Donor Sperm: Why the high cost and low supply? - by Haimant Bissessar (Fall 2010)

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DONOR SPERM
 
Why the high cost and low supply?

by Haimant Bissessar, BSc
Fall 2010

To most of us, the image of a sperm donor is one we often see on television. A young man visits a sperm bank, is given a container in a brown paper bag, goes into a private room and comes out a few minutes later with a semen sample. So, why does it cost between $500.00 and $700.00 for an insemination dose (1/10 of a teaspoon) of about 10 million motile sperm cells when it takes only a few minutes to produce the sample? The answer lies in the business cost to operate a sperm bank. It includes expenses incurred to meet federal regulations, to advertise, recruit, and screen  prospective donors; analyze, process, freeze and store the samples and costs to ship them to the physician’s office or fertility clinic.

Federal Regulations

It is permitted in Canada for a sperm bank to sell sperm to a patient, but to purchase or advertise to purchase sperm from a donor could get you 10 years in jail or a $500,000.00 fine. This criminal provision was written into the Assisted Human Reproduction Act (AHR Act)1 which became law in 2004. The Act allows for the donor to be reimbursed for receipted, out of pocket expenses incurred in the process of providing the donation. This legislated altruistic view of sperm donation and the stringent Health Canada semen regulations had the unfortunate consequence of putting many sperm banks out of business and thus reducing the supply of sperm from Canadian donors. The AHR Act, however, allows for foreign sperm to be imported even though the donor is paid. Approximately 80% of all sperm available for distribution in Canada is imported from the US and Denmark where the sperm donor is paid on average $100.00 for each donation. Women can rest assured that imported donor sperm is safe to use. All donors must conform to Health Canada Processing and Distribution for Assisted Conception Regulations.2 These rigorous regulations outline in detail the eligibility and testing requirements that must be met.   

Advertising

Sperm banks advertise for donors by placing advertisements in university and college newspapers and on social networking internet sites. These advertising costs represent a significant expense in the operations of the sperm bank. Research carried out in the UK showed that men are more willing to consider becoming sperm donors if the print material used in the advertising campaign is professionally prepared. 3 Radio, internet or television advertising must also be of high quality and appeal to the target audience, which are men less than 40 years of age. In the UK, the advertisements for donors are more racy and provocative. The National Gamete Donation Trust (NGDT),4 a national government-funded charity, ran campaigns using sexy women in tight t-shirts with slogans such as and “Give a toss – Britons we want your sperm”.5  Other campaigns targeted sports players and fans with the question “Sperm donation – have you got the balls”; “Strong swimmers wanted” and another with the slogan “Whatever your shape and size, couples need your help”. These recruitment strategies have not been very successful in recruiting sperm donors. According to a study commissioned by the Assisted Human Reproduction Implementation Office (AHRIO) and undertaken by the London Health Sciences Fertility Centre, the most effective strategy to recruit altruistic Canadian sperm donors is donor to donor word of mouth and  advertising in local newspapers.6  

Advertising costs, however, can be significant. To place a single two-line text advertisement for sperm donors in a local newspaper daily would set back a Canadian sperm bank approximately $1,700.00/month or $20,400.00/year.7 Advertisements in multiple newspaper publications and magazines can be quite costly and cannot be justified if eligible sperm donors cannot be recruited.

Recruiting and Screening
 
To properly screen the prospective donors who respond to the advertisements and get them to the commitment stage requires a dedicated full-time donor recruitment coordinator and a team of staff without other conflicting duties. This was the conclusion from studies on strategies for recruiting altruistic donors. 8,9,10 This dedicated team would include a physician to medically assess the donor, to requisition infectious disease testing and to review the donor application and accept the donor into the program. A social worker or psychologist to provide counselling and a laboratory technologist to analyze, freeze and thaw the semen samples would also be part of this multi-disciplinary team.

A pilot study on Altruistic Semen Donation recruitment using these strategies was conducted at ReproMed, a Toronto-based sperm bank.  The results showed that of the 301 who contacted the facility in response to two Sperm Donors Wanted advertisements, only three donors were accepted over a 10-month period and only one was willing to donate without receiving payment.11, 12  This low recruitment rate is consistent with the findings of a UK study that was only able to recruit three donors over a 2-year period.13

So, how much does it cost to recruit an altruistic sperm donor in Canada? Since there are no published studies, a cursory analysis was performed with the numbers from the ReproMed study and certain assumptions made. The study advertised for sperm donors in two publications over a 10-month period and employed a full-time donor coordinator to survey the respondents. Three hundred and one (301) men participated in Phase 1 of the study where they were surveyed by telephone or internet, and forty-nine (49) in Phase 2 which involved donor screening and acceptance or exclusion. Of these 49 men, 12 were tested for infectious diseases and three were accepted for a recruitment rate of 1%.

