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Donor insemination or DI is the oldest and most widely practiced form of assisted conception. Until now, it has been assessed largely from a medical perspective. This book brings together an international group of social scientists to discuss the social, cultural, political and practical dimensions of DI, relating it to the wider debates about fertility treatment. Contributors consider the experience of DI from the viewpoints of all the parties involved, including those treated, the donors, the clinicians, and the children of DI.
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Donor Insemination: International
Social Science Perspectives

Donor insemination or DI is the oldest and most widely practised form of
assisted conception. Until now, it has largely been assessed as if an entirely
medical concern. This book brings together an international group of
social scientists to discuss the social, cultural, political and practical
dimensions to DI, relating it to the wider debates about fertility treatment
and the place of assisted conception in contemporary society. The contributors consider the experience of DI from the viewpoints of all the
various parties involved, including the recipients of the treatment, the
sperm providers, the clinicians, the people conceived and policy-makers
working in the area. The assumptions informing the world-wide practices
around DI and the reactions to it are critically examined, with reference
to cross-national perspectives, and to issues such as the language of DI,
gender, sexuality, ethnicity and identity.
KEN DANIELS is Associate Professor in the Department of Social Work,
at the University of Canterbury, Christchurch, New Zealand. He has
written widely on the policy issues and psychosocial aspects of assisted
conception, and is a member of the New Zealand National Ethics committee on Assisted Human Reproduction.

is Senior Lecturer in Sociology in the Department of
Social Policy, at the University of Newcastle, in England. She has written
extensively on the issues concerning families and identities raised by forms
of assisted conception, and is co-author (with Noel Timms) of Adoption,

ERICA HAIMES

identity and social policy.

Donor Insemination
International Social Science
Perspectives
Edited by

Ken Daniels and Erica Haimes

CAMBRIDGE
UNIVERSITY PRESS

PUBLISHED BY THE PRESS SYNDICATE OF THE UNIVERSITY OF CAMBRIDGE

The Pitt Building, Trumpington Street, Cambridge CB2 1RP, United Kingdom
CAMBRIDGE UNIVERSITY PRESS

The Edinburgh Building, Cambridge CB2 2RU, United Kingdom http://www.cup.cam.ac.uk.
40 West 20th Street, New York, NY 1001; 1-4211, USA http://www.cup.org
10 Stamford Road, Oakleigh, Melbourne 3166, Australia
© Cambridge University Press 1998
This book is in copyright. Subject to statutory exception and to the provisions of relevant
collective licensing agreements, no reproduction of any part may take place without
the written permission of Cambridge University Press.
First published 1998
Printed in the United Kingdom at the University Press, Cambridge
Typeset in 10/13pt Times New Roman in QuarkXPress™ [SE]
A catalogue recordfor this book is available from the British Library
ISBN 0 521 49709 4 hardback
ISBN 0 521 49783 3 paperback

KD:

To Tricia for her love, unstinting support and
many sacrifices

EH:

To my family, friends and Robin to thank them
for all their love and support.

Contents

List of
List of tables
Notes on contributors
Acknowledgements
List of abbreviations
1

figures

page viii
viii
ix
xi
xii

International social science perspectives on donor insemination:
an introduction

1

ERICA HAIMES AND KEN DANIELS

2

The users of donor insemination

7

JUDITH N. LASKER

3

Families created through donor insemination

33

ROBERT AND ELIZABETH SNOWDEN

4

The making of 'the DI child': changing representations of
people conceived through donor insemination

53

ERICA HAIMES

5 The semen providers

76

KEN DANIELS

6

The medical management of donor insemination

105

SIMONE BATEMAN NOVAES

7

Regulation of donor insemination

131

ROBERT BLANK

8

Donor insemination and'public opinion'

151

JEANETTE EDWARDS

9

Concluding comments

173

ERICA HAIMES AND KEN DANIELS

Index

179
vii

Figures

7.1 Regulatory mechanisms: a continuum
7.2 Progression of processes in private policy
7.3 Public role in making policy

page 134
136
138

Tables

5.1 Studies of the motivation of semen providers
7.1 Summary of DI regulations by country

vui

page 84
140

Figures

7.1 Regulatory mechanisms: a continuum
7.2 Progression of processes in private policy
7.3 Public role in making policy

page 134
136
138

Tables

5.1 Studies of the motivation of semen providers
7.1 Summary of DI regulations by country

vui

page 84
140

Notes on contributors

is Professor of Political Science at the University of
Canterbury, Christchurch, New Zealand. He is author of numerous articles
and books on biomedical policy including Rationing medicine (1988),
Regulating reproduction (1990), The politics of pregnancy (1994), and
Human reproduction, emerging technologies, and conflicting rights (1995).
ROBERT H. BLANK

is Associate Professor in the Department of Social Work at
the University of Canterbury in Christchurch, New Zealand. He has been
working in the field of assisted conception and particularly DI for twenty
years, and during that time has published over sixty papers. He has been
used as a consultant by government or government appointed bodies in the
United Kingdom, the United States, Canada, Sweden, Australia and New
Zealand.
KEN DANIELS

is a lecturer in social anthropology at the University
of Keele. She has carried out anthropological research in the north of
England in both community and organisational settings. She is co-author
of Technologies of procreation: kinship in the age of assisted conception
(1993) and is presently completing Born and Bred: Ideas of Relatedness and
Relationships in Late-Twentieth-Century England, addressing contemporary understandings of new reproductive technologies, based on fieldwork
in the north west of England.

JEANETTE EDWARDS

is Senior Lecturer in Sociology, in the Department of
Social Policy, University of Newcastle upon Tyne, United Kingdom. She
has been working in the areas of health, adoption and assisted conception
for fifteen years. Her doctoral thesis was entitled 'Family Connections: The
Management of Biological Origins in the New Reproductive Technologies';
she is co-author (with Noel Timms) of Adoption, identity and social policy
(Gower) and she is currently working on another book provisionally titled
"Families and Identities".

ERICA HAIMES

x

Notes on contributors

is NEH Distinguished Professor and Chair of the
Department of Sociology and Anthropology at Lehigh University in
Bethlehem, Pennsylvania, United States. She received her PhD in sociology
from Harvard in 1976. She is co-author with Susan Borg of two books:
When pregnancy fails: families coping with miscarriage, ectopic pregnancy,
stillbirth, and infant death and In search of parenthood: coping with infertility and high tech conception. Her research and teaching interests focus on
women's health, bereavement, infertility and AIDS.
JUDITH LASKER

SIMONE BATEMAN NOVAES is a sociologist and full-time researcher at the
Centre de Recherche Sens, Ethique et Societe (CERSES) of the Centre
National de la Recherche Scientifique (CNRS) in Paris, France. Her
research focuses on ethical questions raised by novel medical practices, particularly in the area of reproduction, as well as on the legal and political
aspects of these issues. She is interested in the way social practices are constructed around technical innovations which question our usual conceptions of being and acting human. She has recently published Les passeurs
de gametes and has edited a volume Biomedicine et devenir de la personne
(1991).

is a Research Fellow in the Sociology Department,
Exeter University. Together with Robert Snowden she is conducting a longterm, prospective, follow-up study of couples who are parents of children
conceived by donor insemination. She is a founder-member of the British
Infertility Counselling Association and an Honorary Life Member of the
Family Planning Association. She has lectured and published widely on the
social implications of the new reproductive technologies.
ELIZABETH SNOWDEN

is the Professor of Family Studies in the Sociology
Department, Exeter University. During the last twenty-five years his
research interests have focused exclusively on the topic of reproductive
behaviour. The research institute he founded in Exeter University is designated a Collaborating Centre for Research in Human Reproduction by the
World Health Organisation. He was a founder-member of the Human
Fertilisation and Embryology Authority (1990-1993) and is an Honorary
Life Member of the Family Planning Association. In 1994, he was admitted as a Fellow of the Faculty of Family Planning and Reproductive Health
Care of the Royal College of Obstetricians and Gynaecologists. Robert and
Elizabeth Snowden are among thefirstto have undertaken research into the
social and personal implications of donor insemination.
ROBERT SNOWDEN

Acknowledgements

We wish to acknowledge the financial support provided by the University
of Newcastle, UK. Senior Visiting Fellowship Fund and the Department of
Social Policy Research Fund and by the University of Canterbury Research
Fund. Our thanks to Marilyn Strathern, Meg Stacey, Robyn Rowland,
Rona Achilles and Bob Snowden who have all in different ways contributed
to our thinking. A very grateful thank you to Yvette Haimes, Dorothy
McLoughlin, Barbara Seaton, Rosalie Kennedy and Maureen Woods for
their assistance in preparing the manuscript. A special thanks to Catherine
Max and her colleagues for their support and guidance.

