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ORIGINAL ARTICLE
Ahead of print publication  

Sperm donors in Shanghai, China: A study of motivations, characteristics, and semen parameters of actual sperm donors


1 Department of Human Sperm Bank and President Office, Obstetrics & Gynecology Hospital of Fudan University, Shanghai 200000, China
2 Department of Andrology, Shanghai JIAI Genetics & IVF institute-China USA Center, Shanghai 200011, China

Date of Submission02-Feb-2021
Date of Decision08-Mar-2021
Date of Acceptance13-Sep-2021
Date of Web Publication09-Oct-2021

Correspondence Address:
Feng Jiang,
Department of Andrology, Shanghai JIAI Genetics & IVF institute, China USA Center, Shanghai 200011
China
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2096-2924.327879

  Abstract 


Objective: To identify the sociodemographic characteristics, motivations, and semen parameters of sperm donors in Shanghai, China.
Methods: The participants were sperm donors associated with the Human Sperm Bank of Fudan University in Shanghai, China. Among the 334 sperm donors that applied for participation, 329 completed the survey process. The responses obtained in the questionnaire and face-to-face interviews were used to investigate the donor motivations and characteristics, and the semen quality was examined to identify the sperm parameter.
Results: In terms of the sociodemographic characteristics, an altruistic donor in this study was aged between 26 and 30 years, was single, did not have a child, had a college or undergraduate education level, was of the Han ethnicity, and worked full time. The strongest motivation highlighted by sperm donors was a donation for altruistic (26.4%, n = 87) reasons. The second-highest rated motivation was curiosity (20.7%, n = 68), followed by a desire to procreate (17.9%, n = 59). “Complimentary body checks” (14.3%, n = 47) and “financial incentives” (14.7%, n = 47) were regarded as less important. The average semen parameters of the 329 donors were as follows: the semen volume was 3.39 ± 1.21 mL, the semen concentration was 82.75 × 106/mL, the progressive motility rate (PR%) was 63.77% ± 3.13%, the total motility rate was 66.26%, the total progressive motile count was 158.31% ± 54.43 × 106/mL, and the round cell concentration was 0.38 ± 0.51 × 106/mL. The PR% of the procreation motivation group was significantly higher than that of the other motivation groups (P < 0.05).
Conclusions: Sperm donors in Shanghai, China, are altruistic about their donation, although curiosity is also a key motivator. In addition, the decisions of donors are culturally influenced, and the motivation to procreate may influence the PR%.

Keywords: Assisted Reproductive Technology; Donation; Semen Parameters; Sperm Donors



How to cite this URL:
Wang X, Chen MX, Zhang F, Liang GQ, Zhu H, Feng BL, Tao ZW, Jiang F. Sperm donors in Shanghai, China: A study of motivations, characteristics, and semen parameters of actual sperm donors. Reprod Dev Med [Epub ahead of print] [cited 2021 Dec 8]. Available from: https://www.repdevmed.org/preprintarticle.asp?id=327879




  Introduction Top


Human sperm banks collect, freeze, and store donor sperm to provide couples who cannot conceive due to male infertility with the chance to become parents. With the increased demand for donor insemination (DI) and in vitro fertilization (IVF), a shortage of donated sperm is being commonly observed in different sperm banks across various countries.[1],[2] According to a Chinese National Health Commission report on the development of maternal and child health in China (2019), in recent years, the total number of human-assisted reproductive technology (ART) cycles per year has reached more than 1 million, and the number of babies delivered is more than 300,000.[3] Currently, China has 497 medical institutions approved to perform human-assisted reproductive technology and 26 medical institutions approved to establish human sperm banks. However, only four of these institutes have reported a storage amount of 10,000 tubes of semen samples per year, while most of the remaining institutes acquired only 5,000–6,000 tubes per year.[4] The shortage of donated sperm increases the gap between supply and demand and extends the waiting time for couples who wish to use donor sperm to conceive. Moreover, owing to the COVID-19 pandemic, many men have refrained from visiting sperm banks.

In this context, examining the motivations, characteristics, and semen parameters of actual sperm donors in Shanghai, China, is necessary and significant for several reasons. First, a donor's motivations and characteristics may influence the donation attitudes, which are relevant to participation patterns and the progress of the donation process. Second, it is beneficial for DI and IVF studies to determine the donors' sperm parameters. Third, sperm banks and health supervision departments must examine the motivations of sperm donors to facilitate policy-making. Therefore, this study was aimed at clarifying the sociodemographic factors, motivations toward donation, and semen parameters of sperm donors in China associated with the Human Sperm Bank of Fudan University.


