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Kids For Cash
Male Infertility. Smokers.
How a vial of semen goes from £35 for the donor to for £685 for the recipient.
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About 5,300 years ago a 45 year old man died in the Alps and there he remained, deep frozen, until his discovery in 1991. He's been named "Ötzi The Iceman" and he's been studied intensively ever since (01).

I have to admit this guy fascinates me, partly because it's a gripping human interest story, partly because these people were way more clued up than I'd been led to believe. However what blew me away was a report that he had a very low sperm count and was almost certainly infertile (02). Ötzi "shot blanks"!

From cave paintings, artifacts and observing modern day tribes, we know that our ancestors didn't hang around when it came to producing the next generation. They had famine, disease, predatory animals and a stack of other nasties to consider. Relatively few made it beyond infancy so, as soon as they reached puberty, clan rituals kicked in with gatherings arranged in spring, autumn and possibly mid-summer, depending on the clan. Teens would nudge Mum and Dad, who in turn would negotiate with the other side and, probably when he was 14 or 15 years old, Ötzi went through the mating ceremony and got himself hitched.

But they had a get-out clause. It was only for one year, after which they were free to go through the whole shebang again with another partner. Ötzi may have done this several times before he was 20, by which time no amount of skill, no amount of muscles would change things; he couldn't deliver.

Not much has changed over the past 5,000 years. Handfasting (03) was a Celtic variation where trial marriages lasted for one year and one day, leaving the couple to part company if they chose to do so. In some remote Scottish Islands there was a twist; if there were any children from the union they remained with the father, which pretty well guaranteed they'd both stick with it! That tradition only died out in the early part of the last century, though it continues to this day with many tribes in South America, Africa and Central Asia.

These traditions made sense when the survival of the community was the overriding consideration. Not so now where the emphasis is on learning through to age 18, the minimum age for marriage set at 16 and women told their optimum age for child bearing is 24. Now it might seem there isn't any need to rush anything.

With abortions in England and Wales running at 730 per working day in 2009 (04) and 50 per working day in Scotland (05), and only 40% for medical reasons, it might seem that we're swamped with unwanted pregnancies.

But we're not that good with the kids we have; 65,500 are in care in England and Wales (06), and 15,300 in Scotland (07) with many in need of fostering or adoption. Unfortunately many of these children will never know what "family life" means as bureaucratic delays result in an average wait of 31 months in England before a child is placed with an "acceptable" adoptive family. This issue hit the headlines recently as the coalition seeks to reduce waiting times and to cull many of the obstacles placed in the path of adoptive parents. First to be removed from the list of unacceptable traits are fat people and ex-smokers. Unfortunately smokers are likely to remain excluded.

Living together has a lot going for it, aside from the fearsome cost of a "proper" wedding (08). Perhaps it's because we're a little less religious in or outlook, perhaps a little less judgmental or maybe there's some spark of prehistoric man in all of us. Certainly the official marriage route is nothing to shout about with 1 in 4 ending in divorce. Whatever the reason, we've grown very tolerant of couples who refuse to, or defer tying the knot. It makes sense for about 4 million couples, it's tax efficient and there's little if any social stigma attached to them or any children. But there are limits to our tolerance, especially things go pear shaped and we're called upon to foot the bill for abandoned women and children.

This led to the The Child Support Agency. Despite the controversy, they do act on our behalf to hold absentee fathers financially responsible for the maintenance of their failed union. It doesn't matter if they were married or not, taxpayers have no wish to step in and carry the can for their mistakes.

While children are encouraged to get a good education, land a good job, then see themselves financially secure before committing to a permanent relationship, there's no escaping the fact that nature doesn't quite see it that way. Women have a narrow window of opportunity if they're to find a good supportive male and start a family because, despite all the Women's Lib talk, the vast majority want the whole nine yards. The right guy, the house, the picket fence, a good job and a couple of kids to round it off.

Yet competition is fierce; far too many guys now shy away from a firm commitment leaving a serious shortfall of available partners. And women don't have the luxury of messing about with too many "trials". Once they decide they want to have children they go for it, with a vengeance, as many bewildered men can attest!

