Should deceased donors be allowed to donate sperm?

Deceased donor sperm donation is the subject of an article earlier this year, in light of the shortage of donated sperm in the UK:

Hodson N, Parker J. "The ethical case for non-directed postmortem sperm donation,"
Journal of Medical Ethics 2020;46:489-492.

Abstract: In this article we outline and defend the concept of voluntary non-directed postmortem sperm donation. This approach offers a potential means of increasing the quantity and heterogeneity of donor sperm. This is pertinent given the present context of a donor sperm shortage in the UK. Beyond making the case that it is technically feasible for dead men to donate their sperm for use in reproduction, we argue that this is ethically permissible. The inability to access donor sperm and the suffering this causes, we argue, justifies allowing access to sperm donated after death. Moreover, it is known that individuals and couples have desires for certain sperm donor characteristics which may not be fulfilled when numbers of sperm donors are low. Enacting these preferences contributes significantly to the well-being of intended parents, so we argue that this provides a pro tanto reason for respecting them. Finally, we explore the benefits and possible disadvantages of such a system for the various parties affected.

"The United Kingdom (UK) has a shortage of donor sperm. In 2016 there were 2273 donor insemination treatment cycles; 42% of the women registering had a male partner, 41% had a female partner and 17% were single.1 The average number of newly registered sperm donors per year between 2011 and 2013 was 586, an increase from 2004 where there were 237 donors.2 Yet this increase includes donations for specific use by a known individual to create one offspring. In 2016 the Human Fertilisation and Embryology Authority (HFEA) reported 4306 in vitro fertilisation (IVF) treatment cycles with ‘own eggs and donor sperm’ and 924 treatment cycles with ‘donor egg and donor sperm’.1 Clearly there is high demand for donor sperm and HFEA reports demonstrate this is increasing.1

"Commercial imports have been the mainstay of UK efforts to keep up with increasing demand for donor sperm.1 The Department of Health and Social Care estimates that 4000 samples were imported from the USA and 3000 from Denmark in addition to samples from other European Union (EU) countries.3 The HFEA highlights that imports are used to plug the gap because "the cost, time and resources required to recruit donors themselves is too high when there are specialist sperm banks who can carry out an efficient and reliable service".4 The Department of Health and Social Care has raised concerns that the UK's departure from the EU may worsen this state of affairs.3
...
"There are barriers to donating sperm in life that may prevent some men acting on their desire to help others or see their genes continue into future generations through donation. Posthumous sperm donation avoids most of these problems, allowing men to access the positives of sperm donation without the drawbacks. Living kidney donation provides an informative comparison between the motivations to donate in life versus after death. It is difficult to overestimate the value of donated kidneys to those individuals on the transplant list. Many people feel the pull of altruism and have a desire to help those who need a kidney transplant. Yet the potential costs of donating during life mean that individuals would rather donate after death when those costs are eliminated.16 Gamete donation after death parallels kidney donation by offering the same benefits as donation in life with fewer drawbacks, thereby both incentivising men to donate and providing greater opportunity to fulfil some of their reproductive and altruistic desires. This makes voluntary postmortem sperm donation an attractive addition to living donation.
...
"Given the potential impact of postmortem sperm donation on the family, policy decisions could be used to soften the implications of postmortem sperm donation for the family. For our purposes, the important point is that considerations of the family, including a romantic partner surviving the deceased man, do not justify a blanket ban on the use of sperm collected after death, especially if the donor has specified a desire to donate.
...
"The UK consensus is that gametes ought not to be bought although donor expenses should be covered.37 We do not take a view on this generally, but note the dissonance generated when sperm from countries such as Denmark where ‘vendors’ have been paid is used in the UK.38 In so far as society benefits from a coherent bioethical policy reflecting its shared values, using dead donors rather than donors who were paid in other countries to bolster supplies might provide a more coherent policy.

Sperm selection

I've blogged before about selection of sperm donors, but here's a story from the NY Times about the selection of sperm itself:

Tinder for Sperm: Even in the Petri Dish, Looks and Athleticism Are Prized
What makes one sperm cell — a blob of DNA with a tail — stand out? The selection process is like a microscopic Mr. America contest.
By Randi Hutter Epstein

“Not that one with the droopy head,” Lo said, pointing to a sperm that looked like a deflated balloon sagging over its string. He rejected a sperm with a thickened midpiece that he described as a “turtleneck,” and said he also avoids sperm with curlicue tails or an extra tail. Slow pokes and non-swimmers are spurned as well.