  Methods Top


Participants

Data were collected at the Human Sperm Bank of Fudan University from June 2019 to September 2020. All potential donors were recruited by online advertisements, official sperm bank websites, metro advertisements, and referrals from previous donors. Information related to the donation screening process was provided in the advertisements and on the websites, and people who had questions regarding the donation process were encouraged to reach out through phone and email. Potential donors were considered eligible for the screening process if they fit the Chinese sperm donation regulations published in 2003, according to which the donors must (i) be aged 22–45 years, (ii) be Chinese citizens, (iii) have an education level of college (or be currently enrolled) or equivalent or higher education, (iv) be currently healthy, and (v) not have donated in any other sperm bank in China previously. To complete the screening process, the individuals were required to visit the sperm bank in person. The donation process was conducted by certificated doctors, and information collection was subject to the donors signing the informed consent form.

Measures

Phase 1

Potential donors who registered with the Human Sperm Bank of Fudan University were surveyed in phase 1, which involved sociodemographic surveys and sperm quality examinations. The survey involved closed-end questions regarding the (i) age, (ii) education level, (iii) marital status, (iv) paternity status, (v) occupation, and (vi) ethnicity. The semen quality examination included parameters regarding the (i) semen volume (mL), (ii) semen concentration (×106/mL), (iii) progressive motility rate (PR%) (%), (iv) total motility rate (%), (v) total progressive motile count (×106/mL), and (vi) round cell concentration (×106/mL).

Phase 2

A mental health counselor interviewed the eligible donors regarding their donation motivations. The motivations were categorized as follows: curiosity, financial incentives, altruism, complimentary body checks, procreation, multiple reasons, and no reasons. “Curiosity” pertained to that of sperm banks or the donation processes. “Financial incentives” included terms such as “financial payments,” “need to pay bills,” and “lack of money.” “Altruism” included terms such as “helping others,” “helping infertile couples,” and “assisting others.” “Complimentary body checks” consisted of terms such as “free body checks,” “free semen screening,” and “free prepregnancy checkup.” “Procreation” corresponded to concepts such as “pass on my good genes” and “want another child.” “Multiple reasons” meant the donors were motivated by multiple factors, and “no reason” meant that the donors never thought of or were not clear of the reasons for donation. In total, 334 donors qualified for the donation process, 5 individuals quit because of personal reasons, and 329 donors completed the survey process.

Sperm analysis

The eligibility of donors to donate was assessed according to the sperm concentration and motility specified by the World Health Organization 1999, 4th edition guidelines (>60 × 106/mL sperm concentration, >60% motility). The sperm progressive motility rate (%), concentration (×106/mL), total motility (%), total progressive motile count (×106/mL), and round cell number (×106/mL) were measured through a computer-aided sperm analysis (CASA), that is, the CASA system and verified by an andrologist.

Statistical analyses

Data analysis was performed using SPSS 21 (IBM Corp., Armonk, NY, USA). Descriptive statistics were used to describe the sociodemographic variables. The Chi-square test was conducted to compare the sociodemographic response options regarding the motivations. The semen parameters were presented as mean ± standard deviation, while comparing between each motivation and procreation group's semen parameters using independent t-tests. P < 0.05 was considered statistically significant.

Ethical approval

Ethical approval for this study was obtained from the Obstetrics & Gynecology Hospital of Fudan University (EC 2018050702). All donors provided and signed informed consent before the initiation of the screening process.