With local newspaper advertising costing approximately $1,700.00/month, the cost to place advertisements in two publications over a ten-month period would be $34,000.00. It is not unreasonable to assume that the salary for a full-time donor coordinator would be at least $55,000. Cost of performing three semen analyses, freezing, thawing and infectious disease testing, as required under the Health Canada semen regulations, for 12 men in Phase 2 of the study would be  $13,500.14 Providing counselling services at a rate of $150.00/hour each would total  $1,800.00.15  Therefore, by this simple analysis, the total costs to recruit one donor, not including business costs  (equipment, computers, software, insurance, rent, hydro, etc.) as well as physician’s and support services is  $37,767.67, and to recruit one altruistic donor is $104,300.00. (Table 1). At this recruitment rate, it would take 187 years and $19,504,100.00 to replace the 187 donors currently (at time of writing) 16, 17, 18 available for distribution in Canada.

In a similar UK study, the advertising cost alone, including extra staff time but not the cost of counselling and semen assessments, was >£30,000 or the equivalent of CAN $47,500. Three donors were recruited over a two-year period.19

TABLE 1

The donor acceptance rate for the US suppliers of donor sperm to the Canadian market, Fairfax Cryobank19 and Xytex Corporation,20 is also  <1%. This low recruitment rate is partially due to the mandatory requirements of Health Canada semen regulations, but more so is the result of the self-imposed stringent screening and testing requirements of these sperm banks. Men who apply to become donors at these banks are rejected if they do not meet minimum height and education requirements. These sperm banks also test for genetic diseases such as Cystic Fibrosis, Spinal Muscular Atrophy and Tay Sachs and infectious diseases such as Human Papilloma and Herpes simplex virus that are not required under the Health Canada semen regulations.

Even with the costs for these additional tests and the low recruitment rate, the cost to recruit a donor at these sperm banks is between US$5,000.00 and US$10,000.00. These US sperm banks are able to accept more donors per year as more men apply to become donors when a nominal payment is offered. So with this huge recruitment cost, how are sperm banks able to stay in business? The surviving sperm banks are able to utilize economies of scale in donor recruitment and many have been transformed into multinational corporations, distributing sperm samples across the globe. They have also incorporated other services such as in-vitro fertilization (IVF), gamete and cord-blood storage into their business model.

In conclusion, despite the use of  professionally-prepared information, advertising in local newspapers and magazines and employing dedicated staff, the recruitment rate for sperm donors is still less than 1%. With the astronomical cost to recruit altruistic donors in Canada, and the increased patient demands for donor genetic testing, the future survival of Canadian sperm banks is in doubt. The current price of $500 - $700 that patients pay for a sample of donor sperm will continue to increase as the dwindling supply will be unable to meet the increase in demand.

About the author
Haimant Bissessar obtained his Bachelor of Science Degree in Biology from McMaster University in 1985. He has worked in the Assisted Reproductive Technology field for 25 years and is currently employed at ONE Fertility in Burlington Ontario. He is also the Vice President of CAN-AM Cryoservices Corp. a full-service cryobank and exclusive Canadian distributor of Fairfax Cryobank and Cryogenic Laboratories Inc. donor sperm.

References
1  Government of Canada (2004) Assisted Human Reproduction Act. An Act respecting Human Reproduction and Related Research. Ottawa, 29 March 2004.2 Health Canada 2000 Health Canada Directive: Technical Requirements for Therapeutic Insemination. See http://hc-sc.gc.ca/dhp-mps/brgtherap/applic-demande/guides/semen-sperme-acces/semen-sperme_directive_e.html [15 May 2010, date last accessed].
3, 13, 19   McLaughlin EA, Day J, Harrison S et. al. (1998) Recruitment of gamete donors and payment of expenses. Human Reproduction 13, 1130-1132.
4   National Gamete Donation Trust http://www.ngdt.co.uk [15 May 2010, date last accessed]
5   Give a toss web campaign http://www.giveatoss.com [15 May 2010, date last accessed]
6, 10   Feyles V, Daniels K, Haase J et al. (2004) Altruistic Gamete Donation Phase I: Research commissioned by the Health Policy and Communication Branch, AHR Implementation Office of Health Canada and undertaken by the Reproductive Endocrinology and Infertility (REI) Program London Health Sciences Centre (LHSC), London, Ontario.
7   The Hamilton Spectator advertising department.  http://www.thespec.ca
8, 12   Del Valle A, Bradley L, Said T (2008) Anonymous semen donor recruitment without reimbursement in Canada. Reproductive BioMedicine Online Vol. 17 Suppl. 1. 2008 15-20.
9   Yee S (2009) ‘Gift without a price tag’: altruism in anonymous semen donation. Human Reproduction, 24, No.1  3–13.
11   Bradley L, Silva J et al.(2005) Altruistic Semen Donation in Canada: A Pilot Study. CFAS/ASRM Poster. Montreal.
14,16  ReproMed http://www.repromed.ca [15 May 2010, date last accessed]
15  Sherry Dale & Associates  http://www.sherrydale.ca/index.html [15 May 2010, date last accessed]
17   CAN-AM Cryoservices http://www.canamcryo.com [15 May 2010, date last accessed]
18   Outreach Health Services http://www.creatingcanadianfamilies.ca [15 May 2010, date last accessed]
19  Fairfax Cryobank  http://www.fairfaxcryobank.com [15 May 2010, date last accessed]
20  Xytex Cryo International Sperm Bank http://www.xytex.com [15 May 2010, date last accessed]