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ARTIFICIAL INSEMINATION
BY DONOR
(AID)
Artificial
insemination by donor (AID)
is "the technique used to obtain a human conception through the transfer
into the genital tracts of the woman of the sperm previously collected from a
donor other than the husband." (l) This procedure is also called heterologous
artificial insemination. (2)
A
related procedure is confused
artificial insemination (CAI), a procedure which employs a mixture of
sperm from the husband and sperm obtained from a
donor. (3)
Policy
Artificial insemination involving donor
sperm (AID) is
never permissible.
Source of Policy
The
Instruction on Respect for Human Life in
Its Origin and on the Dignity of Procreation (Donum Vitae)
from the Congregation for
the Doctrine of the Faith (1987) renders a
negative judgment on such procedures:
Through IVF and ET and heterologous artificial insemination,
human conception is achieved through the fusion of gametes of
at least one donor other than the spouses who are united in
marriage. Heterologous artificial
fertilization is contrary to the
unity of marriage, to the dignity of the spouses, to the vocation proper to parents, and to the child's right to be
conceived and brought into the world in marriage and from marriage.
...These reasons lead to a negative moral judgment
concerning heterologous artificial
fertilization: consequently fertilization of
a married woman with the sperm of a donor different from her
husband and fertilization with the husband's sperm of an ovum
not coming from his wife are morally illicit. Furthermore, the
artificial fertilization of a woman who is unmarried or a widow,
whoever the donor may be, cannot be morally justified. (4)
____________________
1. Vatican Congregation for the Doctrine of the Faith,
Instruction on Respect for Human Life in Its Origin and on the Dignity of
Procreation (Washington, DC: United States Catholic Conference, 1987), II,
p. 22.
2. Ibid.
3.
Ronald Munson (ed.), Intervention and Reflection: Basic Issues in Medical Ethics, 6th ed.
(Belmont, CA: Wadsworth Publishing,, 2000), p. 670.
4. Vatican Congregation for the Doctrine of the Faith,
Instruction on Respect for Human Life in Its Origin and on the Dignity of
Procreation, II.A.2., pp. 24-5.
COMMENTARY
ARTIFICIAL INSEMINATION BY DONOR (AID)
Reasons Advanced for Using AID
Artificial
insemination by donor may be sought by a married couple "if the male
partner suffers from severe sperm problems (extremely low count, no motile
sperm, no sperm with normal morphology, sperm without the ability to penetrate
the egg or the complete absence of sperm)." (1) This would include men
suffering from infertility due to radiation or chemotherapy treatment for
cancer, congenital problems, spinal cord injuries, sexually transmitted diseases
and infections such as gonorrhea, and vasectomies which cannot be successfully
reversed. (2) Thus the procedure is
sometimes referred to as therapeutic donor
insemination (TDI). (3)
Artificial
insemination by donor may also be sought by a married couple when there is a
rhesus (RH) incompability between husband and wife. (4)
Or again, they may seek it for
genetic reasons, for example, when the husband is the carrier of a dominant gene
for a genetic disorder or when both husband and wife are carriers of a recessive
gene for a genetic disorder. (5)
AID
may be seen as preferable to adopting a child for a number
of reasons. Both husband and
wife can be involved in the pregnancy from conception onward, sharing the
experience of delivery and the
early days of the baby's life. The
desire on the part of the mother to carry a child is satisfied as it cannot be
in adoption. Further, the husband and wife can exercise control over the child's
prenatal care and need not worry that something in the prenatal environment may
cause problems later in the child's life. Moreover,
there is a greater chance that the
child's physical appearance will at
least match that of the mother and, if there are several
children, they are more likely to resemble one another.
There also need be no subconscious fear of the
sudden appearance of the natural mother, as there may be in adoption.
Finally, some couples choose AID because of the privacy it offers; the
adoption of a child is seen as a public statement about their infertility. (6)
Some
single women and lesbian couples have used AID in order to bear a child. (7) In
conjunction with surrogate motherhood, AID
can be used by single men to have a child.
AID
has also been used as part of a eugenic program to produce superior human beings. One such program was the
Repository for Germinal Choice in San Marcos, California, whose
donors of germinal material consisted of Nobel Laureates in science and
other high achievers. The recipients were selected young women of superior
health and intellect, under 35 years of age,
with sterile husbands who agreed
to the use of AID. The aim of the
project was to increase the number of offspring of the
most creative scientists of our time. (8) In a similar vein, the Fairfax Cryobank in Fairfax,Virginia
has a special (and more expensive) category of sperm donors called "Fairfax
Doctorate," consisting of "donors who are in the process of or who
have completed their doctoral degrees." (8) These individuals include "chiropractic, dental, law (juris
doctorate), medical, optometry, and Ph.D. students and graduates." (9)
The Procedure
A sperm donor may be someone known to the recipient or an anonymous
donor. (10) Fresh or frozen sperm
may be used in the procedure. Since
the advent of the AIDS epidemic, the use of frozen sperm is recommended so that
it can be quarantined for appropriate testing of the donor over
a
period of time. (11) Sperm donors
are "recruited from a number of locations, graduate and undergraduate
colleges being the most common." (12)
Potential sperm donors are screened before being accepted by a clinic.
