Willingness of volunteer blood donors to bevolunteer semen donors

Artificial insemination from anonymous paid semen donors is an established therapy for infertility thatresults in thousands of pregnancies each year in the United States and in many other countries. In somecountries, such as France (1), semen donors receive no monetary incentive. In the United States, most semendonations are made to for-profit companies and monetary payment or at least reimbursement of donationexpense is used to motivate semen donation (2–4). However, when financial gain is a primary incentive fordonation, there may be less incentive to give an accurate history of behaviors that can lead to hepatitis and HIVinfection.

The use of semen for artificial insemination has transmitted HIV (5, 6), hepatitis B virus (7), genital herpes(8), chlamydia (9), trichomonas, and bacterial infections. Blood donor experience has shown that the risk ofdisease transmission may be 10–20 times greater with paid donors than with volunteer donors (10). Therehave been no studies demonstrating that semen from paid donors carries a greater risk of transmitting geneticor infectious disease than semen from volunteer donors. Successful recruitment of volunteer semen donorsdepends on the willingness of the community to support semen donation. This study was undertaken to seewhether blood donors are willing to donate semen voluntarily.

Persons who had voluntarily donated whole blood or platelets by platelet pheresis at an upstate New Yorkregional blood center were the subjects of this study. Cytapheresis and whole blood donor names werearranged alphabetically, and a written questionnaire was mailed once to 384 consecutive male whole blooddonors and 209 consecutive male cytapheresis donors between the ages of 19 and 35 years. Answeredquestionnaires were returned anonymously with nothing that would enable identification of the donor. Nofollow-up was attempted. Each donor was asked if he would donate semen if paid or voluntarily, and if not,the reasons. Age, race, and marital, occupational, and educational status were asked.

Completed questionnaires were returned by 67 (32%) cytapheresis donors and 47 (12%) whole blooddonors. Approximately half of the respondees were willing to donate semen (Table 1), suggesting that 16%of the cytapheresis and 6% of the whole blood male donors would be willing to be semen donors. Forty-threepercent of both groups responded that they would donate semen voluntarily, and 6% of cytapheresis and 8%of whole blood donors would donate only if paid. The remainder were unwilling to donate (51% cytapheresisdonors, 49% whole blood donors). One-third of the married blood donors in both groups (38% of marriedpheresis donors and 24% of married whole blood donors) would not donate because of spousal objections(Table 1). Slightly less than half of those unwilling to donate cited religious or ethical reasons. There was nodifference in willingness based on education, student, or employment status.

This study demonstrates that a group of blood donors express willingness to donate semen, and most ofthese do not expect monetary payment. If one assumes that those who did not complete and return thequestionnaire were not willing to donate semen, this study suggests that one in seven apheresis donors and onein 15 male whole blood donors are willing to donate semen. Although many platelet pheresis donors giveblood weekly, this study did not address willingness to donate semen at weekly intervals, which is oftenneeded for a successful semen bank program. The numbers of donors studied were small and from a singlegeographic location, thus it may not be possible to generalize these results to the entire U.S. population.

Artificial insemination using donated semen has transmitted HIV (5, 6) and other infectious diseases (7–9).Based on data showing that monetary incentives to donate blood attracts donors with higher rates oftransmissible infections and results in a greater number of transfusion-transmitted infections (10), it would bereasonable to be concerned that paid semen donors might create more of a risk of infection transmitted byinsemination than would volunteer semen donors. Studies have not been reported to substantiate this. SinceHIV transmission by semen was first reported in 1985 and it became a required practice to cryopreserve semenand release it only after the donor has been found negative for HIV 180 days later (11–14), the risk oftransmitting HIV to recipients of donated semen is quite low. Because of this 180-day retest, the importanceof moving toward exclusive nonpaid volunteer donors for prevention of HIV is uncertain.

However, semen and semen donors are not tested for all microbes that can be transmitted by semen andmay have adverse consequences in the recipient. It is unknown whether nonpayment of donors would reducethe risk of transmitting these infections by insemination. Neither is it known whether voluntary semen

Received February 28,2003; revised andaccepted June 12, 2003.Funds provided by theAmerican Red Cross BloodService.Reprint requests: TedEastlund, M.D., Universityof Minnesota MedicalSchool, Box 609, RoomD251, Mayo Bldg., 420Delaware Street SE,Minneapolis, MN 55455(FAX: 612-273-5410; E-mail: eastl002@umn.edu).

CORRESPONDENCEFERTILITY AND STERILITY�VOL. 80, NO. 6, DECEMBER 2003Copyright ©2003 American Society for Reproductive MedicinePublished by Elsevier Inc.Printed on acid-free paper in U.S.A.

0015-0282/03/$30.00doi:10.1016/S0015-0282(03)02205-2

1513

donations carry a lower risk for transmitting inherited disease,which is largely prevented by avoiding donors with a family historyof inherited disease. Since tests are not performed for most of these,an accurate, truthful history from the prospective donor is veryimportant for prevention.

