Artificial Insemination by Donor (AID)

ARTIFICIAL INSEMINATION BY DONOR (AID)

Explanation of Terms and Procedures  

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).