The motivation for sperm donation is multifaceted and primarily based on economic compensation and altruism. Most Danish donors would stop their donations if economic compensation or anonymity were abolished.

In 2012, the most frequently stated factor was altruism, motivating 90% of the sperm donors, which was not significantly different from the previous surveys. If economic compensations were removed, only 14% would continue to donate. The proportion of anonymous donors who would stop their donations if anonymity was abolished was 51%, 56%, and 67% in 1992, 2002, and 2012, respectively. A significantly increasing proportion of donors felt positive about donation to lesbian couples.

All donors who donated sperm in the study period were asked to participate. The results were compared with those of previous surveys from the same sperm bank.

To study the motivation and attitudes toward donor anonymity, economic compensation, and insemination of lesbian and single women among Danish sperm donors in 2012 compared with the two preceding decades.

You can discuss this article with its authors and with other ASRM members at http://fertstertforum.com/bayb-sperm-donors-attitudes-demography/

The demographic composition, motivation, and attitudes of sperm donors are of great importance not only for patients and lawmakers but also for clinicians and researchers. Especially issues concerning donor anonymity, economical compensation, number of offspring per donor, and insemination of lesbian and single women are continuously raising debate, and legislation varies greatly between countries. The United Kingdom, Norway, Sweden, Finland, The Netherlands, Germany, Switzerland, Austria, Australia, and New Zealand are countries where only identifiable donors are allowed (). In general, The United States is considered to be a liberal country, allowing the use of sperm from both anonymous and nonanonymous donors and insemination of lesbian and single women (). Similarly, in 2007 it was made legal for doctors in Denmark to inseminate lesbian and single women with donor sperm (), and in the autumn of 2012 a revision of the Danish law on fertility treatments allowed the use of both anonymous and nonanonymous donation (), making Denmark one of the least restrictive nations regarding sperm donations. Regarding economic compensation, Canada has prohibited any type of donor compensation apart from actual expenditures (). In general, such legislation may have an impact on the number of available donors and consequently on the availability of treatments for women or couples seeking insemination with donor sperm.

Danish Ministry of Health. Lov nr 602 af 18/06/2012 om ændring af lov om kunstig befrugtning i forbindelse med lægelig behandling, diagnostik og forskning m.v., børneloven og lov om adoption [Law no. 602 of 18/06/2012 about change in law concerning medical fertility treatments etc., diagnoses and research, childrens law, and law concerning adoption].

We aimed to investigate the motivation and attitudes toward these issues among active Danish sperm donors in a large sperm bank. We also aimed to describe the development in motivations and attitudes toward donation over time by repeating a survey conducted at the same sperm bank in 1992 and 2002 (). This is the first study to investigate the demographic composition, motivations, and attitudes regarding sperm donation among sperm donors over a period of three decades.

Surveys do not require approval from an Ethical Committee in Denmark. The study was reported to and approved by the Danish Data Protection Agency (file no. 2012-41-0241).

At the end of the inclusion period, all answered questionnaires were typed into Epidata software () and exported to Stata 12 () for statistical analyses. All answers are reported with means and standard deviations for continuous variables and with absolute numbers and percentages for categoric variables. When comparing the results with the two previous surveys, we used one-way analysis of variance for continuous variables and Fisher exact test for categoric variables. P values

Compared with the previous surveys, supplemental questions were added to make the survey contemporary and to put further focus on certain aspects of donation. Except for two questions, all questions were given with options. The questionnaire was anonymous and contained 30 questions in five domains: basic information, motivations for donation, attitudes and feelings about the children, attitudes toward donations to single or lesbian women, and psychologic factors related to donation. Information on the participating donors' demographic backgrounds was retrieved from the sperm bank's internal registry.

The donor questionnaire was partly based on previous surveys conducted at the same sperm bank in 1992 and 2002, which investigated the motivations and attitudes among donors active at that time (). In 1992 (n = 41), all donors were included in the study whereas in 2002 both active approved donors (n = 62) and donor candidates (not yet approved as a donor; n = 31) were included in the repeated survey. Because the supply of donors was high, the sperm bank did not have a need for new donors in 2012, and only approved donors were included. Therefore, when comparing the motivation and attitudes of donors we included only approved donors from 2002 and 2012, although a small proportion of the donors from 1992 may have answered the questionnaire before approval, because there was no distinction between these donor types in the 1992 survey.