...
"When a sperm cell reaches the egg, it releases hyaluronidase, an enzyme that dissolves the cumulus, a layer of cells surrounding the egg. Next, the acrosome, a vesicle inside the sperm cell’s head, fuses with the outer layer of the egg, igniting the release of enzymes that ease the route inside. The sperm’s vigorously waving tail provides an extra push to help it through. Once inside, proteins within the sperm cell’s head prompt the oocyte to finish maturing and to release chemicals that harden the outer shell of the egg, preventing other sperm from barging in.

"These days, many leading fertility centers use techniques that allow them to bypass all these steps. Instead, they pick a single sperm and inject it into the egg, a technique called intracytoplasmic sperm injection or ICSI (pronounced ICK-see). ICSI was designed to help men with few or defective sperm, but has become so common that it’s used in more than half* of all I.V.F. procedures.
...
"In addition to having a keen eye for promising sperm, an embryologist must have excellent hand-eye coordination. Even then, learning to identify and successfully catch a single sperm before it swims away can take months of practice, said Lo. “I told my parents those years of video game playing, they’ve really paid off.”

* From The Lancet: "Globally, between 2008 and 2010, more than 4·7 million treatment cycles of assisted reproduction techniques were performed, of which around half involved intracytoplasmic sperm injection (ICSI), leading to the birth of 1·14 million babies.

Another pandemic shortage: donor sperm

 Sperm from conventional sperm banks is now in short supply. But there are "known donor" peer to peer websites and Facebook groups for direct donation, without a sperm bank:

The NY Times has the story:

The Sperm Kings Have a Problem: Too Much Demand  By Nellie Bowles

"Many people want a pandemic baby, but some sperm banks are running low. So women are joining unregulated Facebook groups to find willing donors, no middleman required.

...

"“We’ve been breaking records for sales since June worldwide not just in the U.S. — we’ve broken our records for England, Australia and Canada,” said Angelo Allard, the compliance supervisor of Seattle Sperm Bank, one of the country’s biggest sperm banks. He said his company was selling 20 percent more sperm now than a year earlier, even as supplies dwindled.

...

"Michelle Ottey, director of operations at Fairfax Cryobank, another large sperm bank, said demand was up for access to its catalog for online sperm shopping because “people are seeing that there is the possibility of more flexibility in their lives and work.”

...

"About 20 percent of sperm bank clients are heterosexual couples, 60 percent are gay women, and 20 percent are single moms by choice, the banks said.

...

"Each vial from a premium bank can cost up to $1,100. The bank guarantees a vial will have 10 million or 15 million total motile sperm. Each month, during ovulation, a prospective mother (or her doctor) unthaws a vial and injects the sperm.

"The recommendation is to buy four or five vials per desired child, since it can easily take a few months of trying to get pregnant. And since donors sell out fast, if a woman wants two children with the same donor, she needs to be ready with about $10,000.

...

"Apps for finding donors, like Modamily and Just a Baby, popped up. So did Known Donor Registry, where some 50,000 members arrange the giving and receiving of sperm. Facebook groups with tens of thousands of members — where men will post pictures of themselves, often with their own children — began advertising themselves to interested parties.

...

"The legal risk for both parties — risk that a mother will ask the donor for child support, and risk that a donor will want custody — is high, and the laws around this are not consistent in every state. The women who turn to Facebook groups for sperm tend to be unable to afford traditional sperm banks.

Sperm banks may need some regulation

The NY Times has the story: Sperm Banks Accused of Losing Samples and Lying About Donors

Some of the problems reported in the story are of the banking sort: when depositors sought to withdraw the sperm they had deposited (e.g. before undergoing chemo for testicular cancer) they found the bank no longer had it.  Others problems have had to do with incorrect information about donors...

"Frozen sperm has become a major industry, dominated by a few large sperm banks, but with smaller stocks of sperm maintained at hundreds of assisted-reproduction centers nationwide. The Food and Drug Administration requires that donor sperm be tested for infectious diseases. Beyond that, sperm banks are lightly regulated. Several states require health department licensing of the labs, but only New York conducts routine inspections.

"Some of the new cases accuse sperm banks of careless record-keeping, or mishandling or misappropriation of sperm banked for a client’s personal use. Others say the banks use hyped, misleading descriptions to market their donors.

"Several cases accuse a Georgia facility of marketing sperm as belonging to a neuroscientist with a genius-level I.Q. who turned out to be a schizophrenic felon, and who has fathered at least 36 children.
...
"Sperm banks are not required to verify the information provided by donors, and lawyers familiar with the industry say many do not. They set their own limits on how many children a donor can sire, but unless the mothers voluntarily report the births, they may not know how many half-siblings are out there. Some, including the two largest, California Cryobank in Los Angeles and Fairfax Cryobank, headquartered in Virginia, test for many genetic conditions, while others test for very few.

"So it is buyer-beware — for people banking their own sperm for personal use after cancer treatment, and for those relying on a sperm bank’s description of an anonymous donor.

