Gamete donation is the only means of achieving parenthood for those unable to conceive a child with their own gametes. In Portugal, about 9% of couples of reproductive ages are unable to have children due to infertility, and a minority of those will seek to undergo medically assisted reproduction (MAR) with donated gametes or embryos to achieve parenthood (Zegers-Hochschild et al., 2017). Lesbian couples and single women also need to undergo MAR to achieve motherhood, whether through intrauterine insemination or in vitro fertilization with donated sperm. While the medical procedures are technically identical to performing autologous MAR, the use of donated gametes or embryos brings additional concerns and difficulties. In recent years, issues have arisen about identifying donors, whether through legislation or the use of direct-to-consumer DNA testing, and this has raised important concerns (Pennings, 2019a, b). The topic has received more attention in Portugal, where legislation about the identifiability of donors has been recently changed.
Anonymity in Gamete Donation or Lack of It
In 2016, Portuguese law extended MAR treatment to all women, regardless of their marital status, sexual orientation, or any infertility diagnosis. Consequently, it is expected that there will be an increase in the number of children born as a result of heterologous MAR, particularly using donated sperm, in the coming years. There is controversy, however, about who should be able to resort to MAR, as well as a moral dilemma about the identifiability of sperm donors and compensation for the donation (Almeling, 2006; Fortescue, 2003).
An understanding that donor-conceived people have the right to learn the identity of their donors led to legislative changes in some countries to remove donor anonymity (Golombok, 2015). In 1985, Sweden became the first country to allow children conceived through MAR to learn their genetic origins once they reach an age of sufficient maturity (Ekerhovd , Faurskov, & Werner, 2008). Since then, several countries—such as the Netherlands, Finland, the UK, and more recently Portugal—have also changed their laws to allow donor-conceived children to learn the identity of the donors.
Indeed, in 2018, the Portuguese Constitutional Court imposed changes in the anonymity regime for all treatments involving third-party reproduction, such as donated sperm, oocytes, and embryos (Acórdão nº 225/2018). Following this, a child conceived using donated sperm, oocytes, or embryo was allowed to learn the donor’s identity on reaching the age of 18 years old. In line with this change, the importation of gametes was limited to countries with non-anonymous donation. A transition period was established for situations where gametes were donated before the legislative change, and for the following 3 years, the identities of donors would remain anonymous.
The issue of donor identifiability has arisen from a social debate about weighing the rights and duties of the resulting child against the rights of the donor. On the one hand, it is argued that the child has the right to know his or her genetic origins, ancestry, and history (Ravitsky, 2017), while on the other hand, it is argued that the donor has the right to privacy and distance from the child (Pennings, 2019a, b). Of course, these conflicting rights have led to heated debate (Pennings, 2019a, 2019b; MacPherson, 2019).
Since sperm donation is considered an altruistic act (Almeling, 2006; Ekerhovd et al., 2008; Fortescue, 2003; Hedrih & Hedrih, 2012; Thijssen, Provoost, Vandormael, Dhont, Pennings, & Ombelet, 2017; Van der Broeck, Vandermeeren, Vanderschueren, Enzlin, Demyttenaere, & D’Hooghe, 2013), the lack of anonymity may deter donors and increase the gap between supply and demand. In relation to MAR, another ethical debate exists about recruiting sperm bank donors through financial compensation. In Portugal, each donation is rewarded with around €40, with the donor being exempt from paying any user taxes in the National Health Service. However, not all public systems reward gamete donation. In France, for example, donation is anonymous and free, and the donor must already be a parent (Kalampalikis, Fieulaine, Doumergue, & Deschamps, 2013).
A study of sperm donation in Portugal is thus necessary and relevant for a number of reasons. First, access to MAR has been widened to all women, regardless of their marital status and sexual orientation. Second, the recent end to anonymity may influence the motivation to donate. Finally, there is a shortage of gametes. Our goal in this work is therefore to examine the motivations and attitudes toward sperm donation in Portugal, as well as identify which characteristics of potential donors are associated with these processes.
