Portal de Periódicos da CAPES

Sperm donor anonymity: a concept rendered obsolete by modern technology

2018; Elsevier BV; Volume: 109; Issue: 2 Linguagem: Inglês

10.1016/j.fertnstert.2017.12.011

1556-5653

Peter G. McGovern, William D. Schlaff,

Organ Donation and Transplantation

The use of donor sperm began as a medical practice with a level of secrecy bordering on shame. In the United States, donor sperm insemination was first performed by Dr. William Pancoast in 1884 at Thomas Jefferson Medical College in Philadelphia. The patient was never told, and it is unclear whether the husband was completely informed as to exactly what was occurring. This was done to prevent “irreparable harm” to the resultant child and the marriage. The case was not published until 1909, 25 years later. Over the following decades, donor insemination was performed in secrecy. It is unclear how much these couples understood about the process, but it is extremely unlikely that a clear explanation of the procedure was provided or that informed consent, as we understand it today, was ever obtained. Medical students and residents were commonly chosen as donors for reasons of convenience; some of these men may well have been reluctant but felt pressure to participate. It is certain that they rarely if ever had a detailed and informed discussion regarding the medical or long-term implications of their decision to become donors. Due to a poor understanding of how to accurately time the procedure, the inseminations were often repeated daily for 4 to 5 days. This makes it likely that multiple donors would have been recruited to assist in providing these samples. Almost certainly, the patient would not have been told about the use of multiple different donors; and, of course, the samples were used fresh, and the donors did not undergo any type of screening. Anonymous sperm donation using fresh specimens continued to be the governing concept in practice in the United States up until the 1980s. Inseminations were performed through private offices as well as university programs, and bidirectional confidentiality was almost always maintained so that the couple would not know the sperm donor's identity, and the sperm donor would not know the recipient's identity. Donor pools were typically quite small, and donor matching was performed by the physician or, more commonly, the practice staff or nurses. Patients were rarely if ever given a choice or any information about the donor other than his general health and racial group. Donors were typically never informed about whether their samples had indeed resulted in any children to protect their peace of mind. A lack of state laws protecting the rights of either sperm donors or donor sperm recipients was perceived to make this type of confidentiality the safest course for all. Reports published in the mid-1980s of HIV transmission through use of donor sperm insemination (1Stewart G.J. Tyler J.P. Cunningham A.L. Barr J.A. Driscoll G.L. Gold J. et al.Transmission of human T-cell lymphotropic virus type III (HTLV-III) by artificial insemination by donor.Lancet. 1985; 2: 581-585Crossref PubMed Scopus (207) Google Scholar) led to acutely heightened concern regarding the potential for infectious disease transmission. In 1988 the Centers for Disease Control and Prevention (2Centers for Disease Control and Prevention Semen banking, organ and tissue transplantation, and HIV antibody testing.MMWR Morb Mort Wkly Rep. 1988; 37: 57-58PubMed Google Scholar) along with American Fertility Society, the American College of Obstetricians and Gynecologists, and the American Association of Tissue Banks recommended that donor insemination should be performed only with frozen sperm after 6 months of quarantine. Although this approach has theoretically lowered the risk of infectious disease transmission, which was rare even before the new guidelines were published, it also has added to the cost and complexity for both patients and providers. This development made it unrealistic for small programs to maintain donor banks, and it prompted the growth of large commercial sperm banks, which could afford the screening and infrastructure costs and ultimately came to provide specimens for most inseminations in the United States. One result of this transition was that there were much more detailed and complete records identifying the sperm donors responsible for most of the inseminations being performed. In 2005 the U.K. Human Fertilization and Embryology Authority determined that donor-conceived children should be allowed to obtain donor identity information upon request when they reach age 18 (3Human Fertilisation and Embryology AuthoritySEED Report: A report on the Human Fertilisation and Embryology Authority’s review of sperm, egg and embryo donation in the United Kingdom. Human Fertilisation and Embryology Authority, London2005Google Scholar), and other countries soon followed suit. This was anticipated to lead to significant psychosocial trauma and family stress, but most families seemed to take the change in stride, and reproductive medical care overall did not seem to be greatly affected. The evolving process in Britain has been mirrored in some ways by developments in the United States. Mental health professionals far more consistently recommended that couples disclose the origin of sperm (i.e., a