"Sean Tipton, a spokesman for the American Society of Reproductive Medicine, said his group does not see a need for further regulation and believes that the industry is generally reliable.

“All indications are that sperm donation has been a terrific way to help people start a family even if, as with anything that involves humans, there are mistakes and some less-than-perfect actors,” he said."

Sperm banks

What rules should govern sperm banks? Donors may desire anonymity, but children conceived with donated sperm may seek to learn about their biological fathers, and both the children and society in general has an interest in preventing unintentional marriage of half siblings.

Haaretz reports Health Ministry preparing new regulations for Israeli sperm banks

"The regulations will require more detailed family histories from donors and those seeking a donation; limit the number of possible children from each donor; restrict donors to using just one sperm bank; and ban the practice of sperm mixing (in which more than one person's sperm is used).
...
""Israel has had 15 sperm banks, 13 of them public and two private, but only seven are still active. Sperm samples are not included among the standard healthcare services and the prices of imported sperm samples can cost hundreds of dollars (up to five times more expensive than sperm frozen in the country ). Despite the price gap sperm imports have been on the rise, especially for religious women, who have been advised by their rabbis to get a donation from abroad to avoid the slightest risk of unintentional incest."

In Britain, National Sperm Bank stops recruiting donors

The Telegraph has the story: National Sperm Bank stops recruiting donors after just two years

"The National Sperm Bank (NSB) was a joint project run by the National Gamete Donation Trust (NGDT) and the Birmingham Women’s Fertility Centre and launched in October 2014 with a £77,000 grant from the Department of Health.

It was hoped the service would plug the gap in the shortage of donors and prevent couples being forced to look for sperm from overseas.

The bank hoped to be self-sufficient within a year but because the full donor process takes up to 18 months they were unable to generate enough income to keep going.

Although they only managed to recruit seven viable donors, experts said it was the business model that proved their ultimate downfall.

...

"“For every 100 men who enquire about being a donor, only 4 or 5 are ultimately accepted.

The Human Fertilisation and Embryology Authority estimate that 2,000 children are born every year in the UK using donated eggs, sperm or embryos and there are around licensed UK clinics performing sperm donor insemination.

But the majority of clinics are based in London and the south-east of England and treatment can be expensive. The cost of donor sperm from the UK's largest sperm bank, the London Sperm Bank, is currently £950. In contrast the National Sperm bank was proposing to charge £300 per insemination.

...

"The bank has also suffered because since 2005 the children of donors have a right to learn the identity of their fathers when they turn 18. The numbers of men willing to donate sperm has fallen dramatically since their anonymity was removed."

A seller's guide to the U.S. market for sperm

The NY Times has some advice for potential sellers...

10 Things to Know About Being a Sperm Donor

"Your odds of getting into Harvard or Stanford are higher than your chances of being accepted as a donor at the major sperm banks.

California Cryobank and Fairfax Cryobank, the nation’s two largest sperm banks, take only about one in 100 applicants. Some deal-breakers: a low sperm count, an iffy health history or sperm that don’t do well after freezing.

If you’re short, forget about it.

...

You’ll never know how many children you have fathered.

There’s no legal limit, but the biggest sperm banks have policies that one donor’s sperm will not be allowed to sire children for more than 25 to 30 different “family units.” But some families may have two or three children with the donor’s sperm, and others may not report a birth, so they would not be counted in that limit. Some men who have joined the Donor Sibling Registry, a site where donors and their children can connect, have been surprised and disturbed to discover that they have dozens of offspring.

You may or may not get to meet them.

Sperm donors usually have the option to remain anonymous, or to agree that the children can get in touch when they turn 18. There has been a growing recognition of children’s rights to know their genetic parents — and recently a trend toward donor willingness to be identified. Even anonymous donors are increasingly being identified by curious children as genetic testing becomes cheaper and more common."

Bleeding (and more) for Canada

Peter Jaworski in USA today discusses Canadian repugnance for paying for blood or sperm.

If it weren’t for America's free-market ways, more Canadians would have trouble getting pregnant.

"Canada used to have a sufficient supply of domestic sperm donors. But in 2004, we passed the Assisted Human Reproduction Act, which made it illegal to compensate donors for their sperm. Shortly thereafter, the number of willing donors plummeted, and sperm donor clinics were shuttered. Now, there is basically just one sperm donor clinic in Canada, and 30-70 Canadian men who donate sperm. Since demand far outstrips supply, we turn to you. We import sperm from for-profit companies in the U.S., where compensating sperm donors is both legal and normal.
...
"Canada has never had enough domestic blood plasma for plasma-protein products, such as immune globulin. Our demand for those products, however, is increasing. Last year, we collected only enough blood plasma from unremunerated donors to manufacture 17% of the immune globulin demanded. The rest we imported from you, in exchange for $623 million, or $512 million U.S.

