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zoom RSS 精子ドナーの不足/英国医療事情

<<   作成日時 : 2008/11/16 18:32   >>

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 不妊治療の専門家は英国の精子提供者不足により、治療待機が長期化していると報告している。
 英国では毎年少なくとも500人のドナーが約4,000人の女性に精子提供する必要がある。しかし、2006年のBMJ論文によればドナー登録は307人にすぎない。
 ドナー不足の原因の1つは2005年の法改正で、ドナーの匿名性を無くしたことにある。18才になれば、生物学的な父親を知る権利が発生する。
 ドナー不足で数年治療延期している人がいるという。多くの人がスペインやベルギーに行っていると思われる。スカンジナビアから精子が輸入されているという。
 別の解決策として、各ドナーに許される妊娠数を増やす方法があるが、近親交配による遺伝子病の危険があることから法律で10に制限している。しかしこの数に科学的な裏付けが無く、オランダでは25まで許されている。
 さらにもう一つの制限、ドナーは40才までについては、学会が制限緩和を拒否している。
 ドナーに対しては、旅費と、仕事できなかった時間分に対し15-30ドル、最大でも385ドルまでが払われるが、精子に対しての報酬は法律で禁止されている。これも増額するべきと言われている。
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Shortage of Sperm Donors in Britain Prompts Calls for Change
http://www.nytimes.com/2008/11/12/health/12sperm.html

By DENISE GRADY
Published: November 11, 2008

A shortage of sperm donors in Britain has led to long waits at clinics and even caused some clinics to stop offering donor sperm, fertility specialists are reporting, and they are calling for nationwide changes to increase the supply.

Each year, Britain needs at least 500 donors to provide sperm for approximately 4,000 women. But in 2006, only 307 donors registered, according to an editorial being published Wednesday in BMJ, formerly the British Medical Journal. The editorial was based on a report published by the British Fertility Society in September.

The donor shortage may be due in part to a change in the law in 2005, which took away donors’ anonymity. People conceived from donor sperm after the law took effect have the right, once they turn 18, to know the identity of their biological father.

“I’ve heard of people waiting years,” Dr. Allan Pacey, the secretary of the fertility society and a lecturer at the University of Sheffield, said of the shortage of donors. “Technically, you could be placed on a waiting list with no sign of an end, because there are no donors in your locality. We suspect lots of people go to Spain and Belgium.”

He said sperm were also being imported, mostly from Scandinavia.

Dr. Mark Hamilton, chairman of the fertility society and an obstetrician at the University of Aberdeen, said, “Really, we should be getting our own house in order rather than relying on importing sperm from other countries.”

Dr. Pacey and Dr. Hamilton wrote the BMJ editorial, suggesting that a possible remedy to the shortage would be to create regional centers that could do things that many current centers cannot afford to do, including advertise for donors, process them efficiently and remain open in the evenings and on weekends to allow men to donate without having to miss work.

Another solution might be to increase the number of pregnancies that each donor is permitted to produce. The legal limit is 10, set to minimize the chances of what is called inadvertent consanguinity ― half siblings, unaware they had the same donor father, together having children, who would be at risk for genetic diseases caused by inbreeding.

But the BMJ editorial argues that the limit of 10 is arbitrary, with no scientific evidence to support it, and should be reconsidered. The Netherlands, with a smaller population than Britain, allows 25. In the United States, clinics make their own rules about how many children one donor may father, with some permitting 20 or more.

“There are other people we have to think about here, the donor-conceived people themselves, and how they feel as a group about the knowledge that they may have a number of sibling or half siblings that they don’t know about,” Dr. Hamilton said. “For them that might be disturbing, but we really don’t know if it’s a major issue at the present time.”

The editorial also suggests that the nation consider “sperm sharing,” in which fertile men whose partners needed in vitro fertilization could become sperm donors for other women, and the donation would help pay for the fertilization.

The fertility society has already rejected several other proposed remedies, saying that the maximum age for sperm donors should not be raised above 40, and that the standards for semen quality should not be lowered.

Dr. Kamal Ahuja, director of the London Women’s Clinic, said that after the law was passed three years ago removing donors’ anonymity, “we had to redouble our efforts in finding new donors.”

In the past, he said, for every 100 men contacted, 5 to 10 would become donors; now, the number is fewer than 5.

“Before anonymity was lifted, we were supplying sperm to 60 I.V.F. centers in the U.K.,” Dr. Ahuja said. “We stopped three years ago, because we could no longer spare the specimens.”

Men are paid small amounts to cover travel expenses and time lost from work ― between about $15 and $30 per clinic visit, and no more than a maximum of about $385 ― but the law forbids paying for the sperm. Dr. Ahuja said the expense payments should be increased.

Olivia Montuschi, a spokeswoman for a patients’ group, the Donor Conception Network, said the loss of anonymity itself was not to blame for the donor shortage. Rather, she said, it was the failure of doctors at some clinics to change their recruiting efforts to reach a different type of donor, one who would not mind being identified. Doctors who understood the need for change did well, she said.

Dr. Amanda Tozer, a gynecologist at Barts and The London Hospitals, said sperm became scarce after anonymity was taken away, and her hospital could no longer buy enough from other centers. Long waiting lists developed, she said, so her clinic decided to start its own sperm bank in 2007.