List of abbreviations

AFS
AHR
AI
AID
AIDS
AIH
ART
BAAF
CECOS
DI
GIFT
HFE Act (1990)
HFEA
HIV
ICSI
IVF
NAC
OTA
RCNRT
RCOG

xn

American Fertility Society
assisted human reproduction
artificial insemination
artificial insemination by donor
Acquired Immune Deficiency Syndrome
artificial insemination by husband
assisted reproductive technologies
British Agencies for Adoption and Fostering
Centre d'Etude et Conservation du Sperme (and
more recently, Centre d'Etude et de Conservation
des Oeufs et du Sperme Humaine)
donor insemination
gamete intra-fallopian transfer
Human Fertilisation and Embryology Act, United
Kingdom (1990)
Human Fertilisation and Embryology Authority,
United Kingdom
human immunodeficiency virus
intra cytoplasmic sperm injection
in vitro fertilization
National Association for the Childless, United
Kingdom
Office of Technology Assessment, United States
Congress
Canadian Royal Commission on New Reproductive
Technologies
Royal College of Obstetricians and Gynaecologists,
United Kingdom

1

International social science perspectives on
donor insemination: an introduction
Erica Haimes and Ken Daniels

In this book we aim to present the first systematic social science analysis of
donor insemination (DI): the process through which a (usually anonymous) fertile man provides semen (most often with the assistance of
medical personnel) to a fertile women in order to help her try to conceive a
child. The major indication for the use of DI is that the female does not have
a fully fertile male partner. We also aim to locate this practice in its global
setting. In pursuing these aims we shall be both documenting, and contributing to, the debates on practice and policy around DI that have emerged
in the latter half of the twentieth century and that promise to shape the
social identity of DI in the first part of the next century.
It is especially appropriate to tackle this task now since donor insemination has been practised for just over 100 years (the first successful case
occurred in 1884) and is the oldest technique in 'the new technologies of
reproduction'. DI has remained hidden from public view and scrutiny for
much of that time, only emerging fully on to the public agenda with the
development, in the 1970s and 1980s, of other related technologies of reproduction, such as in vitro fertilisation and egg donation. There are numerous
strands to the historical development, and current social context of DI,
both as a medical technique and as a solution to the problem of infertility:
these require identification and disentangling. In this book we make a start
on that task by presenting an analysis that focuses on the perspectives on
DI from a range of social groups involved: the users of DI; the semen providers; the clinicians; the policy makers; the wider community. The major
theme that recurs throughout these different perspectives is the analysis of
why DI has been hidden from such scrutiny for so long and what impact
that secrecy has had on all parties involved, as well as on DI as a social practice. Clearly these perspectives overlap with and inform each other. In documenting the nature of these overlapping influences we, as social scientists,
can begin to gain analytical purchase on the complex web of social relationships that DI both reflects and constitutes as part of a wider social order.
For the sake of clarity we shall briefly outline here what the practice of
DI can involve but, in so doing, we note that any such description itself

2

Erica Haimes and Ken Daniels

constructs the practice of DI in a particular, perspectival way. Thus, we
shall merely sketch out the possible outlines that give it some shape: some
of the following chapters will colour those in, whilst others will provide
alternative sketches which render DI a rather different shape and colouring. It is the claim of this collection that such variations are, paradoxically,
the essence of DI and, of course, of social life as a whole.
Donor insemination emerged from the medical problem of infertility.
The first account of a successful insemination using donated semen was
published in 1909, but described events in 1884, when the sperm from 'the
best looking member' of a doctor's class was used to inseminate a merchant's wife, who successfully conceived. Neither she nor her husband
knew what had taken place though the doctor did tell the husband when he
heard of the pregnancy. At the husband's request the wife was never told.
The author of this article reports shaking the hand of the twentyfiveyear
old, in 1909; the reader is left to assume that the author was also the sperm
provider (Achilles 1992: 15-16).
Donor insemination does not cure male infertility but rather provides a
way of circumventing the associated difficulties. Uses of DI have expanded
in the late twentieth century to situations where a male partner carries a
genetic disorder and thus where the use of donor semen can avoid the
onward transmission of that disorder, or where a male partner has had a
vasectomy, or where a woman wishes for a child but has no male partner or
wishes to avoid intercourse with a man.
Thus, from a clinical point of view, the issues around DI concern questions of diagnosis, treatment, how and when to suggest DI, success rates,
how to recruit semen donors and how to mediate the relationship between
recipients of DI and the providers of donated semen. The only accurate
figures available regarding the use of DI emanate from Britain and France.
While other countries, most notably Australia, New Zealand, the United
States, collect data on assisted human reproduction (AHR) technologies,
DI is not included. In 1994 in the United Kingdom a total of 8,096 women
received 21,180 cycles of treatment and this resulted in the birth of 1,805
children (HFEA 1996). Alnot (1993) says that 20,525 cycles of DI were
carried out in France in 1991 resulting in the birth of 1,777 children. A
United States Report (OTA 1988) estimated that 86,000 cycles of treatment
were provided resulting in the birth of 33,000 children.
However, since the purpose of DI. is to create a baby, another way of
looking at the practice (as evidenced by the 1909 report mentioned above)
is to describe it in terms of making and becoming parents, of having children and forming families. Such a reformulation makes it explicit that DI is
about social relationships and social processes that incorporate, but also go
beyond, the medical perspective. This raises additional questions. Who is

International social science perspectives

3

making the decisions about the use of DI? Who is actually making these
parents? What types of children are being conceived? What types of families are being made? What types of donors are being used? It is not that clinicians are unaware of these other questions, it is just that they are confronted
on a day to day basis with other, more immediate questions of practice and
practicality. It is the social scientist's task to ask these other questions and
to analyse their significance to the wider socio-cultural context. That is what
the authors in this collection are doing: asking about, documenting and
analysing the social relationships that shape and change both the development and deployment of DI as a social as well as a clinical practice.
In claiming that this book presents a social science perspective we have
the following points in mind. First, we follow Giddens in the view that the
social science endeavour is multidisciplinary, involving the combination of
the 'sociological imagination', with 'historical sensibility' and 'anthropological insight' (1982: 22). We would also add social psychology to that list
as a means of addressing the language of individual behaviour and motivation. Secondly, such an approach enables us to address questions concerning DI at the level of the conceptual, the empirical, the cultural, the political
and the practical (Stacey 1992). The purpose of such a multi-layered
approach is that it enables the contributors to this volume to address issues
surrounding, and the reactions to, donor insemination. Thirdly, the social
science approach has itself to be reflective: to acknowledge, that is, the provisional basis of its own claims. Far from being a weakness this allows the
possibility of dialogue and inter-connections between our social science
approach and that of other disciplines (e.g. medicine and science) and
between the apparently narrow issues of donor insemination and the wider
field of social life.
This also explains why it is so important to take a global perspective on
these issues. Since the practice of, and market for, DI is worldwide, it is only
by knowing about what is going on in a range of countries that one can
begin to participate in a fully informed dialogue. One needs to be able to
document the similarities and differences in practice between different
countries in order to break free from familiar patterns of thought and to be
able to place these comparisons in their cultural, conceptual, empirical,
political and practical contexts. Thus, this collection has authors from the
United States, the United Kingdom, France and New Zealand, who each
draw upon their extensive research knowledge of Canada, Australia,
Scandinavia, eastern and southern Europe and Latin America.
Thus the notion of dialogue comes to the fore again. We hope that this
book will contribute to and provoke further dialogues around the world on
DI from a number of different perspectives, since this collection represents
the thinking of leading social scientists who are working in and writing