Reliance on your blood plasma looked like it might change a little bit when, in 2012, a company called Canadian Plasma Resources announced plans to open clinics in Ontario dedicated to collecting blood plasma. The trouble is that its business model included compensating donors. Almost immediately, groups such as the Canadian Union of Public Employees and the Canadian Health Coalition began to lobby the Ontario government to pass a law to stop CPR from opening clinics. Ontario obliged in 2014, passing the Safeguarding Health Care Integrity Act, which among other things made compensation illegal.

When CPR shifted attention to Alberta, so did the groups opposing them. Just this year, the Alberta government introduced the Voluntary Blood Donation Act, which would prohibit compensation.

British Columbia’s government is just now looking at options to ban it as well.

What persuaded these governments? The anti-compensation groups argued that blood plasma from compensated donors was less safe, that people should donate blood plasma for free rather than for money, and that there is something wrong with having a for-profit business model in health care.

The latter two concerns are strangely specific. They don’t seem to apply to you Americans. If they did, the groups would have lobbied to make importation of anything other than products made from unremunerated donors also illegal. But they didn’t.

Instead, they object to a Canadian for-profit company compensating Canadian blood plasma donors in Canada, but American for-profit companies compensating American donors in America does not appear to register on their moral radar. Like the importation of sperm from for-profit U.S. companies that compensate donors, it has all the appearance of moral NIMBYism. It’s fine if it happens in your backyard, and we’ll happily buy the products, but we object to it happening in our backyard."

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And here, in Canada's National Post:

Peter Jaworski: Canada needs blood plasma. We should pay donors to get it

Canada buys the vast majority of its plasma-protein products from American companies that attract plasma donors by paying them. Yet we ban the same practice here

IVF: Experience suggests there's room for some regulation

The Guardian has the story: IVF mix-up: wrong sperm may have fertilised eggs of 26 women
Dozens of women may have had eggs fertilised by sperm cells from someone other than the intended father, say Dutch authorities

"A Dutch medical institution has launched an investigation after discovering that up to 26 women’s eggs may have been fertilised by the wrong sperm at its IVF laboratory.

"A “procedural error” between mid-April 2015 and mid-November 2016 during the in-vitro fertilisation was to blame, the University Medical Centre in Utrecht said.

"“During fertilisation, sperm cells from one treatment couple may have ended up with the egg cells of 26 other couples,” said a statement.

“Therefore there’s a chance that the egg cells have been fertilised by sperm other than that of the intended father.”

Although the chance of that happening was small the possibility “could not be excluded”, said the centre.

Half the women who underwent fertility treatment had become pregnant or given birth.

“For some of the 26 couples frozen embryos are still available but the chance remains that they [too] have been fertilised by the sperm from a man other than the intended father,” the UMC said.

"The couples had been informed, the centre said.

“The UMC’s board regrets that the couples involved had to receive this news and will do everything within its powers to give clarity on the issue as soon as possible.”

...

"Mix-ups do occur, including one in 2012 when a Singapore mother sued a clinic for alleged negligence after it mixed up her husband’s sperm with that of a stranger.

"The ethnic Chinese woman first suspected that something was amiss when her baby, who was born in 2010, had markedly different skin tone and hair colour from her Caucasian husband, news reports at the time said."
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Here's are two recent updates on the Singapore story (and subsequent legal proceedings) from the Straits Times: the first has some details of how the error happened, the second speaks about the legal issues associated with possible damages that might be assessed, and if so for what...
IVF mix-up at Thomson Medical: A look back at the case of 'Baby P'

IVF mix-up at Thomson Medical: Court continues to hear appeal of woman who conceived baby with stranger's sperm

Sperm donation from Denmark to the UK and elsewhere

 The Daily Mail has the story:

'They invaded us once by boat and now they're doing it with sperm!' Why hundreds of British women are giving birth to 'Viking babies' conceived with Danish donors

"These are the main Danish export products - beer, Lego and sperm!"'

"So why are so many British women going Danish? According to Dr Alan Pacey, a fertility expert at the University of Sheffield, one of the reasons is a shortage of homegrown sperm.

'We don't have enough donors in the UK to meet the national need,' he explains. 'We don't have the clinic infrastructure sufficient to recruit enough donors - even when men want to donate.

...

"'The NHS is used to treating patients and you get a fee for treating patients. You don't get a fee for screening a donor that you may not ultimately accept.'

"Compounding the problem for British clinics is the 2005 law that forces men to waive their anonymity, meaning sperm donors face the prospect of offspring turning up on their doorstep once they reach the age of 18.

"Nevertheless, although Danish clinics, among them the world's largest sperm bank, Cryos, cannot sell semen from anonymous donors to British women, business is booming thanks to the huge numbers of local men happy to sign up anyway.