During recruitment and preliminary screening of paid semendonors, 80%–90% of prospective first-time donors are excluded(15, 16). One of the reasons for exclusion is the presence ofbehaviors risky for HIV and HBV. In long-established voluntaryblood donor programs, only about 10% are excluded and mostexclusions are for reasons other than HIV and HBV risk behaviors.The use of blood donors for semen donation has the advantage ofstarting with a population in good health with a record of safedonations and altruistic motivation. The prevalence of HIV andhepatitis in the general population is hundreds of times higher thanin volunteer blood donors. It is possible that recruiting volunteersemen donors from the blood donor population may result in ahigher acceptance rate. This might reduce screening expenses. Thishas not been studied or reported.

Some clinics and semen banks have reported that exclusive useof unpaid volunteer semen donors is practical, and in some coun-tries semen banks rely exclusively on unpaid semen donors (1, 17,18). There are about 6 million persons donating blood annually inthe United States. Approximately half are men and most are under40 years of age. Financial incentives to donate semen seemed to beimportant to only 6% of the blood donors we surveyed who indi-cated willingness to donate semen. Studies involving paid semendonors in the United States and United Kingdom show that pay-ment appears important to most but not all donors (2–4, 19). Ourdata suggest that there may be a potential resource of volunteerlow-risk semen donors in the blood donor population.

Ted Eastlund, M.D.American Red Cross Blood Services, Northeastern New York

Region, Albany, New York

References1. Guerin JF. The donation of gametes is possible without paying donors:

experience of the French CECOS Federation. Hum Reprod 1998;13:1129–30.

2. Cook D, Golombok S. A survey of semen donation: phase II—the viewof the donors. Hum Reprod 1995;10:951–9.

3. Lui SC, Weaver SM, Robinson J, Debono M, Nieland M, Killick SR,et al. A survey of semen donor attitudes. Hum Reprod 1995;10:234–8.

4. Sauer MV, Gorrill MJ, Zeffer KB, Bustillo M. Attitudinal survey ofsperm donated to an artificial insemination clinic. J Reprod Med 1989;34:362–4.

5. Araneta MR, Mascola L, Eller A, O’Neil L, Ginsberg MM, Bursaw M,et al. HIV transmission through donor artificial insemination. JAMA1995;273:854–8.

6. Wortley PM, Hammett TA, Fleming PL. Donor insemination andhuman immunodeficiency virus transmission. Obstet Gynecol 1998;91:515–8.

7. Berry WR, Gottesfeld RL, Alter HJ, Vierling JM. Transmission ofhepatitis B virus by artificial insemination. JAMA 1987;257:1079–81.

8. Moore DE, Ashley RL, Zarutskie PW, Coombs RW, Soules MR, CoreyL. Transmission of genital herpes by donor insemination. JAMA 1989;261:3441–3.

9. Nagel TC, Tagatz GE, Campbell BF. Transmission of Chlamydiatrachomatis by artificial insemination. Fertil Steril 1986;46:959–60.

10. Eastlund T. Monetary blood donation incentives and the risk of trans-fusion-transmitted infection. Transfusion 1998;38:874–82.

11. American Association of Tissue Banks. Standards for tissue banking.McLean, VA: American Association of Tissue Banks, 2001, D4.360.

12. Centers for Disease Control. Testing donors of organs, tissues, andsemen for antibody to human T-lymphotropic virus type III/lymphad-enopathy associated virus. MMWR 1985;34:294.

13. Centers for Disease Control. Semen banking, organ and tissue trans-plantation, and HIV antibody testing. MMWR 1988;37:57–63.

14. American Society for Reproductive Medicine. Guidelines for therapeu-tic donor insemination: sperm. Fertil Steril 1998;70(Suppl 3):1S–4S.

15. Craig JM, Barratt CL, Kinghorn GR. Semen donors and STD screening.Genitourinary Med 1997;73:280–3.

16. Sidhu RS, Sharma RK, Kachoria S, Curtis C, Agarwal A. Reasons forrejecting potential donors from a sperm bank program. J Assist ReprodGen 1997;14:354–60.

17. Daniels KR, Hall DJ. Semen donor recruitment strategies—a non–payment based approach. Hum Reprod 1997;12:2330–5.

18. Daniels KR, Curson R, Lewis GM. Semen donor recruitment: a studyof donors at two clinics. Hum Reprod 1996;11:746–51.

19. Lui SC, Weaver SM. Attitudes and motives of semen donor andnon-donors. Hum Reprod 1996;11:2061–6.

T A B L E 1

Blood donor responses about semen donation.

ResponsePheresis

donors (%)Whole blooddonors (%)

Returned questionnaires 67 47Willing to donate semen?

Yes, only if paid 4 (6) 4 (6.5)Yes, only if voluntary 9 (13) 1 (2)Yes, if paid or voluntary 20 (30) 20 (42.5)

Total number willing 33 (49) 24 (51)Percent willing by group:

Age 19–20 100 63Age 21–25 41 45Age 26–30 33 24Age 31–35 48 71Students 83 75

Percent willing by marital status:Married 13 (40) 8 (35)Unmarried 20 (60) 16 (65)

Not willing to donate 34 (51) 23 (49)Why unwilling to donate?

Religious/ethical reason 16 (47) 10 (43)Embarrassing/awkward 11 (32) 9 (39)Too busy 1 (3) 3 (13)Wife will not approve 13 (38) 5 (22)Not enough information 8 (24) 2 (9)Other 6 (18) 1 (4)

Eastlund. Voluntary semen donation. Fertil Steril 2003.

1514 Eastlund Correspondence Vol. 80, No. 6, December 2003