sperm in informal settings (for example, through contacts on the internet or through friends) but not formal settings (that is, in an assisted reproduction clinic)?’ and ‘What reasons could men have to donate their sperm in formal settings but not informal settings?’ The interviewer encouraged each participant to elaborate on his answers in order to obtain as many reasons regarding sperm Human Fertility
Sperm donation in formal versus informal settings
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Table I. Participant characteristics. Interviews Total (n ⫽ 10) Age (in years) Mean (SD) Range Education level, n (%)a Middle High Religious background, n (%) None Christian Relationship status, n (%) Single Relationship, not cohabiting Relationship, cohabiting Blood donor, n (%) No Yes Organ donor registration, n (%) No Yes
32 (8) 24–49
Sperm donors (n ⫽ 5) 37 (10) 26–49
Card-sorting tasks Non-sperm donors (n ⫽ 5) 28 (3) 24–32
Total (n ⫽ 14)
Sperm donors (n ⫽ 7)
Non-sperm donors (n ⫽ 7)
34 (9) 24–54
39 (10) 28–54
29 (3) 24–34
1 (10) 9 (90)
1 (20) 4 (80)
0 (0) 5 (100)
1 (7) 13 (93)
1 (14) 6 (86)
0 (0) 7 (100)
9 (90) 1 (10)
5 (100) 0 (0)
4 (80) 1 (20)
12 (86) 2 (14)
7 (100) 0 (0)
5 (71) 2 (29)
8 (80) 2 (20) 0 (0)
5 (100) 0 (0) 0 (0)
3 (60) 2 (40) 0 (0)
7 (50) 4 (29) 3 (21)
3 (43) 2 (29) 2 (29)
4 (57) 2 (29) 1 (14)
8 (80) 2 (20)
4 (80) 1 (20)
4 (80) 1 (20)
11 (79) 3 (21)
5 (71) 2 (29)
6 (86) 1 (14)
9 (90) 1 (10)
5 (100) 0 (0)
4 (80) 1 (20)
10 (71) 4 (29)
4 (57) 3 (43)
6 (86) 1 (14)
a
‘Low’: Primary school or lower vocational secondary education, ‘Middle: intermediate general secondary education or intermediate vocational education, and ‘High’: higher general secondary education, higher vocational education, or university education.
donation as possible. After the interviews, all reasons for sperm donation in either a formal or an informal setting were listed by the two members of the research team (Frieda Landwehr and Roswitha G. L. Treucker). This list was evaluated independently by these two members and by a third member of the research team (Ercolie R. Bossema). It was checked whether the statements really reflected reasons for sperm donation in either setting. In addition, statements that involved multiple reasons were divided into separate statements, and those being ambiguous or abstract reasons or reasons not generalizable to the entire participant group were removed. When they differed, the evaluations of these three members were compared and discussed. A fourth member of the research team (Rinie Geenen) was consulted if there was no immediate agreement about specific reasons among the other three members. After this, the statements were adjusted with respect to language and grammar, while retaining the participants’ phrasing, and modified into statements fitting the format ‘If one donates sperm in an informal setting instead of a formal setting ...’. The selected statements were then numbered and written on separate cards for use in the card-sorting tasks. The card-sorting tasks were performed at the participants’ homes. Participants categorized the cards individually with the statements about reasons for sperm donation in informal settings compared with formal settings put into piles according to similarity. Each pile with relatively similar statements was then labelled. The following rules applied: all statements had to be placed in a pile; each statement could be placed in one pile only; each pile could contain 2–25 statements; and 4–12 piles could be formed. The task was performed © 2014 The British Fertility Society
on a table and the participants wrote the results on a scoring form. The study was conducted according to the principles of the Declaration of Helsinki (6th revision, Seoul, 2008) and in accordance with the Dutch Medical Research Involving Human Subjects Act. The Medical Ethics Committee of the Arnhem-Nijmegen region, the Netherlands, declared that its approval was not necessarily given the non-experimental and non-invasive nature of the study. The participants provided written informed consent. Statistical analysis Cluster analysis is a statistical technique used to classify objects of a similar kind into clusters (Clatworthy et al., 2005). These clusters can then be organized hierarchically. We used hierarchical cluster analysis (Ward’s method, squared Euclidean distances) in the statistical software program SPSS, version 16.0 (SPSS, Chicago, IL) to classify the statements that were categorized individually by the participants according to similarity. Statements placed in the same pile by many participants were grouped in lower-order clusters. The lower-order clusters that were most closely related were then grouped in higher-order clusters. These higher-order clusters were grouped in still higherorder clusters until there was a single highest-order cluster. The final number of lowest-order clusters was set by the researchers and based on interpretation of the table and figure (agglomeration schedule and dendogram) produced by the statistical software program, showing which statements were being combined at each stage of the hierarchical clustering process
24 E. R. Bossema et al. (Clatworthy et al., 2005). The main criterion was that the separate lower-order clusters should reflect distinct reasons for sperm donation in either a formal or an informal setting.
Results Interviews The interviews yielded a large number of statements with reasons for sperm donation in informal settings compared with formal settings. Evaluation of the statements by three members of our research team resulted in the selection of 55 final statements, shown in Table II, fitting the format ‘If one donates sperm in an informal setting instead of a formal setting ...’. Card-sorting tasks In the card-sorting tasks, the number of piles with the cards made by the participants varied from four to nine. The minimum number of cards included in a pile ranged from one to seven (one participant accidentally formed a pile including only one statement) and the maximum number ranged from 8 to 24. Labels chosen by the participants to describe a pile with statements included ‘(legal) rules’, ‘procedural’, ‘medical’, ‘sex’, ‘contact with child’, ‘contact with recipient’, ‘advantages’, and ‘disadvantages’. These multiple labels were used by the investigators to interpret the hierarchical cluster solution and to choose final labels for the clusters. Three participants failed to place one of the cards with statements into a pile. For the subsequent cluster analysis, this statement was put in a ‘miscellaneous’ pile for each of these participants. Hierarchical cluster analysis Figure 1 shows the outcome of the hierarchical cluster analysis. The number of lowest-order clusters was set at ten. Decreasing this number to nine combined the clusters ‘social disapproval’ and ‘effort and finances’, which largely reflected distinct reasons. Increasing the number of clusters to eleven divided the cluster ‘engagement’, which only comprised three reasons. The reasons for sperm donation in informal settings compared with formal settings were at the highestorder level divided into ‘personal motives’ (of the sperm donor) and ‘interpersonal motives’ (in relation to the recipient and donor child). The personal motives related to ‘protection’ and ‘procedure’. ‘Protection’ referred to the ‘legal and physical protection’ (6 reasons, e.g. ‘having little legal protection’ or ‘testing the sperm for abnormalities’) and the absence of ‘unwanted paternal feelings’ (5 reasons) when donating in formal settings. ‘Procedure’ concerned the ‘costs’ and the ‘involvement’ of donating in informal settings: ‘costs’ referred to ‘social disapproval’ (6 reasons, e.g. ‘fear of family and friends finding out’ or ‘being rejected by the recipient’) and ‘effort and finances’ (7 reasons, e.g. ‘personally have
to search for a recipient’), while ‘involvement’ referred to ‘engagement’ (3 reasons, e.g. ‘not being anonymous’) and ‘procedural freedom’ with respect to ‘choice of the recipient’ (4 reasons, e.g. ‘being able to choose who you do and do not want to donate your sperm to’) and ‘rules and regulations’ (4 reasons, e.g. ‘not being bound to the rules set by the sperm bank’). The interpersonal motives included potential ‘contact with the donor child’ (7 reasons) and potential ‘contact with the recipient’, with the latter referring to ‘sexual satisfaction’ (4 reasons) and a ‘bond with the recipient’ (9 reasons), which especially apply to informal settings. Table II shows the 55 final statements in the ten lowest-order clusters in the order in which they appeared in the outcome of the hierarchical cluster analysis.