...

"Experts such as Laura Witjens, CEO of the National Gamete Donation Trust, say the excellent customer service deployed by Copenhagen's sperm banks has also contributed to the Viking baby boom.

'It's much easier for a British clinic to order sperm from Denmark which is Fed-exed the next day than to try and recruit their own donors and all the hassle that goes with them,' says Witjens.

'The Danish model is customer service driven. It knows how to deal well with customers, it has a good website, and that's what we could do in the UK as well - it's not rocket science.'

HT: Mario Macis

Sperm donors used to be anonymous. Technology has made that obsolete

Here's a representative story from the NY Times:

Sperm Donors Can’t Stay Secret Anymore. Here’s What That Means.  By Susan Dominus

"To be the biological child of an anonymous sperm donor today is to live in a state of perpetual anticipation. Having never imagined a world in which donors could be tracked down by DNA, in their early years sperm banks did not limit the number of families to whom one donor’s sperm would be sold — means that many of the children conceived have half-siblings in the dozens. There are hundreds of biological half-sibling groups that number more than 20, according to the Donor Sibling Registry, where siblings can find one another, using their donor number. Groups larger than 100, the registry reports, are far from rare.
"Because of the increasing popularity of genetic testing sites like 23andMe, in the past two or three years a whole new category of people, including those who never knew they were conceived via donor insemination, are reaching out to half siblings who may have already connected with others in their extended biological family. 
...
"Over time the adoption movement popularized the principle that individuals had a right to know their biological roots, and lesbian couples and single mothers, dominating ever more of the sperm banks’ market, called for greater transparency. In the early 2000s, California Cryobank offered, for a premium fee, an option for parents to choose a donor who agreed not just to be contacted when the offspring turned 18 but to respond in some fashion (though still anonymously if that was his preference).

By 2010, experts in reproductive technology were starting to note that internet searchability, facial-recognition software and the future of DNA testing would soon render anonymity a promise that the sperm banks could no longer keep. Since 2017, California Cryobank has stopped offering anonymity to its new donors. Donors now must agree to reveal their names to their offspring when they turn 18 and to have some form of communication to be mediated, at first, by the bank."

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And here's an accompanying story, by a man who has now met and photographed many of his half-sibs.

A Family Portrait: Brothers, Sisters, Strangers

Photo essay by Eli Baden-Lasar

Text by Eli Baden-Lasar as told to Susan Dominus

Danish sperm donors and British babies

The Telegraph has the story: Invasion of the Viking babies--With a growing demand for donor fathers, women are turning to Danish sperm banks

"Donors are paid a similar sum in Britain, but clinics can’t recruit enough men to keep up with the growing demand for sperm (the number of women with female partners having donor insemination, for example, rose by 23 per cent between 2010 and 2011). The percentage of new registered donors from overseas has more than doubled in recent years, from 11 to 24 per cent – and around a third of those imports are from Denmark.

“It’s a bit like the Viking invasion of 800AD,” says Dr Allan Pacey, a fertility expert from the University of Sheffield and current chairman of the British Fertility Society. “They’ve invaded us once by boat, and now they’re doing it by sperm.”

"Part of the problem is down to our system, with donor recruitment generally carried out on a small scale in British fertility clinics. On average, just one in every 20 men who applies will be suitable to donate. Men do not only need to have high-quality sperm: they also have to undergo a full range of screening tests for genetically inherited diseases and sexually transmitted infections, and their family medical histories must be assessed. Those deemed suitable will need to commit to regular visits to the clinic, usually during the working day. It’s often easier for a clinic to suggest their clients use a Danish donor, where a specialist sperm bank has the resources to devote to finding the 5 per cent who fit the bill.

"Although some bigger fertility clinics here do have a ready supply of donors, inter-clinic competition means that those who don’t tend to recommend an overseas sperm bank. Olivia Montuschi, of the Donor Conception Network, a charity for those affected by donor conception, told me that patients are not being informed about the clinics that have donors available. “Clinics like to retain their own patients, not share them, and they keep information about donors at other clinics to themselves,” she says.

Outsourcing reproduction

The WSJ has an article on Assembling the Global Baby
"With an international network of surrogate mothers and egg and sperm donors, a new industry is emerging to produce children on the cheap and outside the reach of restrictive laws."

"In a hospital room on the Greek island of Crete with views of a sapphire sea lapping at ancient fortress walls, a Bulgarian woman plans to deliver a baby whose biological mother is an anonymous European egg donor, whose father is Italian, and whose birth is being orchestrated from Los Angeles.

"She won't be keeping the child. The parents-to-be—an infertile Italian woman and her husband (who provided the sperm)—will take custody of the baby this summer, on the day of birth.

