Saturday, March 24, 2007

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."

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