Discussion The shortage of sperm donors in formal settings and the availability of sperm donors in informal settings motivated us to investigate why men may prefer either a formal or an informal setting for sperm donation. Reasons in favour of formal settings predominantly concerned ‘cautious motives’ such as legal and physical protection, evading social consequences, and having a simple procedure in terms of effort and finances. Reasons in favour of informal settings could be described as ‘approach motives’ relating to procedural involvement and contact with the donor child and the recipient. Not all donors are aware of, or consider in depth, their motivation for donation or the future implications of their donation (Hammarberg et al., 2008; Van den Broeck et al., 2013). Our current overview of reasons may be used to help potential sperm donors make an informed decision regarding the setting of their donation. The reasons in favour of sperm donation in formal settings are called ‘cautious motives’ because they may prevent hereditary diseases, unwanted paternal feelings, or social disapproval by friends or recipients. In both formal and informal settings, it is up to the sperm donor whether he wants to share with people around him the fact that he donates. However, only in informal settings do sperm donors risk social disapproval when they meet the recipient, and risk disclosure of being a sperm donor when recipients violate a previously made arrangement about their privacy. Moreover, in the Netherlands, offspring may seek contact with the donor when they reach the age of 16, but the donor has no obligations to the child(ren) and can refuse contact if there are no paternal feelings or to prevent social disapproval. In addition, the effort to be undertaken for sperm donation and the financial compensation for this effort are rather simple and standardized in formal settings and, for example, prevent the donor from having to search for a recipient himself. These findings suggest that sperm donors who do want to donate, but prevent unforeseen consequences, may prefer formal settings. Of course, sperm donors also have other motives for being active as a sperm Human Fertility
Sperm donation in formal versus informal settings Table II. The 55 statements with reasons for sperm donation in informal settings compared with formal settings (‘If one donates sperm in an informal setting instead of a formal setting …’) divided into 10 clusters. Cluster 1. Legal and physical protection … you have little legal protection. … you have few legal rights. … you have no control over the donation procedure. … your sperm has not been tested for abnormalities. … you run the risk of passing on a hereditary disease. … you are not being tested for diseases. Cluster 2. Unwanted paternal feelings … you may develop unwanted paternal feelings. … you may end up being involved in raising the child against your will. … you may develop an unwanted emotional bond with the child. … you may end up having unwanted contact with the child. … you may develop an unwanted emotional bond with the recipient. Cluster 3. Social disapproval … you run the risk of family and friends finding out. … you run the risk of the recipient’s partner becoming jealous. … others may think that you are doing it out of self-interest. … you run the risk of being rejected by the recipient. … you run the risk of being judged by the recipient. … you have to be flexible with regard to the time and place of donation. Cluster 4. Effort and finances … the recipient may reveal your identity to others. … you will have unwanted contact with the recipient. … you have to search for a recipient yourself. … you can broaden your horizons. … you do not have a guarantee of financial compensation. … you have an influence on the level of the financial compensation. … you will have to invest a lot of time and effort. Cluster 5. Engagement … you cannot be anonymous. … there is more emotional involvement in the procedure. … the procedure is more personal. Cluster 6. Choice of recipient … you boost your self-confidence because someone chose you as a sperm donor. … you may meet many different people (such as lesbian couples). … you can choose who you do and do not want to donate your sperm to. … you can help an acquaintance. Cluster 7. Rules and regulations … you are not bound to any legal rules. … you are not bound to the rules set by the sperm bank. … you can stay anonymous, even when the child turns 16. … you can become a sperm donor even if the sperm bank does not want you as a donor. Cluster 8. Contact with donor child … you know the child will have a good home. … you may be able to find out whether the child resembles you. … you may be able to directly play a role in the child’s life. … you may be able to see the child grow up. … you can make agreements about contact with the child. … you may be able to make agreements about how the child will be raised. … you will hopefully have contact with the child. Cluster 9. Sexual satisfaction … you may be able to have sex. … you can satisfy your desire for unprotected sex. … you can satisfy your desire for sex. … you gain more certainty about whether the sperm donation was successful. Cluster 10. Bond with recipient … you at least know who you are providing a service to. … you can be more involved in the conception. … you have contact with the recipient. … you know who the recipient is. … you may be able to build an emotional bond with the recipient. … you can donate your sperm to a woman that you fancy. … you may have permanent contact with the recipient. … you see how grateful the recipient is. … you may be able to have a relationship with the recipient. Note. The order of the statements reflects the outcome of the hierarchical cluster analysis.