"The birth mother is Katia Antonova, a surrogate. She emigrated to Greece from Bulgaria and is a waitress with a husband and three children of her own. She will use the money from her surrogacy to send at least one of her own children to university.

"The man bringing together this disparate group is Rudy Rupak, chief executive of PlanetHospital.com LLC, a California company that searches the globe to find the components for its business line. The business, in this case, is creating babies.

"Mr. Rupak is a pioneer in a controversial field at the crossroads of reproductive technology and international adoption. Prospective parents put off by the rigor of traditional adoptions are bypassing that system by producing babies of their own—often using an egg donor from one country, a sperm donor from another, and a surrogate who will deliver in a third country to make what some industry participants call "a world baby."

"They turn to PlanetHospital and a handful of other companies. "We take care of all aspects of the process, like a concierge service," says Mr. Rupak, a 41-year-old Canadian.
...
"PlanetHospital's most affordable package, the "India bundle," buys an egg donor, four embryo transfers into four separate surrogate mothers, room and board for the surrogate, and a car and driver for the parents-to-be when they travel to India to pick up the baby.

"Pricier packages add services like splitting eggs from the same donor to fertilize with different sperm, so children of gay couples can share a genetic mother. In Panama, twins cost an extra $5,000; for another $6,500 you can choose a child's gender.
...
"Greek surrogacy is regulated by a 2005 law, but the business takes advantage of a legal loophole. Surrogate mothers are not supposed to act for profit. However, they can accept money for pregnancy-related expenses. Typically, the expenses are set at up to $50,000.

"The judge never asks" about the money, says Maria Kouloumprakis, a surrogacy lawyer in Greece. Ms. Kouloumprakis calls the situation "an emptiness in the law."

"Egg donors often come from the U.S. or Eastern European countries since white parents tend to prefer fair-skinned children. Those countries allow donor anonymity. Parents on tighter budgets might opt for a donor from India or Latin America. Sperm is often provided by the fathers-to-be, though it's also available from a network of sperm banks in the U.S. and Europe.
...
"Many factors drive surrogacy's global spread. China and other big adoption destinations have toughened their rules in recent years. Some developed countries, including Japan, Spain, Germany, Italy and France, outlaw or severely restrict surrogacy at home. The United Kingdom prohibits surrogacy for pay, and in 2005 banned donor anonymity. Some U.S. states prohibit surrogacy for pay, and in recent years some have outlawed gay adoption.
...
"[In India, a] couple made payments as the pregnancy progressed, with the final amount due at birth. Of the $35,000, PlanetHospital keeps around $3,600. Another $5,000 goes to the egg donor, plus another $3,000 or so for travel expenses. The surrogate gets $8,000. The rest, around $15,000, is paid to the clinic.
...
"No country has become a greater magnet for the business than India, which made surrogacy legal in 2002. It has an ample supply of inexpensive surrogates and egg donors. There is little regulation beyond guidelines that set age limits for surrogates and prohibit a woman from acting as a surrogate more than three times.
...
"Surrogacy's complexity can give rise to extraordinarily difficult decisions, such as whether or not to abort. This can happen because clinics sometimes implant multiple embryos into multiple surrogates to improve the odds: If one miscarries, there are still viable pregnancies. However, if several implants successfully lead to pregnancy, clients face ending up with not just one or two children, but many."

And here is the PlanetHospital website--they are involved in all sorts of "medical tourism," not just reproductive services.

Deceased donor sperm recovery and conception

I guess it's a case of deceased donor transplantation of sorts. Above the Law has the story:

Posthumous Conception: It Happens More Often Than You Think by Ellen Trachman

 "In the latest high-profile controversy over posthumous conception, last month, we learned of the birth of a baby girl to an Australian woman named Ellidy Pullin, the widow of Olympic snowboarder Alex “Chumpy” Pullin. The Olympian died tragically in a diving accident in 2020.

"Ellidy Pullin turned to their fertility doctor, Andrew Davidson, and asked that her spouse’s sperm be harvested from his body after his death. Davidson described how he entered fertility medicine never expecting to do posthumous sperm retrievals, but now, those requests are becoming more common. The doctor noted that he has done two other posthumous sperm retrievals since the Olympian’s death.

"The process was successful for Pullin — as Davidson notes, it usually is, so long as the sperm is successfully retrieved within 48 hours of death.

...

"In the United States, the hospital itself is the most frequent obstacle that prevents a surviving loved one from having a chance to conceive with the DNA of their deceased spouse or partner. Many hospitals are unwilling to permit the retrieval of reproductive material without specific written consent. And by specific consent, that frequently means not just that the deceased wanted to have children with the survivor. The bar is often set higher. The consent must be that the deceased specifically agreed for their sperm or eggs to be harvested and used for reproductive purposes after their death."