At each department, all donors who came for donation from April 1 to December 31, 2012 (9 months) were asked to participate in the survey. They could fill in the questionnaire on site or at home. Reminders were sent to donors who did not fill in the questionnaire on site or failed to return it from home within 2 weeks.

At the start of donation, the donors choose to be either anonymous, where the identity is forever confidential, or nonanonymous, where a child can have the identity of the donor revealed when he or she is 18 years old. At Cryos International–Denmark, the possibility of being nonanonymous is primarily restricted to donors >25 years old unless a doctor approves the choice of nonanonymity. In addition, the donor chooses to have either a basic profile (ethnicity, hair and eye color, height and stoutness) or an extended donor profile (basic information as well as additional information such as personal traits, interests, etc.). The donors are compensated with an amount of money for their inconvenience and expenses depending on quality and volume as well as type of donor. This amount can be up to a maximum of 65 Euros per donation according to a limit set by the Danish authorities.

This survey was conducted at the sperm bank Cryos International–Denmark, which has four departments in Denmark (Copenhagen, Aarhus, Aalborg, and Odense). The sperm bank is the largest in the world with supply to more than 70 countries worldwide and a selection of sperm from ∼500 donors, of whom ∼100 actively donate on a regular basis.

As in the previous surveys, the donations did not affect the sexual life for a large majority of the donors in 2012 (78%). To the question of whether the donor ever or sometimes regretted he was a donor, most of the donors answered “never” (91% in 2012, 94% in 2002, 66% in 1992; P=.002), only a few donors answered “sometimes” (7% in 2012, 2% in 2002, 12% in 1992; P=.066), and no one answered “often.” The degree of openness about being a donor had not changed over the years (P=.811); 27% of the donors in 2012 were completely open about it, 52% shared the information with only a selected group, and 22% did not discuss the matter with anyone.

Similarly, there was a significant change in the attitude toward donations to single women compared with the survey in 2002 (not included in the 1992 survey). In 2012, there was a substantially higher proportion of the donors with positive feelings about donations to single women (72% vs. 40% in 2002) and a lower proportion being against it (6% vs. 22% in 2002).

The attitude toward donation to lesbian couples had changed significantly over time. In the current survey a large majority were positive (76%) and only a few against it (5%; Table 4 ). There was a significant time trend across the three surveys in 1992, 2002, and 2012 regarding these differences (P=.025).

The donors were asked what—in their opinion—the acceptable number of children per donor was ( Supplemental Table 1 , available online at www.fertstert.org ). They could either write a number or choose between “does not matter” or “uncertain”. The answer from 20 donors was a number of children from 4 to infinity. A number of children >100 were subsequently categorized as “does not matter” and 7 donors were recoded to this category. Thus, 13 donors answered with a number of children ranging from 4 to 100 (mean 22, median 15), 69 donors (71%) answered that the number did not matter, and 15 (15%) were uncertain. However, as in the survey from 2002, only 46% of the donors in 2012 were certain that they would like to know whether their donations resulted in pregnancies, but among these donors 31% would like to have no specific information about the children (looks, personality, development, etc.). Overall, the majority of the donors in 2012 indicated that they would like to have no specific information about the children (57%). There were no significant differences among the surveys in 1992, 2002, and 2012 regarding the amount or content of information the donors would like to know about the children. However, most donors answered that thoughts about the offspring resulting from their donations make them happy and that they do not worry about the childhood and development of the donor children.

In 2012, a significantly higher proportion of the donors would allow disclosure of all nonidentifying information about their person to the recipients (e.g., age, occupation, height, etc.; P=.003; Table 3 ). However, there were no significant differences in the reactions to an abolishment of anonymity. After exclusion of the nonanonymous donors in 2012, the proportion of anonymous donors who would stop their donations if anonymity were abolished was 51%, 56%, and 67% in 1992, 2002, and 2012, respectively. Significantly more anonymous donors in 2012 answered that they would like to know the number of children (P=.012) and that they would accept that the children knew their identity if anonymity was abolished (P=.002). In contrast, there were no differences in the proportion of anonymous donors who would accept that the children contact them (22%, 15%, and 18% in 1992, 2002, and 2012, respectively).

In 2002 three donors answered yes but not in which direction; they were classified as uncertain. The question was not a part of the 1992 survey.

c In 2002 three donors answered yes but not in which direction; they were classified as uncertain. The question was not a part of the 1992 survey.

P value for no difference between all three groups if not otherwise specified.

a P value for no difference between all three groups if not otherwise specified.