donor) to their offspring, and a trend to increase openness in many societal situations has been manifested in this field as well. Popular culture has enthusiastically embraced the idea of children tracking down their “anonymous” sperm donors, and several movies have promoted discussion of issues of anonymity. In Delivery Man (2013), starring Vince Vaughn, one man's donations produced hundreds of children, some of whom he sets out to meet on a cross-country journey of apology and self-discovery. In The Kids Are All Right (2010), when the teenage twins of a lesbian couple locate and establish contact with their sperm donor, the unsuspecting donor is, of course, delighted and desires a relationship with the twins, thereby throwing the relationship between parents and children into turmoil. Despite these trends in U.S. popular culture, no formal legislative initiative has addressed or codified the requirement for more open donor disclosure that has been adopted in other countries. At present we feel that this field is on the verge of a major transition, which will occur with or without our concurrence. The legacy of embarrassment and shame regarding the use of donor sperm, largely derived from regrettable beliefs that link male sexual potency and reproductive potential, is clearly waning. However, we still have not come to grips with how we as a specialty feel about full disclosure of the identity of donors at a time when society and technology may soon be making that decision for us. Currently patients and couples can continue to pursue donor insemination and maintain the illusion of privacy and anonymity of their chosen donor. At the same time, we note that recently an adult child who had been conceived using donor sperm was contacted within 2 weeks of using Ancestry.com by a person claiming to be her third cousin. After contacting her “cousin” then using Facebook, in short order the biological parent's sperm donor was revealed (K. Hall, Ph.D., personal communication). None of this required any use of records from a donor sperm bank or clinic, nor did it involve hiring a private detective. In the comfort of one's home, a cheek swab and a little time on social media can easily penetrate the “anonymity” of the sperm donation process. Indeed, as reported by PBS Independent Lens in 2015, a number of organizations promoting strategies and databases to identify sperm donors are now available online (4Who am I? Resources for donor-conceived people and their families. PBS: Independent Lens, August 11, 2015. Available at: http://www.pbs.org/independentlens/content/donor-unknown_donor-conceived-resources-html/.Google Scholar). Thus, in one quick stroke, technical advances and the availability of genetic information, facial recognition software, and social media have crushed the illusion of donor and recipient privacy like a paper-mache castle. How will these developments affect the medical practice of infertility and the business of sperm (or egg) banks? Only time will tell, but we suspect that the current generation of sperm donors (who must be under 40 years of age) are likely to maintain Facebook accounts and use social media on a regular basis. Via social media, they will disclose—to a vast network of friends and acquaintances—personal information about their daily lives and opinions that older generations might find shocking. We think it is likely that they will be much more comfortable with being identified by offspring as compared with the donors in the past. Indeed, in December 2016 ABC News reported that 70% of donors at the Sperm Bank of California agreed to give up their anonymity after being counseled about the process (5Miller, J. Sperm-donor child to meet her father. ABC News, December 13, 2016. Available at: http://abcnews.go.com/WNT/Health/story?id=129948&page=1.Google Scholar). Given the trajectory of this social phenomenon we think it will become increasingly common for children conceived through donor insemination to try to identify and establish contact with the donor. We should acknowledge that this can now happen as soon as the children become old enough to use the available techniques for themselves—even if disclosure laws upon reaching age 18 like in Great Britain, Italy, Australia, and elsewhere never become law in the United States. Patients, especially heterosexual couples for whom secrecy would be more possible, will have to come to terms with the fact that their child(ren) will likely learn about the origin of their conception. Further, their tech-savvy offspring are fairly likely to be able to identify the actual source of the gametes, no matter what the wishes of the parents or donor might be. As our patients are contemplating this new reality, we should rethink how we counsel them and what sperm banks should tell donors in this new world where anonymity can no longer be realistically promised. It seems timely to engage in a thoughtful dialogue about proactively deciding that donor records will be made available to the children who ultimately decide they would like to know the identity of the donor whose sperm initiated their conception. It is no massive leap to anticipate that in the future these issues will have an impact on children conceived through donor oocytes and embryos, which is all the more reason to take serious stock of our present policies and approaches.