The influence of culture and religion on sexual and reproductive health and behaviour has increasingly become an area of study in contemporary time [31]. Sperm donation has evolved dramatically over the last decades, introducing a multitude of dilemmas. From a medical perspective, advancements in genetic technologies have opened new frontiers for the genetic assessment and diagnosis of donors, recipients, and offspring. Socially, there has been shift toward focusing on a healthy patient population rather than solely on the infertile male, altering the trajectory of medical treatment. The rights of offspring to know their biological father have led to regulatory changes in several countries, significantly impacting the population of sperm donors [32]. A considerable number of sperm donation programs offer open-identity sperm donation. In contrast to traditional anonymous donors, open-identity donors agree to release their identifying information to adult offspring [33]. Pacey et al. recently reported that more applicants are accepted as sperm donors among those who choose identity disclosure than those who prefer to maintain their anonymity [34]. As these trends are anticipated to progress, it becomes imperative to address previous regulations and concepts. Adapting policies and practices may offer better answer to developing and evolving demands. These evolving regulations should rely not only on professionals and participants in the sperm donation process but also consider the perceptions of the general population. We believe that such attitudes contribute to a global social viewpoint on sperm donation, demanding attention and thorough investigation.

To delve into these intricate matters, more than 250 students from diverse faculties responded to a targeted questionnaire. The findings represent herein reflect the perceptions of young adults—an important and relevant age group concerning sperm donation. Not surprisingly, nearly half of the participants reported a personal acquaintance with sperm donation. Yet, the relatively low objective knowledge score (with an average of 31/100) confirms our primary objective in recruiting participants who represent the general population rather than individuals already familiar with sperm donation. The terms “general population” or “public” are used to refer to those groups who have not necessarily had direct experience of either donating gametes or utilizing donated gametes in infertility treatment [23]. Furthermore, employing 6–7 questions for each section of the questionnaire enabled thorough investigation and assessment. Overall, participants’ responses to various questions exhibit consistent perceptions within each section, affirming the robustness of the findings presented.

Participants’ perceptions regarding sperm donation

The questionnaire comprised seven solid stigmas, encompassing both positive and negative assertions. We adhered to extreme phrasing to trigger authentic responses (ex. “Parents love their children less if they are not genetically identical to them”). Participants’ responses reflected consistently low scores for both positive and negative stigmas (1.3–2.2). Decades ago, Edwards categorized diverse risks that preoccupy people in terms of gamete donation as psychological, biological, and relational [35]. However, growing and evolving data have unveiled a much more complex picture. Both adults and adolescents conceived by sperm donation have reported varied sentiments—ranging from ‘positive’ to ‘indifferent’ or ‘negative’—regarding their method of conception [18, 36]. Additionally, differences among recipients—comprising single women, same-sex couples and heterosexual couples—have been documented, further complicating the implications of sperm donation [37]. We interpret participants’ responses, which tend to diverge from stigmas, as indicative of a more nuanced perspective on sperm donation, transcending the simplistic notions of ‘good’ or ‘bad’. In other words, social trends observed among patients involved in sperm donation, are mirrored in public perceptions as well.

Sperm banks’ roles and activities

The regulation of sperm banks activities is a matter of debate across countries and societies. While sperm donation for heterosexual couples is widely accepted and relatively common for single women, not all European countries permit sperm donation for female couples and, to an even lesser extent, for men couples [38]. The primary dilemma presented in the questionnaire was related to the fundamental conception of sperm banks—whether they should be viewed as medical or commercial institutions. According to Israeli regulations, each sperm bank must be associated with and operate under the affiliation of a medical centre, leading to a predominantly medical approach. Conversely, American sperm banks encompass both commercial and non-profit entities, operating within fertility centres or as stand-alone programs [33]. Remarkably, participants notably categorized sperm banks as medical rather than a commercial institutions. This clarification holds implications beyond theory. For instance, from ethical and legislative standpoints, sperm banks’ medical responsibility may limit patients’ autonomy, in contrast to the customer autonomy observed in commercial interactions.

Perspectives on sperm donation from both patients and physicians have yet to be fully ascertained and can be perceived across a spectrum. At one end of this spectrum, sperm banks may be regarded as a form of ‘romantic partner substitution’. Considering that most married couples typically do not undergo genetic screening for the male partner, some patients may perceive even basic evaluation of donors as supplementary and nonessential. Conversely, at the opposite end of this spectrum, sperm banks are seen as medical institutions bound by the obligation to utilize the most advanced technologies and methodologies. Participants in the present research assigned similar importance scores to both medical and non-medical factors throughout the donor selection process (scoring 2.6 and 2.5, respectively). We interpret this similarity as representing a balance or equilibrium on this matter.

While assessing medical and social impacts, we aimed to explore participants’ perceptions regarding a religious perspective. Schenker highlighted the importance of understanding diverse religious viewpoints concerning reproduction, as religious groups actively influence public bioethical stances, especially regarding procreation, abortion, and infertility treatment [39]. Notably, conservative monotheistic religions such as Judaism, Sunni Islam, and Roman Catholicism often impose limitations or even prohibit sperm donation [30, 38]. The statement ‘Religious factors should be considered during sperm donation’ received a low score of 1.6 in the current general cohort, primarily comprising secular participants. Nevertheless, significant differences emerged between religious and traditional participants compared to their secular counterparts. A possible implication of these findings relates to single religious women as a susceptible subgroup. Apart from the personal psychological burdens that might result from the absence of a romantic partner, they confront negative attitudes from their surroundings instead of receiving support while applying for sperm donation.