© 2014 The British Fertility Society
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26 E. R. Bossema et al. Legal and physical protection
Protection Unwanted paternal feelings
Personal motives
Social disapproval Costs
Effort and finances
Procedure Engagement
Reasons for sperm donation in formal versus informal settings
Involvement
Choice of recipient Procedural freedom
Rules and regulations Contact with donor child
Interpersonal motives Contact with recipient
Sexual satisfaction Bond with recipient
Figure 1. The hierarchical overview of reasons for sperm donation in formal versus informal settings.
donor. A major motive for sperm donation is altruism, as we and others have described previously (Pedersen et al., 1994; Lui et al., 1995; Daniels et al., 1996; Lui & Weaver, 1996; Emond & Scheib, 1998; Lalos et al., 2003; Almeling, 2006; Ernst et al., 2007; Ekerhovd et al., 2008; Ripper, 2008; Thorn et al., 2008; Riggs & Russell, 2011). Altruism, however, is not unique for donors in formal settings, as this motive is also considered important among donors in informal settings (Ripper, 2008; Riggs & Russell, 2011). The reasons in favour of sperm donation in informal settings are called ‘approach motives’ because action is taken to experience positive consequences, such as engagement, and the possibility of having contact with the donor child and the recipient. This kind of psychosocial need and experience on the part of the donor we found in our study have been largely neglected in research (Van den Broeck et al., 2013). Also, sperm donors who either desire a higher financial compensation or insist on becoming a sperm donor ‘even if the sperm bank does not want him as a sperm donor’ may be motivated to turn to informal settings. In formal settings in the Netherlands, profitable payment for donation is not allowed; only compensation for expenses made for the donation, such as travelling costs, is accepted (Organ Donation Law [Wet op de orgaandonatie]; a rule in force since 1998, http://www.wetten.overheid.nl/ BWBR0008066). Our findings show the importance of considering the psychosocial needs of potential sperm donors, and indicate that sperm donors who prefer to take their own initiative and are open to more experiences than solely the donation of sperm, may prefer informal settings. An exception to these approach motives is when the sperm donor wants to maintain anonymity,
since nowadays in the Netherlands only in informal settings may donors and recipients agree upon donor anonymity, even when the donor child has reached the age of 16. Our findings indicate that cautiousness (‘behavioural inhibition’) and approach (‘behavioural activation’) may influence the choice of a setting. Behavioural inhibition is more typical for people high on the personality dimension neuroticism, while behavioural activation is more typical for extraverted personalities (Elliot & Thrash, 2002; Smits & Boeck, 2006). This could lead to the tentative hypothesis that sperm donors in formal settings obtain higher scores on neuroticism and that sperm donors in informal settings obtain higher scores on extraversion. The personality characteristics of sperm donors in the two settings have not yet been compared. However, compared with non-sperm donors, actual sperm donors in formal settings had personality characteristics indicative of low instead of high neuroticism, such as lower harm avoidance and higher self-directedness and cooperativeness (Sydsjö et al., 2011). This finding makes the hypothesis regarding neuroticism less likely, but more research on the possible relationship between personality characteristics and the setting of the sperm donation is needed. This is the first study to investigate possible reasons for sperm donation in formal versus informal settings. The high education level and single marital status of most of the sperm donors in our study are characteristic of sperm donors in formal and informal settings (Riggs & Russell, 2011; Sydsjö et al., 2011; Cook & Golombok, 1995), and indicate that our group may be representative of sperm donors in general. The limitations of our study are the small sample size, especially regarding Human Fertility
Sperm donation in formal versus informal settings sperm donors from formal settings, and the part inclusion of the same participants in the interviews and the card-sorting task. The difficulty in recruiting sperm donors as participants, possibly because of the taboo still surrounding sperm donation, which resulted in the small sample size may have led to some bias in the findings. On the other hand, the heterogeneous sample of sperm donors will have increased the chance of finding many different reasons in the interviews, and the sample size is considered appropriate for concept mapping (Trochim, 1989). Moreover, the two parts of the study (interviews and card-sorting tasks) appealed to distinct knowledge and abilities of the subjects. Future research could examine in a large sample whether the observed reasons are influenced by participant characteristics, such as being or not being a sperm donor and if so, the setting in which the donation was given and previous experiences with sperm donation. In addition, our findings may provide useful starting points to discuss whether and perhaps how formal settings could meet some preferences of sperm donors who may otherwise donate in less regulated informal settings. In conclusion, this study provides a comprehensive set of reasons for sperm donation in formal and informal settings. The overview identified may be used to help potential sperm donors in considering whether to donate in a formal or informal setting. Furthermore, the findings may guide further research on reasons to donate in either setting, and fuel discussions about the most appropriate conditions and legislation for sperm donation in formal settings. Declaration of interest: The authors report no declarations of interest. The authors alone are responsible for the content and writing of the paper.
References Almeling, R. (2006). ‘Why do you want to be a donor?’: gender and the production of altruism in egg and sperm donation. New Genetics and Society, 25, 143–157. Bossema, E.R., Janssens, P.M.W., Landwehr, F., Treucker, R.G.L., van Duinen, K., Nap, A.W., & Geenen, R. (2012). A taxonomy of possible reasons for and against sperm donation. Acta Obstetrica et Gynecologica Scandinavica, 92, 679–685. Clatworthy, J., Buick, D., Hankins, M., Weinman, J., & Horne, R. (2005). The use and reporting of cluster analysis in health psychology: a review. British Journal of Health Psychology, 10, 329–358. Cook, R. & Golombok, S. (1995). A survey of semen donation: phase II – the view of the donors. Human Reproduction, 10, 951–959.