  Results Top


Motivations

The sperm donors' motivation profile is presented in [Figure 1]. The strongest motivation highlighted by the sperm donors was altruism (26.4%, n = 87). The second-highest rated factor was curiosity regarding donation (20.7%, n = 68), followed by the desire to procreate (17.9%, n = 59). The “complimentary body checks” (14.3%, n = 47) and “financial incentives” (14.7%, n = 47) were regarded as less important. Only 4.8% of the donors (n = 16) stated multiple reasons, and less than 2% of sperm donors reported no reason (n = 5).
Figure 1: Count of donation motivation of sperm donors in Shanghai, China

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Sociodemographic factors and motivations

Age

Details of the sociodemographic characteristics are shown in [Table 1]. The 329 donors were aged between 22 and 45 years, and the mean age was 29.4 ± 5.5 years. When the individuals were grouped by age (22–25, 26–30, 31–35, 36–40, and 41–45 years), most of the donors (32.52%, n = 107) were noted to be between 26- and 30-year-old, and donors aged 41–45 constituted only 4.6% of the population. For the 329 donors who provided data regarding the motivations and age, significant age differences were noted across different motivations [P < 0.001, [Table 2]].
Table 1: Sociodemographic characteristic of sperm donors

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Table 2: Number and percentage values associated with various sociodemographic factors and motivations to donate

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Marital and paternity status

Most of the donors reported that they were single (68%, n = 224) and did not have any children (78.4%, n = 258). The primary and secondary motivational factors for donors who did not have a child were altruism (n = 72, 27.9%) and curiosity (n = 58, 22.5%). In contrast, donors who had children were likely driven by the complimentary body checks (n = 18, 25.4%) and desire to procreate (n = 18, 25.4%), followed by altruism (n = 18, 25.4%).

Moreover, the participants were grouped according to their marital status and their motivation to donate was examined. Both unmarried and married donors reported that they were motivated to help others (27.2% vs. 24.8%). In addition to this reason, single donors indicated that curiosity (n = 25, 22.5%) was their secondary reason to donate, whereas married donors indicated that the complimentary body checks (n = 24, 23.8%) and desire to procreate (n = 24, 23.8%) were their secondary reasons. When donors were grouped by their paternity or marriage status against their motivation to donate, the data indicated significant differences across different motivations [P < 0.05 or P < 0.001, respectively, [Table 2]].

Education

The donors were grouped into three categories according to their education level: 37.4% (n = 123) of the donors had a college-level education, 43.8% (n = 144) of the donors had an education beyond the undergraduate level, and 18.8% (n = 62) had an education beyond the graduate level. Donors of all education levels indicated that altruism (25.2% vs. 25.7% vs. 30.6%) was their primary reason to donate. No significant difference was found among different education levels and motivations [P > 0.05, [Table 2]].

Occupation status

The 329 donors were categorized into three groups: currently registered as students, full-time workers, and part-time workers. Most donors (n = 267, 81.2%) were working full time, only 3% of the donors were working part-time, and the remaining 15.8% of the donors were students. The students indicated that helping others (n = 13, 25.0%) and curiosity (n = 13, 25.0%) were their primary factors for donating. In addition, donors who were working full time stated that altruism, in terms of helping others (n = 72, 27.0%), was their primary factor to donate. However, the part-time working donors reported that they were mostly driven by curiosity (n = 3, 30.0%), followed by financial incentives, desire to procreate, and altruism (20% vs. 20% vs. 20%). No significant difference was found across different occupation statuses and motivations [P > 0.05, [Table 2]].

Ethnic

The number of donors with Han ethnicity (96.7%, n = 318) was more than that of the donors with minority ethnicities (3.3%, n = 11). For the Han donors, the primary motivations were altruism (n = 85, 26.7%). The 11 men with minority ethnicities reported that their primary motivations were the desire to procreate (n = 3, 27.3%) and financial incentives (n = 3, 27.3%). No significant difference was found among different ethnic groups in motivations [P > 0.05, [Table 2]].

Semen parameters

The statistical results showed that the average semen parameters of the 329 actual donors were as follows: the semen volume was 3.39 ± 1.21 mL, semen concentration was 82.75 × 106/mL, progressive motility rate was 63.77% ± 3.13%, total motility rate was 66.26%, total progressive motile count was 158.31% ± 54.43 × 106/mL, and round cell concentration was 0.38 ± 0.51 × 106/mL.

Semen parameters and motivations

When the group motivated by “procreation” was compared with those having other motivations (curiosity, altruism, financial incentives, complimentary body checks, multiple reasons, and no reason), no significant differences were noted in the sperm volume, concentration, total motility, total PR count, and round cell concentration in the semen (P > 0.05). However, the PR% of the group motivated by procreation was significantly higher than those for the groups motivated by curiosity, altruism, financial incentives, complimentary body checks, multiple reasons, and no reason (P < 0.05), [Table 3].
Table 3: Semen parameters of the group motivated by procreation compared to groups with other motivations (X̄ ± S)

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  Discussion Top


This study was aimed at providing novel insights regarding the sociodemographic characteristics, motivations, and sperm parameters of sperm donors in Shanghai, China. The three most popular factors motivating sperm donors in Shanghai are altruism, curiosity regarding sperm banks, and desire to procreate.

