UK BioNews: Donor recruitment: is "tackiness" the answer? (March 2007)

Eric Blyth is Professor of Social Work at the University of Huddersfield and Adjunct Professor at the John Dossetor Health Ethics Centre, University of Alberta, Canada Irene Ryll RN is convenor of Infertility Connection, Edmonton, Alberta, Canada

"In a previous Bionews Commentary, Joanne Adams, Elizabeth Pease and Brian Lieberman wrote of their experiences of recruiting sperm donors following the 2005 legislative change in the UK requiring donors to agree to the disclosure of their identity to any people conceived as a result of their donation. Their account of their success in recruiting donors cast doubt on the repeated claims that the change in law was necessarily responsible for a crisis in donor recruitment in the UK (after all many countries that still protect donor anonymity, such as Canada, also report donor shortages). They also challenged those wishing to provide donor services to change their attitude towards sperm donation.

Whether the change in attitude represented by the latest "Give a Toss" sperm donor recruitment campaign (http://www.giveatoss.com) was quite what they had in mind is another matter. Since it was established in 1998, the National Gamete Donation Trust (NGDT) has certainly not had an easy task either in raising awareness of gamete and embryo donation or increasing donor recruitment donors and the free PR, which has enabled the "Give a Toss" campaign to be launched, appears to have been an offer it couldn't refuse.

"Give a Toss" is provocatively tacky, designed to reach the potential sperm donors that other methods have failed to reach, although ironically perpetuating the very stereotype of sperm donation that NGDT was previously keen to dispel (1).

Relying on the tried and tested "sex sells" formula, the campaign website features young women in "We Want Your Sperm"- emblazoned T shirts, encouraging would be donors to practice and improve their "wrist action" on an interactive "Toss-O-Meter" game.

Among some useful facts about sperm and human reproduction, the website imparts further knowledge of the impact of ingesting certain foods on the taste of semen (we haven't tested these recipes, so readers will have to take the campaign's word for it - or try for themselves), although - to misapply an analogy - since you cannot have your cake and eat it, we can't quite see the relevance of semen as a dietary supplement for a campaign for sperm donation.

We could go on, but the two points we want to make here are, first, that we are not humourless killjoys who can't have a laugh when there is a laugh to be had. The second point, though, is that we think there's a time and a place, and a serious sperm donor recruitment campaign is not the place to employ adolescent humour to disparage sperm donation. One thing the campaign seems unlikely to do is encourage any man to advertise the fact that he donates sperm and so possibly recruit other donors through personal example.

Many people, including ourselves (IR as the mother of three donor conceived children and EB as an academic researcher) - as well as NGDT itself - have been working to change the image of sperm donation for years. We have promoted gamete donation in our own countries as a responsible and respectable activity that affords due respect to donors, to parents who have used donor conception to build their families and to donor-conceived people. In what appears to be a desperate measure to maximize recruitment, this campaign risks not only undermining much of that work but also of disrespecting, distressing and offending donors, people who have used donor conception, and donor-conceived people. Far better, as one young person has suggested to us, to share letters from recipients or donor-conceived people who want to thank their donor. Perhaps some may think that "thank you" letters won't "sell" sperm donation. Alternatively, they may well inspire prospective donors and honour past donors that they are involved in a valued form of family building.

The two Manchester clinics for which Joanne Adams and her colleagues are recruiting donors account for around a quarter of current UK sperm donors. Their approach may not generate the newsworthiness of the "Give a Toss" campaign, but it is delivering the goods while respecting the dignity of all those involved in gamete donation. Self-evidently, if two clinics can make such a difference, their model of donor recruitment can be emulated elsewhere in the UK without resorting to the tawdry message of the "Give a Toss" campaign."

(1) BBC Radio 4 (2006) Woman's Hour. 14 August

http://www.bbc.co.uk/radio4/womanshour/01/2006_33_mon.shtml

UK BioNews: Donor recruitment: change attitudes, not the law (October 2006)

Joanne Adams, Senior Andrologist, Manchester Fertility Services; Dr Elizabeth Pease, Consultant in Reproductive Medicine, St Mary's Hospital, Manchester and Professor Brian Lieberman, Medical Director, Manchester Fertility Services 16 October 2006

"In the late 1990's when removal of donor anonymity was first mooted in the UK, many felt that it would herald the end of treatment with donor sperm. Recruitment became more difficult and costly, and many potential donors were discouraged by the lack of information and rumours that the change may be retro-active. As a consequence donor numbers dropped precipitiously and many of the smaller banks closed.

