Ethical Considerations When Using an Anonymous Donor
Once upon a time, doctors advised infertile couples to keep the fact of donor conception a secret from everyone, including the child. It was thought to be an issue too confusing, to have a parent who was not biologically connected to his or her offspring.
Generally records were not kept of the donor, who came in at a scheduled time to provide fresh semen while the woman was waiting down the hall for insemination. Records were often obscured so that donors and recipients could not someday be linked.
Led partly by the lessons of adoption, however, today's families tend to be more motivated to share the truth of conception and origins with the child, as a birth right. And especially these days, with more importance placed on knowing ones genetic markers and family medical histories, being able to make a connection, however slight, with a biological donor has become increasingly encouraged.
When choosing a sperm bank and donor (and clinic), be sure that its policies about record-keeping and secrecy are similar to yours. And this can involve a bit of foresight. Invariably the women of young children and teenagers today who didn't consider biological history of much concern when picking a donor are regretting that oversight. Some have children with unexplained medical issues. Many have children asking questions about the donor that cannot be answered.
No matter how much information you have about a donor, of course, it might never be enough for a child who grows up burning to understand more about that missing person in his or her life. Or even for that child who has a subtle longing, or simple curiosity, to be able to know whether his or her big feet, or sense of humor, or interest in art, comes from the donor's side. Or for the person who would like nothing better than to be able to sit down across from the biological father (or mother, in the case of donor egg) and find similarities in appearance, mannerisms, interests. Or the young parent who is expecting your grandchild, and wishes more were known about the "other" side of the family.
To belabor the point, a strong philosophy of Choice Moms LLC founder Mikki Morrissette (editor of this book) is that every child should have the right to understand their genetic history if they want, just as every single woman who proactively and conscientiously wants to become a mother should be able to do so. A child's story of origin should belong, as much as possible, to that child, not "owned" and guarded by the adults who helped that child come into the world.Most adopted children who wish they could access their original birth record might say the same.
Many prospective parents focus on finding a donor with specific characteristics but don't pay as much attention to the policies of the sperm bank they plan to use. And this can have a profound impact on the family and the child someday.
In choosing a sperm bank, you are making a decision that will have lifelong consequences for your child. Do not pick a bank simply because it is the one recommended by your doctor (who might merely have the clinic's paperwork or a sperm bank's marketing materials in mind) Before you settle on a sperm bank, research its policies so that you can be assured it is one you will be happy with for the lifetime of your child. Banks differ significantly in terms of:
- Providing open donation. Each bank has their own policies regarding what information they release, if and how donor information is maintained over the years, and how much support they provide for youth, donors and parents before and after birth. A few banks whose donors were strictly anonymous in the past are sometimes willing to carefully and respectfully make contact with them to see if they might accept communication from offspring in hindsight. However, many parents also have reported disappointments, particularly if a child has become sick and the bank is unwilling or unable to find the donor to provide clues. Some banks are slowly changing policies to address some of these issues. Others are not. (The Choice Mom discussion board is one place to get input about sperm banks during the selection process. The ChoiceMoms.org website will have a directory of peer-led reviews in the future.) Be direct in asking questions: Any sperm bank should be able to answer questions about whether and how it communicates with its donors over time, both anonymous and open-identity, and what the experiences of its families have been like so far.
- Tracking Outcomes. After sperm vials are shipped, there is very uneven reportage of how many pregnancies or live births result. Some banks are much stronger than others at tracking this data. Only an estimated 40 percent of parents report a birth after the fact. Doctors don't always do the paperwork either. If there is a reason to make contact after the fact with families that share a donor's genes, currently it is nearly impossible to do so in a comprehensive way. It becomes difficult to measure the fertility of a donor's sperm: what is the miscarriage rate, inherited birth defects, live births? Limits on donor offspring (see below) also become rather meaningless without these reports.
- Family Limits. There are no regulations that require sperm banks to limit the number of offspring per donor. The American Society of Reproductive Medicine recommends no more than 25 offspring per population of 800,000. But since all U.S. sperm banks ship nationally, this doesn't offer a significant limit. Some donors are known to have 50 offspring. Others are estimated to have as many as 150, based on how many years they donated (each donation is split into multiple vials).
Having a donor with proven pregnancies is a plus, but some women are uncomfortable not knowing exactly how many live births have been the result, especially since they don't know what cities they live in. Each sperm bank will have a policy on its donor limits, and should be able to explain how they keep track of this. The Sperm Bank of California is one of the tightest ships in the business (it is a non-profit program), with no more than 10 families built from one donor (allowing for the fact that some families will prefer to have siblings from the same person) before he is retired from the program.
If an open donor is used, of course, he is likely to be much more cautious if the offspring is the 10th, or 30th, to contact him. Before that child is born, you are understandably more likely to be interested in finding a donor with many vials available, who meets many of your preferred characteristics. But if your child actually wants to make contact some day, or you don't like the idea of your child have dozens of half-siblings somewhere in the world, a bank with smaller donor limits - and known tracking abilities - might be beneficial.
Who regulates the industry?
The Food and Drug Administration provides some regulation, but its rules are primarily about safety protocol designed to prevent disease transmission, not related to factors that might come into play after a child is born. The nationally recognized accrediting organization in the U.S. is the American Association of Tissue Banks. The AATB has a rigorous inspection and accreditation program. Accreditation by the AATB is voluntary, and an expensive process for some of the smaller banks. State regulations vary widely and only the New York and California Departments of Health inspect the banks prior to issuing a license.
For any reliable sperm bank, all donors should be:
- Tested for sexually transmitted diseases. A donor's samples must be quarantined six months, at which time the donors are retested again. If they "pass," the original samples can be released to the public. This process must be taken for every donation, not simply done once per donor.
- Given an annual physical exam, and tested for a handful of genetic illnesses.
- Able to provide personal and family medical history to help evaluate the risk of hereditary illness. There is no guarantee, of course, that the donor (generally a college student) will know his history accurately. Many medical issues will not yet have come to light in his family background. And some donors aren't completely honest when they are trying to be admitted into the elite ranks of a paid donor program. A few sperm banks are discussing how to correct the imbalances of this system. Stay tuned to the ChoiceMoms.org website for updates.
One of the sticking points in the industry is that there are no regulations requiring sperm banks to track offspring health issues or make this information available to other families who used the same donor.
Many health issues have complicated causes, so it's not always as simple as knowing whether a donor (and/or the mother) carries a certain gene. But there have been several complaints lodged by Choice Moms, and others, about lack of disclosure or assistance when health issues come to light. Some sperm banks are reluctant to get involved with a potentially litigious situation.
A sperm bank should be able to tell you what its policy is regarding tracking and evaluating health information reported by families or donors, and how that has played out in the past. (We don't know of many sperm banks who haven't had to deal with this; especially the larger ones have had many clients and donors, and thus inevitably issues to contend with.)
Note that a growing number of independent websites and discussion groups have formed that connect donors directly with people who are in search of sperm. There obviously are no safeguards with this kind of contact. Many of the donors indicate they are giving altruistically, motivated only to help people create families. We are highly skeptical of anyone who chooses to work outside of a clinic setting, where they could provide altruistically as a directed donor, providing tested sperm that would pass a rigorous screening process. It might be tempting to get "free" sperm, but many individuals have reported that these donors tend to want to have sex, rather than donate for insemination.
