Study context

The study was conducted in the context of Danish legislation on treatment of assisted reproduction, that up until 2007 only allowed anonymous sperm donation. However, since 2007, sperm donors have had the option of anonymous or non-anonymous donation. In anonymous donation, the identity of the donor is not known by the recipient or the offspring and the offspring will not be able to receive any further identifiable information from the sperm bank. In non-anonymous donation, the identity of the donor is not known by the recipient or the offspring, however, the offspring will be able to receive the name and latest address on the donor by request to the sperm bank after they reach 18 years of age. Neither anonymous nor non-anonymous donors are able to receive identifying information regarding the DCPs.

Recruitment

Participants were recruited via Cryos International sperm bank at four branches across Denmark (www.cryosinternational.com). From February to November 2021, former donors were contacted in batch by the Cryos Research Team to be invited to participate in a range of studies, including this one. The inclusion criteria were: 1) > 10 years since last donation, and 2) available contact information. Approximately 200 former donors met these criteria, and in total 77 responded to contact. Recruitment for the present study took place from May to September 2021, and all former donors who responded to Cryos Research Team contact during that period were consecutively invited to participate in the interview study. As a result, a total of 39 former donors were invited to participate and 29 consented to being contacted by the first and second author, who were primary researchers in the study and not affiliated with the sperm bank. They provided potential participants with additional information and, upon consent, an interview appointment was arranged. Out of 29 potential participants, two declined participation, and four could not be reached, thus leaving a sample of 23 former donors.

Data collection

All interviews were conducted by phone (n = 21) or video (n = 2) and lasted on average 24 minutes (range: 9 to 47 minutes). All interviews were conducted by SL and SB, who are both experienced in qualitative interviewing. The interviews were guided by a semi-structured interview guide informed by current qualitative literature and the interdisciplinary team of authors. Topics in the interview guide and examples of questions can be found in Table 1. The same guide was used for all interviews, but the extent of probing to different topics varied between participants. Before all interviews, oral consent was obtained and recorded, and all participants were encouraged to speak freely and introduce topics that they found relevant. All interviews were audio-recorded and transcribed verbatim. Transcripts were not sent back for checking.

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Table 1. Examples of topics and questions in the interview guide.

https://doi.org/10.1371/journal.pone.0281022.t001

Data analysis

The material was analysed using reflexive thematic analysis [13,14]. All transcripts were thoroughly read by SL, SB, and a research assistant, TP, who individually developed a set of preliminary codes. These codes were compared, collated and divided into five clusters consisting of three to six codes each related to: ‘Reasons’, ‘Experiences’, ‘Anonymity’, ‘Relations’ and ‘Disclosure’. Three interviews were test-coded independently by SL, SB, and TP for coding reliability, and discrepancies in coding were discussed and settled. Finally, all interviews were coded by TP using NVivo 12 software (QSR International, Melbourne, Australia). The coded material was subsequently read, re-assessed and sorted into themes [13]. For example, the subtheme ‘Defining (non-) relatedness’ included codes from both ‘Experience’, ‘Relations’ and ‘Disclosure’ clusters. During these analytical, back-and forth processes, an overall theme was identified that captured a recurrent pattern across the data material: Unproblematic and in the past. Four subthemes that represented different aspects of the overall theme were developed: (i) Being a donor was convenient and meaningful; (ii) It’s in the past; (iii) Defining (non-)relatedness; and (iv) Thinking about potential contact. Theme and subthemes were then investigated in relation to the full dataset while looking for discrepancies and disconfirming evidence, before writing up the findings. To secure anonymity for participants, all identifying information have been left out of the manuscript and all participants have been assigned a pseudonym.

Ethical approval

The study was presented to the Central Denmark Region Committee on Health Research Ethics (J. No. 172/2022). According to Danish legislation, research using questionnaires and interviews that do not involve human biological material (§14(2) of the Committee Act) interview studies are exempt from approval from the Committee on Health Research Ethics (https://en.nvk.dk/how-to-notify/what-to-notify). The study was approved by the Danish Data Protection Agency (J. No. 1-16-02-201-21, April 24 2021). Informed oral consent was obtained and recorded prior to all interviews.

Being a donor was convenient and meaningful

This subtheme contains the men’s motivation for becoming a donor, their interaction with the sperm bank at that time, and their reasons for stopping as a donor. The analysis revealed several concurrent motivations for initially applying to be a sperm donor. First, many of the participants had been students at the time of recruitment and considered sperm donation to be an easy way to make extra money. Being a sperm donor was ’easier and funnier’ than other student jobs. Also, several participants described living close to the sperm bank, thus making donation easy:

It was mainly the financial part that appealed. And the convenience–pop in and deliver, go home, and collect. And not spend a thought more on it. (Brandon)

Second, all men mentioned the altruistic opportunity to help people struggling with infertility. Thus, being a sperm donor was considered by them as a win-win situation where monetary and altruistic purposes could be conveniently and meaningfully combined. For three men, however, altruism was the main motivation. They had all experienced the distress of infertility first-hand (e.g., among family or friends):