Doing the research on this piece has opened my eyes to the single minded determination of some women to have a child. Devious, manipulative, underhand and just plain old self centered tactics are all used. To ensnare, tie down or force a guy to commit to a relationship.

Oral sex is no guarantee to a man who won't commit. One woman placed the contents of her mouth into a syringe and was outraged when the father of her child felt nothing but loathing for her and the infant. Roundly rebuffed and now aware that kids, far from being cuddly little cherubs, are stridently demanding, time consuming and extremely expensive to raise. She enlisted the help of the CSA - and help they did, despite the underhand methods employed! One middle aged husband finds 20% of his salary is taken at source for a child he didn't want to a woman with whom he never intercourse!

There's a certain naivety with some women. While it's true that many men have married because their girlfriend became pregnant, for the most part it was to save the child from being labeled a bastard and from being ostracized in their own community. Most men quickly adapted to their new role as husband, provider and father and never looked back. Some didn't, they stuck with it only for the sake of their child and in a small number of cases they never forgave the woman and they never forgot. As soon as their children left home, they cut and ran themselves. Post war Britain was hugely influenced by a severe shortage of men and many young women, very aware that it was a buyers market, used whatever means they had at their disposal. In Britain today social attitudes have changed and men caught in a honey trap are far more likely to insist on an abortion rather than end up snared in a loveless relationship.

Examples like this plus well publicized cases of older women seducing under-age children, all aligned with the threat of HIV and other communicable diseases, have helped galvanize many parents. From the onset of puberty they're biting the bullet, getting on board with their sons, talking about the facts of life and giving them a list of reasons why they should always use a condom. Older men, whether married or not, are far more likely to heed the warning "if it seems too good to be true then it is probably is."

While these are the extremes to which a tiny minority will stoop the effect on young males, most armed with access to a numerous social media outlets, is one of peer caution and support. The sensible, the good looking and the well educated (the pick of the bunch) are justifiably reluctant to jeopardize their career prospects or, like their counterparts in Japan (09), simply do not see marriage, mortgage or kids as being for them. Here we don't use the term "Herbivore Man" (10), we know them as "Young, Dumb & Living off Mum".

It's not an exclusive male thing, many young women share their views, however the most vocal traditionalist use the comments section of on-line articles to vent their feelings of rage and frustration that so many guys can afford to take their time and are more likely to be very discerning in their choice of partner.

One by-product is the number of women who, perhaps because they themselves are a little too demanding, or intimidating or simply repel too many men, have found themselves "unlucky in love". Some, ranging in age from their late twenties to late thirties, have taken out insurance by harvesting some of their eggs while relatively young, then paying to have them kept frozen on the off chance they may one day meet Mr Right (11).

Conversely some successful women, especially those who have a career that allows them to work from home, have taken matters into their own hands and had their child without the hassle or disappointment of a man. It's now quite routine in America to find mothers who have never had any physical contact with the father of their child, they've simply paid for the sperm of a man whose characteristics appeal to them.

Unfortunately they seem to have very similar views on their ideal man and this has resulted in one sperm donor becoming the father of more than 150 children (12). The demand for sperm donors is so buoyant that some men have their own sperm donor web pages (13). The advantage of this blond haired, blue eyed, milky white skin, ex-navy guy is he charges nothing for his services and has no problems with same sex couples. Thus far he's fathered more than 60 kids (14). Europeans seem to prefer cuddly with dark hair, glasses and a nice smile. And gratis (15).

As any single child knows, it's bad enough having a mother who seems to be a second skin. These have the added drawback that Mum always wants to know full details of anyone they fancy for fear they may be a half-sibling.

Invariably it's the woman who's most likely to seek medical help if she can't conceive within a reasonable time frame. Where the difficulties lie with her it seems they're prepared to go to extreme lengths to conceive and, with private treatment costing several thousand Pounds and rising at a rate that's well above inflation, many have no choice except to seek help from the NHS.

