A national study of the provision of oncology sperm banking services among Canadian fertility clinics.

The purpose of this study was to survey the current state of oncology sperm banking services provided by fertility clinics across Canada. A total of 78 Canadian fertility facilities were invited to complete a questionnaire related to the availability, accessibility, affordability and utilisation of sperm banking services for cancer patients. The total response rate was 59%, with 20 (69%) in vitro fertilisation clinics and 26 (53%) other fertility centres returning the survey. A total of 24 responding facilities accepted oncology sperm banking referrals. The time frame to book the first banking appointment for 19 (79%) facilities was within 2 days. Inconsistent practice was found regarding the consent process for cancer patients who are of minority age. Eight (33%) facilities did not provide any subsidy and charged a standard banking fee regardless of patients' financial situations. Overall, the utilisation of oncology sperm banking services was low despite its availability and established efficacy, suggesting that Canadian cancer patients are notably underserved. The study has highlighted some important issues for further consideration in improving access to sperm banking services for cancer patients, especially for adolescents. Better collaboration between oncology and reproductive medicine to target healthcare providers would help to improve sperm banking rates.

The ethical debate on donor insemination in China.

This article gives an overview of the ethical thinking about donor insemination among Chinese ethicists. We analysed the ethical arguments dedicated to the use of donor spermatozoa published in the important bioethics journals of China of the last 15 years. On the one hand, the general Confucian values strongly favour the genetic link as it fits with the traditional importance attached to the continuation of the family line. Therefore, artificial insemination by donor (AID) is highly controversial in China because the involvement of a third party (the donor) severs the genetic link between the husband and his family. On the other hand, procreation is regarded as an important aspect of Confucian filial piety and it is a basic right of every human being to enjoy a family life. AID should be thought of as a means to help infertile couples to overcome infertility. Nowadays, Chinese bioethicists are trying to reinterpret Confucianism in order to adapt it to modernity. One such reinterpretation focuses on the affectionate rather than the genetic tie between parents and child. As the application is still new in China, more discussion and open debate on ethical aspects is needed.

A cross Canada survey of sperm banking practices in pediatric oncology centers.

BACKGROUND: Childhood cancer survivors have identified fertility preservation as a major concern. Sperm banking is an established fertility preservation option in pubertal males. We sought to describe current practices in Canadian pediatric oncology programs, and to identify perceived barriers to sperm banking for male adolescents. PROCEDURE: A questionnaire was developed to (1) describe current sperm banking practices and facilities; (2) report on the utilization of sperm banking; and (3) identify barriers to sperm banking and possible solutions to improve current practices. A healthcare professional with an interest in fertility preservation within each institution was approached to participate in the study. RESULTS: Fifteen of 16 institutions participated, 2 have fertility preservation teams. Only one has written guidelines or adolescent focused educational material. Over 2 years, 50/262 (19%) adolescents in 12 institutions successfully banked a specimen. In 11 of these, additional information was available: of 85/172 (49%) adolescents offered the option to bank, 38/85 (45%) subsequently attempted. Reported barriers to sperm banking included the pressure to start therapy and restricted banking hours. Formal education of healthcare providers in fertility preservation practices, provision of financial support for families, and an adolescent focused approach were identified as important initiatives to improve sperm banking. CONCLUSIONS: There is a disparity in current sperm banking practices in Canada and at present, <25% of eligible male adolescents attempt to bank sperm. The development of a fertility preservation team, adolescent-specific guidelines, adolescent friendly sperm banking units, financial support, and improving knowledge translation among professionals and patients may improve the rates of banking.

Anonymous semen donor recruitment without reimbursement in Canada.

A previous review of 22 studies from eight countries, conducted between 1980 and 2003, concluded that semen donors who are older, married or are fathers are less likely to be financially motivated. Despite the Assisted Human Reproduction Act coming into force in 2004, no data originating from Canada have been published on this topic. The objective of this study was to validate these findings in the Canadian population within the context of an anonymous semen donor programme in Canada. A survey of 301 donor applicants was conducted to collect demographic data including age, marital status, paternity status and occupation, in addition to information assessing donor eligibility and willingness to donate without reimbursement. Eligible candidates were screened to determine their acceptance or exclusion from the semen donor programme. The results showed that the relationships found between donor applicant demographics and their willingness to participate without reimbursement do not appear to be consistent with earlier published studies in various countries. Further screening resulted in a recruitment rate of less than 1%. Additional studies will be required to investigate the feasibility of altruistic semen donation programmes in Canada, and to determine the potential impact of these findings on Canadians who rely on donor gamete services to build their families.

History of commercializing sexed semen for cattle.

