Sperm donation: A different kind of bank

Recently, we woke up to news that a couple was suing a U.S sperm bank because their donor had unreported schizophrenia and unreported criminal history. Aside from the moral questions, a lot of legal questions surround the practice: What about the child's right to identity because anonymous donations mean that they can never know their biological father? What happens in future when the child develops a genetic disease? What about the risk of accidental incest?

More than three million babies worldwide have been born through assisted reproductive technology reports the International Committee for Monitoring Assisted Reproductive Technology.

With that comes an ethical and moral question, especially in cases of anonymous sperm donation. In Kenya, although not regulated by the law, donations are usually anonymous and the donor has no parental rights or obligations. The Kenya Christian Professionals Forum in the statement on the IVF Bill (now the Assisted Reproductive Technology Bill) said, "Recent developments in the legal and social environment threaten the very survival of the Kenyan society." The United Kingdom law removed anonymity for all donors; donor offspring have a right to identify their genetic parent once they are 18-years-old. These, some news sources say, led to a decline in sperm donation. Doctors are trying to control cases of accidental incest by limiting the number of times each donor's sperm can be used.

What does the Kenyan law say?

Unfortunately, no law has been passed on the matter though there is a bill in parliament. In Kenya, the Assisted Reproductive Technology Bill that seeks to regulate the use of reproductive technology states that a person who has reached the age of 18 may get information whether he or she was conceived by means of assisted reproduction. The donor offspring also has the right to know if the person he or she proposes to marry could be a relative. The bill, however, does now allow for the release of information regarding the identity of a person whose gametes (sperm or egg) have been used or from whom an embryo has been taken if the donation was anonymous. Which, again, brings about the argument of a child's right to identity.

The bill prohibits use of any human reproductive material for the purpose of creating an embryo unless the donor of the material has given written consent. You also cannot remove a human reproductive material from the body of a donor after the death of the donor for the purpose of assisted reproductive technology unless the donor of the material had given written consent and the use of assisted reproductive technology for any purpose other than human procreation.

How do you become a donor?

"Donors are not singled out based on their physical characteristics because recipients usually want a close physical match," says Dr Wanyoike Gichuhi, a consultant obstetrician and gynaecologist and fertility expert at the Nairobi Fertility Clinic. They conduct donations every three months.

Donors are screened for infectious diseases—HIV, Hepatitis B, Chlamydia, Gonorrhoea, and more— genetic and systematic diseases before giving a sample.

After the screenings, the donor avoids ejaculation for at least three days for good quality sperm when producing a sample (usually in a private room at the doctor's). The donor ejaculates into a sterile cup through masturbation. The sample is them analysed to make sure they are of good quality, explains Dr Gichuhi. A good sperm has good movement, good count and good morphology –a normal sperm has an oval head with a long tail.

After the semen testing, the sample is frozen in liquid nitrogen for six months before being used, during which the donor is tested again at the third and sixth month for infectious diseases such as HIV.

Although there are no strict age requirements, majority of donors in Kenya are college students who are at the prime of their youth. People who don't make the cut are the elderly, people with mental illness and smokers. "Smoking can damage the sperm," explains Dr Gichuhi.

"Compensation is usually a small amount to cover expenses of the donor during the whole process and is usually Sh10,000- Sh12,000. Although the recipients are usually couples and single women, sometimes there are cases where a couple doesn't live together and the man decides to freeze the sperm for later use, so the couple can conceive without the hustle of travelling back and forth."

What to expect when using donor sperm

Recipients, he says, are not usually very particular about the tribe of the donor, but they are when it comes to race. It is particularly hard to find donors of Asian and European descent.

"The donation is anonymous meaning that the donor will not know the recipient and the recipient will only know the basic characteristics of the donor such as height, complexion and age. One person can only donate three times. Donor sperm for intrauterine insemination costs around Sh40,000 and for IVF costs around Sh400,000," he says.