4

Erica Haimes and Ken Daniels

about this area. In chapter 2, Judith Lasker explores the issues that arise for
the users of DI, as they go through the process of considering, and then
deciding to use, DI. She describes their assessment of the costs, the risks
and the alternatives to DI use. She also analyses how they perceive the man
who provides the semen and their concerns for the child who is conceived
from this donated semen. In her analysis she draws out the similarities and
differences between the various user groups, including heterosexual
couples, single women and lesbian couples.
In chapter 3, Robert and Elizabeth Snowden build upon their pioneering
work in the field of DI in the 1970s to explore the issues that arise for the
families that are created through the use of DI. Using data taken primarily
from their own interviews with parents, the Snowdens analyse the nature of
biological and nurturing family relationships and of how their, and our,
understanding and experience of these has been shaped by DI. One theme
around which other aspects of these relationships turn is the question of
how much information about the child's conception is shared within the
family. The Snowdens demonstrate, through rich and detailed data, that,
whether they decide to tell their child or not, this is an aspect that no DI
parents can ignore.
In chapter 4, Erica Haimes suggests that one of the legacies of not telling
children about their DI conception is that we have very little data on how
people who have been conceived in this way view that fact. What we have
instead is very full data on how others have claimed the authority to speak
on their behalf. Haimes explores the historical and social processes through
which those claims have been established and the ways in which these claims
have led to certain characterisations of the people conceived as having particular needs and interests. The emerging body of data that directly presents
the views of the people conceived, although still thin, provides a potential
challenge to these characterisations and thus to policy and practice.
In chapter 5 Ken Daniels uses a historical perspective to show how the
position of the semen provider has moved from one of obscurity to one of
acknowledgment. He argues that the next stage needs to be one of valuing
the semen provider for the contribution he makes, especially when that
contribution is analysed in terms of gift dynamics and when efforts are
made to reduce the marginalisation of providers. Daniels' worldwide review
of research also indicates that semen providers have rather more complex
motivations and views than they have commonly been attributed with by
the clinicians who have usually spoken on their behalf. This research also
indicates that semen providers are more open to the possibility of future
contact with offspring than had previously been assumed.
The chapter by Simone Novaes highlights how DI came to be constructed as a medical treatment for male infertility, through the focus on DI

International social science perspectives

5

as merely a technical act under clinical management. Thus the doctor came
to fulfil a mediating role between the infertile couple and the semen provider which, in turn, allowed for the establishment and maintenance of
secrecy between recipients and providers. The advent of semen banks
moved DI from its quasi-clandestine position to one of greater social acceptance. Novaes concludes her chapter by asking questions about the extent
to which the specific domain of competence that clinicians inhabit legitimises their role in making wider decisions about reproduction.
Robert Blank shifts the focus to the public policy context and asks what
role, if any, governments ought to play in regulating fertility services, and
reproduction more generally. He explores the regulatory options that are
available to cover the DI field and cautions against 'excessive public
control'. He provides a worldwide overview of the current regulation covering DI in different countries, highlighting the diversity of approaches
adopted but also highlighting the number of areas in which no regulation
exists. He suggests the UK Human Fertilisation and Embryology
Authority provides one regulatory model that has 'promise' and argues that
an approach is needed that provides a form of public accountability.
In the final substantive chapter, Jeanette Edwards, an anthropologist,
examines the question of whether we can usefully talk about 'public
opinion' in relation to DI. In exploring the views held by people not directly
involved in DI she notes that most made sense of this procedure in terms of
its potential for creating and affecting social relationships. The people with
whom Edwards discussed these issues drew upon their own experiences of
kinship to make sense of DI and were able to turn the issues around and see
them from a range of different perspectives: at one point from the child's
perspective, at another point from the recipients' perspective. This not only
alerts us to the dangers of assuming that any one individual can only speak
from one perspective, it also alerts us to the dangers of assuming that there
is only one 'public' and only one 'opinion'.
In the concluding chapter we return to the theme of the multiplicity of
perspectives in order to reflect on those which have been most influential in
directing our thinking about DI and those which have, until recently, been
relatively neglected. We consider a range of debates that have yet to be conducted around DI whilst, at the same time, noting just how much the
authors in this collection have helped to broaden the existing analysis of
donor insemination.
REFERENCES

Alnot, M. (1993) '1992 results of sperm donor procreation. French Federation of
CECOS and private cooperative centers'. Contraception, Fertilite, Sexualite
21(5): 371:3.

6

Erica Haimes and Ken Daniels

Achilles, R. (1992) Donor insemination: an overview. Royal Commission on New
Reproductive Technologies, Ontario, Canada.
Giddens, A. (1982) Sociology: a brief but critical introduction. London: Macmillan.
Human Fertilisation and Embryology Authority (1996). Fifth Annual Report 1996.
Stacey, M. ed. (1992) Changing human reproduction: social science perspectives.
London: Sage.
United States Congress. Office of Technology Assessment. (1988) Infertility:
medical and social choices, Washington DC: US Government Printing Office.

The users of donor insemination
Judith N. Lasker

Introduction

Donor insemination (DI) is the oldest, most widely used, and probably
most effective alternative method of conception in use today. Yet its use
continues to be fraught with anxieties, controversies, and a deep cloak of
secrecy. Those who consider donor insemination often do so at first with
great reluctance and with fears about the ramifications and the results. The
focus of this chapter is on the concerns and experiences of those who are
potential or actual users of DI. Donor insemination has two very distinct
types of users, and these two groups have almost entirely different needs
and priorities, different experiences and different dilemmas. Although most
fertility programmes are geared exclusively or primarily to married couples,
and in some countries they are limited by law to married couples, donor
insemination is increasingly being used in many parts of the world by single
women, both heterosexual and lesbian. Two important changes are pushing
this trend: alternative treatments have become increasingly available that
allow men with severe fertility impairments to father children, eliminating
the need for a donor, and the idea of single motherhood through insemination has become more widely accepted. In addition, the possibility of
finding ones own donor and carrying out the insemination at home eliminates for many single women the necessity of having to get past the barriers that exist to their using medical services (Stephenson and Wagner 1991).
Thus, there is reason to believe that single women are gaining rapidly in
their representation among insemination clients (Leiblum et al. 1995).
Many single women, both lesbian and heterosexual, consider it to be an
important advantage that they can conceive a wanted child without
concern about sexual and emotional involvement with a man and without
the stigma which may be associated with becoming pregnant accidentally.
Donor insemination allows them to explain to the children, and to others,
that this was a planned and desired conception, and it allows them to select
desired characteristics of the genetic father and to have some confidence
that he has been screened for genetic and other illness.

8

Judith N. Lasker

For heterosexual couples in which the man is infertile, donor insemination offers the possibility of having an apparently 'normal' pregnancy and
birth with the man present at both the conception and birth. Both partners
can share the experience of pregnancy just like any fertile couple, without
ever having to reveal the man's infertility. In contrast to adoption, the child
will have a genetic tie to one member of the couple, and there will not be
the uncertainty about the physical and social conditions in which the birth
mother carried the pregnancy.
Donor insemination is also the simplest and least expensive form of alternative conception. Because of the apparent disadvantages and the growing
difficulties and higher costs associated with adoption, insemination has
become increasingly popular among many couples in which the man is
infertile as well as among lesbians and single heterosexual women.
Occasionally, donor insemination is chosen by couples in which the man
carries a genetic trait which they do not want to pass along to the child, or
where both members carry a recessive gene which may result in a child
having a serious illness. It is also used in cases where the male partner had
a vasectomy or has undergone chemotherapy. There have been a few cases
of widows using the sperm of their deceased husbands; in one case a woman
asked for sperm to be withdrawn shortly after her husband's sudden and
violent death (Caplan 1995).
Although technically quite simple and in use for many years (it is therefore inaccurate on at least two counts to call donor insemination a 'new
reproductive technology'), there are serious social and psychological issues
which emerge from the use of DI. This chapter will focus on the experiences
of men and women who consider and try DI and on the types of issues and
dilemmas which they face. In particular, I will consider what is known
about: first, the decision to try DI; second, the effects of going through the
procedure; and third, the looming issue of secrecy. Many of these issues
affect the two client groups quite differently. Therefore, in discussing each
of the three subjects, I will first address the common concerns of both
groups and then consider the concerns which are particular to each group
separately.
Much of the information and all of the quotations used in this chapter
come from a study of people who considered or tried various methods of
achieving pregnancy (Lasker and Borg 1994). Respondents were recruited
by word of mouth, through infertility clinics, and by notices in the newsletters of the RESOLVE infertility support group. Approximately two dozen
subjects were interviewed by phone, and the interviews were taped (with
permission) and transcribed. An additional ninety-four people completed
questionnaires sent out to those who responded to the request in RESOLVE
newsletters. Thus, as in most studies, they do not represent all infertile

The users of donor insemination

9

people or all people using artificial means of conception, but rather they
reflect many of the concerns and opinions of people who are able to consider using these methods and are willing to talk about their experiences.
Findings from this study are combined in this chapter with results from the
work of others who have studied programmes of donor insemination and
the people who use them.
Considering donor insemination