Sperm donors in Shanghai, China, are motivated by altruism, followed by curiosity

In our study, altruistic reasons were the primary motivation for sperm donation. In several countries, unlike blood donation, the primary incentive for donors to donate sperm is not always to help others. For instance, studies performed in the USA often highlight financial incentives driving donation,[5] whereas Sweden, Australia, and Canada report a high percentage of altruistic motivations.[6],[7] A survey on the willingness of Chinese college students to participate in sperm donation indicated that more than half the students recognized sperm donation as social public welfare behavior, and nearly 37% of the students stated that the aspect of helping others encouraged them to donate sperm.[8] The findings of this study also indicated that more than one-fourth of the donors were motivated by the desire to help others, and Chinese donors considered their sperm donation to be an altruistic act.

Curiosity, rarely seen as a motivation for sperm donation, was rated as the secondary motive by sperm donors in this study. Over one-fifth of the donors indicated that they were curious about sperm banks and donation processes. This finding is consistent with that of a previous survey, which reported that only 2.83% of Chinese undergraduate students were familiar with sperm donation processes;[9] expectedly, donors visited sperm banks to satisfy their curiosity in person. These donors were more likely to withdraw their donations once they experienced the screening process compared to those who wished to donate to help. To narrow the gap between sperm banks and individuals in terms of the basic knowledge of male reproductive health, human sperm banks in China must enhance public sperm donation awareness, popularize the knowledge related to male reproductive health, or help potential donors understand the basic sperm donation process to ensure that donation is considered more objectively, thereby decreasing the withdrawal rate.

The decisions of sperm donors are culturally influenced

Because cultural norms affect the sociodemographic characteristics and motivations of sperm donors in Shanghai, China, the following social characteristic results are of significance.

The desire to procreate was indicated as a common motivation in this study. Compared with other motivations, the decision to denote for procreation-related reasons may have been influenced by social elements in China. Usually, studies define procreation as a desire to pass one's genes; however, our results show that procreation incentivizes donors to fulfill more than one inclination. Through interviews with mental health counselors, we learned that the meaning of “I want to pass my genes” varies among donors, and procreation can be subcategorized into different aspects: the biological aspect of procreation (which means passing on one's genes and contributing to reproduction) and social-biological aspect of procreation (wanting to participate and assisting in raising a child).[10] Furthermore, several donors in this study indicated a new definition of procreation: the donors wanted to have more children, but they could not afford another child. Thus, sperm donation was the most efficient way for such individuals to engage in procreation without any personal effort in terms of child development.

In terms of sociodemographic characteristics, an altruistic donor in this study was aged between 26 and 30, single, did not have a child, had a college or undergraduate education level, was of the Han ethnicity, and worked full time. Previous studies regarding donor ages indicated that older donors were more inclined to donate for altruistic reasons.[11] Conversely, most of the 26- to 30-year-old donors in this study were motivated by altruism and curiosity, whereas older donors were more highly motivated by the free body checks and desire to procreate. In addition, in this study, a relatively high proportion of donors reported being single and having no children, which indicates that parenthood and marital status may alter the motivation to donate. An existing study reported[12] that marital status and parenthood often caused men to become altruistic donors. However, in our study, marriage and parenthood did not promote donation behavior. These results were in line with a multicenter study conducted in China in 2011, which indicated that in China, most (95.2%) donors were single and did not have a child.[13] The contradictory findings associated with Shanghai may imply that traditional family or ethical values may cause older and married donors and donors having children sperm donors to be hesitant regarding donations. For instance, Liu et al.[14] stated that traditional cognition and ethical concerns led to reduced sperm donation in China. Single and younger donors who are not at a childbearing age have fewer family and paternity considerations regarding donations. In contrast, individuals with partners or children may experience resistance to donation through family members. Notably, the age limit varies in different countries worldwide: the upper limit in the UK is 41 years.[15] Most sperm banks require donors to be aged between 18 and 39 years in the USA[16] and 21–40 years in Canada.[17] According to the Chinese sperm donation regulations, the current donor age limit is 22–45 years.[18] Owing to the characteristics of Chinese culture, limiting the age of donors by health supervision departments may encourage more men with altruistic intentions to donate and enhance the operation of sperm banks in China.