Motivations and Attitudes Toward Sperm Donation
Three major motivations to donate sperm have been highlighted in the literature: (i) altruism, (ii) financial compensation, and (iii) verification of one’s own fertility (Ekerhovd et al., 2008; Hedrih & Hedrih, 2012). Altruism refers to a willingness to help others without prospect of personal benefit. In the case of sperm donation, this relates to a desire to help childless couples to fulfil their dream of having a child (Ekerhovd et al., 2008; Hedrih & Hedrih, 2012; Thijssen et al., 2017; Van der Broeck et al., 2013). Altruism has been associated with financial compensation becoming less important, with many donors saying they would still donate if no compensation were provided (Ekerhovd et al., 2008; Hedrih & Hedrih, 2012; Thijssen et al., 2017). However, other studies have found that many potential donors would cease donating if compensation was discontinued (Van der Broeck et al., 2013). Financial compensation is therefore another motivation for donating sperm (Bay et al., 2014; Hedrih & Hedrih, 2012; Thijssen et al., 2017; Van der Broeck et al., 2013). A third motivation relates to verifying the donor’s own fertility (Hedrih & Hedrih, 2012; Thijssen et al., 2017; Van der Broeck et al., 2013). Studies have shown that some individuals show a curiosity and willingness to pass on their “good genes,” as well as a need to confirm their capacity to procreate (Thijssen et al., 2017), although the latter phenomenon was only observed among young people (Thijssen et al., 2017). One of our goals in this study was to explore possible differences in these three motivations among our participants.
Different attitudes toward sperm donation have been identified, such as attitudes toward the potential receivers of the donation, the relationship with the resulting offspring, the anonymity of the donation, and the process’s social aspects (Hedrih & Hedrih, 2012; Thijssen et al., 2017). In this study, we discuss attitudes toward anonymity and attitudes toward donating to lesbian couples versus other family configurations.
As stated above, the debate about donor anonymity extends across many countries beyond Portugal. A study in Belgium investigated the motivations and attitudes of candidate sperm donors (Thijssen et al., 2017). Half of these participants said they would like to know how many children were conceived from their sperm, but only a quarter wanted to receive information about the family and any children who were conceived. Most participants expressed that parents should decide whether to inform children about their genetic origin, but half of them believed that parents should be honest with their children. Most indicated their willingness to provide information about themselves to resulting children, but only 26% of them were willing to donate if their identity might be disclosed. Another study among Danish donors aimed to examine the motivations and attitudes toward sperm donation (Bay et al., 2014). Half of the participants stated they would no longer donate if anonymity could not be assured, and only a minority said they would, or might, continue donating. Most donors said they would reveal non-identifying information about themselves, would like to know how many children were conceived from their sperm, and would accept that the children could learn their identity. These studies show a relatively positive view of non-anonymous donation, even though men tend to withdraw from donating if their identities may be disclosed. We would therefore expect a similar pattern of attitudes toward non-anonymity in Portugal.
Another controversial topic with assisted reproduction with donated gametes relates to the recipients. Overall, positive attitudes toward donation to single women and/or lesbian couples have been reported (Bay et al., 2014; Ekerhovd et al., 2008; Thijssen et al., 2017), but negative attitudes toward lesbian and gay parenting families continue to be reported (e.g., Crawford & Solliday, 1996; Gato & Fontaine, 2013, 2016). College students in the USA, for example, considered gay couples to be less emotionally suited and less apt to become parents when compared with heterosexual couples (Crawford & Solliday, 1996). In Portugal, Gato and Fontaine (2013) highlighted university students’ apprehension toward adoption by same-sex couples when it comes to the normative sexual and gender development of children. This apprehension was especially strong in cases where a boy is adopted by a lesbian couple, compared to when a girl is adopted by a gay couple (Gato & Fontaine, 2013). The same authors (2016) later confirmed that among a sample of undergraduate students from helping professions, men expressed more negative attitudes toward same-sex families than women did. The participants also considered that the sexual orientation of the couple only impacted psychosexual development in cases where a boy is adopted by two men. When evaluating parental competences, male participants believed that lesbian and gay couples were less stable and less suited to become parents, as well as more likely to harm the child, when compared with heterosexual couples (Gato & Fontaine, 2016, 2017). Concerning the impact of the potential donors’ sexual orientation, Freeman et al. (2016) showed that gay and bisexual men had an open mind when it came to anonymity, and they were more willing than heterosexual men to be contacted by any conceived children.