This screening process can include taking a medical and genetic history
of the applicant and family members, a physical exam, semen analysis, and
testing for various infectious diseases and genetic disorders. (13)
Clients of sperm banks may select the donor.
Attempts are made to match the donor with the clients in terms of ethnic
background, blood type, and physical characteristics such as height, weight, and
eye and hair color. (14) However,
the selection process may well go beyond this.
Some sperm banks make available both extensive medical histories (which
include medical and genetic information on the donor, donor siblings, parents,
aunts and uncles, and grandparents) and personal files on the donor (which
indicate personality test results, personal interests and goals, academic
scores, military record, and specific physical and facial features).
Donor essays and audio interviews may also be available. (15)
Artificial insemination of the woman may be preceded by the use of
fertility drugs to stimulate the development of more than one follicle in the
ovaries. (16) The
insemination may be either intra-cervical, placing the raw ejaculate into the
cervix (ICI), or intra-uterine, placing a washed specimen directly into the
uterus (IUI). (17) The
success rate of AID is an average of 50% pregnancies after six attempts. (18)
The cost of a single dose of donor semen varies from one to several
hundred dollars. (19) Additional costs may be incurred for the insemination
procedure itself, sperm washing (if done),
and medications to stimulate ovaries and induce ovulation (if these
procedures are used) with concomitant monitoring through ultrasound and blood
testing. (20)
Ecclesiastical Opposition to AID
Artificial
insemination by donor is not morally permissible because it
removes procreation from within the marriage bond; see the handbook entry
General Policy on Assisted Reproductive
Technologies (ART), principles 1 and 2.
This position was clearly stated by Pope Pius XII:
Artificial insemination outside matrimony must be condemned as
immoral purely and simply.
In fact the natural law and divine positive law state that
the procreation of new life cannot take place except in marriage. Only
matrimony safeguards the dignity of the partners--in the
present case principally that of the woman--their personal
well-being, and guarantees at the same time the well-being of
the child and his upbringing.
...Only
the husband and wife have the reciprocal right on the body of the other for the purpose of generating new life: an
exclusive, inalienable, incommunicable right. And that is as
it should be, also for the sake of the child. To whoever gives life to the tiny creature, nature imposes, in virtue of that
very bond, the duty of protecting and educating the child. But when the
child is the fruit of the active elements of a
third person--even granting the husband's consent,--between
the legitimate husband and the child there is no such bond of
origin, nor the moral and juridical bond of conjugal procreation. (21)
Anecdotal evidence indicates that feelings
of adultery can accompany the use of AID by married couples:
A
couple who had been treated for male infertility for three years had just
finished their second and last IVF cycle in which they did not get
fertilization. ...They made an appointment with the psychologist to discuss
donor insemination. The husband
stated that he was ready to move on to DI... His wife was far more hesitant,
telling the psychologist timidly, "I've never told anyone this, but my
husband is the only man I have ever had sex with.
I'm afriad that having another man's sperm inside me would make me feel
like I was sleeping with someone else."
Men similarly
may express feelings of hesitancy about DI due to fears that if their wife
conceives, they will feel as if she is carrying another man's child. (22)
Pius XII notes as well that only matrimony guarantees the well-being of
the child and his or her upbringing. This
point is especially relevant to the practice of single women using AID to have a
child. A child needs a certain type
of environment in which to develop and flourish and, ideally, this is provided
by the marital setting. (See the entry General
Policy on Assisted Reproductive Technologies.)
Also noteworthy is the statement of Pius XII that "to whoever gives
life to the tiny creature, nature imposes, in virtue of that very bond, the duty
of protecting and educating the child."
Indeed, ethicists have raised the question of the moral responsibilities
a sperm donor has to the child produced using his sperm, and whether it is
appropriate to compare donating sperm to the case of donating blood where the
donor is simply free to walk away after making his or her donation. (23)
Psychological Dimensions of AID
A Canadian study of 120 couples using AID indicated that use of this
procedure "generates intense and troublesome feelings both within and
between spouses." (24). The researchers found that "common reactions for men are
loss of self-esteem, emotional withdrawal, and temporary impotence." (25)
For their part, women experience "anger, guilt, and a wish to make
reparations." (26)
Artificial insemination by donor involves a loss of genetic continuity.
Most children "have some qualities of each parent that are
recognizable." (27) Couples
contemplating AID, however, "must face their feelings of sadness about not
being able to see some of the father's traits reflected in their children."