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Daniels, K.R., Curson, R., & Lewis, G.M. (1996). Semen donor recruitment: a study of donors in two clinics. Human Reproduction, 11, 746–751. Ekerhovd, E., Faurskov, A., & Werner, C. (2008). Swedish sperm donors are driven by altruism, but shortage of sperm donors leads to reproductive travelling. Upsala Journal of Medical Sciences, 113, 305–313. Elliot, A.J. & Thrash, T.M. (2002). Approach-avoidance motivation in personality: approach and avoidance temperaments and goals. Journal of Personality and Social Psychology, 82, 804–818. Emond, M. & Scheib, J.E. (1998). Why not donate sperm? A study of potential donors. Evolution and Human Behavior, 19, 313–319. Ernst, E., Ingerslev, H.J., Schou, O., & Stoltenberg, M. (2007). Attitudes among sperm donors in 1992 and 2002: a Danish questionnaire survey. Acta Obstetrica et Gynecologica Scandinavica, 86, 327–333. Hamilton, M. (2010). Sperm donation in the United Kingdom in 2010. Human Fertility, 13, 257–262. Hammarberg, K., Carmichael, M., Tinney, L., & Mulder, A . (2008). Gamete donors’ and recipients’ evaluation of donor counselling: a prospective longitudinal study. Australian and New Zealand Journal of Obstetrics and Gynaecology, 48, 601–606. Janssens, P.M., Simons, A.H., van Kooij, R.J., Blokzijl, E., & Dunselman, G.A. (2006.) A new Dutch Law regulating provision of identifying information of donors to offspring: background, content and impact. Human Reproduction, 21, 852–856. Lalos, A., Daniels, K., Gottlieb, C., & Lalos, O. (2003). Recruitment and motivation of semen providers in Sweden. Human Reproduction, 18, 212–216. Lui, S.C. & Weaver, S.M. (1996). Attitudes and motives of semen donors and non-donors. Human Reproduction, 11, 2061–2066. Lui, S.C., Weaver, S.M., Robinson, J., Debono, M., Nieland, M., Killick, S.R., & Hay, D.M. (1995). A survey of semen donor attitudes. Human Reproduction, 10, 234–238. Nuytinck, A.J.M. (2008). Het omgangsrecht van de spermadonor op grond van diens nauwe persoonlijke betrekking met het kind [The visiting right of the sperm donor based on his close personal relationship with the child]. Ars Aequi, February 2008, 133–138. Pedersen, B., Nielsen, A.F., & Lauritsen, J.G. (1994). Psychosocial aspects of donor insemination. Sperm donors – their motivations and attitudes to artificial insemination. Acta Obstetrica et Gynecologica Scandinavica, 73, 701–705. Riggs, D.W. & Russell, L. (2011). Characteristics of men willing to act as sperm donors in the context of identity-release legislation. Human Reproduction, 26, 266–272. Ripper, M. (2008). Australian sperm donors: public image and provate motives of gay, bisexual and heterosexual donors. Health Sociology Review, 17, 313–325. Smits, D.J.M. & Boeck, P.D. (2006). From BIS/BAS to the Big Five. European Journal of Personality, 20, 255–270. Sydsjö, G., Lampic, C., Brändström, S., Gudmundsson, J., Karlström, P.-O., Solensten, N.G., et al. (2011). Who becomes a sperm donor: personality characteristics in a national sample of identifiable donors. British Journal of Obstetrics and Gynaecology, 119, 33–39. Thorn, P., Katzorke, T., & Daniels, K . (2008). Semen donors in Germany: a study exploring motivations and attitudes. Human Reproduction, 23, 2415–2420. Tomlinson, M.J., Pooley, K., Pierce, A., & Hopkisson, J.F. (2010). Sperm donor recruitment within an NHS fertility service since the removal of anonymity. Human Fertility, 13, 159–167. Trochim, W. (1989). An introduction to concept mapping for planning and evaluation. Evaluation and Program Planning, 12, 1–16. Van den Broeck, U., Vandermeeren, M., Vanderschueren, D., Enzlin, P., Demyttenaere, K., & D’Hooghe, T. (2013). A systematic review of sperm donors: demographic characteristics, attitudes, motives and experiences of the process of sperm donation. Human Reproduction Update, 19, 37–51.
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ORIGINAL ARTICLE
An inventory of reasons for sperm donation in formal versus informal settings ERCOLIE R. BOSSEMA1, PIM M. W. JANSSENS2, ROSWITHA G. L. TREUCKER1, FRIEDA LANDWEHR1, KOR VAN DUINEN3, ANNEMIEK W. NAP4 & RINIE GEENEN1 1
Department of Clinical and Health Psychology, Utrecht University, Utrecht, the Netherlands, 2Department of Clinical Chemistry and Haematology/Semenbank, Rijnstate Hospital, Arnhem, the Netherlands, 3Department of Medical Psychology, Rijnstate Hospital, Arnhem, the Netherlands, and 4Department of Gynaecology, Rijnstate Hospital, Arnhem, the Netherlands
Abstract The shortage of sperm donors in formal settings (i.e., assisted reproduction clinics) and the availability of sperm donors in informal settings (such as through contacts on the internet) motivated us to investigate why men may prefer either a formal or an informal setting for sperm donation. Interviews with ten sperm donors and non-sperm donors yielded 55 reasons for sperm donation in the two settings. These reasons were categorized according to similarity by 14 sperm donors and non-sperm donors. These categorizations were then structured by means of hierarchical cluster analysis. Reasons favouring formal settings included being legally and physically protected, evading paternal feelings or social consequences, and having a simple, standardized procedure in terms of effort and finances. Reasons favouring informal settings related to engagement, the possibility to choose a recipient, lack of rules and regulations, having contact with the donor child, and having an (intimate) bond with the recipient. The overview of reasons identified may help potential sperm donors decide on whether to donate in a formal or informal setting, and may fuel discussions by professionals about the most appropriate conditions and legislation for sperm donation in formal settings.
Keywords: Assisted reproduction clinics, internet, motives, sperm banks, sperm donation
Introduction
settings. In a previous study (Bossema et al., 2012), we used a concept-mapping technique to derive three main categories of possible reasons for and against sperm donation: selfishness (including narcissism and procreation), psychosocial drives (including altruism, detached procreation, and sexual/financial satisfaction), and psychosocial barriers (including moral barriers related to oneself, one’s spouse, the donor child, and society). Reasons for sperm donation previously cited by other studies are financial compensation and altruism, including empathy and knowing infertile couples, procreation, including having as many children as possible and passing on genes, evaluating one’s own fertility, having a physical and biochemical examination, helping clinical staff, the desire to parent, the desire not to parent, and curiosity (Pedersen et al., 1994; Lui et al., 1995; Daniels et al., 1996; Lui & Weaver, 1996; Emond & Scheib, 1998; Lalos et al., 2003; Almeling, 2006; Ernst et al., 2007; Ekerhovd et al., 2008; Ripper, 2008; Thorn et al., 2008; Riggs & Russell, 2011). Some of the reasons identified
Since 1985, in an increasing number of countries, the debate on the right of a child conceived by donor insemination to know their donor has led to legislation abolishing donor anonymity when the child reaches a certain age, although without actually obliging the donor to have contact with the child. This legislation may have decreased the number of sperm donors in formal settings, that is, in assisted reproduction clinics (Janssens et al., 2006; Hamilton, 2010; Tomlinson et al., 2010), and may have increased the number of sperm donors in informal settings, such as through contacts on the internet (Ripper, 2008). The shortage of sperm donors in formal settings (Janssens et al., 2006; Hamilton, 2010) and the availability of sperm donors in informal settings (Ripper, 2008; Riggs & Russell, 2011) motivated us to investigate why men may prefer a formal or an informal setting for sperm donation. Reasons for sperm donation have only been examined without distinguishing between formal and informal
Correspondence: Rinie Geenen, Department of Clinical and Health Psychology, Utrecht University, P.O. Box 80.140, 3508 TC Utrecht, the Netherlands. Tel: ⫹31 30 253 4916, Fax: ⫹31 30 253 4718 E-mail: [email protected] (Received 16 December 2012; revised 8 July 2013; accepted 7 October 2013)
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22 E. R. Bossema et al. by previous studies only apply to sperm donation in formal settings, such as receiving a physical and biochemical examination and helping clinical staff, whereas other reasons may apply more to sperm donation in informal settings, such as the desire to parent. However, neither our study nor others provided reasons that may be used by potential sperm donors to weigh the pros and cons of sperm donation in formal versus informal settings. The individuals in our previous study (Bossema et al., 2012) participated in a second study which aimed to identify possible reasons for sperm donation in formal settings (i.e., assisted reproduction clinics) versus informal settings (such as through contacts on the internet). First, an inductive, open-minded interview approach was used to obtain a large number of reasons to donate in either setting. Second, a concept-mapping technique (Trochim, 1989), consisting of a card-sorting task and hierarchical cluster analysis, was used to structure these reasons.