The possibility of donor insemination begins for the majority of heterosexual couples when they recognize that the man is unable to produce
sufficient numbers of healthy sperm to fertilise the woman's eggs in vivo.
Thus the first and most important issue to be faced is the reality of his
infertility. For single women, infertility is rarely the reason for choosing DI.
For them, it is a very different recognition, that they are not going to have
a male partner with whom to conceive a child. This may be by choice in the
case of lesbians, who often have committed women partners, or by 'default'
in the case of heterosexual women who have not found a suitable partner
or do not want one and do not want to wait any longer to become mothers.
Issues for both groups. Both groups have to consider the costs in time,
money, and stress of going through the procedure, the chances of success
and the physical risks, as well as their feelings about using a donor. Both
may also have concerns about the effects of using DI on their relationships
and on any future children, but these will be addressed separately for the
two groups.
1. Cost. The costs of the procedure are part of the challenge. Although
artificial insemination usually costs far less than in vitro fertilisation or
hiring a surrogate mother, the monthly expenses mount up quickly. Each
time a woman is inseminated, there is the charge for the office visit and the
fee for the sperm sample. In addition, she may be taking expensive fertility
drugs to stimulate her ovulation. The American Office of Technology
Assessment's 1987 survey of practitioners of artificial insemination concluded that the average patient cost for four cycles was about $ 1,000, with
physicians who carry out the most inseminations reporting considerably
higher charges. Approximately three-fourths of the total costs in the United
States are paid by the patients themselves (Office of Technology Assessment
1988). A recent report gave much higher estimates: that an initial work-up
costs between $400 and $500, and each cycle can cost anywhere from $500
to $2,500 depending on the technology used ('Sperm Banks and Clinics'
1994).
There is also a non-monetary cost, such as the pressures of checking daily
temperatures and being available for insemination at the time of ovulation.

10

Judith N. Lasker

There is often a great deal of inconvenience, compounded by the anxiety
and stress of the procedure. Women who have been through DI often complain about the difficulty of coordinating their ovulation with the physician's schedule. The increased use of frozen sperm has alleviated the
logistics problems somewhat, as it is no longer necessary in these cases to
coordinate with the donor as well.
2. Risks. Donor insemination increasingly involves treatment of the
woman with powerful drugs. In the last few years, many fertility centres
have introduced the use of superovulation through hormonal treatment of
the woman before insemination because of the greater likelihood of pregnancy after hormone injections. Nevertheless, these drugs are inconvenient
to administer, expensive, and often have side effects (Stephenson and
Wagner 1993).
Another risk of donor insemination is the possibility of transmitting
infections or genetic disorders. A study of 316 Danish and Swedish couples
who had been through DI revealed that 85 per cent of them had worried
about contracting a sexually transmitted disease as a result of donor
insemination (Nielsen et al. 1995). A recent study identified seven cases of
women in five fertility clinics in the United States and Canada who were
infected with HIV through DI prior to 1986; while the availability of screening has greatly reduced this risk, it remains a concern for many women
(Araneta et al. 1995).
3. Success rates. Studies of donor insemination report widely varying
success rates, dependent in part on the woman's age and the treatment strategy. Generally DI is much more likely than IVF to result in pregnancy, but
many couples are surprised that it may take six months or longer of inseminations before this may be accomplished, and some drop out after one or
more attempts.
4. The donor. Perhaps the greatest concern of those who are deciding
whether or not to try DI is over the identity, the health, and the characteristics of the donor. Usually the donor is not known to the couple at all
unless they seek him out themselves. In most cases, the physician finds a
donor, either through personal contacts or through a sperm bank, and the
identity is carefully guarded. Baran and Pannor (1989) found that many
couples fantasise about the donor and have considerable anxiety about
him.
Many people who use DI express uncertainty about the real identity and
characteristics of the donor. One woman commented: 'They asked what
characteristics we wanted from the donor but warned that special requests
might mean a delay since there were so few donors. We often joked that it
was probably one guy who went behind a screen and put on a different wig
each time depending upon the request'.

The users of donor insemination

11

Such joking reflects considerable anxiety on the part of many couples
about the donor's identity. News events about unusual cases can certainly
contribute to this anxiety. For example, several couples reported that they
had experienced worries during the pregnancy about a racial mix-up
(Lasker and Borg 1994). In June 1995, it was reported that just such an
error had occurred in a Dutch fertility clinic, with a couple undergoing IVF
having twins, one darker than the other, because sperm from an Aruban
man was left in the pipette in which the Dutch man's semen was placed to
fertilise his wife's ova (Simons 1995).
Speculation and concern about the appearance of the donor are common
among people going through DI and in particular during a pregnancy
resulting from insemination. A study of Polish couples seeking DI found
some of them wanting more information about the characteristics of the
donor, and most of them were concerned that he should look like the
husband (Bielawska-Batorowicz 1994). Of 316 Danish couples who had
been through DI, 82 per cent agreed that before the treatment, they had
speculated about the appearance of the donor and whether the child would
look like them; a third wished they had more descriptive information about
the donor (Nielsen et al. 1995). The same desire for more information was
expressed by single heterosexual and lesbian women in an American study;
in this study, the donor characteristics of greatest importance to the women
were education, ethnicity, and height (Leiblum et al. 1995).
Some women also worry that the doctor might himself be the donor.
Accounts of the physician being the donor are indeed nothing new. There
was a great deal of publicity in the United States about the arrest and
conviction of an American physician who had used his own semen in many
cases without informing the patients (Snowden et al. 1983; Rubin 1995).
People who have used donor insemination report widely differing feelings toward the donor. Some wish they could meet him and see what he
looks like or thank him for his help. Others dismiss the donor, saying they
have purchased a product and the person producing it is irrelevant to them.
Most people know that they will never be able to find out who the donor is
and prefer to try to forget about him. Some fathers are plagued by feelings
of inferiority when they compare themselves to the bright and accomplished type of man who is selected to be a donor (Lasker and Borg 1994;
Baran and Pannor 1989).
Because of the potential problems with choosing donors, some couples
and many single women decide to select their own and avoid physicians
altogether. Another reason for this results from new policies which encourage the use of frozen sperm due to concerns about the transmission of
disease, and in particular of HIV infection. When semen is frozen, the
donor can be screened for HIV both at the time of the donation and again

12

Judith N. Lasker

six months later before the specimen is used. Frozen semen is, however,
more expensive and has a lower success rate, thus often requiring additional
cycles before pregnancy is achieved (Barlet and Penney 1994; Nachtigall
1994). As a result, some potential users of DI seek out their own donor and
try to avoid the sperm banks. A relative of the husband or a close friend
may be asked. The majority of people, however, prefer not to know the
donor because of anticipated complications in their relationships, or else
they cannot find a willing man, and thus they rely on the uncertainty but
also the anonymity of a donor programme.
Heterosexual couples

Heterosexual couples thinking about using donor insemination must consider some specific issues, including the alternatives available to them, the
impact of male partner infertility and of DI on their relationship, and concerns about the effect on future children. These issues differ to some extent
depending on the reasons why DI may be selected.
1. Reasons for considering DI. Most heterosexual couples choose DI for
one of three reasons: infertility, prior vasectomy, or to avoid transmitting
an unwanted genetic trait. Yet there have been almost no studies of how
these differences affect the experience of DI or the choice to use it.
One exception is the study by Baran and Pannor (1989), who interviewed
individuals and couples who used DI for all three reasons mentioned above.
Their sample included twelve men and thirty women in couples where the
husband was infertile, thirteen men and seven women who used DI because
of a vasectomy, and four couples in which the man had a genetic problem
he did not want to pass along to his children. They were recruited primarily through newspaper ads and were almost all middle to upper-middle
class. They found striking differences between the people who used DI for
infertility and the other two groups. The infertile men were much more
uncomfortable about using DI and were more likely to feel inadequate and
powerless in their families. They were also the most concerned about
keeping DI secret. In many cases they were convinced by the physician and
by their wives to resort to DI just after learning of their infertility and thus
had no opportunity to grieve the loss or deal with the shock. DI was seen
by others as a 'solution' but was accepted by the men only with a great deal
of anguish and ambivalence. In contrast, the men who had genetic problems were not concerned about their infertility and had come to the decision not to father children on their own, sometimes before getting married.
They were the most comfortable with the idea of donor insemination, and
in the case which Baran and Pannor describe, insisted on meeting the donor
father and on telling the children of their origins.