It was hardly surprising that when the law was changed and donor anonymity removed, that the UK was left with few donor banks, unevenly distributed across the the UK. From 1st April 2006 the stocks of frozen donor sperm from anonymous men could only be used to create siblings for existing donor conceived children.

In Manchester, we recognised that a new strategy would be necessary to recruit men willing to be identified in the future by their genetic offspring. Both Manchester Fertility Services (MFS), a fee paying centre and the NHS DI service at St Mary's Hospital have successful donor recruitment programmes.

At MFS more than 40 identifiable men are currently donating, and it is anticipated that 50 will be donating by the end of the year. Eleven donors have been recruited so far within the NHS.

At MFS we anticipated a change in the law and from early 2004 were pro-active and recruited only donors prepared to be identified, knowing that it takes 9-12 months to have fully quarantined and ready to use donor sperm. We also asked 10 of our most recently recruited anonymous donors if they were prepared to convert to being identifiable and four agreed to do so, thus becoming our first identifiable donors.

Recruitment was fairly slow at the beginning of 2004, with only four or five donors recruited midway through the year. We reassessed our strategy. We were advertising but had no idea which adverts were effective. We decided to log all enquiries and audit which advertisements were most effective. We were then able to perform a crude cost/benefit analysis. This strategy is still used as we try different advertising methods, and enquiries are reviewed periodically to assess the success of each method. The 'Big Issue' magazine is the most successful, and currently responsible for approximately half of our identifiable donors. We still recruit a handful of student donors by advertising once a year during 'freshers week' in a student magazine. A recent radio advertisement played over two weeks generated a lot of interest but to date only two donors have been recruited via the air waves.

We regard donors as special people who need to be cherished. We deal with each enquiry promptly and personally. Our secretarial staff ensure that each and every enquiry is transferred to a specific member of our scientific staff and if they are unavailable, a return call is made on the same day. The change in law and the screening procedure are explained in reasonable detail. Messages left on our answer-phone are personally and promptly returned. Previously we just sent out an information pack in response to an enquiry. This wasted a lot of time and most men did not respond. Having spoken to us the enquirers are much more likely to proceed. They are then sent a sperm donation information pack that includes our own literature and that produced by the Human Fertilisation and Embryology Authority, and our own questionnaire, which they are asked be complete and return.

If the information provided on the questionnaire suggests that the applicant is suitable, an appointment is made for a semen analysis and implications counselling. The initial counselling is now carried out by a trained member of the laboratory team and provides the opportunity to impart detailed information about the donation process, the responsibilities of being a donor as well as asking for more detailed information about the family history and medical issues. It also provides the potential donor with the opportunity to ask any questions. Introducing this step has meant that we are able early on, to screen out the obviously unsuitable, and to initiate investigations into some of the potential medical issues before an appointment is made with a member of the medical staff. This has consequently cut down on wasted appointments slots with the doctors. Two consultants take a special interest in donor recruitment. Other simple strategies have been employed such as reminding people of appointments, following up those that did not attend and being flexible with appointment times. All these tactics amount to nurturing the applicant through the process and have collectively helped to increase our take on rate.

The profiles of identifiable donors, are different to previous donors. As anticipated they are older, mostly in employment and quite often have families of their own, compared with the younger, generally student, anonymous donors. Gone are the days where sperm donation was regarded as 'beer money'. Nowadays we need to encourage men to come forward and commit themselves to a lengthy but rewarding process. We must treat them with the respect they deserve. The change in the law has been for the better and this is recognised by the modern donor. This is self-evident from some of the Goodwill Messages and Pen pictures on their registration forms. We certainly do not have a shortage of potential donors in Manchester but donor recruitment requires a dedicated team who recognise and support the wisdom underlying the change in the law. Changing the law is not the answer, what is necessary is a change in attitude of those who wish to provide donor treatment with donated sperm."