Only anonymous donors (n = 68), because all donors in 1992 and 2002 were anonymous. Twenty donors did not answer.

b Only anonymous donors (n = 68), because all donors in 1992 and 2002 were anonymous. Twenty donors did not answer.

Payment of the donors was a major motivation for donation ( Table 2 ), although significantly fewer 2012 donors stated this as a motivational factor compared with donors in 1992 and 2002 (P

Forty donors (41%) stated that they had no partner at the start of donation. Two donors did not answer the question.

c Forty donors (41%) stated that they had no partner at the start of donation. Two donors did not answer the question.

P value for no difference between all three groups if not otherwise specified.

a P value for no difference between all three groups if not otherwise specified.

In 2012, donors were 70% anonymous and 30% nonanonymous. The age of the nonanonymous donors (32.7 ± 7.6 y) was significantly higher than that of the anonymous donors (27.5 ± 5.2 y; P<.001). There were no differences in the proportion of donors with a partner or children or in the occupation status between anonymous and nonanonymous donors. In 2012 a total of 34% of the donors had chosen to have a basic profile and 66% an extended profile. There were no associations between type of profile and age, partner status, children, or occupational status. The mean number of donations was 77 ± 63 in 2012. The average compensation for a donation was 33 Euros (±12), based on information from an internal registry at the sperm bank. The proportion of donors that also performed blood donations was 46%.

Demographic characteristics of the donor population are presented in Table 1 . In 2012, the mean age of the donors was 29.1 years (± 6.5). This was 1.2 years higher than in 2002 (95% confidence interval [CI] 0.1–2.5 y; P=.08) and 4.9 years higher than in 1992 (95% CI 3.6–6.2 y; P

P value for no difference between all three groups if not otherwise specified.

a P value for no difference between all three groups if not otherwise specified.

A total of 105 active donors who came for donations during the inclusion period were asked to participate, and 97 completed the questionnaire (response rate 92%). No donors had been active long enough to have participated in either of the previous surveys from 1992 and 2002.

Discussion

This survey investigated the motivation and attitudes toward donation among active Danish sperm donors in 2012 and compared the answers with those of previously conducted surveys in the same setting in 1992 and 2002. Although the views on several aspects of sperm donation had not changed over the past decades, we observed a significantly increased age of the donors and a change in occupational status. Furthermore, there were more liberal attitudes toward disclosure of nonidentifying information about their persons and toward donation to lesbian and single women.

9 van den broeck U.

Vandermeeren M.

Vanderschueren D.

Enzlin P.

Demyttenaere K.

d'Hooghe T. A systematic review of sperm donors: Demographic characteristics, attitudes, motives and experiences of the process of sperm donation. 10 Lalos A.

Daniels K.

Gottlieb C.

Lalos O. Recruitment and motivation of semen providers in Sweden. 11 Ekerhovd E.

Faurskov A.

Werner C. Swedish sperm donors are driven by altruism, but shortage of sperm donors leads to reproductive travelling. Besides being the first study to investigate changes in motivation and attitudes toward aspects of sperm donation over three decades, this is one of the largest surveys conducted among active donors (). Furthermore, the response rate was very high (92%), which has been the case in other sperm donor surveys as well (). Although the questionnaires were anonymous, the high response rate was most likely due to the fact that the donors are very familiar with both the setting and the sperm bank staff asking them to participate. This ensures a high representativeness of the target population; nevertheless, several attitudes may reflect the fact that active sperm donors indeed are a highly selected group. To qualify as a donor, the candidate has to have good sperm quality, a normal medical examination, and a normal family history and screening for a selection of infectious and genetic diseases. However, being a private business, the sperm bank performs an additional selection regarding the donor candidates' wishes to be anonymous/nonanonymous and basic/extended based on supply and demand in the market. Because nonanonymous donors tend to be older, this may affect their attitudes toward aspects of donation. Furthermore, the increasingly positive feelings toward donation to lesbian and single women may be partly explained by a presumed tendency to enroll as a donor in Denmark only if one concurs with the legislation that allows insemination of these women. This legislation was imposed in 2007, but since we found a significant trend across all three surveys in 1992, 2002, and 2012, we think that the positive attitudes also originate in an increasing open-mindedness and tolerance among the donors. This is consistent with results from a Swedish study conducted before lesbian women were allowed insemination with donor sperm in 2005. The study showed that a total of 93% of the donors would donate sperm to single women and 87% would donate to lesbians ().