The users of donor insemination

13

In the middle, but most like the second group, were men who had had
vasectomies and had had children before. They had proven their fertility
and were not concerned about their masculinity. They tended to regret
having had the vasectomy, but their biggest concern was about becoming
parents again, often at an age when they already had grown children. Yet
Baran and Pannor report that they were often the most relaxed about parenting and enjoyed their new children with a minimum of stress. This is consistent with thefindingsof Humphrey and Humphrey (1993), who studied
men who had had vasectomies and then had children with DI. The authors
suggest that these men tend to be older and to have had children in a previous marriage, and that as a result they are more mature and more sensitive to their wives' desire for children.
2. Alternatives. Couples in which the man is infertile have for years had
to choose between adoption, DI, and not having children. In recent years,
they have had another option due to the increased use of in vitro fertilisation for male infertility and in particular the development of a variety of
techniques for micromanipulation of sperm, which introduce sperm
directly into the egg in a laboratory. These developments allow men who
have a very low sperm count the possibility of fertilising ova in IVF programmes. Until the development of micromanipulation techniques, such as
ICSI (intra cytoplasmic sperm injection), the possibilities of fertilisation
were very low when the man was oligospermic. Today there is a chance that
the woman's eggs can be successfully fertilised with only a few sperm
through IVF procedures (Ben-Chetrit et al. 1995; Tucker 1995; Palermo et
al. 1995). This procedure, when compared to DI, is much more expensive,
involves more physical risks for the woman, and has a lower success rate.
Yet some couples are willing to attempt it, and many infertility specialists
are sure to recommend it instead of DI, in order for the man to have a
genetic tie to the child and to avoid the difficulties posed by having a donor.
As new techniques for dealing with male infertility improve and become
more widely available outside major medical centres in a limited number of
countries, the demand for donor insemination by heterosexual couples is
certain to drop. Those who choose DI over IVF are likely to do so because
of the unavailability, inconvenience or cost of the latter, or after failing to
achieve a pregnancy with IVF.
Most couples who choose DI consider adoption first, and some actually
begin adoption proceedings. In Daniels' study (1994) offifty-fourcouples in
New Zealand who gave birth after DI, 72 per cent had considered or
attempted adoption. They ended up choosing DI both because of the advantage it offered for the woman to have a genetic and biological tie to the child
and also because of the uncertainties and difficulties presented by adoption.
Owens and colleagues (1993) mailed questionnaires to approximately 500

14

Judith N. Lasker

couples who belonged to the British National Association for the Childless
and who were listed in the NAC records as having infertility attributed to
the male partner. This is clearly a quite atypical group, but useful in the findings obtained. Analysis of 205 useable responses showed that, while 32 per
cent were considering adoption and 41 per cent had taken active steps in that
direction or had already adopted a child, two-thirds of the sample still indicated that they felt that DI was the only way of overcoming infertility.
Indeed, 61 per cent of the sample had taken active steps toward DI, and the
majority of those had already conceived or become parents. Approximately
a fifth of the sample was also considering IVF or GIFT, and another 23 per
cent had taken active steps in that direction.
In a Danish study of couples who had tried DI, 23 per cent said they had
first tried to adopt a child; the remainder said they preferred to have a biological link and therefore had rejected adoption (Rosenkvist 1981). A
Polish study of thirty-five couples who had sought donor insemination also
found that they had concluded that DI would be preferable to adoption
(Bielawska-Batorowicz 1994).
It would be very useful to have a comparable study of couples who considered DI and then rejected it in favour of adoption. One reason given in
the study of RESOLVE members (Lasker and Borg 1994) by couples rejecting DI in favour of adoption was that they preferred to have no biological
connection to the child rather than to have an unequal one in which only
one parent would be connected genetically. In the Owens study (1993),
those couples who had rejected DI gave as the most frequent reason (43 per
cent) their discomfort with a third party being the genetic father and the
likelihood of deception associated with that fact. The second most frequently given reason related to ethical or religious concerns. Also mentioned by some couples was preference for adoption or IVF, worry about
marital problems arising from DI, hope that a natural pregnancy would
still be possible, and the fear of AIDS. Some of these couples who rejected
DI indicated that they would be willing to reconsider if other means did not
work.
3. Relationship issues. Couples who consider DI for infertility follow a
somewhat different trajectory from those who are considering IVF or other
routes to pregnancy. In these other cases the woman is extensively tested
and treated, and the cause of infertility is sought in her body. Even when
both partners are found to have fertility impairments, the majority of
testing and treatment is carried out on the woman. The major difference
with DI is that it is appropriate for couples in which the woman is at least
relatively fertile and the man is completely or almost completely lacking in
sperm. Thus the cultural assumption of infertility being primarily a female
problem is violated for these couples.

The users of donor insemination

15

For the man, there is often a blow to his sense of himself as a man if he
is infertile. Some men feel ashamed that they cannot father a child; others
feel that they have let their wives down. Some are upset that they cannot
pass the family genes on to the next generation. For the woman, there may
be anger at her partner, guilt for feeling angry, and guilt that she is fertile
when he is not. With both husband and wife feeling angry with themselves
and with each other, it is not surprising that conflict may develop between
them. Thus couples considering DI often wonder about the possible effects
of going through the procedure and of a subsequent birth on their relationship.
Researchers have concluded that women generally appear to be more distressed and preoccupied by infertility than are men (Greil et al. 1988; Draye
et al. 1988; Brand 1989; Andrews et al. 1991). This difference in reaction
may create considerable tension during the period of deciding about and
then pursuing donor insemination.
Is the greater distress on the part of women equally the case when the
man is infertile and the woman is not? Some researchers have concluded
that the woman is more distressed regardless of which partner is infertile,
while others find that both are more distressed in cases of male infertility;
men tend to be more distressed by their own infertility than by that of their
wives (Greil 1993). Male infertility may disrupt the unspoken assumption
of the man's dominance in a relationship, giving the woman more power
than either of them feels comfortable with. Some women even say they feel
guilty about being 'whole' when their partners are not. There are even
accounts of women ceasing to ovulate when DI begins (Reading et al.
1982).
In our study (Lasker and Borg 1994) we heard many reports of women
who said they would cover up for their husbands' infertility, saying that the
problem was their own. If they had previously told friends that the infertility was their husband's problem, and then they used DI, they would change
the scenario to protect their husbands. A woman who wrote to RESOLVE
expressed her bitterness about having to cover up her husband's infertility
by letting others think that she was the one with a problem:
I was trying to get away from responding to infertility like a case of'cooties', something you feel compelled to pin on 'the other guy'. So even though I knew my sexual
identity was intact, it felt like a hollow reassurance. I seemed to be the only one who
knew this . . . If everyone else sees you as infertile, it is hard not to react as though
you are. (Hartman 1985: 3).

Another woman wrote to RESOLVE about the difficulties she was experiencing because her husband wanted no one to know that he had had a
vasectomy during a previous marriage. The cover-up even affected the

16

Judith N. Lasker

woman's relationship to her own mother, who felt guilty about her daughter's supposed infertility (Anonymous 1985).
Do such women who falsely assume the responsibility for infertility feel,
whether consciously or unconsciously, that they are supposed to be the ones
who are infertile, especially since that is what everyone else assumes? Does
her assuming the responsibility for infertility restore the previous state of
power between them?
The inequality of diagnosis often means that partners have to be very
cautious in how they discuss their situation. This caution makes decision-making more complicated, sometimes leading the fertile partner to
resort to subtle pressures. In one study of couples seeking donor insemination, the authors made this interesting observation:
Most often it is the husband who makes the first suggestion [to try AID], possibly
because in the majority of cases the problem is felt to be particularly his. As far as
the woman is concerned, she is afraid of hurting him or provoking some unexpected
reaction by broaching the subject of AID... [But] we often had the impression that
the wife had done everything in her power to persuade the husband to suggest AID.
(d'Elicioef al. 1980:409-10)
The stresses of infertility and of decision making about treatment may
affect every aspect of a couple's relationship. They may have a profound
impact, for example, on a couple's sex life. The physical and emotional
strain of treatment, as well as the depression which accompanies failure,
often reduce interest in sex.
Utian (1983) observed, as have other researchers, that a couple's fertility
problems may lead the husband or wife to have an affair. He concludes that
some people may be trying to test their fertility with other partners.
Infertility can affect a sexual relationship in another way. For instance,
psychiatrist David Berger (1980) studied sixteen men diagnosed as having
a very low or absent sperm count and discovered that eleven of them
became impotent for several months following the diagnosis.
Yet Greil and colleagues (1989, 1991) note, importantly, that sexual
difficulties which arise from fertility pressures and treatments do not necessarily lead to marital breakup or even to marital dissatisfaction. Couples
may view their sexual problems as temporary and still find their relationship strengthened by the joint struggle to achieve a shared goal.
Researchers and practitioners who have studied the impact of insemination on couples often recommend that they wait until they have resolved
their feelings about the man's infertility before starting DI (Berger 1980).
Yet some have also found that infertile men are not nearly as distressed by
DI as expected. Blaser and colleagues in Switzerland (1988) interviewed
and administered psychological tests to four groups of men: infertile men