DNA tests are revealing medical misconduct in early sperm donation

The NY Times has the story, summarizing many recently discovered cases in which fertility doctors used their own sperm in place of other sperm donors:

Their Mothers Chose Donor Sperm. The Doctors Used Their Own.
Scores of people born through artificial insemination have learned from DNA tests that their biological fathers were the doctors who performed the procedure.

"With the advent of widespread consumer DNA testing, instances in which fertility specialists decades ago secretly used their own sperm for artificial insemination have begun to surface with some regularity. Three states have now passed laws criminalizing this conduct, including Texas, which now defines it as a form of sexual assault.

"Dr. Jody Madeira, a law professor at Indiana University, is following more than 20 cases in the United States and abroad. They have occurred in a dozen states, including Connecticut, Vermont, Idaho, Utah and Nevada, she said, as well as in England, South Africa, Germany and the Netherlands."
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There's an old saying that good judgement comes from experience, and experience comes from bad judgement.  The same thing might be said about well regulated markets...

Different misconduct in sperm donation

One reason it is rewarding to study unregulated markets is that it gives you some idea of why some regulation might be desirable.  The growth in DNA registries has allowed many children of sperm donors to identify their biological father, and it also allows donors to identify their children, sometimes with unsettling results.

Here's a story from the Washington Post:

Sperm donor says fertility clinic ‘lied’ after discovering he fathered 17 kids ― most in the same area

"It was 1989 when he gave his sperm to the fertility clinic at Oregon Health & Science University, where he was a first-year medical student, believing his donation would help infertile couples and advance science. The facility promised that once his sperm had conceived five babies in mothers living on the East Coast, the rest would be used for research, Cleary said at a Wednesday news conference. He had assured his wife that the donor kids were far enough away that their own four children could never run into them in their Oregon town, or unwittingly befriend them or fall in love with them.

“So you can imagine his shock,” his attorney Chris Best said at the news conference, “when, after 30 years, Dr. Cleary recently [learned] that no less than 17 children have been born from his donations” ― all of whom were born in the state of Oregon and the Pacific Northwest."

The demand for blue eyed babies (from American sperm donors) in Brazil

The WSJ has the story:
Demand for American Sperm Is Skyrocketing in Brazil
Explosive growth spurred by more wealthy single women and lesbian couples turning to U.S. donors

"Over the past seven years, human semen imports from the U.S. to Brazil have surged as more rich single women and lesbian couples select donors whose online profiles suggest they will yield light-complexioned and preferably blue-eyed children.

"is one of the fastest-growing markets for imported semen in recent years, said Michelle Ottey, laboratory director of Virginia-based Fairfax Cryobank, a large distributor and the biggest exporter to Brazil. More than 500 tubes of foreign semen frozen in liquid nitrogen arrived at Brazilian airports last year, officials and sperm-bank directors said, up from 16 in 2011. Complete data from Anvisa, Brazil’s health-care regulator, isn’t yet available for 2017.
...
"Money is also a factor setting parameters for the DNA import boom. Carefully categorized and genetically vetted sperm from U.S. providers has to be procured from Brazilian fertility clinics at a cost of some $1,500 a vial, often as part of an in vitro fertilization procedure that costs roughly $7,000 an attempt. Whites are more likely able to afford that in a country where about 80% of the richest 1% are white, according to Brazil’s statistics agency.

"Imports are rising in part because many Brazilians simply don’t trust the national product. Unlike in the U.S., it is illegal to pay men to donate their sperm here, so domestic stocks are low and information about Brazilian donors sparse.

“It basically says ‘brown eyes, brown hair, likes hamburgers’ and what their zodiac sign is—that’s it,” said Alessandra Oliva, 31, of the information available on local donors. She has 29 pages of information on the American father of her 14-month-old son, from a photo of him as a child to genetic tests for cystic fibrosis."

The end of anonymous sperm donation...

 In  Colorado, a new law ending anonymous sperm donation seeks to catch up with the technological developments involving genetic sequencing that have already made anonymity of sperm or egg donors fairly fragile. Here's an account in JAMA:

The End of Anonymous Sperm Donation in Colorado--A Step Forward to a New Fertility Future in the US?  by I. Glenn Cohen, JD1; Eli Y. Adashi, MD, MS2; Seema Mohapatra, JD, MPH3   JAMA. Published online October 24, 2022. doi:10.1001/jama.2022.19471

"On May 31, 2022, Colorado became the first state to effectively ban anonymous gamete donation.1 Starting in 2025, fertility clinics in Colorado must collect identity and medical information from sperm and egg donors and may not match donors that do not agree to such disclosure (the statute uses the word “donor” though in many instances compensation is provided). The new law also requires that the clinics make a request that donors update their contact information and medical history at least once every 3 years. The law provides that a donor-conceived person aged 18 years or older shall be provided donor information upon request. The statute purports to also prohibit fertility clinics outside Colorado from providing gametes to Colorado residents (or individuals located in Colorado) if they do not abide by these rules. The statute also instructs clinics not to match a donor once it is known or reasonably should be known that “25 families have been established using a single donor in or outside of Colorado.”1

...

