illustration by Monica Ramos
By RENE ALMELING
NEW HAVEN — The new movie “Delivery Man” stars Vince Vaughn as a former sperm donor who finds out that he has more than 500 children. Is this a Hollywood exaggeration or a possible outcome? Truth is, no one knows. In the United States, we do not track how many sperm donors there are, how often they donate, or how many children are born from the donations.
Unlike a Hollywood happy ending, however, this lack of regulation has real consequences for sperm donors and the children they help produce. The Journal of the American Medical Association published one case study of a healthy 23-year-old donor who transmitted a genetic heart condition that affected at least eight of 22 offspring from his donated sperm, including a toddler who died from heart failure. The American Society for Reproductive Medicine recommends genetic screening of sperm donors, and many banks do it, but the government does not require it. The risks become magnified the greater the number of children conceived from each donor.
How did we get to this point? Sperm donation has evolved from a practice of customized production to an industry that resembles mass manufacturing.
One of the first uses of donated sperm was reported in 1909 by a doctor recalling his days as a student observing medical practice. A 41-year-old wealthy merchant and his wife had been unable to conceive. An examination revealed that the husband did not produce sperm. The doctor requested a sperm sample from the “best-looking member of the class.” He asked the wife to come in for an examination, administered chloroform, and without her knowledge, inseminated her with the student’s sample. Nine months later, she gave birth to a healthy boy.
Several aspects of this vignette foreshadow the trajectory of sperm donation (but not the practice of inseminating women without their knowledge). The medical profession continued to play a central role. Doctors selected donors on the basis of their “superior” qualities, secrecy marked the enterprise, and sperm was produced for a particular recipient. According to one mid-century study of several hundred men, the majority of donors produced less than 10 samples.
AIDS changed everything. As doctors in the 1980s learned how the disease was transmitted, it was no longer advisable to transfer fresh samples directly from donor to recipient. Physicians began to use frozen sperm from commercial banks because it could be quarantined for six months, after which the donor could be retested for H.I.V.
Under these conditions, mass manufacturing began to make sense. A sperm program required personnel to keep track of donors, lab technicians to test samples, facilities to store the frozen vials, and distribution departments to ship the product around the world. Doctors could not handle these complexities on their own, so the procurement of sperm was outsourced to for-profit banks.
Today, the supply of sperm in the United States is concentrated in a few large companies that maintain multiple offices around the country, generally near college campuses. Recruiters write cheeky advertisements (“Get paid for what you’re already doing!”). They comb through hundreds of applicants to find the “few good men” who will pass rigorous medical screening and have sperm counts high enough to survive cryogenic freezing. Because of the large investment in finding donors, sperm banks require men to make regular deposits for months on end, resulting in large caches of genetic material that can produce tens and perhaps even hundreds of offspring.
Regulation has not kept up with the fundamental shift in how the fertility industry sources sperm. No federal agency or professional organization monitors the number of men donating, vials sold, or children conceived. The Food and Drug Administration requires that sperm banks test donors for particular diseases, but does not collect data about how many times men donate. The Centers for Disease Control and Prevention conduct an annual survey of fertility clinics, but don’t ask about sperm donation. Sperm banks say they cap the number of offspring per donor, but have no way of compelling customers to report when they get pregnant or give birth.
Similar information gaps about the number of donors, and the number of children born, plague egg donation. But until now, the market for eggs has resembled the old-fashioned version of sperm donation: women produce a small number of fresh eggs for a particular customer. Now that scientists have figured out how to successfully freeze eggs, egg banks are being established, and the scale of production may eventually lead to the same challenges sperm banks face.
We owe it to sperm donors and the children born from their donations to gather basic data. Sperm banks should be required to report the number of vials sold per donor to the F.D.A. The C.D.C. should expand its survey to include sperm donation. These reasonable first steps would allow for an evidence-based discussion about whether there should be regulations to limit the number of offspring per donor. At the least, we would get a handle on whether the typical number is in the dozens or hundreds.