The users of donor insemination

17

whose wives were pregnant from DI, infertile men whose wives were still
attempting DI, fertile husbands of pregnant women, and husbands who
considered themselves fertile and were planning children in the future.
Although they do not provide the number of subjects included in the study
or how they were recruited, they conclude that the infertile men feel no
more impaired or lacking in self-confidence and that they show no more
symptoms of distress than the fertile men. The former indicated that they
had coped well with the diagnosis and the process of insemination.
4. Concerns about children. There is a range of questions which heterosexual couples contemplating DI may have about their prospective children. In the forefront are their concerns about the children's' general health
and genetic background, followed by whether the child will resemble them
in looks and personality (Klock et al. 1994). In addition, many have questions about what to tell the children about their origins (see section on
secrecy below) and about how the children would feel towards their father
if they were to know about the DI.
Some parents also fear the consequences for their children of knowing
about DI and not being able to identify their biological father. Certainly the
appearance of news stories about DI children searching with great anguish
for anonymous donors has given pause to some parents who wonder if they
are serving children well by creating such a situation (Orenstein 1995). For
some, this adds to the incentive not to tell the children; for others the conflict between wanting to be honest and knowing that such honesty may
produce difficulty for the child can be a factor in choosing not to pursue
DI. Again, there is very little information on this aspect of the decisionmaking process.
Single women

Single heterosexual and lesbian women who want very much to have children are turning more and more to DI as a solution. It has been estimated
that 10,000 children conceived through DI in the United States have been
born to lesbian mothers; other estimates of the number of American homosexuals who are raising children range from 1 to 2 million (McNamee
1994). The US government Office of Technology Assessment estimated that
30,000 single women undergo DI each year (1988). It is impossible to know
the numbers, however, as lesbians are more likely than heterosexual single
women or couples to seek out their own donors for insemination. Indeed,
the total number of people using donor insemination is impossible to ascertain because of the secrecy which surrounds this procedure. This is even
more the case in the countries where DI is limited by law to married women
(Shenfield 1994).

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Judith N. Lasker

The issues which single women, lesbian or heterosexual, face in deciding
upon insemination are quite different from those of heterosexual couples.
They have to deal with public disapproval, with lack of access to the procedure, and with legal ramifications not faced by married couples.
1. Motivations and alternatives. Many single heterosexual women who
seek out donor insemination hope to get married but cannot wait any
longer to find the right man before having children. As difficult as it is for
married couples to adopt, it is even more so for unmarried women. Single
heterosexual women and lesbians who are either single or in a couple have
few other options besides donor insemination. Although some adoption
agencies will consider single parents, the obstacles are even greater than for
married couples and are particularly great for homosexuals.
Single women, straight or lesbian, may not want intimacy with a man in
order to conceive, or they may prefer to avoid problems by not knowing the
identity of the father (McGuire and Alexander 1985; Pies 1989; Strong and
Schinfeld 1984). Among thefifteenlesbian couples in a Belgian clinic who
explained why they came for DI, twelve did not want to violate their fidelity and/or sleep with a man, eight did not want to introduce a third party
into their plans, eight considered it morally questionable to involve a man
temporarily, and seven were afraid of being infected with HIV (Englert
1994). As one lesbian woman said, 'Sex with somebody that I'm not
involved with otherwise would seem so mercenary. It wasn't anything I ever
considered. I kind of liked the idea of having a virgin birth. And anyway,
conception is conception, it's just a matter of how the sperm gets there'.
Leiblum and colleagues (1995) surveyedfifty-onewomen, all of them single
heterosexual and lesbian women who had completed one course of DI at a
New Jersey (USA) medical school; of these, forty-five (88 per cent)
responded, including twenty-eight heterosexuals, fourteen lesbians, two
bisexuals and one woman who described herself as celibate. The major
considerations in choosing DI for the heterosexuals, who were older than
the lesbian women, were that time was running out and that they had not
met a man who would be an appropriate father. The lesbians, ten of whom
were living in couples, focused on wanting to share parenting with their
partners and on their feeling that they had sufficient support and encouragement to embark on DI. Both groups agreed that their feelings of security in their employment and confidence that they had resolved their
concerns about parenting were major factors influencing their decision to
try DI.
Thus, many women who are not in a sexual relationship with a man consider donor insemination to be the best of all the alternatives for having
children. Yet they also share the concerns of heterosexual couples about the
identity of the donor and about the welfare of prospective children. Many

The users of donor insemination

19

of the respondents in Leiblum et al.'s study (1995) expressed a desire to
know more personal information about the donor, such as his motives for
being a donor, personality characteristics, interests, and medical background; for some of them this desire was motivated by wanting to share
such information with the child.
2. Access. The most difficult problem faced by unmarried women is
obtaining donor insemination. Many physicians and clinics refuse to
inseminate anyone who is not in a stable marriage; others insist on first
having a psychological evaluation (Ostrom and King 1993; Cornacchia
1994; Englert 1994). Some countries have official policies restricting donor
insemination to married couples. Despite the growing number of children
conceived by the artificial insemination of unmarried women, they still
comprise a very small percentage of all inseminations. This proportion is
certain to increase, but the obstacles, according to Stephenson and Wagner
(1991), provide an example of the medical and legal professions' enforcement of social biases in relation to technologies for conception.
Public attitudes toward donor insemination, especially for single women,
are changing but still unsympathetic. Many people object to DI for single
or lesbian women because they believe a child born into such a situation
will suffer. The British Human Fertilisation and Embryology Act of 1990
does not make it illegal to treat single women, but it does assert a 'need for
a father' as a criterion for the child's welfare (Shenfield 1994). Yet studies
which exist on the children of single heterosexual and lesbian mothers do
not show a negative effect on children (Bleckman 1982; Strong and
Schinfeld 1984; Golombok and Tasker 1994; Flaks 1995).
Other arguments against making DI available for single women include
the idea that it is a treatment for male sterility and thus there is no indication for using it in situations where there is no sterility. Englert (1994)
responds that DI is not a treatment for men at all; it is always a procedure
performed on women and has no medical effect on infertile men.
Despite Englert's defence of DI for single women, including lesbians, the
Belgian clinic with which the author is associated requires special psychological screening for such women. Interestingly, such screening is much
more likely to result in turning away single heterosexual women than lesbians. In sixteen out of twenty-one requests from the former group, it was
determined that the women had major family and relationship problems,
with considerable trauma and sometimes abuse in their history. In these
cases it was judged that the request 'seemed to be more of a desperate search
for a way out of their solitude than plans for a child' (Englert 1994: 1975),
and they were denied access to DI. In contrast, the fifteen lesbian women
who requested DI were all in ongoing stable relationships, had substantial
social and family support, and had carefully considered the implications of

20

Judith N. Lasker

choosing DI. Of these, only one request was postponed while the woman
sought therapy for sexual abuse in childhood (Englert 1994).
Because of the barriers, many single heterosexual and lesbian women
seek out a physician or a sperm bank willing to help them, or simply to do
the insemination themselves. One sperm bank in California has a large
lesbian clientele and offers clients and donors the possibility of knowing
each others' identities. Information regarding techniques of home insemination is widely available in networks of lesbian women seeking to avoid the
difficulties (and expense) of approaching physicians.
3. Custody. The number of court cases over custody of children born as
a result of DI is rapidly increasing. There are two main types of such cases:
in one, the partner in a lesbian couple who is not the biological mother of
the child either seeks to adopt the child or, if the couple separates, to have
visitation rights with the child she helped to raise. The other type of case is
brought by sperm donors who want more involvement with the lives of
their biological children. The outcomes of such cases indicate the obstacles
facing lesbian and single heterosexual mothers. Courts in several American
states have ruled that even if a woman is equally involved in raising a child
conceived by donor insemination, she has no legal rights to that child if she
is not the biological mother (Dreyfous 1991; Selby 1995; Bailey 1995;
Henry 1993). This is particularly ironic in light of the decision of the first
judge in the famous 'Baby M' case, who ruled that being a biological
mother gave Mary Beth Whitehead no rights at all to her child. Yet a few
courts are beginning to rule in favour of the non-biological parent
(McCann 1994; Dean 1994).
In a few cases, the sperm donor has won visitation rights over the objection of the lesbian or single heterosexual mother (Holding 1994). These
rulings demonstrate the tremendous difference between donor insemination used by married couples and by unmarried women. In the case of a
heterosexual marriage, the sperm donor has no legal rights, and the birthmother's husband is usually considered to be the parent by law.
4. Concerns about Children. Many of the same concerns about the health
of the child are shared by all prospective parents. For single mothers who
are not in a couple, there is sometimes also anxiety about being able to take
care of the child. Both lesbian and heterosexual single mothers worry that
the child will be unhappy about not having a known father and that he or
she will be teased or ostracised by others (Brewaeys et al. 1993; Curley 1995;
Leiblum et al. 1995). Many make careful plans for how the child will be
informed and how they will form networks with other similar families so
that the child will not feel abnormal (Lasker and Borg 1994).
Given all of these issues, how much do we really know about the process
by which people decide whether or not to try donor insemination? How

