Why is it that Canada, a country of 12 million adult men, has only 33 sperm donors to supply its thousands of infertile couples? That's the question being asked by some fertility doctors as many couples look elsewhere for help growing their families.

Canada once had about two dozen sperm banks. But in 2004, the federal government passed the Assisted Human Reproduction Act, which outlawed payment to sperm or egg donors. The only money that has been allowed to change hands is for expenses incurred in the donation process, such as the costs of traveling to the clinic.

Five years later, there are very few Canadian sperm donors willing to donate for free, says Dr. Tom Hannam of the Hannam Fertility Centre in Toronto. That's left many couples, especially those among visible minorities, without many choices.

"Today, there is one South Asian donor for all of Canada," he says, noting that couples are often shocked at the limited choices.

"There is a significant shortage of donor semen in this country, yes."

Contrary to popular thought, becoming a sperm donor is not a simple as filling out an application, filling a cup and then leaving, cheque in hand. In fact, of every 100 men who apply to donate, only five qualify.

Donors have to be screened through several appointments, filling out questionnaires on their family history, providing sperm samples, and undergoing blood work and physical exams. They also have to commit to providing samples once a week on an ongoing basis.

Egg donors have to undergo the same screenings as well as many more doctors' visits. They have to inject themselves with fertility medications and undergo uncomfortable procedures to extract the eggs.

For this, they are only compensated for expenses they can prove with receipts. With compensation so restricted, few Canadians have been willing to donate to help couples achieve their dreams of a family. So doctors and patients have had little choice but to use sperm and eggs from south of the border.

One of the biggest suppliers of donor sperm is Outreach Health Services which imports and distributes semen for assisted reproduction clinics across Canada. The company imports sperm from an agency that collects primarily from men in Georgia and northern Florida, where donors are paid about $100 per visit.

With so much sperm coming from the States, some estimate that up to 80 per cent of babies conceived in Canada through donor sperm have American DNA.

Some scratch their heads at Canada's seeming hypocrisy. On the one hand, Canada is okay with clinics importing sperm from paid foreign donors in the States, yet won't allow clinics in Canada to compensate potential Canadian donors.

"We are importing sperm that is paid out, outright. This makes absolutely no sense to me," says Dr. Alfonso De Valle of ReproMed, one of a handful of sperm banks in Canada.

De Valle thinks a better solution would be to offer donors "a reasonable reimbursement" that covers their expenses but doesn't turn sperm into a commodity.

Dr. Cliff Librach of the CReATe Fertility Centre in Toronto says when the AHR Act passed, the government promised regulations on reimbursing "reasonable expenses," but so far none have come.

"The legislation said donors could only be compensated for expenses that could be receipted. There was a grace period where people could be compensated for non-receipted period and we've been in that grace period ever since," he tells CTV.ca, explaining how they've managed to keep the Canadian donors they have.

Those non-receipted expenses include such thing as compensation for time off work and costs of attending appointments. He says for the amount of energy and discomfort donors undergo, the compensation is very modest.

In Britain, the ban on paying donors has created such a critical shortage, officials are considering reinstituting compensation. Lisa Jardine, the head of the Human Fertilisation and Embryology Authority, suggested that setting compensation standards and regulating them would help stem the flow of British couples who travel for fertility treatment abroad, where facilities may not be monitored and where donors may be exploited.

Here in Canada, clearer regulations on compensation could be a long time coming. That's because in April 2008, the Quebec Court of Appeal struck down dozens of provisions of the Reproductive Act. It deemed the sections unconstitutional because they encroached on the province's jurisdiction over health legislation.

In response, the federal government appealed the decision to the Supreme Court of Canada. It heard arguments this past spring, but it's unclear when the Supreme Court will issue a decision.

Librach says the hope is that if the Supreme Court strikes down the sections of the AHR Act that banned donor payment, the provinces will take over compensation regulation.

"A lot of us in the field are hoping the provinces will prevail so that they can then regulate this better so there will be allowance for sperm banks to open up," he told Canada AM.

If the compensation sections are upheld, the federal government's planned regulations will impose such tight restrictions on paying sperm and egg donors, he says, it could result in even fewer donors willing to offer their sperm and eggs to those who need them.

"What they're proposing is an amount so low, it would actually cost the donor money to donate their sperm," says Librach.

With a report from CTV medical specialist Avis Favaro and producer Elizabeth St. Philip