(28) Indeed, "some couples are
so troubled by this reality that they ask to have the husband's semen mixed with
the donor's, hoping to hold on to the possibility that he will be the genetic
father." (29)
When a couple is considering AID, "the husband often wonders whether
he could love 'another man's child'." (30)
Couples who have a strong sense of family roots may feel that donor
insemination is severing their ancestral ties and that they may disappoint their
families by choosing AID. Concomitantly,
they may worry that, if their family learns about their use of AID, the
grandchild will not be loved or accepted in the same way a biological child
would be. (31)
In contrast to the case of adoption in which neither parent is
biologically related to the child, couples using AID may worry that the
biological inequality may cause the husband to distance himself if a crisis
develops with the child, or cause him to feel unauthentic or second class. (32)
Participating in AID can also have psychological ramifications for the
sperm donor. The following case illustrates the impact which may occur
later in his life:
A
psychologist had the opportunity to meet with a thirty-five-year-old physician
who had been a sperm donor several times while in medical school.
For years after he graduated, he rarely thought about having been a
donor. As his donor offspring were
about to enter adolescence, however, he found himself wondering whether he might
accidentally bump into a young man who looked and was built just like him.
The donor himself was the spitting image of his father, a fact that
countless people had remarked on throughout his life.
He had always assumed that if he had sons, they too would carry on this
family resemblance. This thought
had begun to plague him more frequently, occasionally intruding in his work, and
he was contemplating whether to seek counseling.
Another reason that this issue probably surfaced was at the time he was
engaged, and he and his fiance planned to have children.
He wondered about whether he was still fertile and how he would feel if
he learned otherwise. (33)
A sperm donor must face the fact that "he will have offspring whom
he will not know." (34) Further,
"if the donor has children of his own, they will have half-siblings whom
they do not know," and the donor "must think about whether he would
tell his children about their unknown genetic siblings." (35)
A sperm donor must also "consider whether he will tell his spouse
(or future spouse) and how his spouse might react to the information." (36)
In sum, there are significant psychological and practical consequences of
using AID which need to be considered by anyone contemplating its use.
Nonecclesiastical Documents
The
Council on Ethical and Judicial Affairs of the American Medical Association does
not oppose the practice of AID, even in the case of single women and lesbian
couples. Guidelines are presented
for the use of this procedure on such issues as the screening of donors for
infectious or inheritable diseases, the maintenance and confidentiality of
records, the establishment of limits on the number of pregnancies resulting from
a single donor source in order to avoid future consanguineous marriages or
reproduction, informed consent procedures, legal rights and obligations, and
compensation for donors. (37)
Legal Considerations
In almost all cases, the law accords the semen donor no
parental rights. For example, California Civil Code 7005, entitled
"Father of Child Conceived by Artificial Insemination," stipulates
that "when proper consents are signed and donor insemination is performed
under the supervision of a physician, the husband is treated in law as if he
were the natural father of the child thereby conceived and that the semen donor
is treated in law as if he were not the natural father." (38)
One exception is the Colorado case In
re R.C., which establishes that the rights and duties with respect
to a child conceived by artificial insemination do not apply
to terminate a semen donor's parental rights in situations
involving a known donor and an unmarried recipient who had
expressly agreed at the time of the artificial insemination
that the donor could be treated as the father if a child was
conceived. (39)
1. Infertility, Gynecology, & Obstetrics (IGO) Medical Group of San
Diego, The Fertility
Institute,"Therapeutic
Anonymous Donor Insemination," http://www.igomed.com/fertilityserv. htm.
2. Susan Lewis Cooper and Ellen Sarasohn Glazer, Choosing
Assisted Reproduction Social,
Emotional & Ethical Considerations (Indianapolis, IN: Perspectives
Press, 1998), pp. 157-8.
3. IGO Medical Group of San Diego, The Fertility Institute,
"Therapeutic Anonymous Donor Insemination," http://www.igomed.com/fertilityserv.htm;
Infertility and IVF Center, St. Louis, MO, "Artificial Insemination,"
http://www.ivfctrstl.org/ai-meanings.htm.
4.
International Federation of Fertility Societies, "International Consensus
on Assisted Procreation," Artificial Insemination with Donor Sperm, http://www.mnet.fr/iffs/a_artbis.htm.
5. Cooper and Glazer, Choosing Assisted Reproduction, pp. 158-9.
6.
Edward D. Schneider, "Artificial Insemination," in Edward D. Schneider
(ed.), Questions About the Beginning of Life (Minneapolis: Augsburg, 1985),
p. 14; Cooper and Glazer, Choosing
Assisted Reproduction, pp. 165-7; International Federation of Fertility
Societies, "International Consensus on Assisted Procreation,"
Artificial Insemination with Donor Sperm, http://www.mnet.fr/ iffs/a_artbis.htm.