Because the condition is not in the least life threatening and the cost of treatment is just as expensive to any NHS Trust, all Trusts have very strict acceptance criteria and are driven by a cost/benefit result. Typically it's fat people, those who have one child already, those aged over 45 and smokers who will be refused access to expensive fertility treatments. No Hospital Trust will contemplate unlimited treatments with most agreeing to one course only, with a second course very much on a case by case basis.

While infertility poses no physical risk whatsoever there's no doubt it takes a serious emotional and psychological toll on a good many women. In some cases it can evolve into such a fixation that no amount of discomfort, no amount of time and no amount of money will deter a small yet very determined minority. Prices for private treatment in the USA (16) are lower than the UK and many feel they're treated with greater respect. They offer a wealth of alternatives and have state of the art procedures that can make a difference in borderline cases. Furthermore, like all private clinics, they're only too pleased to continue to offer treatment indefinitely, with many ruthlessly exploiting that inexplicable "need / yearning / ache" because in some cases it is a hopeless cause. Thankfully sheer exhaustion on the part of the client, her spouse or - more likely - their cheque book usually brings matters to a close. For some people its a case of it ain't going to happen, not in this lifetime.

"Donor" Dad

Yet, infertility is a 50/50 split. Men are just as likely as their partners to be infertile.

Because women are the first to seek medical help, they're the first to find out if there's nothing wrong with them. That leaves one obvious conclusion - it's him. Any wife worth the name can get a semen sample from her husband and that can be presented for analysis, with or without his knowledge.

Therefore it's the female who, quite frequently, knows exactly what his problem is and the likelihood of correcting it. In some cases it's hopeless or not worth the bother. With things like a low sperm count or poor quality sperm there are grave risks of pushing nature too far. One thing nature does exceptionally well is get shot of weaknesses. Taking drugs to boost sperm count can result in serious problems for any child born out of that procedure.

What women do with that information is best illustrated using official figures (17):

~ In 2009 there were 5,462 courses using donor sperm (including IVF) that resulted in 1,008 children.

~ In 2009 they carried out 55,694 courses of IVF or ICSI treatment (including donor eggs) resulting in 12,936 pregnancies.

While male infertility can often be resolved by something as simple as a change of underwear to boxer shorts or a change of diet to include a high proportion of seafood, especially oysters, there's little doubt that most women who find they can't conceive because of their partner chose to make their own arrangements. Quite what they are, or if their partner is a party to the arrangement is irrelevant. On the basis of this data, there are thousands of babies born each year where the person signing as "father" on the birth certificate is fibbing, knowingly or not.

It's perfectly understandable that infertile couples sort things out themselves. Far better to make arrangements with a close relative of the husband, or a well loved friend. That way the child has the benefit of two males who have a vested interest in its survival and, with a relative, the family line continues and things like blood transfusions etc., if needed by the child, are less complicated. Other issues include the ridiculous charges levied on couples that want to make arrangements through "official" channels.

Every fertility clinic operating in the UK must register with and adhere to guidelines issued by the Human Fertilisation & Embryology Authority (HFEA) (18). This came into being following a series of scandals when it was discovered that clinic employees were substituting their semen in vials marked as anonymous donor. In one spectacular case of abuse of trust a white couple ended up with a mixed race child, courtesy of a consultant.

The overriding principle of the HFEA is all donations should never be for monetary gain. It is they who set the payment for semen donors at £35 per donation. This is supposed to cover out of pocket expenses for the registration process, the interviews, the tests, taking time from work to attend a clinic, to then jack-off in the clinic before finding their own way home! Donors can do this until they have fathered 10 children, however they can no longer do so with complete anonymity.

Much of this is driven by a desire to help couples have a child and that's meritorious. Some parents don't want to know anything bar the basics about the sperm donor and want no involvement from him in raising the child. However, in all this, the rights of the child slipped through the cracks and it was only after a test case in 2005 that the law was changed in favour of the child's right to know. Since then, upon reaching the age of 18, any donor-child has the right to know everything about its genetic father and all clinics must produce that data on demand. A step in the right direction I feel, but nowhere near enough for the children who would like some sort of connection with their genetic father during early childhood (19). (That "there's a person in all this" is a sentiment I've seen repeated with Intersexed children (20). Their message is addressed to the medical profession, bureaucrats (birth certificates) and parents to accept them as they are and let nature take its course.)

