A long time ago I wrote about the severe sperm shortage Canada is experiencing. This is one aspect of the larger picture of how ART is managed in Canada which I’ve written about recently for other reasons–mostly the case brought by Olivia Pratten that is pending British Columbia.
Anyway, here’s a news story about a report documenting the Canadian sperm shortage. (While the report itself is somewhat controversial, I think the news story is accurate.) If the report is anywhere near right, the dimensions of the shortage are astonishing—60 altruistic (i.e. unpaid) donors and 5500 potential patients (their word) who’d like to use donor sperm.
There are a couple of other things that are striking, too. A substantial part of the demand is from single women or lesbian couples. (That really isn’t surprising if you think about it. Beyond the obvious explanation (heterosexual couples have a source of sperm handy) there’s ICSI, which I’ve discussed before.)
Then there’s this quote:
Patients here obtain more than 90% of semen from the United States, and the federal government appears to turn a blind eye to the fact they buy it from mostly for-profit sperm banks — a criminal offence in this country.
This is the globalization problem exemplified. Just a little bit to the south of the vast majority of the Canadian population you’ll find one of the most robust ART markets in the world–right here in the US. It’s not hard to see why prosecutors in Canada aren’t rushing to prosecute those who purchase sperm from US (or other country) sperm banks located around the world. But short of prosecution, what do you do about this?
And then there’s the report’s recommendation–which is not (as I had expected) to ditch the ban on payment. Rather it is to create a more systematic campaign in support of altruistic donations. The analogy drawn by the author is to blood donations. It’s fascinating to me that even this recommendation is controversial. (See this commentary, for instance. ) That suggests that the general discourse in Canada is very far removed from that found in the US.
In the end, there are a series of issues raised here, and it is important to me to try to untangle them. I’ll try and list the main questions below, though this is always subject to amendment/revision.
1. Should there be payment for providing sperm for use by a third party? I’m inclined to care less about whether we characterize money as payment for sperm or compensation for expenses, but you might see that as a sub-question. Here you might find arguments about commodification and perhaps autonomy/choice.
2. Should altruistic donation (which really would be donation) be encouraged? You can see some reasons for opposing it in the commentary I linked to. I’m generally unsympathetic to this point of view, which is probably not surprising to you. It strikes me that the arguments offered are generally heteronormative–which is to say, they assert that people ought to partner up in heterosexual couples and have their kids early and if you don’t do that you are on your own.
3. The more extreme version of 2 might be whether use of third-party gametes–no matter how you get them–is allowed.
4. If you allow use of third-party gametes, what is the legal status of the gamete provider? What information is made available to whom? When and how is that done? This is where the Pratten questions go.
What’s important to note is that you can to some degree mix-and-match answers here. Thus, you could say that the child conceived via third-party gametes should have a right to information about the gamete provider and that it is good to encourage altruistic donation. Or you could say you don’t approve of exchanges for money, but in the event of altruistic donation, anonymity is okay. Or you could be completely opposed to the use of third-party gametes, in which case you might say anyone conceived via use of them has a right to know their donor, but really, that’s not a big issue–because there shouldn’t be any such children. And so on.
It’s easy to conflate and conjoin these issues in discussions and I don’t think that advances understanding, so I just wanted to take this opportunity to try to unbundle them.
Related Topics 
1. Regarding compensation. Should be treated like any other tissue or fluid
2. Regarding and educational campaign to promote donations.
Why the heck should the state get involved?
Is there a serious population crunch in Canada that the state needs to promote more births by any means possible?
I find the idea of a public education campaign quite objectionable.
Surely we in the US would object to large scale governnent sponsored campaign either promoting or opposing abortion for example. Private agencies are free to promote whatever they want. But that’s not the government’s role except in a clear uniquivocal public health interest.
kisarita: You might not regard infertility as a health problem, but most infertile people do. We’re sprinting off-topic here, but I think most people would argue that health care is about quality of life as well as protecting people from infecting others, or keeping them employable so they can pay taxes. Most health plans would cover ED for example or at least some forms of cosmetic surgery.
Some more views:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1308532/
http://theassassinbug.com/2011/01/07/is-infertility-a-public-health-problem/
http://theassassinbug.com/2011/01/25/is-infertility-a-public-health-problem-the-responses/
actually Mark, I am exactly the type of person the proposed campaign would be catering too. I am a middle aged single woman who would have wanted nothing more to be a mother when I still could have. Instead, I became the world’s greatest auntie.
I have a sorrow. But I do not have a health problem. I was not infertile.
(And if I was, buying sperm would not have cured it…)
And by the way I am employed by a medicaid funded insurance company and no we do not cover elective cosmetic procedures.