Although the basic principles controlling the sex of mammalian offspring have been known for a relatively long time, recent application of certain modern cellular methodologies has led to development of a flow cytometric system capable of differentiating and separating living X- and Y-chromosome-bearing sperm in amounts suitable for AI and therefore, commercialization of this sexing technology. After a very long history of unsuccessful attempts to differentiate between mammalian sperm that produce males from those that produce females, a breakthrough came in 1981 when it was demonstrated that precise DNA content could be measured. Although these initial measurements of DNA content killed the sperm in the process, they led to the ultimate development of a sperm sorting system that was capable, not only of differentiating between live X- and Y-sperm, but of sorting them into relatively pure X- and Y-sperm populations without obvious cellular damage. Initial efforts to predetermine the sex of mammalian offspring in 1989 required surgical insemination, but later enhancements provided sex-sorted sperm in quantities suitable for use with IVF. Subsequent advances in flow sorting provided minimal numbers of sperm sufficient for use in AI. It was not until the flow cytometric sorting system was improved greatly and successful cryopreservation of sex-sorted bull sperm was developed that efficacious approaches to commercialization of sexed semen could be implemented worldwide in cattle. A number of companies now offer sex-sorted bovine sperm. Innovative approaches by a diverse group of scientists along with advances in computer science, biophysics, cell biology, instrumentation, and applied reproductive physiology provided the basis for commercializing sexed semen in cattle.

Donor insemination: Israel as a representative case of a competitive market examining the possibility of policy reform.

AIM: To measure the private and social benefits of donor insemination (DI). METHODS: An empirical model investigates the general public and DI clients' willingness to pay (WTP) for DI, and the willingness of potential donors to become altruistic or paid sperm donors. RESULTS: The general public and DI clients value DI and have a positive WTP for it, whereas willingness to donate, altruistically or for payment, is either low or very low. CONCLUSION: The general public's and DI clients' WTP for DI is in average above actual cost, so the government should consider funding or subsidizing DI. The government should encourage altruistic gamete donation through information and education of all parties involved directly and indirectly in the process of donation whose ultimate goal is the birth of a child.

There's a big niche market for infertility care.

A lucrative niche remains in a market increasingly dominated by managed care and cost containment. Many infertile women are willing to pay just about any price for infertility products, usually not covered by their insurers, writes Pamela Moore, managing editor of Healthcare Advertising Review.

Danish sperm donors across three decades: motivations and attitudes.

OBJECTIVE: To study the motivation and attitudes toward donor anonymity, economic compensation, and insemination of lesbian and single women among Danish sperm donors in 2012 compared with the two preceding decades. DESIGN: Anonymous survey. SETTING: Danish sperm bank. PATIENT(S): Sperm donors active in 2012 (n = 97), 2002 (n = 62), and 1992 (n = 41). INTERVENTION(S): All donors who donated sperm in the study period were asked to participate. The results were compared with those of previous surveys from the same sperm bank. MAIN OUTCOME MEASURE(S): Motivation and attitudes toward donor anonymity, economic compensation, and insemination of lesbian and single women. RESULT(S): In 2012, the most frequently stated factor was altruism, motivating 90% of the sperm donors, which was not significantly different from the previous surveys. If economic compensations were removed, only 14% would continue to donate. The proportion of anonymous donors who would stop their donations if anonymity was abolished was 51%, 56%, and 67% in 1992, 2002, and 2012, respectively. A significantly increasing proportion of donors felt positive about donation to lesbian couples. CONCLUSION(S): The motivation for sperm donation is multifaceted and primarily based on economic compensation and altruism. Most Danish donors would stop their donations if economic compensation or anonymity were abolished.

Sperm banking: use and outcomes in patients treated for testicular cancer.

OBJECTIVE: To identify the frequency that sperm banking was used by men being treated for testicular cancer at our institution, and to characterize the differences between men choosing to bank sperm or not, and outcomes in terms of after-treatment pregnancies. PATIENTS AND METHODS: A questionnaire addressing sperm banking and fertility was administered to men treated for testicular cancer at our institution between 1994 and 2004; the results were evaluated statistically. RESULTS: Overall, 31 of 129 (24%) respondents had banked sperm. Of these, two had used their banked sperm to father a child, and 12 had had children naturally. Men who banked sperm were a mean of 10.3 years younger (P < 0.001) and less likely to have children at the time of diagnosis (P < 0.025) than men choosing not to bank sperm. The cost of banking sperm was reported to include a mean fee of US dollars 358 (median 300, range 0-1000), and a mean annual maintenance fee of US dollars 243.86 (median 300, range 0-1200). CONCLUSIONS: Only a minority of men in this study chose to bank sperm (24%). Among those who did, the use of banked sperm was low (<10%), and many men could have children without using banked sperm. Given the relatively high costs of sperm banking and the low rate of sample use, patients should be counselled on the costs and benefits of sperm banking before treatment for testicular cancer.