To summarize, while responders clearly defined sperm banks as medical institutions, recipients’ perspective is viewed as more complex. Social factors, such as restrictions on the number of offspring per donor, emerge as relevant and important.

Sperm donors’ identity disclosure versus anonymity

There is a global trend toward open-identity gamete donation, with an increasing number of countries enacting legislation permitting only identifiable donors [40]. This trend aligns with the rising number of single women and same-sex couples seeking sperm donation, leading to heightened awareness concerning the long-term medical well-being and emotional welfare of offspring. Notably, female couples and single women pursuing donor insemination approach the prospect of potential contact with donor-linked families within a distinct relational context compared to heterosexual couples [37].

Despite the global trend advocating for donors’ identity disclosure, anonymity remains crucial for a significant portion of men who consider sperm donation [12]. Certain studies have highlighted adaptations in donors’ characteristics, including older age and having children of their own [41]. Other studies have underscored a noticeable shortage of donors to meet the growing demands, resulting in a rise of importation of sperm or reproduction traveling [42,43,44]. Recently, we reported that losing anonymity is the leading cause to avoid sperm donation among young students, who represent a potential population for donors’ recruitment [13]. Within the current cohort, a clear preference for donors’ anonymity over disclosure was evident. Firstly, the statement ‘Donors’ anonymity preservation is crucial to maintain sperm donation’ received a high score of 3.7. Secondly, the mean score of phrases associated with donor identity disclosure was significantly lower than those related to seeking half-siblings. These responses suggest a bidirectional perspective on this matter. On the one hand, students’ responses align with recipients’ expressed interest in connection with individuals sharing the same donor, as previously outlined [45]. Such desires are mainly relevant for single women and lesbians who seek the option of open-identity donation for their children [33]. On the other hand, participants expressed a significantly higher preference for maintaining donors’ anonymity. We posit that these findings, which oppose the overall global trend, may be explained through different perspectives. Firstly, sperm donation in Israel involves single men, which is contrasts with the open donor profile seen in other countries. Secondly, these findings might mirror ethical and psychosocial concerns associated with removal of anonymity. For instance, the decision to disclose conception details to offspring places substantial pressure on parents. Specifically, fathers may feel threatened by the donor, the potential impact of the disclosure on their relationship with their offspring, and the anonymity factor acts as a shield against the stigma linked to male infertility [10].

Perceptions’ selectivity related to demographic parameters

A notable finding from the current research involves the substantial influence of demographic characteristics on participants’ perceptions (Table 3). Particularly noteworthy was the impact of gender, with women exhibiting a greater level of acceptance toward sperm donation, displaying higher willingness for identity disclosure, either in seeking half-siblings or revealing donors’ identities, compared to men. Another significant observation was that personal acquaintance with patients or any involvement in sperm donation resulted in lower stigma scores. This may reflect former prejudice, which is confronted and challenged in case of personal exposure. While difference related to religiosity have been previously reported [30], studies focusing on the general population are relatively scarce. To the best of our knowledge, this is the first extensive study focusing on the student age group that unveils perceptions selectively linked to demographics. Therefore, our hypothesis regarding the importance of these parameters was confirmed.

Importance of current findings and “real world” possible applications

An important aspect of the current research lies in broadening the scientific inquiry beyond the scope of sperm donors and recipients to encompass young adults who are not directly involved in sperm donation but share common demographic characteristics such as age and marital status. The current cohort demonstrates a rather surprising level of comprehension regarding the contentious issues associated with sperm donation.

These findings align with several ongoing processes that have evolved over recent decades. Firstly, expanding genetic screening for donors, aimed to reduce the risk for hereditary disease among offspring, is supported by our participants despite the possible restriction impact on donors’ supply. Secondly, donors’ anonymity is strongly upheld as a fundamental and crucial principle in sustaining sperm donation. Israeli regulations, which exclusively permit anonymous donations are widely accepted among the participants. Thirdly, our study demonstrated a different attitude towards recipients versus offspring related to seeking relatives. These results suggest the potential merit in establishing a formal system, possibly coordinated by sperm banks, that would facilitate offspring in finding their half-siblings while upholding the anonymity of the donor.

Limitations

The current research possesses several limitations that merit acknowledgment. Primarily, the focus on a student population may not offer a wholly reliable representation of the entire general populace. However, our study aimed to concentrate on the perceptions toward sperm donation among young adults, making this limitation justifiable. Additionally, the student population may not precisely mirror the young adult segment of the general population. The inclusion of participants without children holds relevance for the study, as it allows for an exploration of perceptions among those who have stronger linkage to the process of sperm donation. In the contrary, the dominant impact of women (more than 60%) and medical students (41.6%) require additional studies with different cohorts (such as parents, religious participants etc.) to confirm our results. Conducting investigations within the broader general population necessitates different settings, which fall outside the scope of the present study. Nevertheless, by concentrating on students, we facilitated a detailed examination using specific inquiries (e.g., those focused on donors’ anonymity versus disclosure), leading to a comprehensive and statistically significant outcome. Despite the accepted usage of non-validated questionnaires in the literature, the lack of psychometric validation in the current questionnaire is another limitation. Developing specific validated tool for the sake of sperm banks related studies is challenging. Yet, future efforts should be made to establish reliable and validated questionnaire, which may be used by diverse studies in various populations to improve our scientific methodology.