I can think of a couple of reasons why one could at least argue for a public education campaign. One is the reason alluded to by Mark Lyndon, below. If you think there is public health need for third-party gametes (I know this is a debatable point–but that’s why I said “if”) then encouraging altruistic donation is in the public interest. I wouldn’t be surprised or offended if the governmnet encouraged blood donation, for example.
I realize there is a major “if” there and beyond that people will disagree about what the legitimate need for third-party gametes is–is it limited to heterosexual couples who document infertility, for example? But setting all those discussions to the side, if you think this is about public health then the education campaign might look reasonable.
The second reason I can see is more pragmatic. If you think people are going to be using third-party sperm anyway, then having an inadeqeuate legal supply may just push folks into illegal action (importing sperm from the US say) or resort to some form of black market. Now if there was a reason for the regulated regime in the first place (and in Canada there clearly are reasons of principle) then this is undesireable.
Put slightly differently, you could argue that the only way to make the regulated scheme work is if it can meet demand. Otherwise people will just go around the regulated scheme and the whole thing falls apart. Of course there is an alternative, which is to rigorously enforce the scheme as it is established, prosecute those importing sperm, shut down the black market. I wonder if there is much appetite for that?
I was hung up on the fact that it was inappropriate to call someone who sells something a donor. I did truly see these people as clinic vendors, not donors and certainly not patients. Then I watched a video Karen Clark linked to from a CBS Morning show I think. It was about how a bad economy is driving more women to do what the show called “donate their eggs” There was a physician from a fertility clinic who was clearly pro-anti-regulation reminding the audience that they don’t take just anyone you have to be of a certain physical and intellectual callibur and she said she reminds women that the process is not just about the money “this is a fertility treatment”. And like a ton of bricks it hit me, they are not vendors, they’re patients seeking treatment to improve their chances of conceiving offspring through IVF using their own eggs or through artificial insemination/IVF with their own sperm. They just like any other patient seeking fertility treatment with the goal of conceiving offspring – their desire to raise or not raise their offspring is immaterial to the doctor patient relationship at the time the treatment is sought and provided. Its a professional and ethical loophole for physicians but I think its a safe one. Fertility treatments don’t make infertile people fertile. Doctors in these clinics are not treating infertile people so that they can reproduce. Infertile men are not their patients at all. Infertile women do not receive fertility treatment perse because their own eggs were not fertilized and the treatment they receive is unrelatied to reproduction, they will be gestating and delivering which is really turns out a whole seperate process from fertilization and fertility treatments. So bottom line the word donor just throws everyone off of whats really going on and the money is a secondary issue. Calling these particular patients donors takes them out of the same class as patients who intend to raise their resulting offspring when from a medical standpoint they are situated exactly the same – and really what happens with regard to custody and support of the children after they are born is none of anyones businees before the child is born.
I believe that laws to regulate the industry need to set aside the intentions, contracts, and financial exchanges that may or may not be pertinent to issues of custody and support and first focus on making sure policies protect the health not just of the immediate players but of the entire population. Nobody talks about the fact that parents need to know the identity and health of their offspring just as much as ther children need to know theirs. I recently read about a woman whose older brother was born with downs syndrom and given up for adoption. She was born 11 months later. On paper she and her brother had the same father, their mother’s husband. In reality their mother had conceived them with two different anonymous men by being artificially inseminated at a fertility clinic. Because of anonymity, her brother’s father was not named on his birth certificate. He was not informed of her brothers condition. His health history was not associated with her brother’s condition. If like most men who conceive their children anonymously he fathers in the neighborhood of 20 children, he might have chosen to stop after 3 or 4 of his children were born mentally retarded. He might not have wanted his child to be given up for adoption, maybe his family would have takem her brother in. You just never know. I’d submit to you that its dangerous for people not to know about the health of their offspring because unlike mental retardation other genetic conditions that cause still births, can be managed so that a healthy baby is born. But it takes a few stillbirths to realize you should be tested for a particular condition and that can’t happen if the parent does not know that 3 or 4 of their children died within days of their births. And so none of their children will ever get to live because that pattern of recurrent fetal death can’t be detected when one or both parents is anonymous. Regulation will have to mandate that patients be treated as patients and that anyone with offspring be documented. The money and contracts and intentions are secondary to the health of the children being born. Thats just not something that a registry or getting access to info at 18 will solve. It has nothing to do with being well adjusted or happy it just has to do with the fact that there are good reasons why the original birth certificate needs to name the actual maternal and paternal parents. I don’t think that can be argued successfully. Not intelligently anyway.