They believe that the removal of donor anonymity in 2005 may have contributed to the current shortage of donors.
With around 4000 UK patients requiring donor sperm each year, and the UK legal limit of 10 pregnancies from a single donor, a minimum of 500 new donors are needed every year to meet demand. But in 2006 there were only 307 new registrations.
The authors say increasing the number of families that can be created from a single donor should be considered. To prevent siblings born from donation later inadvertently having children together, UK law limits the number of families that can be created from any one donor to 10. But Hamilton and Pacey argue that this figure is arbitrary and not evidence based, and a more flexible approach is needed.
They point out that the size of the UK population is enough for a large safety margin to already exist. Interestingly, in the Netherlands, which has a smaller population than the UK, the upper limit is 25 offspring per donor, while in France it is five.
The British Fertility Society has called for major changes in the organisation of recruitment services to increase the number of new donors. Possible changes that Hamilton and Pacey describe include implementing a new national service framework for sperm donation with large regional centres providing the bulk of donor management and smaller local centres providing services for recipients. Currently, up to 35% of potential donors are lost after their first enquiry and never assessed. Making services more accessible and efficient may reduce this figure and encourage more men to participate.
According to the authors, another option would be the introduction of sperm sharing schemes that would work along the same lines as egg sharing programmes that are already in place in the UK, whereby fertile male partners of women who need IVF could become donors and have their fertility treatment partly funded by sperm donation.
Some options that the British Fertility Society decided not to recommend, due to concerns over safety standards, include increasing the age limit of donors from the present 40 years and lowering the acceptable levels of semen quality.
Both Hamilton and Pacey conclude that all these proposals need to be evaluated, so future decisions and policies can be based on clear evidence.