“We’ve done quite well,” she said. “Donors come in knowing about the loss of anonymity. Loss of anonymity is a good thing in terms of children being able to find out about their genetic background. The donors who come forward don’t have a problem with it. We can now accommodate our own patients, but don’t have any sperm to spare.”

Pam Kent contributed reporting from London.

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Published 11 November 2008, doi:10.1136/bmj.a2318
Cite this as: BMJ 2008;337:a2318
Editorials
Sperm donation in the UK

Current mechanisms for recruiting sperm donors are insufficient to meet demand

For some years, providers of assisted conception services in the United Kingdom have highlighted difficulties in maintaining the infrastructure needed to recruit sperm donors. In 2006, the number of donors registered with the Human Fertilisation and Embryology Authority (HFEA) was 60% of that in 1991.1 Controversially, the removal of donor anonymity in 2005 may have contributed to this problem. Currently, many clinics struggle to recruit donors, have long waiting lists for those needing treatment, have high costs, and in some areas have ceased to provide treatment services altogether.2 To propose solutions to this problem, a working party of the British Fertility Society has published a report on how the UK recruits donors and uses their donations in assisted reproduction.1

The numbers of women using donor sperm in the UK have decreased by 40% since 2000 to around 3000 each year.3 The introduction of intracytoplasmic sperm injection in the mid-1990s may . . .


Mark Hamilton, consultant obstetrician and gynaecologist1, Allan Pacey, senior lecturer in andrology2

1 Department of Obstetrics and Gynaecology, University of Aberdeen, Aberdeen AB25 2ZD, 2 Academic Unit of Reproductive and Developmental Medicine, School of Medicine and Biomedical Sciences, University of Sheffield, Sheffield S10 2SF

m.hamilton@abdn.ac.uk

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British Fertility Society calls for national infrastructure to improve sperm donor recruitment in the UK
http://www.britishfertilitysociety.org.uk/news/pressrelease/08_11-DonorRecruitment.html
12 November 2008

The British Fertility Society (BFS) has issued new recommendations to address the critical shortage of sperm donors in the UK. In a report published in the journal Human Fertility, the BFS calls on the Department of Health to assist the sector in implementing a nationally co-ordinated strategy to improve the donor recruitment infrastructure across the country.

In 2007 the BFS convened a working party, including representatives from the Donor Conception Network, Infertility Network UK and the National Gamete Donation Trust, to address key issues relating to the national provision of sperm donation services and recommend new proposals to increase donor numbers and therefore allow more patients to be treated. The review reveals that the current national shortage of sperm donors is at a critical level, with only a small proportion of UK fertility clinics having the resources to recruit new donors. Figures from the Human Fertilisation and Embryology Authority show that fewer patients received treatment with donor sperm in 2006 than any year previously recorded. The working party concluded the demand for donor insemination (DI) in the UK is approximately 4000 patients per year, which would require at least 500 sperm donors to be recruited each year. In 2006, there were only 307 newly registered donors, 40% lower than the number registered in 19911.

The report recommends a national framework of sperm donation services should be implemented, based on a ‘hub and spoke’ model. Under this plan, main regional ‘hub’ centres would coordinate and implement the majority of services for donors, such as recruitment, screening tests, sample storage, and counselling, with smaller local ‘spoke’ centres providing services for patients requiring treatment, such as counselling, medical assessment and treatment with donor sperm. According to current demand for DI, the report proposes that 14 main ‘hub’ centres should be set up across the UK. These main centres would also be responsible for regulating family numbers per donor, and delivering sperm samples across the country. This proposed service plan is designed to increase the efficiency of donor recruitment and management, particularly during the early stages of the process between the initial enquiry and first attendance at a clinic where up to 35% of potential donors are currently lost. It will also allow donation services to be evenly spread across the country, allowing greater accessibility and improved public awareness.
Additional key recommendations of the report:

* The number of families allowed to be created by a single donor (currently 10) should be re-evaluated and flexible in approach. The working party call for further research in this area to assess the impact of any policy changes on donors, their current children, and donor-conceived children and adults.
* More research into ‘sperm sharing schemes’ is needed to increase donor availability. Such schemes allow male partners of women seeking fertility treatment to donate sperm for DI, which in turn reduces the cost of their IVF treatment.
* Better counselling facilities should be offered by clinics to known donors and their recipients. There is currently inconsistency among clinics on policy in this area.
* The current thresholds for acceptable sperm quality and the maximum age limit of male donors should remain unchanged, so as not to compromise safety standards.
* Patients should be given the option of choosing donors with similar physical characteristics to themselves, such as stature, hair or eye colour.

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内 容 ニックネーム/日時
自分の意思…

な〜んて思っている
けれど、じつは、
遺伝子に操られている
なんて話しもあります
よね。

それに、親子を見てると
遺伝子ってこわいなぁ〜
ってつくづく思うほど
ソックリだし。

遺伝子って超重要だと
思います。
選べるものなら選びたい。

でも、不確率な部分を
コントロールしてるのが
遺伝子であり、神であり
何らかの存在であると
するならば、選ぶなんて
それこそ神をも恐れぬ行為
ってことですね。(^_^;)
ビショップ
2008/11/17 08:46

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精子ドナーの不足/英国医療事情 医師の一分/BIGLOBEウェブリブログ
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