In the religious texts of Islam, procreation and having children are things that are praised, and there has been a lot of emphasis and encouragement in this regard. Also, the most important function of the family is to bear children, and there are many hadiths encouraging men to get married to women who are capable of bearing children (1). On the other hand, the financial, psychological, and physical challenges caused by assisted reproductive technologies probably put additional stress on infertile couples (2). It is estimated that infertility affects 8–12% of couples of reproductive age worldwide. The prevalence of infertility in Iran has been reported to range from 10.3% to 24.9% (3-4). Also, the infertility rate in South and West Asia is up to 30% (5). In Indonesia, it is about 10-22% (6). About 20–30% of cases are infertile due to male factors; however, a study by Vander Borght et al. showed that overall, 50% of infertility is caused by male factors (5). Another study showed that infertility affects about 70 million people worldwide. The World Health Organization (WHO) estimates that 9% of couples around the world struggle with fertility problems, and the male factor accounts for 50% of these cases (7). WHO has reported that male infertility has various causes in the male reproductive system. Infertility is usually caused by ejaculation dysfunction, asthenospermia, oligospermia, or the abnormal shape (morphology) and movement (motility) of sperm (8).
While assisted reproductive technologies (ART) have been available for more than three decades and more than 5 million children
worldwide have been born from ART interventions such as in vitro fertilization (IVF), these technologies are still largely unknown in many regions due to their high cost and some cultural attitudes in developing countries. Studies on the possible relationship between male infertility and oncological, cardiovascular, metabolic, chronic, and autoimmune diseases predict hospitalization and mortality (9).
The religion of Islam recognizes infertility as a fundamental problem and encourages its believers to seek treatment for infertility as with any other illness. Therefore, if any form of ART is accepted as a legal and ethical treatment in the Islamic framework, Muslims are allowed to use it (10). Basically, reproduction using the donation of gametes or embryos from people other than the spouse is considered new and is one of the novel issues in Muslim societies. The Iranian Parliament passed the law governing the donation of embryos to infertile couples in 2003, and its executive regulations were passed and implemented in 2004. Among the various fertility methods, this law deals only with embryo donation and says nothing about other insemination methods (egg and sperm donation, etc.) (11). Due to the lack of a law, according to Article 167 of the Constitution, it is possible to refer to the fatwas of Marjas (religious scholars) (12). According to the opinion of many Marjas of Islamic jurisprudence, donating gametes and embryos is considered permissible, but it is necessary to observe some Shari'a prerequisites for performing the procedures, including non-permissible touching and looking, as well as the presence of privacy during insemination between sperm and egg (13). The process of justifying ART interventions generally began in Shia Muslim countries when Ayatollah Khamenei (the political-religious leader of Iran) issued a fatwa that allowed gamete donation by third parties. This legal approach paved the way for the legal approval of gamete donation, including egg, sperm, and embryo donation to infertile spouses (14-15).
Using donated sperm is one of the assisted reproductive methods used to help infertile couples. In this method, the semen of a third party is transferred to a woman's uterus during IUI or through IVF. Regarding sperm donation, there are different opinions; Sunni scholars are completely against it, and among Shia scholars, many support it and some are against it. Therefore, the opinions of the Sunni scholars will be explained, and then we will discuss the points of view of the Shia scholars. Sunni Muslim jurists also consider this type of sperm donation to be haram (not permissible) and argue that, firstly, without a doubt, this action leads man to the circle of animals and plants and excludes him from humanity and civil society; it is an ugly crime and a great sin, which has the same nature as adultery, and their result (intentionally depositing a man's semen in the womb of a woman that is not his wife) is the same (16-17). Secondly, it is inferior in comparison with adoption, which is forbidden in Islam, because in adoption, it is known that this child belongs to another person, but in a gamete or embryo donation, it is not known and a foreign party enters the lineage. Citing the Quran verse (Ahzab: 5), they believed that, as God says in this verse, children are attributed to their fathers, while in this type of insemination, mixed lineage occurs. In embryo donation, the child is attributed to the couple while it is not formed from the father's sperm, and he knows that this child does not belong to him, and as a result, he must reject the child, otherwise, there will be a problem in the lineage (18).
There is a difference of opinion among Shia scholars regarding the use of donated sperm. Applying this method, few scholars approve of sperm donation, like Ayatollah Khamenei, Seyyed Mohammad Mousavi Bejnarodi, Ayatollah Mazaheri, Ayatollah Mousavi Ardabili, etc., and more are opponents (Imam Khomeini, Seyyed Mohammad Reza Mousavi Golpayegani, Mohammad Fazel Lankarani, Hossein Vahid Khorasani, Ayatollah Sistani, Ayatollah Boroujerdi, Ayatollah Makarem Shirazi, Ayatollah Nouri Hamdani, etc.). According to Ayatollah Khamenei's opinion, if the forbidden conditions such as non-permissible looking or touching, etc. do not occur, it is possible to use a third-party sperm (not the husband's) for fertilization with a woman's ovum. However, it is obvious that the woman's spouse will not be the father of the child. As mentioned in the review of other authors based on the above fatwa, "These children are not related to the infertile man" (19). This child is legally eligible for all parental rights and obligations from the sperm donor. According to the verses (Furqan: 54; Sajdah: 8) and traditions, some of the Shia jurists of the past and present believe that the child is related to the owner of the sperm, and in fact, the child's father will be the owner of the sperm. Some other jurists believe that to attribute the child to the owner of the sperm, a child must be born as a result of the intercourse between the woman and her husband (20). If, according to a recent opinion, the owner of the sperm is not related to the child, then who will be the father of the child?
So, if the sperm donor is the true and legal father of the child, he is in charge of all duties, including paying the child's expenses and all fatherly duties such as maintenance, education, care, and love for the child, and he should not fail to fulfill these duties. In this case, no man will enter the sperm donation process to help infertile couples. Also, psychologically, it may not be desirable to have a child with a woman other than one’s wife.
For the above reason, in most cases, the sperm sample is taken from the sperm bank (located in the Fertility and Infertility centers), and the donor does not have any information about the recipient couple. An infertile couple can do the paperwork for full custody of their child getting help from a lawyer. In this circumstance, the details of the sperm donor remain confidential with the sperm bank. Of course, the uncertainty of the child's relative relationship with the parents will cause emotional trauma and confusion for the family receiving a gamete and will cause emotional and psychological trauma, which will be extremely harmful to such a child, the family receiving the embryo, and society. (21). It should be noted that although adoption is another option for infertile couples, it may not be considered a suitable alternative to ARTs (14). Despite the approval of the law for the protection of underprivileged children in 1975 and the legalization of adoption according to the approved conditions, today there are social and cultural resistances against adoption by infertile couples (22).
With the acceptance of embryo donation and the legalization of gamete donation (23), there are still many questions that must be addressed. Adequate counseling should be given to families regarding the complications, possible risks, legal issues, psychological consequences, and genetic characteristics of this procedure. Infertile couples must also get information about the following concerns from specialists in relevant clinics, psychologists, and religious scholars: the inability of the child to know his genetic background if the donor is unknown, Personal and cultural issues such as feeling ashamed or frightened about receiving sperm from unbelieving donors, the future concern for the marriage of the child resulting from fertilization of the embryo or donated gametes with his or her mahram (siblings) (necessity of conducting a DNA test) and the role of religion in sperm donor's and recipient's beliefs regarding the permissibility of this practice.
Conflicts of interest
Authors declared no conflict of interest.