"Two states, Utah and Washington, have enacted statutes requiring the collecting and sharing of identifying information about a donor with donor-conceived children who request it after reaching the age of 18 years.3 However, both states also permit a donor to opt out, thereby limiting the utility of the laws. By contrast, the UK, Germany, Sweden, France, and many other countries have created mandatory registries that donor-conceived individuals can access when they turn 18 years of age, having an effect similar to the new Colorado law.3,4

"The new Colorado law highlights the gap between the law and reality of gamete donor anonymity in the US outside Colorado. Banks have promised donors anonymity in other US states and prior leaks of donor information from banks’ files have been exceedingly rare, if they ever happened at all; the banks have litigated to protect the identifying information provided by the donor.3 But in a practical sense, the promise of anonymity is now much less thoroughgoing.4 Direct-to-consumer genetic testing has become very common, and it has been estimated that 100 million people worldwide have taken a direct-to-consumer genetic test by 2021.4 Studies estimate that a genetic database covering only 2% of the population could match nearly anyone in that population.4 The combination of direct-to-consumer genetic testing, publicly available information, and social media suggest that many donor-conceived individuals will in fact be able to reidentify their gamete donor."

Markets for blood, milk, and sperm (new book)

Here's the announcement of a forthcoming book from Harvard University Press (by Professor Kara Swanson, whose earlier papers include The Birth of the Sperm Bank):

Banking on the Body

The Market in Blood, Milk, and Sperm in Modern America

Kara W. Swanson

Not yet available

Book Details

HARDCOVER

$35.00 • £25.95 • €31.50

ISBN 9780674281431

Publication: May 2014

Available 05/05/2014

* Academic Trade

310 pages

6-1/8 x 9-1/4 inches

10 halftones

World

Related Subjects

• MEDICAL: History
• HISTORY: United States: 20th Century
• LAW: Property
• MEDICAL: Health Policy
• SOCIAL SCIENCE: Sociology: General

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• About This Book
• About the Authors
• Table of Contents

Scientific advances and economic forces have converged to create something unthinkable for much of human history: a robust market in human body products. Every year, countless Americans supply blood, sperm, and breast milk to “banks” that store these products for later use by strangers in routine medical procedures. These exchanges entail complicated questions. Which body products are donated and which sold? Who gives and who receives? And, in the end, who profits? In this eye-opening study, Kara Swanson traces the history of body banks from the nineteenth-century experiments that discovered therapeutic uses for body products to twenty-first-century websites that facilitate a thriving global exchange.

More than a metaphor, the “bank” has shaped ongoing controversies over body products as either marketable commodities or gifts donated to help others. A physician, Dr. Bernard Fantus, proposed a “bank” in 1937 to make blood available to all patients. Yet the bank metaphor labeled blood as something to be commercially bought and sold, not communally shared. As blood banks became a fixture of medicine after World War II, American doctors made them a frontline in their war against socialized medicine. The profit-making connotations of the “bank” reinforced a market-based understanding of supply and distribution, with unexpected consequences for all body products, from human eggs to kidneys.

Ultimately, the bank metaphor straitjacketed legal codes and reinforced inequalities in medical care. By exploring its past, Banking on the Body charts the path to a more efficient and less exploitative distribution of the human body’s life-giving potential.

Here's the table of contents:

• Introduction: Banking for Love and for Money
• 1. Bankable Bodies and the Professional Donor
• 2. Banks That Take Donations
• 3. Blood Battles in the Cold War
• 4. Market Backlash
• 5. Feminine Banks and the Milk of Human Kindness
• 6. Buying Dad from the Sperm Bank
• Conclusion: Beyond the Body Bank

When does sperm donation equal paternity?

There are lots of issues to be settled about transactions related to reproduction, such as surrogacy, and egg and sperm donation. Some of these are illustrated by a case going through both the courts and the media in California. Here's the NY Times story: Does ‘Sperm Donor’ Mean ‘Dad’?

Here's a relevant paragraph about the existing laws:

"California, like many states, according to Professor Cahn, has conflicting statutes. One provides that any man can establish parentage if he “receives the child into his home and openly holds the child out as his natural child.” But another statute holds that a man who provides his sperm to a doctor for the purpose of inseminating an unmarried friend is “treated as if he were not the natural father” — unless there is a specific written agreement ahead of conception."