Materials and methods Setting As society and the legal framework of a country may affect views regarding sperm donation, a description is given of the situation in the Netherlands, where this study was performed. Fulfilment of a wish to have child by means of gamete donation is not a strong taboo in the Netherlands, neither for heterosexual parents nor for lesbian couples or single women. Currently, there are eight officially registered sperm banks, united in the Dutch-Belgian Society for Artificial Insemination. Registration of a sperm bank is required according to the Safety and Quality of Bodily Material Law [Wet veiligheid en kwaliteit lichaamsmateriaal], in force since 2005 (http://www.wetten.overheid.nl/BWBR0014682). This law implies that the sperm bank has to comply with all legal and professional regulations related to gamete donation and practised by the medical profession. The rights of donor children are described in the Artificial Insemination Donor Information Act [Wet donorgegevens kunstmatige bevruchting], in force since 2004 (http://www.wetten.overheid.nl/BWBR0013642). According to this law, a donor offspring has the right to obtain identifying information of their donors from the Dutch national donor registry on reaching the age of 16. The ‘general donors’ in formal settings whose sperm is used to help multiple women, do not get to know the recipients of their gametes and the conceived donor children. This, however, may change when their identity is revealed to the children conceived by their gametes in case these children seek contact with them. Nevertheless, a donor in such a situation has no obligations to the child or the recipients and is even free to refuse contact with the donor child. The situation is different for the ‘private donor’ in formal settings who is personally requested by a specific recipient, and for donors in informal settings. Both kinds of donors
have been in contact with the recipient; they know each other’s identity and may keep in touch with each other, if they want. Via the recipient, the private donor and donor in informal settings may possibly come into contact with their offspring, or be denied this, in line with the wish of the recipients. While general donors in formal settings will never have obligations towards their offspring, private donors and donors in informal settings may have such obligations, depending on the arrangements the donors and recipients made and on the kind of personal relationship akin to parenthood between the donor, recipient, and offspring. The latter is suggested by legal rules of the Court on issues relating to donor responsibilities and obligations (Nuytinck, 2008). Participants Sperm donors were recruited through letters given to sperm donors at the assisted reproduction clinic of Rijnstate Hospital in Arnhem, the Netherlands, and through announcements for finding sperm donors on Dutch websites. This resulted in five sperm donors agreeing to be interviewed. One of them had donated in a formal setting (10 times), two in informal settings (up to 30 times), and one in both a formal and informal settings (up to 19 times). Two of these five sperm donors did not wish to participate in the subsequent cardsorting task. A new recruitment resulted in four new sperm donors, and a total of seven sperm donors participating in the card-sorting task. Two of them had donated in formal settings (up to ⱖ 20 times), four in informal settings (up to 30 times), and one in both formal and informal settings (ⱖ 20 times). To balance the number of sperm donors and non-sperm donors, a similar number of non-sperm donors (five in the interviews and an additional two in the card-sorting tasks) were recruited among the acquaintances of the researchers. Demographic characteristics of the participants are given in Table I. The number of 14 participants in the cardsorting task is considered appropriate to obtain a variety of categorizations (Trochim, 1989). Procedure The interviews took place at Utrecht University and were performed by one member of the research team, while another member wrote down the answers. For reasons of privacy, interviews were held individually and answers not tape-recorded. Two open questions asked the participants to consider reasons to donate sperm in informal settings compared with formal settings: ‘What reasons could men have to donate their sperm in informal settings (for example, through contacts on the internet or through friends) but not formal settings (that is, in an assisted reproduction clinic)?’ and ‘What reasons could men have to donate their sperm in formal settings but not informal settings?’ The interviewer encouraged each participant to elaborate on his answers in order to obtain as many reasons regarding sperm Human Fertility
Sperm donation in formal versus informal settings
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Table I. Participant characteristics. Interviews Total (n ⫽ 10) Age (in years) Mean (SD) Range Education level, n (%)a Middle High Religious background, n (%) None Christian Relationship status, n (%) Single Relationship, not cohabiting Relationship, cohabiting Blood donor, n (%) No Yes Organ donor registration, n (%) No Yes
32 (8) 24–49
Sperm donors (n ⫽ 5) 37 (10) 26–49
Card-sorting tasks Non-sperm donors (n ⫽ 5) 28 (3) 24–32
Total (n ⫽ 14)
Sperm donors (n ⫽ 7)
Non-sperm donors (n ⫽ 7)
34 (9) 24–54
39 (10) 28–54
29 (3) 24–34
1 (10) 9 (90)
1 (20) 4 (80)
0 (0) 5 (100)
1 (7) 13 (93)
1 (14) 6 (86)
0 (0) 7 (100)
9 (90) 1 (10)
5 (100) 0 (0)
4 (80) 1 (20)
12 (86) 2 (14)
7 (100) 0 (0)
5 (71) 2 (29)
8 (80) 2 (20) 0 (0)
5 (100) 0 (0) 0 (0)
3 (60) 2 (40) 0 (0)
7 (50) 4 (29) 3 (21)
3 (43) 2 (29) 2 (29)
4 (57) 2 (29) 1 (14)
8 (80) 2 (20)
4 (80) 1 (20)
4 (80) 1 (20)
11 (79) 3 (21)
5 (71) 2 (29)
6 (86) 1 (14)
9 (90) 1 (10)
5 (100) 0 (0)
4 (80) 1 (20)
10 (71) 4 (29)
4 (57) 3 (43)
6 (86) 1 (14)
a
‘Low’: Primary school or lower vocational secondary education, ‘Middle: intermediate general secondary education or intermediate vocational education, and ‘High’: higher general secondary education, higher vocational education, or university education.