The users of donor insemination

21

many people worry over each of these concerns? How many choose not to
try DI because of one or more of them? We still know very little that would
allow us to answer these questions, despite the growing amount of research.
We do know that most people do not decide upon DI instantly, that they
are more likely to take their time after the possibility is first raised. Klock
et al. (1994), in their study of forty-one American couples, found that 21
per cent waited less than a month to decide, 28 per cent waited one to six
months, 21 per cent waited six to twelve months, and the remaining 29 per
cent started DI more than a year after diagnosis of male infertility.
Berger (1980) interviewed sixteen couples in Canada in which the man
had been diagnosed as infertile from eight months to four years prior to the
interview. Of the sixteen, two had decided against DI, four were still deciding, and four had pursued DI without delay. The remaining six couples had
decided to try DI but had delayed from several months to several years.
Those who began DI without delay were reported to be having difficulties
with the process. In Owens et al.'s (1993) study of British couples, the
average time between diagnosis and first insemination was 2.4 years, with a
range from less than one month to twenty-two years.
Some of this variation reflects the fact that some men know early in life
that they are sterile. But for the most part, it does indicate that the decision-making process is a challenging and difficult one, something that most
people are not prepared to conclude immediately. Yet Klock et al. (1994)
found no relationship between time taken to decide and measures of psychiatric symptomatology or marital adjustment.
Going through donor insemination

There are many stresses involved in going through donor insemination,
some of which have already been mentioned with regard to deciding on
whether to try it at all. The costs and pressures of the insemination, the
worries about success, the anxiety about the donor: these continue and
sometimes increase over time.
Some couples who have been through donor insemination now wish they
had done it at home, if possible. In that way they could have avoided some
of the difficulties that arise when coordinating with the physician's schedule. More important, it would have been less impersonal, and the partner
could be actively involved. Some physicians teach couples how to do this if
they ask for instruction.
Zoldbrod (1988) reported herfindingsof the experience of donor insemination, based on a study of nine women who responded to a request in
newsletters of RESOLVE, the American support organisation for infertile
people. These women cited eight negative feelings or problems they had

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Judith N. Lasker

experienced with insemination: lack of confidentiality in the clinic, loss of
libido and sexual pleasure, loss of control in their lives related particularly
to scheduling problems and errors, the inconvenience of scheduling, control
struggles with the physicians, feelings of shame and humiliation during
treatment, physical pain during insemination, and increased stress with the
number of inseminations. Many of these problems are even more acute
when the people involved are committed to keeping DI a secret; it is difficult
to explain to an employer or family member why one has to disappear for
a mysterious appointment periodically.
Relationship problems sometimes appear during the process of DI. A
study of couples participating in donor insemination found the wives to
have greater stress levels and to consider DI to be more challenging than
their husbands, who focused more on the beneficial side of insemination
(Prattke and Gass-Sternas 1993).
A writer who interviewed twenty-two infertile British men, whom she
acknowledges to be quite unusual in their willingness to talk, found them
to be less concerned about issues of sexual potency than they were with
their inability to help their partner fulfill her desire for pregnancy and also
a feeling of being marginalised by the process of donor insemination
(Mason 1993).
Some infertility programmes offer counselling for distressed patients, but
counsellors are most often used for initial screening before couples are
accepted, and thus there may be a subtle pressure to deny problems. Many
couples express the desire for more on-going therapeutic support as they
deal with the issues surrounding donor insemination. Klock and colleagues
(1994) studied forty-one couples prior to insemination and found that 95
per cent believed there should be a mandatory psychological consultation.
It has even been suggested that emotional adjustment might be predictive
of success in becoming pregnant, although a recent study of 120 American
couples found no connection between level of distress at the time of evaluation and pregnancy outcome twenty months later. However, those identified as distressed did have one counselling session (Schover et al. 1994).
Despite some case studies that indicate psychological and relationship
problems for people going through DI (Alexandre 1980; Berger 1980),
larger scale research on such families has uncovered relatively few significant problems as a result. A number of studies indicate that people going
through donor insemination are no more distressed and experience no
greater marital difficulty than comparison groups (Klock et al. 1994;
Nielsen et al. 1995). Some studies even found that couples using DI have a
much lower divorce rate than average, although the validity of these results
has been challenged (Milson and Bergman 1982, Humphrey and
Humphrey 1987). It would appear that the divorce rate is at least no higher

The users of donor insemination

23

than among other groups and that couples consider their marriages to be
the same or better than before (Levie 1967; Nielsen et al. 1995; Stone 1980).
Perhaps the process of working through the conflicts of infertility leads to
stronger relationships in those who have tried donor insemination. This
issue requires much more research.
The most difficult problem for people attempting DI is often the failure
to conceive. Many women assume that they will become pregnant on the
first try. As with many treatments for infertility, there is usually enthusiasm
on the part of the physician or clinic staff that this procedure will offer the
solution that has been sought. With DI especially, the parties have been
carefully screened and the timing carefully planned. When it does not work,
as is most commonly the case after one attempt, many women become discouraged and depressed (Rosenkvist 1981).
Many people drop out of donor insemination after one or two cycles or
even while still on a waiting list. One study of 375 couples in a New Zealand
programme found 165 had withdrawn without a pregnancy. Most of these
reported natural conceptions, adoption, marital separation, or moving
away from the region (Danesh-Meyers et al. 1993). Leiblum et al.'s (1995)
study of 45 single heterosexual and lesbian women who started DI showed
that 15 per cent had stopped because it was too expensive, another 15 per
cent were discouraged by the lack of success, and an additional 8 per cent
dropped out because they felt it was too time-consuming or because they
were not receiving support from others.
A study carried out in Ohio (USA) followed 120 couples for an average
of twenty months after first requesting donor insemination. In this group,
53 per cent had become pregnant, 11 per cent never began DI, 17 per cent
were continuing, and 19 per cent had dropped out. Reasons for dropping
out were not given, as outcome was derived from programme files rather
than interviews. Since the range of follow up was one to thirty-nine
months, these data do not give an exact picture of likelihood of dropping
out. None the less, the researchers discovered that the percentage of
couples who either never began or dropped out early was considerably
lower (17 per cent compared to 33 per cent) in the segment of their population which began after the programme hired a nurse practitioner who
coordinated care and provided education and support to the couples
(Schover et al. 1994).
Keeping donor insemination secret

Almost every discussion of donor insemination raises the question of
secrecy. As with other issues addressed above, the concern for secrecy is very
different depending on the DI client. For heterosexual couples, it is strongly

24

Judith N. Lasker

encouraged and for the most part widely adopted. In contrast, single
women are more likely to want the DI to be publicly known.
Heterosexual couples. Secrecy is an overriding issue at every step of the
process. Because of this secrecy, donor insemination is rarely discussed, and
most people are even unaware of its availability. Most physicians and other
staff members of donor insemination programmes strongly encourage their
patients to keep their experience of insemination a secret from everyone.
They even suggest not telling the obstetrician who delivers the baby, so that
the husband's name will be put on the birth certificate without hesitation.
As one woman said:
The doctor told us it's nobody else's business, that it's just between the two of us and
him, and no one else has to know. That was a hard thing, you know, because so
many times you want to say it. It's a hard thing to explain, and people seem to think
that if you can't have your own, you shouldn't have any or you should adopt. I have
a feeling his parents wouldn't accept the baby if they knew. They wouldn't think she
was a part of him.
Aware of the possibility of problems, many parents wonder if they should
tell a child or anyone else about the conception through DI. A recent survey
of couples who had a child from DI found that 74 per cent did not intend to
tell the child (Owens et al. 1993). This is consistent with the findings of many
other studies of this topic (Bielawska-Batorowicz 1994; Ledward et al. 1982;
Schover et al. 1992) although see chapter by Daniels in this collection.
It is clear that secrecy is a much greater issue with DI than with any other
method of conception. In a survey of ninety-four American men and
women who had considered or tried several different alternatives (Lasker
and Borg 1989), those who had been through DI were by far the most secretive, with 62 per cent of the parents of children born after DI saying it was
important to keep it a secret from others; 50 per cent expected to tell the
children. In contrast, 96 per cent of all those in the survey who had or were
still trying to have a child through IVF intended to tell the child. They
generally want the children to know how special they are and how much
trouble the parents went through to have them. Couples who hired surrogate mothers were a little less sure, but they generally planned to treat the
subject openly. Logically, the child is least likely to need to know about an
IVF conception where there was no donor involved, and yet this is the
situation in which parents are most likely to plan to tell.
The key difference between DI and other methods is that the former
usually involves male infertility and that other methods usually treat female
infertility. AIH, artificial insemination using the husband's sperm, which
can be used for either partner's problem, is more likely to be kept secret
when used for male than for female infertility (Lasker and Borg 1989). It

