Sarah in many ways is a typical 16-year-old girl. She attends high school, enjoys shopping and has plenty of friends. She is, however, different in one important respect: she does not know her biological father—and probably never will. Sarah, who lives in British Columbia and asked that her real name not be used, was born after her mother visited a fertility clinic to be inseminated with sperm provided by an anonymous donor. Today, an important part of Sarah’s social and medical history is missing. The doctor who performed the insemination has divulged only the donor’s height and the color of his hair and eyes. Without knowing more, Sarah says she is left without answers to profound questions about her personal identity and genetic health. As she puts it: “I just want my basic right, which is my history.”
Sarah is not alone. But no one knows precisely how many share her plight. Health Canada estimates that anywhere from 1,500 to 6,000 babies are born in Canada each year as a result of so-called donor insemination. But because of haphazard record keeping that continues to this day, authorities are unable to be more precise than that. What is more, the lack of records leaves young adults like Sarah with no way of finding out whether hereditary diseases run in their father’s family. These children are also saddled with the psychological burden of never knowing their father. “We know from the lessons from adoption that if somebody knows nothing at all about a biological parent, a substantial proportion of people feel incomplete,” says Dr. Patricia Baird, who chaired the Royal Commission on New Reproductive Technologies.
“For the sake of the child, you need some social and medical history of the donor."
With Parliament resuming this week,
Health Minister Allan Rock is under mounting pressure to introduce legislation on reproductive technologies—first promised more than two years ago in response to the royal commission’s 1993 report. Advocates such as Nanaimo, B.C.based Shirley Pratten, who co-founded a
support group called the New Reproductive Alternatives Society in 1987, want Rock to create a national registry to track sperm donors and their offspring as they do in Sweden, New Zealand and parts of Australia. The registry would store and update a donor’s medical history throughout his life and allow the donor’s offspring to look up that information or contact the biological father. As well, limits on the number of children that a donor can father should be lowered from the 10 typically allowed by clinics, Pratten says. Unlike donating blood, she adds, a sperm donor’s duty does not end with a sample in ajar, and requires a lifelong commitment. “We believe,”
‘For the sake of the child, you need some social and medical history of the donor’
—Dr. Patricia Baird, Royal Commission on New Reproductive Technologies
Pratten says, “that donors are morally and ethically responsible for their children.”
Although the first recorded case of donor insemination took place well over a century ago—in Philadelphia in 1884—the practice is still often treated as a dirty little secret. There are several reasons for that. Few men are comfortable admitting that they are infertile, fearing their inability to procreate will be equated with impotence. Physicians have also been known to take a doctorknows-best approach by selecting a donor, then refusing to tell the woman anything about him in the name of protecting his anonymity. Some doctors have destroyed medical records for the same reason. Canada has no law ensuring the long-term preservation of these medical records. In Ontario, for example, the College of Physicians and Surgeons allows doctors to destroy files after 10 years of inactivity.
To address those perceived wrongs, Toronto sociologist Rona Achilles favors bringing donor insemination out of the closet.
“Male infertility has been hard to talk about and stigmatized—it can be a real blow to a man,” Achilles says. “Then to have this other guy who walks in and impregnates your wife ... well, you’ve got to talk about that.”
Achilles is, of course, speaking metaphorically. Under the procedure, a doctor injects donated sperm into the woman’s uterus. Canadian practitioners are required to use sperm that has been quarantined for six months to guard against AIDS. Beyond that, the industry is largely self-regulated and relies on voluntary guidelines established by groups like the Canadian Fertility and Andrology Society and the American Society for Reproductive Medicine. As for the users themselves, they typically fall into three categories: women whose husbands are infertile, single women and lesbians.
In recent years, most sperm banks have taken steps towards meeting the public’s growing demand for more information. One of them, Toronto-based ReproMed Ltd., has earned a reputation as a trendsetter, in part because it maintains its records indefinitely. Moreover, the sperm bank stores samples of the donor’s DNA and blood for
future medical screening. If one of a donor’s offspring, aged 18 or more, requests identifying information about his or her father, ReproMed will inform that donor. Then, if the donor consents, the two can meet.