The desire to procreate may influence the PR%

In reviewing the motivations for sperm donors to donate, we noted that certain donors sought satisfaction from psychological rewards, including donation for altruism, curiosity, or procreation; certain donors sought satisfaction from physical rewards such as financial payments and free body checks; and other donors may have multiple reasons or no reasons. However, the “procreation” motivation is the only reason related to the reproductive desire among the reviewed motivations. Comparing the sperm parameters associated with the groups motivated by the desire to procreate to those of groups with other motivations, a unique and interesting phenomenon was noted: the PR% of the former group was significantly higher than that of the other groups. From the statistical results, it is difficult to prove that the desire to procreate directly influenced the sperm PR%; however, this finding may suggest that psychological components influence the male sperm quality. Donors motivated by procreation-related reasons may be influenced by biological and psychological reasons and their social interactions. Notably, the sympathetic and parasympathetic nerves play an important role in the sperm accumulation process in regulating the distributions of adrenergic, cholinergic, dopaminergic, and other neurotransmitter receptors.[19] Moreover, many neurotransmitter receptors, such as dopaminergic receptors, influence goal achievement and motivation behavior. This finding may explain why men who wish to contribute to reproduction may have a higher sperm quality. In additiony, men who desire to pass on their genes or have more children may demonstrate additional self-control and responsibility in their daily lives. This desire may cause such individuals to better manage their health, such as consuming a healthy diet, obtaining sufficient sleep, and engaging in regular exercises, which can help maintain sperm quality. Although a substantial number of studies have focused on male infertility, extremely few studies have attempted to explore the interplay between psychosocial and biological factors influencing sperm quality, and these aspects must be further researched.

Recruitment by compensation is a future research direction

In this study, the widely recognized controversial aspect of financial incentives was not the primary or even a secondary reason that motivated donors. Nevertheless, a survey in 2013 indicated that most Chinese college students considered donating for compensation.[20] Van de Broeck et al. indicated that motivations are correlated with local policies; for example, when a donation is commercially driven, compensation dominates the motivation, and when financial payments are limited or prohibited, similar to those in European countries, altruistic reasons outrank compensation.[21] Currently, the financial payment for sperm donors in Shanghai, China, is approximately 5,000 yuan (RMB) for 10 donations, and because donors must travel and miss work, altruistic reasons outrank the financial incentives. Regardless of whether donors are incentivized by compensation, certain concerns have been raised regarding the use of compensation to recruit donors. Certain studies have shown that financial payments may affect children's psychological development, making them feel similar to a tradable “good”[22] (Wilkinson). In contrast, other studies have indicated that financial payments may encourage donors to treat donations similar to jobs; in this framework, donations may become more efficient and the possibility of donors wishing to be associated with sperm recipients can be reduced.[23] This aspect must be further investigated considering the aspects of Chinese culture. Notably, in this study, most donors were motivated by other reasons, and financial compensation was only one incentive among various motivations.

In conclusion, the existing research regarding sperm donor motivations in China is limited. This study provides novel information regarding the sociodemographic characteristics and motivations of sperm donors in Shanghai, China. Recruitment of sperm donors is challenging for human sperm banks. Understanding the characteristics and motivations of donors can help human sperm banks develop efficient recruitment strategies to recruit altruistic donors or those that can commit to stable donation behavior. As the sperm donor population in China is exhibiting sustained growth, the psychological and physiological aspects of Chinese sperm donors must be further investigated.

Limitation

This study recruited participants from only one human sperm bank in Shanghai, China, and the results are thus unlikely to be representative of all sperm donors in China. However, Shanghai is an open and highly mobile city that attracts donors from all over the country. Therefore, this study obtained relevant and novel findings, especially regarding the donors' semen parameters and donation motivations in Shanghai, China.

Acknowledgments

The authors thank the Human Sperm Bank of Fudan University for the research partnership. Moreover, we extend our sincere thanks to the sperm donors in this study.

Financial support and sponsorship

This project was supported by the Shanghai Municipal Science and Technology Major Project (2017SHZDZX01).

Conflicts of interest

There are no conflicts of interest.



 
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