Like all soldiers on active service, Sergeant Rick Clements was briefed by the army about the possibility of losing limbs in Afghanistan. The possibility of losing his fertility was never raised. When an IED bomb blast in Helmand a year ago left him without his legs, it was a double blow to discover he could never father a child with his fiancee.

Now he thinks that all soldiers should be offered free treatment to freeze their sperm to protect their fertility.

“The Ministry of Defence is doing brilliant work warning soldiers about the dangers of losing limbs at war. But there is no warning that fighting could leave you unable to have children. No one wants to talk about losing your testicles – it’s a highly emotive subject.”
Rick Clements

The prevalence of IEDs in Afghanistan means it’s becoming more common for soldiers to receive serious injuries to the legs and groin. Military couples are taking advantage of new technology to store sperm before going on active service to ensure they can still have a family should the worst happen. But sperm storage is expensive, and for some it’s already too late.

Surely when someone has sacrificed so much, they deserve a bit of help to get their life back on track now they’re home.

• Soldier’s campaign for sperm to be frozen before frontline deployment
• Soldiers in sperm bank bid for wives

Using donors from the US adds complication to an already complex process. First, there’s the issue of ‘egg miles’. Eggs would need to be frozen due to the time and distance they need to travel, meaning fresh transfers aren’t possible. Despite how far technology has come in the last few years, pregnancy rates from frozen eggs or embryos are still not as high as pregnancy rates from fresh embryos.

Then there’s the issue of recruiting donors in a country where vast amounts of money are paid to donors for their eggs. To donate to British couples, donors would have to abide by UK law and accept no more than £250 in reimbursement for loss of earnings.

Looking to the future, it’s also important to recognise how much harder it might be for a donor-conceived person to trace a biological parent who lives outside the UK.

It must have cost a large sum of money to set up and run these trials. Given this, and the greater success rates from treatment with fresh eggs ‘sourced locally’, how many home-grown donors could have been recruited in the UK if the money had been spent on advertising and donor care instead?

Donors have to attend clinics a number of times before their treatment starts, for tests and counselling. During treatment, egg donors attend at least seven times and sperm donors more than that, as their donation cycle lasts much longer. Some clinics will only pay travel and other expenses when the donation cycle is over. But this leaves the donor to cover their own travel and any other expenses, such as childcare, out of their own pocket until they’re reimbursed later.

Clearly, donors who are less well off are disadvantaged more by this. And they’re proportionately more likely to be people in their 20s with children – exactly the kind of people who would make perfect donors.

Some clinics understand that paying expenses in a lump sum at the end of the donation, while it’s easier for them to administer, makes life harder for their donors. But for those who continue to do this, where the smooth running of the clinic is prioritised over the donor experience, you have to ask whether those priorities are really helping recruit the best donors.

Let’s do a quick compare and contrast.

Of course, in the UK donors only get expenses rather than being paid hefty sums of money, but still, sperm donors do their bit towards getting a couple pregnant, yet seem to go unappreciated. The lads insist the disparity is because women moan more while they suffer in manly silence. What do you think?

Dear Dr Ruth

Anne

There are a lot of ideas and not a lot of certainties about low ovarian reserve. I would love someone to do the research project, which would have to involve a large number of women being tracked over probably 20 years to get any meaningful results. But at a time when no one has done this work, I shall just have to explain our hunches.

I need to go back a bit and talk through some biology: when a woman is born she has a large number of immature eggs in small pools of fluid, called follicles, in each of her ovaries. By the time she has reached her menarche (when her periods start) she has already lost a lot of her eggs. At the start of each period after that a number of follicles start ripening.

In a natural cycle, one follicle gets ahead of the others and is called the dominant follicle. The other follicles shrivel away and only one (or sometimes two) continue to mature and pop to release an egg.

If a woman is having an IVF cycle the drug treatment keeps all those follicles destined for one cycle going on to maturity, so that several mature eggs can be harvested. Since only some of those mature eggs will fertilise and go on to form embryos, the doctors will want there to be a good number of follicles and hence eggs in each cycle, particularly if they want to give the eggs to someone else (egg donation).

We have some ways of trying to work out whether a woman is likely to produce sufficient eggs to be an egg donor. We can do scans of her ovaries. If her ovaries are small, or if there are only a few follicles visible, she is unlikely to produce many eggs. We can test her blood and AMH is one of two blood tests that we use to predict how ovaries are likely to respond.

