The practice of sperm sharing-whereby a man must make a minimum of 10 sperm donations in exchange for a reduction in the cost of his partner's fertility treatment-should be subject to the same regulatory oversight as egg sharing, argues a mental health doctor in the Journal of Medical Ethics.
Egg collection is much more invasive than sperm production, possibly fuelling the misguided belief that the stakes are lower, but this is far from the truth, suggests Dr Nathan Hodson of the University of Warwick.
It has a higher risk of emotional and social complications than egg sharing because of the number of donations a would-be sharer has to make, he says.
UK fertility clinics have been offering women discounted treatment in return for sharing their eggs for treatment or research since the 1990s. More recently, some clinics have started offering the option of sperm sharing to men in return for discounted fertility treatment for their partners.
But the practice has emerged without debate about the pros and cons of similar, plausibly better, approaches-in sharp contrast to the extensive discussions around egg sharing and 'egg giving', says Dr Hodson.
In egg giving, the eggs from the first cycle are 'donated' while the eggs from the second can be used by the 'giver' for her own subsidized fertility treatment.
Sperm sharing has an upper age limit, usually 40, and would-be sharers must also undergo testing for genetic conditions and infections. They are ineligible if they have genetic or serious medical histories, and men who have been adopted may also be excluded.
There are several ways in which sperm sharing differs from egg sharing, says Dr Hodson.
Sperm sharers must agree to contribute to 10 families and undergo a quarantine period after which further tests are carried out on the sperm sharer before their benefits-in-kind can be realized.
Hundreds of women 'share' their eggs in the UK every year, but only with one other family. The UK regulator, the HFEA, counts how many cycles of IVF use eggs obtained through egg sharing. Yet it doesn't count how many cycles of IVF involve sperm sharing, points out Dr Hodson.
There may be occasions when egg sharers don't have a live birth but the recipient does, which can be distressing. This outcome is much more likely for sperm sharing, given the number of donations made, he argues.
The number of fertility cycles for women seeking IVF is usually no more than 3, but in sperm sharing the number of recipient cycles can be much higher. Clinics require authorization to use a sharer's sperm to create 10 families, each of which may involve several treatment cycles and multiple children.
Compared with egg sharing, sperm sharing leads to a higher number of donor-conceived births, which can be a source of distress for those involved.
Unlike egg donation, sperm donation doesn't involve hormone treatment or surgery. But the fact that a man is producing sperm for his own partner's IVF doesn't make it safer for him to produce 10 further sperm donations, says Dr Hodson.
While egg sharing reduces the total physical health risks involved, sperm sharing doesn't, and arguably has even higher social and emotional risks for the sharer and donor-conceived people, he adds.
Demand for sperm donations outstrips supply in the UK, but other arrangements need to be considered, says Dr Hodson, who outlines several options.
One option would be to enforce a strict policy of altruistic sperm donation and limit the number of sperm donor recipients. Another would be to scrap altruistic donation entirely by introducing paid donations.
A third option would be a compromise between sperm vending and sperm sharing: exchanging sperm donations for vouchers for private medical treatment other than for fertility treatment, he suggests.
A fourth option would be to exchange sperm for fertility treatment for someone else, such as a friend or relative, but not a partner. Anecdotally, similar arrangements already exist in egg sharing, notes Dr Hodson.
Given its morally relevant differences from egg sharing, sperm sharing requires its own ethical analysis. The HFEA should begin recording sperm sharing arrangements in order to enable meaningful ethical and policy scrutiny."
Dr Nathan Hodson, University of Warwick
Hodson, N., (2022) Differences between sperm sharing and egg sharing are morally relevant. Journal of Medical Ethics. doi.org/10.1136/medethics-2021-107887.