REFLECTIONS
A survey of sperm donors' attitudes: a
much-needed perspective
Sperm donation has been used to create families for more than
100 years. Originally, privacy about donor sperm use was
encouraged as a way to normalize the conception by obfus-
cating male infertility and to protect the child from the stigma
of this nontraditional form of conception. In the past 20 years,
there has been a movement from recipients and others advo-
cating for more information sharing between donors, recipi-
ents, and donor-conceived children. Lay media coverage of
donor conception has prompted more open discussion and
consideration of this form of family building. In addition to
heterosexual couples, single women and lesbian couples also
have availed themselves of donor sperm to build their families.
Although there have been dozens of studies examining
recipients' attitudes and behaviors and some studies
describing the adjustment of offspring, there have been very
few that have investigated the motivations and attitudes of
sperm donors. In their paper published in this issue of Fertility
and Sterility, Bay et al. (1) have provided a unique three-
decade cross-sectional study of the attitudes of sperm donors
in Denmark in 1992, 2002, and 2012. The results of this study
help to elucidate the attitudes and beliefs of donors who have
previously been under-represented in the research on sperm
donor families. Moreover, including the results from three
different decades provides a unique contribution that allows
us to understand the changes in attitudes over time, particu-
larly given legislative changes in Denmark that now allow for
nonanonymous donation. And although the sample of donors
are from Denmark, the relatively similar liberal setting for the
practice of donor insemination may provide useful insights
into donor insemination practice in the United States.
The investigators assessed the demographics, motivation,
and attitudes among Danish sperm donors. The investigators
noted significant shifts in age, occupation, and the percentage
of donors with their own children over the three assessment
times. Donors in the 2012 sample were older, one-third had
a child, and only one-half were students (down from 98% in
the 1992 sample). In terms of motivation, the investigators
found that altruism and payment remained the two significant
motivators. Significantly fewer donors in the 2012 sample
cited payment as a motivational factor, but only 14% would
continue to donate if financial compensation were not pro-
vided. Altruism is a necessary but not sufficient motivation
for most donors. There was a significant positive shift among
donors supporting donor sperm use among lesbian couples,
from 55% of donors in 2002 to 76% in 2012. This positive shift
was also found in donors' attitudes toward single women re-
cipients of donor sperm, with 40% and 72% of donors feeling
positively toward that in 2002 and 2012, respectively.
One of the most controversial aspects in donor sperm use is
the question of disclosure: 1) informing offspring and others
about the use of donor sperm for conception; and 2) sharing non-
identifying and identifying information about the donor with the
recipient and child. Recipients, children, and donors all have
varying and complex beliefs regarding this important topic (2).
In the mental health literature, there has been a call for more
openness and information exchange among donors, recipients,
and children, focusing on the well-being and best interest of
VOL. 101 NO. 1 / JANUARY 2014
the donor-conceived child. This view has also been adopted by
the American Society for Reproductive Medicine in their most
recent Ethics Committee document, ‘‘strongly encouraging’’ par-
ents to inform their children of their donor origin (3). Bay et al.'s
study provides new information about information sharing from
the donors' perspective. Among the 2012 sample of donors, when
given a choice of being either anonymous or nonanonymous (the
donor-conceived child can learn the identity of the donor when
he or she is 18 years old), 70% chose to be anonymous. These do-
nors were significantly younger than the nonanonymous do-
nors, but there were no differences in partner status, having a
child, or type of occupation. Among the donors who wished to
stay anonymous, only 17% stated that they would continue to
donate if anonymity could not be assured. Even though a major-
ity of donors in this sample opted to remain anonymous they
were still willing to provide nonidentifying information about
themselves to the recipient couple. In fact, over the three decades
of assessment there was a significant increase in the amount of
information donors thought should be shared with the recipient,
with 85% of donors in the 2012 sample indicating that all non-
identifying information could be shared. These findings high-
light the gradation in information sharing among donors;
most are willing to share nonidentifying facts about themselves
but want to keep their identity private.
What do these findings mean in terms of the practice of
donor insemination?
In this study, from the donors' perspective, there is support
for sharing nonidentifying information but resistance among
the majority of donors to have their identity known to the recip-
ients and potentially to the child. When donors were asked what
type of openness they would accept if anonymity was changed,
two-thirds would like to know only the number of children that
were born from their sperm, approximately one-half would
accept that the child could know their identity, and only 18%
would accept contact from the child. This is in contrast to results
of a study of donor offspring indicating that donor offspring
consider the sperm donor to be their ‘‘biological father’’ and
would like identifying information about their donor as well
as to meet the donor and establish a relationship with him (4).
The discrepancy between the donors' wishes and the chil-
drens' wishes highlight a significant disconnect in the competing
interests of donor insemination participants: the child's wish to
know the source of his or her genetic material and the donor's
wish to stay unknown. As this study uniquely demonstrates,
though, attitudes change over time. It is possible that as donors
become more aware of the importance of their role to their
offspring they will be more willing to share information and be
known to their offspring. Alternatively, as the push for nonanon-
ymous donation continues, a subset of donors may opt to stop
donating. Clinically, recipients and donors should be counseled
to consider all aspects of information sharing to facilitate the
best outcome. Finally, more prospective longitudinal research
is needed to deepen our understanding of the well-being of all
participants in the donor insemination treatment process.
Susan Klock, Ph.D.
Department of Obstetrics and Gynecology, Northwestern
University Feinberg School of Medicine, Chicago, Illinois
http://dx.doi.org/10.1016/j.fertnstert.2013.09.040
43
REFLECTIONS

You can discuss this article with its authors and with other REFERENCES
ASRM members at 1. Bay B, Larsen PB, Kesmodel US, Ingerslev HJ. Danish sperm donors across
http://fertstertforum.com/klocks-sperm-donation- three decades: Motivations and attitudes. Fertil Steril 2014;101:252–7.
disclosure/ 2. MacDougall K, Becker G, Scheib J, Nachtigall R. Strategies for disclosure: how
parents approach telling children that they were conceived with donor gam-
Use your smartphone etes. Fertil Steril 2007;87:524–33.
to scan this QR code 3. Ethics Committee of the American Society for Reproductive Medicine. Inform-
and connect to the ing offspring of their conception by gamete or embryo donation: a committee
discussion forum for
opinion. Fertil Steril 2013;100:45–9.
this article now.*
4. Mahlstedt P, LaBounty K, Kennedy WT. The views of adult offspring of sperm
* Download a free QR code scanner by searching for “QR donation: essential feedback for the development of ethical guidelines within
scanner” in your smartphone’s app store or app marketplace.
the practice of assisted reproductive technology in the United States. Fertil
Steril 2010;93:2236–46.

44 VOL. 101 NO. 1 / JANUARY 2014