The individual or couple goes through counselling, to better help them deal with the process of using a donor sperm. After they've understood the treatment, the couple or individual signs consent to the treatment and disclosure of information. The couple or individual chooses a donor. "The donor sperm is then analysed because after the freezing you might find that only 50 per cent in a particular sample is viable for use. In some cases, we have to find another donor sample." The sperm is then placed in the woman's uterus, a process called intrauterine insemination (IUI). Sometimes IUI is repeated several times before a pregnancy occurs. That's why, explains Dr Wanyoike, it is important that couple go through counselling before the whole procedure. "Women often have a 10 to 20 per cent chance of getting pregnant with one IUI cycle," he says.

The psychological costs

Evidence from a study in the Journal of Family Psychology shows that those who become parents through assisted reproductive procedures involving egg or sperm donation tend not to tell their children about their donor conception and thus the majority of children conceived in this way remain unaware that the person they know as their father (in the case of sperm donation) or their mother (in the case of egg donation) is not their genetic parent. This has its pitfalls: "Studies of adoptive families show that the earlier children are informed about their adoption, the better the outcome in terms of their emotional and identity development," read the study which also suggested that assisted reproductive families may benefit from disclosure to children about the nature of their conception before they enter school.

 

A study released by the Commission on Parenthood's Future shows that regardless of socioeconomic status, donor offspring are twice as likely as those raised by biological parents to report problems with the law before age 25; they are more than twice as likely to report having struggled with substance abuse and they are about 1.5 times more likely to report depression or other mental health problems. The study further showed that donor offspring suffer more than adopted children: "hurting more, feeling more confused and feeling more isolated from their families. Getting rid of the secrecy would go a long way towards helping relieve the pain offspring feel."

The age that they are told and the manner under which they are told plays a big role in how donor offspring deal with the circumstances of their conception. If the news comes unexpectedly or at a late stage, they are likely to suffer more confusion and have a sense of betrayal that can sever family bonds.

"Children are very intuitive," says Wandia Maina, a counselling psychologist in Nairobi, "even if you don't tell them, they will sense that they are different. And the truth always has a way of coming out. If not from the parent then it can come out from an outside source who knows the truth about the child's conception. The earlier you tell the child that he or she was born through unconventional means the better. You can do this by giving them snippets of age-appropriate information as they grow."

Costs:

1. To the recipient: Donor sperm for intrauterine insemination costs around Sh40,000 and for IVF costs around Sh400,000

2. The sperm donor receives Sh10,000- Sh12,000 to cover his expenses.

• To reduce the chances of accidental incest, one cannot donate sperms more than three times and sperm is often disposed of after about ten years in the bank.

• There is no official Sperm Bank Centre in Kenya but the services are provided in fertility centres countrywide.

Nick, a one-time sperm donor, laughs long and hard when I ask him if he donated sperm for monetary or altruistic reasons. He says if he decided to do something for financial gain, he would make sure it was money he could speak of with a straight face; sperm donation doesn't really fall into the lucrative category. "I got a little money to cover travel and other related expenses. Besides, the human life has no price. How do you even start negotiating price for something that can't be bought, can't be sold?" Although he was broke ("College students are always broke," he jokes) he explains that he wanted to help people who couldn't conceive otherwise. He is 25. He made the donation when he was 23 and in campus at a local university. He agreed to talk on condition of anonymity and strictly on phone. Not that he is embarrassed about it. "It's a subject that elicits strong emotions from all sorts of people and I'm really ready for all that," he says.

A friend in medical school who also made a donation told him about it. It didn't take him long to decide. The only people who knew about his decision are friends who had also made donations. "The doctor explained to me what the procedure would entail. The donation would be anonymous. I would never know the recipient and the recipient would never know me. I went through rigorous medical screening before donating and more screenings afterwards," he says. In fact, the thorough screening is the reason he never made a second or third donation: "It was hectic for me. I did it the first time and I constantly remind myself that if for some reason I don't succeed in life, there's that one thing I did right," he says.

Even though he goes through the odd moment when he sees a baby in a crowd and wonder if it could be his, he has no regrets.