If your blood test shows that you are unlikely to respond well to drugs a clinic will not want to start you off on treatment. First of all it would be hard for you to have all the drugs and then have little response and secondly it would be disappointing for the woman you are hoping to donate to. So you would be discouraged from donating.

Your other question is what does it mean in terms of your chances of having children. This is a difficult one. I suspect there are lots of women who if tested would be shown to have low ovarian reserve but have had children without any problem. And if you have no other problem and if your partner has a normal sperm count it’s possible that you will not have any problems either. Another scenario is that you may be a bit slower at getting pregnant than your friends but do get there in the end.

However, if you were to need IVF you might not do well because, as we’ve shown before, you won’t respond as well to the drugs and won’t produce the sort of number of mature eggs needed to make a treatment cycle go well. So I would say that your chances of getting pregnant naturally are better than with treatment.

I’ve warned you that there are very few hard facts in this area but there are suggestions that women with poor ovarian reserve go on to have a menopause (defined as over a year without a period, the average age in this country being 52) earlier than other people and we think that women are not as fertile for the ten years before this.
So there is some reason for encouraging all women to have the children they want before the age of 42 and for women who might have an earlier menopause to consider having children earlier still.

So, no, it doesn’t mean you can’t get pregnant but it does mean you might want to consider having your children earlier rather than later and that you may take longer than your friends. You are also possibly more likely to get pregnant naturally than with IVF treatment.

I wish you all the best for the future.

The Guardian recently ran a piece in their Letters you always wanted to write series, from a woman who had a child by sperm donation with her partner. Among many other touching words, she says:

To my son’s sperm donor, I mostly want to say thank you, and hope that the joy that you have brought to us is reflected in equal measure in your life.

The Trust is making a collection of letters like this to make into a book to give to donors. This is to help donors realise just how much of a positive impact their unselfish gift can make to another family. People don’t always realise they can send their donor a thank you letter via the clinic, so donors don’t always receive this simple acknowledgement from one person to another.

In an environment where donation is largely anonymous, it also acts as a reminder of the human story behind the statistics. Donors, recipients and donor-conceived children are all curious about each other.

Maybe he’ll come to look for you when he turns 18; maybe he won’t feel the need to. I like the fact that he has that choice… I like to think that if he does seek you out, you’ll be proud of the person you helped to create.

And if you’re reading this now and thinking, maybe it is worth the hassle, perhaps I could think again – thank you.

• Letter to my son’s sperm donor

Bionews, published by Progress Educational Trust (PET), regularly features egg, sperm and embryo donation issues as well as news and views on genetics and stem cell research. Over the years it has published comment pieces from most of the best known figures in the field, including our own Laura Witjens, Chair of the National Gamete Donation Trust.

As well as Bionews, PET regularly organises conferences on assisted conception issues, bringing together people interested in donation from all perspectives (academic, clinicians, counsellors, charities, individual donors and recipients and many more).

We’d like to raise a toast to them for their hard work in keeping donation issues on the agenda, for keeping us all up to date with what’s going on, and for covering what can be controversial topics from all perspectives.

• Bionews

Is being outrageous the most effective way to get people to listen to your message?

In 2007, the NGDT released a viral campaign to recruit sperm donors, raising awareness of the need for sperm donors in a direct and fun way. Called ‘Give a toss‘, it included video of a spoof news item about ‘National Sperm Day’ and a cheeky online game, the Toss-o-meter. It was designed to appeal to men who had never thought about infertility but who might ‘give a toss’ about couples who need donor sperm to have kids. The Give a toss campaign lasted for five months; over 500 people passed it on to their friends, and enquiries went up all over the country as a result.

At the time, some critics thought it was inappropriate to talk about sperm donation in a humorous way, and argued that joking about masturbation would make infertility patients and donor conceived adults feel belittled.

Marie Stopes defended their video, saying it raised awareness of condoms and contraception in ‘a fun way’.

‘This tongue-in-cheek approach leads young people to a website with all the information and contact details they need to make informed lifestyle choices.’

From our own experience, we know it’s important to talk to donors in a way they can relate to. Different people have different needs: some respond well to sensitively-written text about how much recipients want a baby. Others, who perhaps who haven’t thought about it before, find earthy humour a more comfortable way to begin to talk about sperm donation.

• Musical safe sex video advises ‘one up the bum and you won’t be a mum’
• Recruiting sperm donors: why it’s time for a new approach, Bionews 401
• Donor recruitment: is tackiness the answer? Bionews 399