Well, I witnessed how my sister and brother-in-law struggled to have children. I saw first-hand how miserable they were. And when [sperm bank] opened in [city of residence at the time] then I just thought… this is a way where I can maybe make a difference for someone. (Chris)

An additional motivation for some men was curiosity about their sperm quality. Being approved by the sperm bank and having acceptable sperm quality was a source of satisfaction, or even pride, that also provided peace of mind regarding own future fertility:

I was motivated by several factors, but honestly, I was curious about sperm quality… if it was good enough. I guess it was a bit of a vanity thing… (Daniel)

Finally, a main motivation and (for many) the very foundation for even thinking about becoming a donor was the opportunity to be anonymous. Many stressed that the option of anonymity and their confidence in the sperm bank’s ability to uphold that anonymity was essential for their decision to become donors:

For me it was essential that it was anonymous. I imagine that very few would donate if you couldn’t do it anonymously. (Joe)

Only by being anonymous can you put it away again and say: I am donating something, ok, and I will never know any more about it. Or risk being confronted with it in the future. (Kevin)

Anonymity was often described as a way to protect their future self from unwanted and unpredictable consequences. Two men had chosen to be non-anonymous donors, as they thought that offspring should have right to contact if interested. One of them had been motivated by the possibility of reproducing his genes:

I think it’s exciting to know that future generations carry my genes. I think it’s something deep in our biology, that all humans want to multiply. (Michael)

Generally, the men had felt well-informed by the sperm bank during their time as a donor; and, in hindsight, had not required any further information or support during or after it finished. The reasons for stopping being a donor varied. A few had their contract cancelled by the sperm bank and a few were unhappy with changes in remuneration, but for the majority it was simply no longer convenient (e.g., due to relocating to a new area and/or starting a family). At the time of the interview, only one participant expressed regret for having been a donor. He had been informed that a diseased child had been born from his donation and expressed feelings of guilt towards the recipients and child. However, today, most men still felt positive about, or even proud of, having been a sperm donor.

It’s in the past

During interviews, most men (including one non-anonymous donor) reported they hardly ever thought about having been a sperm donor. It was described as a ’closed chapter’ that belonged to the past; not a secret, but simply not relevant to their current lives. For these men, many of the interview questions guide were answered with ’I haven’t thought about it’ or ’I don’t know’, but many tried to offer more explanation. However, it was obvious that having been a sperm donor did not impact their current lives. Many had now settled in family life and considered donating part of their youth:

I still feel good about it [having been a sperm donor]. But I am also somehow happy that it’s history. Because now I have my family, I have a life that is quite different from back then… when I was the young bachelor type. (Matt)

Thus, donating sperm was understood as a temporally bounded event that belonged to the past. For a few men, however, the boundary was less clear and their time as a donor was still present in their current lives. For example, one non-anonymous donor often thought about and looked forward to being contacted by offspring, while an anonymous donor had actively searched for recipients and offspring. Except for the latter, all men were content with their original choice of donor status (non-anonymous or anonymous) and found it important to uphold their contractual rights and obligations towards the sperm bank, the recipients and donor offspring.

Defining (non-)relatedness

When addressing their perceived, potential relationship or relatedness to donor offspring, many men found it difficult to articulate or define, often asking the researcher to repeat or re-phrase the questions. Most men simply maintained that there was no relationship at all:

There is no relationship. At all. That was essential for me going into this… I mean, of course there is the ’good cause’ and all, but it wasn’t my primary motivation and I have no relation to… It was a job. I thought of it as a job and that is all [laughs]. (James)

It’s like an organ or… I guess it’s a bit cynical, but…. […], It’s something you pay for, when you want to have a child. I give something, they get it, that’s all there is to it really. (Jacob)

However, when explicitly asked about relatedness, many men acknowledged that they potentially shared genes with DCPs ’out in the world’, and some would joke about how ’lucky’ or ’poor’ this donor offspring was. Most men made the distinction between genetic origin and fatherhood, and the latter only extended to their relationship to their ’own children’. It was emphasised that fatherhood is a status and a privilege that is socially and emotionally achieved rather than genetically determined:

It’s not just a matter of genes. It’s raising, protecting, and caring for a child that defines parenthood to me. Not the genes. And I passed the ’raising, protecting and caring’ part on to those who received the donation. (Chris)

To claim the status of fatherhood thus entailed protecting, bringing up and being a part of the children’s lives. For the fathers in the sample, all concern and loyalty were firmly directed at their own children, and they stressed that they in no way should or could be perceived as having a father-like relatedness to offspring.