donation as possible. After the interviews, all reasons for sperm donation in either a formal or an informal setting were listed by the two members of the research team (Frieda Landwehr and Roswitha G. L. Treucker). This list was evaluated independently by these two members and by a third member of the research team (Ercolie R. Bossema). It was checked whether the statements really reflected reasons for sperm donation in either setting. In addition, statements that involved multiple reasons were divided into separate statements, and those being ambiguous or abstract reasons or reasons not generalizable to the entire participant group were removed. When they differed, the evaluations of these three members were compared and discussed. A fourth member of the research team (Rinie Geenen) was consulted if there was no immediate agreement about specific reasons among the other three members. After this, the statements were adjusted with respect to language and grammar, while retaining the participants’ phrasing, and modified into statements fitting the format ‘If one donates sperm in an informal setting instead of a formal setting ...’. The selected statements were then numbered and written on separate cards for use in the card-sorting tasks. The card-sorting tasks were performed at the participants’ homes. Participants categorized the cards individually with the statements about reasons for sperm donation in informal settings compared with formal settings put into piles according to similarity. Each pile with relatively similar statements was then labelled. The following rules applied: all statements had to be placed in a pile; each statement could be placed in one pile only; each pile could contain 2–25 statements; and 4–12 piles could be formed. The task was performed © 2014 The British Fertility Society
on a table and the participants wrote the results on a scoring form. The study was conducted according to the principles of the Declaration of Helsinki (6th revision, Seoul, 2008) and in accordance with the Dutch Medical Research Involving Human Subjects Act. The Medical Ethics Committee of the Arnhem-Nijmegen region, the Netherlands, declared that its approval was not necessarily given the non-experimental and non-invasive nature of the study. The participants provided written informed consent. Statistical analysis Cluster analysis is a statistical technique used to classify objects of a similar kind into clusters (Clatworthy et al., 2005). These clusters can then be organized hierarchically. We used hierarchical cluster analysis (Ward’s method, squared Euclidean distances) in the statistical software program SPSS, version 16.0 (SPSS, Chicago, IL) to classify the statements that were categorized individually by the participants according to similarity. Statements placed in the same pile by many participants were grouped in lower-order clusters. The lower-order clusters that were most closely related were then grouped in higher-order clusters. These higher-order clusters were grouped in still higherorder clusters until there was a single highest-order cluster. The final number of lowest-order clusters was set by the researchers and based on interpretation of the table and figure (agglomeration schedule and dendogram) produced by the statistical software program, showing which statements were being combined at each stage of the hierarchical clustering process
24 E. R. Bossema et al. (Clatworthy et al., 2005). The main criterion was that the separate lower-order clusters should reflect distinct reasons for sperm donation in either a formal or an informal setting.
Results Interviews The interviews yielded a large number of statements with reasons for sperm donation in informal settings compared with formal settings. Evaluation of the statements by three members of our research team resulted in the selection of 55 final statements, shown in Table II, fitting the format ‘If one donates sperm in an informal setting instead of a formal setting ...’. Card-sorting tasks In the card-sorting tasks, the number of piles with the cards made by the participants varied from four to nine. The minimum number of cards included in a pile ranged from one to seven (one participant accidentally formed a pile including only one statement) and the maximum number ranged from 8 to 24. Labels chosen by the participants to describe a pile with statements included ‘(legal) rules’, ‘procedural’, ‘medical’, ‘sex’, ‘contact with child’, ‘contact with recipient’, ‘advantages’, and ‘disadvantages’. These multiple labels were used by the investigators to interpret the hierarchical cluster solution and to choose final labels for the clusters. Three participants failed to place one of the cards with statements into a pile. For the subsequent cluster analysis, this statement was put in a ‘miscellaneous’ pile for each of these participants. Hierarchical cluster analysis Figure 1 shows the outcome of the hierarchical cluster analysis. The number of lowest-order clusters was set at ten. Decreasing this number to nine combined the clusters ‘social disapproval’ and ‘effort and finances’, which largely reflected distinct reasons. Increasing the number of clusters to eleven divided the cluster ‘engagement’, which only comprised three reasons. The reasons for sperm donation in informal settings compared with formal settings were at the highestorder level divided into ‘personal motives’ (of the sperm donor) and ‘interpersonal motives’ (in relation to the recipient and donor child). The personal motives related to ‘protection’ and ‘procedure’. ‘Protection’ referred to the ‘legal and physical protection’ (6 reasons, e.g. ‘having little legal protection’ or ‘testing the sperm for abnormalities’) and the absence of ‘unwanted paternal feelings’ (5 reasons) when donating in formal settings. ‘Procedure’ concerned the ‘costs’ and the ‘involvement’ of donating in informal settings: ‘costs’ referred to ‘social disapproval’ (6 reasons, e.g. ‘fear of family and friends finding out’ or ‘being rejected by the recipient’) and ‘effort and finances’ (7 reasons, e.g. ‘personally have
to search for a recipient’), while ‘involvement’ referred to ‘engagement’ (3 reasons, e.g. ‘not being anonymous’) and ‘procedural freedom’ with respect to ‘choice of the recipient’ (4 reasons, e.g. ‘being able to choose who you do and do not want to donate your sperm to’) and ‘rules and regulations’ (4 reasons, e.g. ‘not being bound to the rules set by the sperm bank’). The interpersonal motives included potential ‘contact with the donor child’ (7 reasons) and potential ‘contact with the recipient’, with the latter referring to ‘sexual satisfaction’ (4 reasons) and a ‘bond with the recipient’ (9 reasons), which especially apply to informal settings. Table II shows the 55 final statements in the ten lowest-order clusters in the order in which they appeared in the outcome of the hierarchical cluster analysis.