7.
International Federation of Fertility Societies, "International Consensus
on Assisted Reproduction," Artificial Insemination with Donor Sperm,
http://www.mnet.fr/iffs/a_artbis.htm; Council on Ethical and Judicial Affairs of
the American Medical Association, Current
Opinions, E-2.05 "Artificial Insemination by Anonymous Donor,"
http://www.ama-assn.org/apps/pf_online/ pf_online?f_n=browse&doc=policyfi.../E-2.01HTM
.
8.
D. Gareth Jones, Brave New People
(Grand Rapids, MI: Eerdmans, 1985), p.
91-2.
9.
Fairfax Cryobank, "Glossary," "Schedule of Fees," http://www.fairfaxcryobank.com.
10.
Cooper and Glazer, Choosing Assisted
Reproduction, pp. 168ff.; Council on Ethical and Judicial Affairs of the
American Medical Association, Current
Opinions, E-2.04-2.05, http://www.ama-assn./org/apps/pf_online/pf_online?f_n=browse&doc=policyfi.../E-2.01HTM.
11.
Cooper and Glazer, Choosing Assisted
Reproduction, p. 177. See also
the Council on Ethical and Judicial Affairs of the American Medical Association,
Current Opinions E-2.05
"Artificial Insemination by Anonymous Donor," http://www.ama-assn.org/apps/pf_online/pf_online?f_n=
browse&doc=policyfi.../E-2.01HTM.
12.
Ibid., p. 189.
13.
Fairfax Cryobank, "Donor Information," http://www.fairfaxcryobank.com;
IGO Medical Group, The Fertility Institute, "Therapeutic Anonymous Donor
Insemination," http://www.igomed. com/fertilityserv.htm.
14.
IGO Medical Group, The Fertility Institute, "Therapeutic Anonymous Donor
Insemination," http://www.igomed.com/fertilityserv.htm.
15.
Fairfax Cryobank, "Donor Profiles," http://www.fairfaxcryobank.com.
16. Infertility and IVF Center, St. Louis, MO, "Different Meanings of Artificial Insemination," http://www.ivfctrstl.org/ai-meanings.htm.
17.
Ibid.; IGO Medical Group, The
Fertility Institute, "Therapeutic Anonymous Donor Insemination," http://www.igomed.com/fertilityserv.htm.
18,
International Federation of Fertility Societies, "International Consensus
on Assisted Procreation," Artificial Insemination with Donor Sperm, http://www.mnet.fr/iffs/a_artbis.htm.
19.
The Fairfax Cyrobank's fee schedule for donor semen ranges between $115 and $275
per dose; http://www.fairfaxcyrobank.com. At
the Infertility and IVF Center in St. Louis, each dose of donor sperm ranges
between $165 and $380 in conjunction with intrauterine insemination; http://www.ivfctrstl.org/ai-cost.htm.
Cooper and Glazer report that "The price of a vial of sperm is usually
between $150 and $300, plus the fee for the insemination." (Choosing
Assisted Reproduction, p. 167.)
20.
Infertility and IVF Center, St. Louis, MO, "Artificial Insemination,"
http://www.ivfctrstl.org/ai-cost.htm.
21.
Pope Pius XII, "Christian
Norms of Morality" (Sept. 29, 1949) in
Kevin D. O'Rourke, 0.P. & Philip Boyle, Medical
Ethics Sources of Catholic Teachings, 3rd ed.
(Washington, DC: Georgetown University Press, 1999), p. 66.
22.
Cooper and Glazer, Choosing Assisted
Reproduction, p. 164.
23.
Ronald Munson, Intervention and Reflection
Basic Issues in Medical Ethics, 6th ed. (Belmont, CA: Wadsworth,
2000), p. 670.
24,
Cooper and Glazer, Choosing Assisted
Reproduction, p. 161.
25.
Ibid.
26.
Ibid.
27.
Ibid., p. 162.
28.
Ibid., p. 162.
29.
Ibid., p. 162.
30.
Ibid., p. 163.
31.
Ibid., p. 163.
32.
Ibid., p. 165.
33.
Ibid., p. 184.
34.
Ibid., p. 184.
35.
Ibid., p. 184.
36.
Ibid., p. 184.
37.
Council on
Ethical and
Judicial Affairs
of the
American Medical
Association, Current
Opinions E-2.04 "Artificial Insemination by Known Donor" and
E-2.05 "Artificial Insemination by Anonymous Donor," http://www.ama-assn.org/apps/pf_online/pf_online?f_n=browse&doc=policyfi.../E-2.01HTM.
38.
IGO Medical Group, The Fertility Institute, "Therapeutic Anonymous Donor
Insemination," http://www.igomed.com/fertilityserv.htm.
39.
In re R.C., 775 P 2d 27 (Colorado
1989).
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