Donors wanted T shirt

The cry is always the same, there aren't enough donors, yet the selection process is not user driven and is the primary reason there is a shortage of sperm donors. They reject almost 90% of all volunteers at the interview stage (21). Certainly they know what the demand is for albinos, dwarfs, giantism, cleft palates, protruding ears or eyes and disfiguring birthmarks. And few are keen to pass on baldness or red hair (22) to their children. But they also exclude smokers and regular drinkers, effectively barring about 40% of the population and neither are hereditary conditions. The decision to exclude smokers or drinkers should be left to the recipients otherwise this is nothing more than a crude form of eugenics.

It seems that whilst they had the cover of anonymity, prior to 2005, a sizable percentage of donors were married men. They've all but vanished since then. Seems the knowledge that a teenager may contact you some 18 years down the line is enough to cause any thinking man to consider very carefully whether that might be an encounter he'd prefer to avoid. Another issue is that frozen sperm isn't all it's cracked up to be (all sperm is frozen for 6 months to guard against HIV infection that donors may carry). Children born of frozen sperm seem to have more health problems than their normal peers. Again it gives reason to consider carefully what may happen when you meet your kid, or if you may be called upon to donate blood, bone marrow or body organs.

However recent legislation means that single women, lesbian couples and older women now qualify for donor insemination (23). That raises a number of issues that include morals, ethics and religion.

Most donors believe they're helping a "normal" couple and their child will be raised by a man and a woman. I suspect most of them would like their kid to have an upbringing that's similar or better than theirs. The question might be, what happens if a boy is the outcome? (Yes pre-sexing is now quite routine, however there's a 10% failure rate and it's not a choice every couple makes). Will he be taught things like football, cricket and fishing? And why would a perfectly healthy woman, single or lesbian, need to go to a fertility clinic? Surely she can speak to friends or acquaintances or simply seduce a guy in a disco? Then there's the religious angle to consider because most faiths are clear about same sex relationships. Some consider their decision to pursue a solo or same sex lifestyle as perfectly acceptable but de facto non-productive. In other words; it's your bed, go lie in it. The issue is slightly different for women aged 40 or more; they're far less likely to conceive using frozen sperm and there's the question of the risk to the mother's health as well as what donors themselves feel about their child having a 60 year old Mum when it's only 15.

Common to all are feelings expressed, quite vocally in many cases, that there are more than enough children in Britain as is and they want to have no part in making matters worse.

Then there's the money side of things - and this helps explain why single women and lesbians have little choice but to go through an official insemination process. Sperm donors have no financial responsibility for the child if it's born through an HFEA approved clinic (24). On the other hand if a man decides to help out a single woman, or a lesbian who is not in a civil union on an informal basis, then he is financially liable as the father should the mother ever ask for help from the CSA. Now that really is a major disincentive for any guy with a claim to a brain. It has happened (25) and it's not worth it.

All these issues help explain why there are so few sperm donors and this is where the HFEA policies again show their lack of consideration for the child. In the UK you can become a sperm donor if you're between the ages of 18 and 45. The maximum age is far too high and there is no minimum standard of education. Kids deserve way, far better than that. A straight fact is the younger the donor, the better the sperm and it's partly for these reasons that many heterosexual couples shy away from fertility clinics in Britain. In America, where donors can pick up $1000 plus per month and get a free medical to boot, they can be more demanding. There the age range is usually set at far more sensible 18 to 34 and they usually insist on a university standard of education as well as a minimum height (26).

The greatest disincentive for most British couples has to be the outrageous charges they make for donor semen. £685 for one private clinic in the UK. Even worse is when the couple bring their own donor to the clinic; for this they charge an eye watering £465 (both amounts are for the semen only and do not include all their other add-ons) (27)! And they're by no means the most expensive (28). Yes the HFEA charge every clinic £37.50 for every client treated and they do need to keep records, but for most people either charge is far too high, especially when considered against the success rate of a paltry 1 in 8 in some cases.