Discussion The shortage of sperm donors in formal settings and the availability of sperm donors in informal settings motivated us to investigate why men may prefer either a formal or an informal setting for sperm donation. Reasons in favour of formal settings predominantly concerned ‘cautious motives’ such as legal and physical protection, evading social consequences, and having a simple procedure in terms of effort and finances. Reasons in favour of informal settings could be described as ‘approach motives’ relating to procedural involvement and contact with the donor child and the recipient. Not all donors are aware of, or consider in depth, their motivation for donation or the future implications of their donation (Hammarberg et al., 2008; Van den Broeck et al., 2013). Our current overview of reasons may be used to help potential sperm donors make an informed decision regarding the setting of their donation. The reasons in favour of sperm donation in formal settings are called ‘cautious motives’ because they may prevent hereditary diseases, unwanted paternal feelings, or social disapproval by friends or recipients. In both formal and informal settings, it is up to the sperm donor whether he wants to share with people around him the fact that he donates. However, only in informal settings do sperm donors risk social disapproval when they meet the recipient, and risk disclosure of being a sperm donor when recipients violate a previously made arrangement about their privacy. Moreover, in the Netherlands, offspring may seek contact with the donor when they reach the age of 16, but the donor has no obligations to the child(ren) and can refuse contact if there are no paternal feelings or to prevent social disapproval. In addition, the effort to be undertaken for sperm donation and the financial compensation for this effort are rather simple and standardized in formal settings and, for example, prevent the donor from having to search for a recipient himself. These findings suggest that sperm donors who do want to donate, but prevent unforeseen consequences, may prefer formal settings. Of course, sperm donors also have other motives for being active as a sperm Human Fertility
Sperm donation in formal versus informal settings Table II. The 55 statements with reasons for sperm donation in informal settings compared with formal settings (‘If one donates sperm in an informal setting instead of a formal setting …’) divided into 10 clusters. Cluster 1. Legal and physical protection … you have little legal protection. … you have few legal rights. … you have no control over the donation procedure. … your sperm has not been tested for abnormalities. … you run the risk of passing on a hereditary disease. … you are not being tested for diseases. Cluster 2. Unwanted paternal feelings … you may develop unwanted paternal feelings. … you may end up being involved in raising the child against your will. … you may develop an unwanted emotional bond with the child. … you may end up having unwanted contact with the child. … you may develop an unwanted emotional bond with the recipient. Cluster 3. Social disapproval … you run the risk of family and friends finding out. … you run the risk of the recipient’s partner becoming jealous. … others may think that you are doing it out of self-interest. … you run the risk of being rejected by the recipient. … you run the risk of being judged by the recipient. … you have to be flexible with regard to the time and place of donation. Cluster 4. Effort and finances … the recipient may reveal your identity to others. … you will have unwanted contact with the recipient. … you have to search for a recipient yourself. … you can broaden your horizons. … you do not have a guarantee of financial compensation. … you have an influence on the level of the financial compensation. … you will have to invest a lot of time and effort. Cluster 5. Engagement … you cannot be anonymous. … there is more emotional involvement in the procedure. … the procedure is more personal. Cluster 6. Choice of recipient … you boost your self-confidence because someone chose you as a sperm donor. … you may meet many different people (such as lesbian couples). … you can choose who you do and do not want to donate your sperm to. … you can help an acquaintance. Cluster 7. Rules and regulations … you are not bound to any legal rules. … you are not bound to the rules set by the sperm bank. … you can stay anonymous, even when the child turns 16. … you can become a sperm donor even if the sperm bank does not want you as a donor. Cluster 8. Contact with donor child … you know the child will have a good home. … you may be able to find out whether the child resembles you. … you may be able to directly play a role in the child’s life. … you may be able to see the child grow up. … you can make agreements about contact with the child. … you may be able to make agreements about how the child will be raised. … you will hopefully have contact with the child. Cluster 9. Sexual satisfaction … you may be able to have sex. … you can satisfy your desire for unprotected sex. … you can satisfy your desire for sex. … you gain more certainty about whether the sperm donation was successful. Cluster 10. Bond with recipient … you at least know who you are providing a service to. … you can be more involved in the conception. … you have contact with the recipient. … you know who the recipient is. … you may be able to build an emotional bond with the recipient. … you can donate your sperm to a woman that you fancy. … you may have permanent contact with the recipient. … you see how grateful the recipient is. … you may be able to have a relationship with the recipient. Note. The order of the statements reflects the outcome of the hierarchical cluster analysis.
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26 E. R. Bossema et al. Legal and physical protection
Protection Unwanted paternal feelings
Personal motives
Social disapproval Costs
Effort and finances
Procedure Engagement
Reasons for sperm donation in formal versus informal settings
Involvement
Choice of recipient Procedural freedom
Rules and regulations Contact with donor child
Interpersonal motives Contact with recipient
Sexual satisfaction Bond with recipient
Figure 1. The hierarchical overview of reasons for sperm donation in formal versus informal settings.
donor. A major motive for sperm donation is altruism, as we and others have described previously (Pedersen et al., 1994; Lui et al., 1995; Daniels et al., 1996; Lui & Weaver, 1996; Emond & Scheib, 1998; Lalos et al., 2003; Almeling, 2006; Ernst et al., 2007; Ekerhovd et al., 2008; Ripper, 2008; Thorn et al., 2008; Riggs & Russell, 2011). Altruism, however, is not unique for donors in formal settings, as this motive is also considered important among donors in informal settings (Ripper, 2008; Riggs & Russell, 2011). The reasons in favour of sperm donation in informal settings are called ‘approach motives’ because action is taken to experience positive consequences, such as engagement, and the possibility of having contact with the donor child and the recipient. This kind of psychosocial need and experience on the part of the donor we found in our study have been largely neglected in research (Van den Broeck et al., 2013). Also, sperm donors who either desire a higher financial compensation or insist on becoming a sperm donor ‘even if the sperm bank does not want him as a sperm donor’ may be motivated to turn to informal settings. In formal settings in the Netherlands, profitable payment for donation is not allowed; only compensation for expenses made for the donation, such as travelling costs, is accepted (Organ Donation Law [Wet op de orgaandonatie]; a rule in force since 1998, http://www.wetten.overheid.nl/ BWBR0008066). Our findings show the importance of considering the psychosocial needs of potential sperm donors, and indicate that sperm donors who prefer to take their own initiative and are open to more experiences than solely the donation of sperm, may prefer informal settings. An exception to these approach motives is when the sperm donor wants to maintain anonymity,
since nowadays in the Netherlands only in informal settings may donors and recipients agree upon donor anonymity, even when the donor child has reached the age of 16. Our findings indicate that cautiousness (‘behavioural inhibition’) and approach (‘behavioural activation’) may influence the choice of a setting. Behavioural inhibition is more typical for people high on the personality dimension neuroticism, while behavioural activation is more typical for extraverted personalities (Elliot & Thrash, 2002; Smits & Boeck, 2006). This could lead to the tentative hypothesis that sperm donors in formal settings obtain higher scores on neuroticism and that sperm donors in informal settings obtain higher scores on extraversion. The personality characteristics of sperm donors in the two settings have not yet been compared. However, compared with non-sperm donors, actual sperm donors in formal settings had personality characteristics indicative of low instead of high neuroticism, such as lower harm avoidance and higher self-directedness and cooperativeness (Sydsjö et al., 2011). This finding makes the hypothesis regarding neuroticism less likely, but more research on the possible relationship between personality characteristics and the setting of the sperm donation is needed. This is the first study to investigate possible reasons for sperm donation in formal versus informal settings. The high education level and single marital status of most of the sperm donors in our study are characteristic of sperm donors in formal and informal settings (Riggs & Russell, 2011; Sydsjö et al., 2011; Cook & Golombok, 1995), and indicate that our group may be representative of sperm donors in general. The limitations of our study are the small sample size, especially regarding Human Fertility
Sperm donation in formal versus informal settings sperm donors from formal settings, and the part inclusion of the same participants in the interviews and the card-sorting task. The difficulty in recruiting sperm donors as participants, possibly because of the taboo still surrounding sperm donation, which resulted in the small sample size may have led to some bias in the findings. On the other hand, the heterogeneous sample of sperm donors will have increased the chance of finding many different reasons in the interviews, and the sample size is considered appropriate for concept mapping (Trochim, 1989). Moreover, the two parts of the study (interviews and card-sorting tasks) appealed to distinct knowledge and abilities of the subjects. Future research could examine in a large sample whether the observed reasons are influenced by participant characteristics, such as being or not being a sperm donor and if so, the setting in which the donation was given and previous experiences with sperm donation. In addition, our findings may provide useful starting points to discuss whether and perhaps how formal settings could meet some preferences of sperm donors who may otherwise donate in less regulated informal settings. In conclusion, this study provides a comprehensive set of reasons for sperm donation in formal and informal settings. The overview identified may be used to help potential sperm donors in considering whether to donate in a formal or informal setting. Furthermore, the findings may guide further research on reasons to donate in either setting, and fuel discussions about the most appropriate conditions and legislation for sperm donation in formal settings. Declaration of interest: The authors report no declarations of interest. The authors alone are responsible for the content and writing of the paper.