Correlates of Motivations and Attitudes Toward Sperm Donation
Numerous factors can influence the motivations and attitudes of individuals toward sperm donation. In this study, besides the sexual orientations of donors and recipients, we investigated the role of other characteristics of potential donors—such as personality traits (White, Poulsen, & Hyde, 2017), empathy (Verhaert & Van den Poel, 2011), social values (Ryckman, Gold, Reubsaet, & van den Borne, 2009), and religious values (Rubio, 2015)—in influencing motivations and attitudes toward sperm donation.
Conscientiousness is described as a tendency for people to be hardworking, purposeful, and disciplined, as opposed to being easygoing, unambitious, and weak-willed (McCrae & Costa, 2008). It has also been identified as particularly relevant to altruistic behaviors. For instance, highly conscientious people have a greater tendency to volunteer their time (White et al., 2017). Furthermore, one study that aimed to explore the relationship between motivation for post-mortem body part donation and personality traits (Bolt, Eisinga, Venbrux, Kuks, & Gerrits, 2011) highlighted conscientiousness as a major motivation for body part donation.
Openness to experience describes imaginative, curious, and exploratory tendencies rather than rigid, practical, and traditional tendencies (McCrae & Costa, 2008). People with a high level of openness are not passive recipients of a panoply of experiences they are unable to project—instead, they actively seek new experiences. However, closed individuals tend to be traditional and repetitive, and they oblige their functions to escape from stress (McCrae & Costa, 1997). We therefore intended to explore the relationship between conscientiousness and openness to experience and the attitudes and motivations toward donating sperm.
Decety and Jackson (2004) defined empathy as a sense of similarity between the feelings of the self and the feelings of others. It has been established that empathy is an antecedent to various altruistic behaviors (Batson, 1987). Empathy can also influence the perceived benefits of deciding to donate organs, and this affects how motivated individuals are to donate for themselves or for others (Cohen & Hoffner, 2013). People with high levels of empathic concern make donations in various contexts, with them focusing on alleviating the suffering of others and seeming rather other-oriented and compassionate toward others (Verhaert & Van den Poel, 2011). Given this, we therefore intend to explore the relationship between empathic concern and the motivations and attitudes toward sperm donation.
Schwartz (1992) defined values as criteria that individuals use to select and justify their actions, as well as the basis for evaluating events and people (including the self). This theory proposed an organization of 10 types of motivational values, namely power, achievement, hedonism, stimulation, self-direction, universalism, benevolence, tradition, conformity, and security (Schwartz, 1992).
The study of Ryckman et al. (2009) aimed to identify which personal values were associated with intentions to register as an organ donor. It found that individuals with higher levels of social conformity, but lower levels of hedonism expressed a greater intent to register as organ donors. The study also highlighted how personal values could play an important role in health-education campaigns that seek to increase the supply of donor organs for transplantation.
Conservative (or Conservation in Schwartz’s terminology) values express a desire to preserve the status quo (e.g., family security, social order) and the security it provides in relationships with others, traditions, and institutions (Schwartz, 1992, 1994). Hence, we therefore sought to explore the relationship between conservative values and the motivations and attitudes toward sperm donation.
Although the Catholic Church has influenced Portuguese society for a long time, nowadays, “Portugal is, in a modern way, simultaneously a secularized, religious and Catholic country” (Dix, 2010, p. 25). Catholicism tends to reject alternative family formation, arguing about the nature of sex, marriage, and the family, as well as the dignity of the embryo, the rights of the child, and the means used to improve biological reproduction (Rubio, 2015). Thus, we aimed to explore the relationship between religious values and the motivations and attitudes toward sperm donation.
In summary, the goals of this study were as follows:
1. To explore possible differences between the motivations to donate, attitudes toward anonymity, and attitudes toward donating for specific groups
2. To explore possible differences between these motivations and attitudes as a function of sexual orientation
3. To explore the relationship between the motivations to donate, attitudes toward anonymity, attitudes toward donating for specific groups, and participants’ psychological characteristics
Regarding our second goal, we expected heterosexual participants to show more negative attitudes toward donating to lesbian couples and/or single lesbian women when compared to heterosexual couples and/or single heterosexual women (Hypothesis 1). No differences were anticipated in the case of gay and bisexual men (Hypothesis 2). Furthermore, we expected heterosexual participants to show more negative attitudes toward non-anonymous donation than non-heterosexual participants (Hypothesis 3).