The donors in 2012 were older and had a significantly different occupational profile compared with the previous surveys. This might have caused changes in both motivations and attitudes, because young students may have stronger economic motivations than older working men with a steady income. Thus, compared with the previous surveys we expectedly found that significantly fewer donors in 2012 stated that the economic compensation was a motivating factor (71%). However, although most 2012 donors stated that altruism was a motivation for donation (90%), the proportion of donors that would continue if compensations were abolished (17%) was not significantly different from the surveys in 1992 and 2002. The average compensation per donation was 33 Euros, which was not statistically significant from the average amount the donors considered to be the least acceptable (38 Euros). It is conceivable that although a major motivating factor for donation is altruism, there is a threshold for the will to donate at compensational levels around 30–40 Euros. However, the average compensation and least acceptable amount were significantly associated (Pearson correlation coefficient r = 0.23; P=.027). It may be that the donors deliberately answered a least acceptable amount close to what they are usually compensated or higher to justify their own compensational level or to avoid a potential reduction in their current compensation.

12 Bloddonorene. Donorundersøgelsen 2010. En spørgeskemaundersøgelse blandt bloddonorer i Danmark [Donor investigation 2010. A survey among blood donors in Denmark]. Bloddonor.dk, 2010. 6 Ernst E.

Ingerslev H.J.

Schou O.

Stoltenberg M. Attitudes among sperm donors in 1992 and 2002: a Danish questionnaire survey. 9 van den broeck U.

Vandermeeren M.

Vanderschueren D.

Enzlin P.

Demyttenaere K.

d'Hooghe T. A systematic review of sperm donors: Demographic characteristics, attitudes, motives and experiences of the process of sperm donation. 13 Daniels K.R. Semen donors in New Zealand: their characteristics and attitudes. 14 Handelsman D.J.

Dunn S.M.

Conway A.J.

Boylan L.M.

Jansen R.P. Psychological and attitudinal profiles in donors for artificial insemination. 15 Riggs D.W.

Russell L. Characteristics of men willing to act as sperm donors in the context of identity-release legislation. Although ∼10% of the Danish population aged 20–45 years are blood donors (), we found that 46% of the active sperm donors in the 2012 survey also acted as blood donors. Blood donation in Denmark is not economically compensated, and the high proportion of blood donors among sperm donors shows that these men have a strong desire to help other people. Like several earlier studies, we therefore conclude that the motivations for sperm donation are multifaceted ().

6 Ernst E.

Ingerslev H.J.

Schou O.

Stoltenberg M. Attitudes among sperm donors in 1992 and 2002: a Danish questionnaire survey. 16 Frith L.

Blyth E.

Farrand A. UK gamete donors' reflections on the removal of anonymity: implications for recruitment. 17 Lui S.C.

Weaver S.M. Attitudes and motives of semen donors and nondonors. 18 Mahlstedt P.P.

Probasco K.A. Sperm donors: their attitudes toward providing medical and psychosocial information for recipient couples and donor offspring. 19 Pedersen B.

Nielsen A.F.

Lauritsen J.G. Psychosocial aspects of donor insemination. Sperm donors—their motivations and attitudes to artificial insemination. 13 Daniels K.R. Semen donors in New Zealand: their characteristics and attitudes. 18 Mahlstedt P.P.

Probasco K.A. Sperm donors: their attitudes toward providing medical and psychosocial information for recipient couples and donor offspring. 19 Pedersen B.

Nielsen A.F.

Lauritsen J.G. Psychosocial aspects of donor insemination. Sperm donors—their motivations and attitudes to artificial insemination. 20 Thorn P.

Katzorke T.

Daniels K. Semen donors in Germany: a study exploring motivations and attitudes. In the surveys from 1992 and 2002 all donors had to be anonymous owing to the legislations at that time. In 2012, all donors chose to be either anonymous or nonanonymous at the beginning of their engagement at the sperm bank. To ensure the highest degree of comparability we included only anonymous donors in the assessment of attitudes toward anonymity (70% of the donors). However, although these donors had specifically chosen specifically to be anonymous and already had opted out of the possibility of being nonanonymous, there was no significant difference in the reaction to an abolishment of anonymity between the surveys. In 2012, only 17% of the anonymous donors would continue to donate if anonymity was abolished, which is lower than reported in earlier studies, where this number varies from 20% to 50% (). However, this proportion is most likely a reflection of the fact that the donors in the 2012 survey have had the possibility to choose between anonymous and nonanonymous donation before being approved as a donor. But as reported by others, most donors were willing to share further nonidentifying information ().