At the time of the interview, sixteen men had children of their own. For some, fatherhood had led them to consider the wellbeing of potential offspring; but they also emphasized how such knowledge could be ’damaging’:

When I was younger, I didn’t care [about the fate of offspring]. But today, I have children of my own and I realise how dependent they are–on love and good surroundings. So, in some ways I am concerned [for DCP], and there is a sort of relief that I don’t know who they are. […] If one of the children were born into a deeply dysfunctional family, then that would make me upset. I would feel responsible. Therefore, it’s better not to know. (Alex)

The men (fathers and non-fathers) expressed how knowing about their donor offspring and recipients could create unwanted feelings of relatedness and responsibility towards them. This was something that they wanted to protect themselves and their families from. Most men had informed their current partner about their past as a donor and generally, the partners were reported to be overall accepting. A few men described their wives as a ’a bit unhappy’ with not having the sole rights to the man’s gene pool:

Back then it wasn’t a problem, but over the years…I don’t know. After we got our own kids, she started thinking about it differently… that I might have a few more out there. (Tyler)

This could indicate that some partners attached meaning to genetic relatedness and that the past donorship threatened the exclusivity of their genetic relatedness. The potential meaning and importance of genetic relatedness was addressed by several men, who acknowledged that such information might be of importance to DCPs. Many men understood genetics to be an explanatory factor in understanding both appearance and personal traits. While maintaining that the recipients were, and would always be, the DCP’s parents, many donors accepted that knowing about genetic inheritance could be important to some DCPs:

I can definitely relate to that. Particularly when you’re a teenager and figuring things out. Who am I? Where do I come from? You’re looking for answers, and I understand why one might be interested in biological origin. And maybe some explanations… about appearances, but also reactions and behaviors. I think it’s really interesting. (John)

As such, several men expressed sympathy towards some DCPs’ desire to meet a donor but felt that their rights to anonymity and the protection of his family should carry more weight.

Thinking about potential contact

All men reported to trust the security of their data at the sperm bank but also acknowledged the ever-increasing possibilities for online investigations and searches where DCPs could be successful in identifying siblings and/or the donor. Generally, the donors were not well informed about, or interested in, the presence of online ancestry databases, voluntary registers, or Facebook communities; a finding that resonates well with the donor’s lack of interest in contact with potential offspring. However, many men also mentioned that the (unlikely) risk of unwarranted contact from an offspring was an inherent uncertainty in sperm donation:

I know that sometimes they manage to find the father, even if he’s anonymous. If it happens, it happens. I’ll deal with it. (David)

Many men clearly stated that breach of anonymity would be ’highly problematic’ or ’very unfortunate’, while others described offspring-initiated contact as a matter of ’crossing that bridge when I get there’. The men who had been anonymous donors had generally not given offspring contact much thought and had not planned for what to do in that unlikely event:

I haven’t thought about it. I guess it’s one of those things where you can’t really know until it happens. It’s a difficult question and I can’t predict my response. (Chris)

The main concern regarding breach of anonymity was that offspring contact would create an unwanted disturbance in their current lives and families. Fathers expected to be particularly concerned about the response of and impact on their children, none of whom knew at the time of the interview that their father had been a sperm donor, mainly because they were still quite young:

I also have a family to take care of and that’s probably… Like, I think I could probably deal with it OK, but what about the rest of the family? […] It will create an imbalance in the family when they have to deal with it too. And that would be the hardest for me, that it would disturb their everyday life. (Joshua)

Another concern was that offspring-initiated contact would ’force’ a personal relationship onto the man. Many former donors imagined how being confronted with an ’actual, living person’ would probably make it difficult not to get engaged in that person’s life, even if they were initially not interested in it:

I wanted to be anonymous, because… well, if someone came around, I just think… I think I’m this loving person and I could really just end up seeing them as family. And they already have a family, I know, but I think I couldn’t help think that we were family too. That’s why I chose to be anonymous. (Joe)

Several men brought up, that if a donor offspring had gone through such troubles to circumvent anonymity, then they must be very much in need of answers and the men expected to feel morally obliged to respond. While some men imagined that setting boundaries for this relationship or contact could be difficult, others felt that they could maintain very clear boundaries if a donor offspring unexpectedly made contact:

OK, so let’s go have a cup of coffee. Somewhere neutral. And let’s talk through it all, could be interesting. And then, that would be the end of it. Like, I am your genetic origin and we can talk about that. But we are not going to discuss me being your dad. ‘Cause I’m not. (Alex)

Such boundaries would allow the man to ’be a decent person’ and respond to a human being who had gone through a lot of trouble while still protecting his family and clearly place them as top priority.

A few men described a fleeting interest in having contact with their donor offspring, mainly due to curiosity about similarities in appearance and personality traits. A couple of men had done a little online research but stopped themselves:

I am curious about it and I thought that if I could maybe find them [DCP] without making contact… It seemed very easy. But then, I guess, knowing about them would create an imbalance. I’d risk my everyday life just to satisfy a curiosity. Not worth it. (Justin)

Two men, both without children, explicitly expressed interest in meeting their offspring due to curiosity about their lives, their appearance and personal traits. One of them, an anonymous donor, described sometimes ’romanticizing’ the potential relationship with donor offspring (e.g., imagining going on fishing trips). The other, a non-anonymous donor, were excited about the future, potential relationship and imagined himself being like ’an uncle’. Even so, the men were mindful of the potential vulnerabilities and risks of contact (e.g., the absence of predefined roles and boundaries). Nevertheless, this uncertainty was outweighed by their desire for meeting their donor offspring.