References Almeling, R. (2006). ‘Why do you want to be a donor?’: gender and the production of altruism in egg and sperm donation. New Genetics and Society, 25, 143–157. Bossema, E.R., Janssens, P.M.W., Landwehr, F., Treucker, R.G.L., van Duinen, K., Nap, A.W., & Geenen, R. (2012). A taxonomy of possible reasons for and against sperm donation. Acta Obstetrica et Gynecologica Scandinavica, 92, 679–685. Clatworthy, J., Buick, D., Hankins, M., Weinman, J., & Horne, R. (2005). The use and reporting of cluster analysis in health psychology: a review. British Journal of Health Psychology, 10, 329–358. Cook, R. & Golombok, S. (1995). A survey of semen donation: phase II – the view of the donors. Human Reproduction, 10, 951–959.
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Daniels, K.R., Curson, R., & Lewis, G.M. (1996). Semen donor recruitment: a study of donors in two clinics. Human Reproduction, 11, 746–751. Ekerhovd, E., Faurskov, A., & Werner, C. (2008). Swedish sperm donors are driven by altruism, but shortage of sperm donors leads to reproductive travelling. Upsala Journal of Medical Sciences, 113, 305–313. Elliot, A.J. & Thrash, T.M. (2002). Approach-avoidance motivation in personality: approach and avoidance temperaments and goals. Journal of Personality and Social Psychology, 82, 804–818. Emond, M. & Scheib, J.E. (1998). Why not donate sperm? A study of potential donors. Evolution and Human Behavior, 19, 313–319. Ernst, E., Ingerslev, H.J., Schou, O., & Stoltenberg, M. (2007). Attitudes among sperm donors in 1992 and 2002: a Danish questionnaire survey. Acta Obstetrica et Gynecologica Scandinavica, 86, 327–333. Hamilton, M. (2010). Sperm donation in the United Kingdom in 2010. Human Fertility, 13, 257–262. Hammarberg, K., Carmichael, M., Tinney, L., & Mulder, A . (2008). Gamete donors’ and recipients’ evaluation of donor counselling: a prospective longitudinal study. Australian and New Zealand Journal of Obstetrics and Gynaecology, 48, 601–606. Janssens, P.M., Simons, A.H., van Kooij, R.J., Blokzijl, E., & Dunselman, G.A. (2006.) A new Dutch Law regulating provision of identifying information of donors to offspring: background, content and impact. Human Reproduction, 21, 852–856. Lalos, A., Daniels, K., Gottlieb, C., & Lalos, O. (2003). Recruitment and motivation of semen providers in Sweden. Human Reproduction, 18, 212–216. Lui, S.C. & Weaver, S.M. (1996). Attitudes and motives of semen donors and non-donors. Human Reproduction, 11, 2061–2066. Lui, S.C., Weaver, S.M., Robinson, J., Debono, M., Nieland, M., Killick, S.R., & Hay, D.M. (1995). A survey of semen donor attitudes. Human Reproduction, 10, 234–238. Nuytinck, A.J.M. (2008). Het omgangsrecht van de spermadonor op grond van diens nauwe persoonlijke betrekking met het kind [The visiting right of the sperm donor based on his close personal relationship with the child]. Ars Aequi, February 2008, 133–138. Pedersen, B., Nielsen, A.F., & Lauritsen, J.G. (1994). Psychosocial aspects of donor insemination. Sperm donors – their motivations and attitudes to artificial insemination. Acta Obstetrica et Gynecologica Scandinavica, 73, 701–705. Riggs, D.W. & Russell, L. (2011). Characteristics of men willing to act as sperm donors in the context of identity-release legislation. Human Reproduction, 26, 266–272. Ripper, M. (2008). Australian sperm donors: public image and provate motives of gay, bisexual and heterosexual donors. Health Sociology Review, 17, 313–325. Smits, D.J.M. & Boeck, P.D. (2006). From BIS/BAS to the Big Five. European Journal of Personality, 20, 255–270. Sydsjö, G., Lampic, C., Brändström, S., Gudmundsson, J., Karlström, P.-O., Solensten, N.G., et al. (2011). Who becomes a sperm donor: personality characteristics in a national sample of identifiable donors. British Journal of Obstetrics and Gynaecology, 119, 33–39. Thorn, P., Katzorke, T., & Daniels, K . (2008). Semen donors in Germany: a study exploring motivations and attitudes. Human Reproduction, 23, 2415–2420. Tomlinson, M.J., Pooley, K., Pierce, A., & Hopkisson, J.F. (2010). Sperm donor recruitment within an NHS fertility service since the removal of anonymity. Human Fertility, 13, 159–167. Trochim, W. (1989). An introduction to concept mapping for planning and evaluation. Evaluation and Program Planning, 12, 1–16. Van den Broeck, U., Vandermeeren, M., Vanderschueren, D., Enzlin, P., Demyttenaere, K., & D’Hooghe, T. (2013). A systematic review of sperm donors: demographic characteristics, attitudes, motives and experiences of the process of sperm donation. Human Reproduction Update, 19, 37–51.
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