One consequence of these barriers has been the emergence of Internet sites that match people on a voluntary basis (29). They have their place, however their stated reason for existence is to reduce costs and to place both parties in a position to make a reasoned choice. Of course what transpires with respect to the reimbursement of expenses is usually far greater than donors would receive under HFEA guidelines, but substantially lower than recipients would pay if they went through a registered clinic.

Nevertheless prospective parents will have to pay for blood tests or risk passing on something very nasty indeed to their child, because there are some very good liars out there (30). And any donor will insist on a legal waiver to guarantee he will never be made financially liable for the child. These costs all add up, but may be worth it if all parties want some degree of personal contact beforehand and are happy for the donor-father to have some involvement with his genetic child.

I wanted to know if smokers are being refused NHS funded fertility treatments and the answer is yes. Women who admit to smoking are invariably told to quit before treatment can be considered. I'm grateful to Subrosa (31) for sharing an experience of one of her friends in the 1990's: it goes that far back. There is evidence that some females can become fertile again if they quit, however that is very rarely the only reason for their infertility. It might be reasonable to suspect this is little more than an excuse to reduce waiting lists.

With men the situation is very similar. Indeed the smoking husband is frequently used as the likely cause of the problem, even at the interview stage. In reality, for most males in their 20's and 30's, smoking is seldom the only issue and infertile men would be well advised to consider very simple changes to their diet and looser underwear. The last thing a guy wants to be sporting when trying to become a father is "manties" (32).

For whatever reason, it seems that infertile couples can experience a change of fortune by looking after a child for a reasonable period of time. If possible, volunteer to look after a niece or nephew while their parents have a long weekend of quality time.

What comes through consistently is the greater the meddling with nature the greater the problems faced by any subsequent child. Yes a perfectly normal child is the usual outcome, even if the semen has been frozen for several years, and for some couples this is their only choice. It's a little more risky but it's a one that many are prepared to face up to, albeit with the option of an abortion if the child will be guaranteed to suffer.

It is a complex issue and the HFEA got headlines when they announced that women should receive £750 instead of £250 for donating their eggs. Nevertheless sperm donors are not being paid enough to cover justifiable expenses and they do not have enough say in the way their contribution is used. Allowing for 2 hours from work, plus transport, plus waiting time, a realistic figure would be closer to £50 per visit, starting from the registration process. This may also act to correct the skew that favours donors from the medical profession, who can simply pop round during their lunch hour and are more likely to take full advantage of the rule that allows them to father up to ten children. Furthermore donors should have far more say in how their semen may be used. Some may want it restricted to heterosexual couples, others may give their okay for same sex married couples, or anyone who needs it - and these wishes should be honored. (Something that may help increase the number of organ donors as well).

The law has changed, yet the HFEA seem oblivious to the impact this has had on potential donors. If these changes result in a greater availability of sperm and more choice for recipients, then so much the better for everyone, because it's us, the general public, who have to live with the 1,000 plus "official" sperm-donor-children born each year.

I started with Ötzi because he reminds us that humans have had to deal with male infertility since day one. Despite his advancing years Ötzi had virtually no fat on him; he was lean, wiry and handsome. He had tattoos on each of his scars plus tribal tattoos - and these were only visible when he was nude. We know he was an excellent shot with his bow and arrows. We know he worked with metals and he almost certainly created useful things with them. He could provide for himself and any family and he could defend them very well. He must have cut quite a dash when he meandered down, buck naked, to bathe himself, or in his leather apron making things out of metal. Not capable of fathering children, but a darned good catch nonetheless.

Otzi showing cloak

There's only circumstantial evidence to support this (he was nursed through a series of illnesses shortly before his death, the intricacy of his garments, the patterns used and the fact others came to his aid when he was wounded). Yet my hunch is Ötzi had a family because then, as now, his partner would have valued his qualities as husband, provider and companion. And when it came to kids, well she'd sort that out as her great (x 262) granddaughters do today without fuss or fanfare, because he was worth it and he'd be a first class role model and Daddy, to any child.
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Smoking Scot
March 2012