But there are problems. ReproMed supplies non-identifying information about the donor’s physical characteristics, aptitudes and personality with every sperm sample shipped to a physician’s office. Where the system breaks down, however, is with the doctors and other health-care practitioners who perform donor insemination. Currently, no law requires physicians to pass along the information to the patient, says Cathy Ruberto, ReproMed’s assistant clinical director. The woman receiving the sperm, therefore, has to know what to ask for. “A lot of people still are not aware that that kind of information is available to them,” Ruberto adds. “All they need to do is ask.” In fact, a lot of people go through donor insemination without asking enough questions, not only about the donor, but also about the consequences of raising a child who will very likely never know his or her biological father. That was the case with two Toronto social workers—call them Jeff and Barbara—who found themselves in need of help in the early 1990s. Married, they both wanted a child, but Jeff was infertile. They opted for donor insemination under a procedure that eventually cost them about $2,000. The fertility clinic supplied the donor’s age, hair and eye color, profession, interests, skills and race. It did not, however, offer counselling. “Basically, the attitude was: ‘You can’t have a baby; you want a baby; we’re going to get you a baby,’ ” Jeff says. “There wasn’t any sense about what would happen later on, or any discussion about disclosure or advice about any other possible fallout.”
Jeff and Barbara now have a healthy five-year-old boy who loves sports. But because they never received any counselling, they lack answers to important questions. Jeff, for example, is stymied when asked whether the sperm bank he and his wife went to has kept up-
dated medical records of the donor. “I don’t know the answer to that,” he says. “I don’t think they ever told us.” All Jeff recalls the bank giving him is a list of medical tests performed to assess the donor’s health at the time the sperm sample was supplied. “We were given a printout and the impression that that would be all we ever wanted to know,” he says.
When the couple tried to have a second child about a year after their son was born, the experience horrified them. Barbara was in the clinic’s stirrups, moments from being inseminated, when her doctor casually told her that the sperm he would be administering belonged to the couple’s second choice of donor. She was stunned. When they had first visited the clinic, she and Jeff had picked two donors: a preferred choice and a backup. The preferred donor had fathered their son, and staff at the clinic had as„ sured the couple that any subset; quent children would be by the 8 same donor. But during the proli cedure, the doctor explained that £ the first donor’s sperm was frozen ¿ and unavailable. With Barbara in 3 shock, lying with her legs spread and feeling understandably vulnerable, and with inadequate time to weigh the consequences, she did not protest when the doctor went ahead. “In effect, the doctor gave her no choice to stop the process,” Jeff recalls. “It was outrageous.” Fortunately, he adds, his wife did not conceive, so they did not end up having children by two different fathers. (For unrelated reasons, the couple has since decided not to have a second child.)
Another concern lies with the law. Most provinces do not address a donor’s legal obligation to the children he fathers. Only Quebec, Newfoundland and the Yukon have amended their laws to sever the sperm donor’s legal responsibility for the child. Elsewhere, the legal vacuum has forced the courts to be creative. In 1995, an Ontario man estranged from his wife, who had a daughter who was conceived through donor insemination, was declared the girl’s father despite the absence of provincial law governing the reproductive technology. The judge, citing Ontario and federal legislation protecting the best interests of the child, ruled the girl needed a father since she would never know the anonymous sperm donor. In another case in Ontario last year, a lesbian lawyer took the rare legal step of trying to get herself declared the second mother of a child born to her partner as a result of donor insemination. The two women had lived together for seven years and separated. The judge awarded custody to the birth mother.
Despite the emotional hardships and bureaucratic inequities, Shirley Pratten in Nanaimo is quick to emphasize that donor insemination has made a lot of people happy by giving them wonderful children. “We’re not saying that this an awful procedure,” Pratten says. ‘We’re just saying there are some important issues to think about.” Jean Haase, a social worker with the department of reproductive endocrinology and infertility at the London Health Sciences Centre, agrees, adding that it is up to the would-be parents to get all their facts straight. “People have to think of themselves as consumers,” Haase says, “and not just vulnerable patients.” □
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