The users of donor insemination

25

appears that the couples, and society as a whole, consider male infertility a
much more serious stigma than female infertility; hence, secrecy is more for
the protection of the infertile man (as well as for the physician and donor)
than for the benefit of the child. It is much easier to keep DI secret than
other forms of conception, and certainly easier than adoption. There is no
legal transaction, and the mother has an apparently normal pregnancy and
birth. The father's name is on the birth certificate, and often the attending
obstetrician or midwife is unaware of the origin of the pregnancy. In addition, particularly in the United States, most physicians who offer DI and
therapists who counsel prospective parents about donor insemination
strongly advise the couples to maintain secrecy, never to tell the child or
anyone else (Waltzer 1982).
The difference between men and women in feelings about secrecy can be
a particularly difficult source of trouble. This difference is especially hard
on a woman who needs to talk but feels she must comply with her husband's
wishes to keep their infertility problems a secret. In our research (Lasker
and Borg 1994), most couples said they agree with each other about
whether or not to tell others of their experiences. Some couples, however,
found this to be a problem. Generally, the men were more likely to want to
keep everything secret (Lasker and Borg 1989; Back and Snowden 1988). A
woman whose baby was conceived through donor insemination (also called
AID) explained:
My husband insisted we tell no one about the AID procedure, and that was very
hard for me. I felt that, in trying AID, I would be carrying another man's sperm,
and if the process worked, I would be living with a 'lie' the rest of my life. I finally
broke down and told a close friend. It felt like I was releasing an enormous pressure
from my mind.

More parents are beginning to have a more open view of donor insemination. Our study showed that somewhat more people intended to tell their
child about their origins than did not. Many were still uncertain, hoping to
find an answer as the child grew older. The sample, like many in such
studies, is not representative, since most of the people are members of the
RESOLVE support organization. They are people who are willing to talk
about infertility (Lasker and Borg 1994). But they are likely to represent a
growing trend toward more openness about infertility. In Nielsen's study of
Danish and Swedish couples at a Danish clinic, 51 per cent said they would
tell the child when he or she grew up (Nielsen et al. 1995).
Most couples feel very torn between a desire to keep the information
private and a strong need to talk to others about it. They are fearful of others'
reactions. Yet they also talk about the stress of 'living a lie' and the wish to
share such an important event with those to whom they are close. Schilling

26

Judith N. Lasker

(1995) reports that ten of thirty-four German couples interviewed five years
after beginning insemination reported feeling 'oppressed by secrecy'.
Some people who use DI wish they could meet other people who have
also used donor insemination so they could compare their feelings and
experiences with each other. There are very few opportunities for this to
happen, although a support group (DI Network) was established in 1993 in
Great Britain, and RESOLVE in the United States provides an opportunity
for people to contact each other (and more recently similar groups have
now been established in Canada, Australia and New Zealand).
No matter how strongly they express a commitment to secrecy, most
people included in studies of secrecy with DI had told at least one or two
others. They are selective, often telling one set of parents but not the other,
or certain friends they assumed would be sympathetic. But they have found
it very difficult not to tell anyone at all. Klock and colleagues found that 38
per cent of the American couples they interviewed before insemination
planned to tell someone else about DI, but only 27 per cent planned to tell
the child (1994). As one father said, 'I couldn't tell him. You know, I will
have raised him all his life and I just wouldn't have the heart to tell him. I'm
afraid he'd be ashamed of me. It might break my heart as well as his.' Some
experts claim that it is essential that children know their medical history
and not assume they may share any medical problems experienced by the
fathers who raise them. Some also fear that maintaining a secret about the
child's origin is ultimately unhealthy for the family. Clamar emphasises this
possibility: 'By its very nature, a secret is a potent force, assuming undue
proportion and power within the family - an existential fact that remains
unspoken, yet controls and colors the lives of the people involved' (1980:
176). Baran and Pannor, who began their study of donor insemination with
a belief in the value of secrecy, were led by their findings to the opposite
conclusion. They found that secrecy is 'lethal and destructive to the families involved. We are convinced that in all DI families, the need to maintain
secrecy and anonymity has had an adverse effect upon all of the members'
(1989:13,152). Daniels and Taylor (1993) argue for the child's right to know
his or her origins. The British Warnock Committee came out in favour of
telling children about their conception (a position not held by most physicians) but still recommended that the donor be totally anonymous (Haimes
1993).
The decision to tell a child when he or she may never be able to find the
donor creates an added dilemma for the parents, as noted earlier. The physicians who provide donor insemination usually counsel silence; social scientists who have studied DI almost always encourage openness. Yet most
parents are opting for silence, and in some cases they are found to regret
having decided to tell others (Nielsen et al. 1995; Klock et al. 1994).

The users of donor insemination

27

Single heterosexual and lesbian women. For lesbians and heterosexual
single women, the question of secrecy is totally different. The majority of
single heterosexual and lesbian women who use DI do not keep the
information secret (Golombok and Tasker 1994). They would rather that
others, and the child, realise that the conception was planned and wanted,
not the accidental result of a casual affair. Secrecy, then, is usually not a
problem, nor is the issue of genetic inequality between parents. In Leiblum
et al.'s (1995) study of single heterosexual and lesbian women who underwent DI, all of them planned to tell a child conceived through DI, and 57
per cent reported that they would like their prospective child to be able to
meet the donor.
Conclusion

For those who do succeed, donor insemination, like many of the new technologies, is regarded very positively. Most studies indicate that parents of
children conceived with DI are delighted with the results, and many of them
return for another child. Yet the process also creates dilemmas for individual families to resolve. DI is certain to become increasingly common and
more successful and therefore probably more public. Even so, it is likely to
remain a secretive process, one producing great joy for many families but
also many questions.
Many issues remain to be more carefully researched and considered; for
example, the effects of DI on relationships, both heterosexual and homosexual. While there is very little known about how married couples cope
with DI, there is essentially no research on the experience of lesbian
couples. Is the partner who is not inseminated experiencing anxiety or jealousy? Should counselling be required for anyone who is having DI and for
their partners? Should people who appear to be troubled by the process be
excluded, or is this discriminatory?
We also know very little about the dynamics of decision-making within
couples. Baran and Pannor (1989) suggest that often DI is actively promoted by physicians in almost the same breath with which they announce
the man's infertility. Would it indeed be better to delay any discussion of DI
until the man and his partner have had an opportunity to accept his infertility first? What are the consequences for couples, and for children, if the
partners are ambivalent about going through with DI, or if one partner is
more motivated than the other?
Since almost all studies of donor insemination are based on volunteers
who select themselves, it is likely that there are many people who use DI
who are simply not represented in research. It is also the case that programmes run by physicians and fertility centres attract a clientele almost all

28

Judith N. Lasker

of whom can afford the treatment. Thus what little we do know is skewed
towards white and relatively affluent people, mostly in the United States,
Western Europe, and Oceania. A study from Cameroon suggests that there
are very different issues of cultural norms and attitudes toward DI in that
country than in countries where most studies are carried out (Savage 1992).
How do social class, nationality, race, and ethnicity affect the likelihood of
considering DI and the experience of using it? Are poorer women more
likely to seek out their own donors, and if so, with what consequences?
Baran and Pannor (1989) point out that the only working-class people in
their study were lesbians who had found their own donors. In the study by
Klock et al. (1994) of all couples seeking DI at a university-based infertility clinic, over three-quarters had a yearly income of at least US $50,000.
There is also very little known about how people select their own donors
and the types of relationships which they have with the donor. What is the
impact, for example, of having a brother of an infertile man donate sperm
with which to inseminate his wife? There is the advantage that the child will
share some genes with his or her father, but what happens to the family
constellation in this kind of situation? Despite the court cases which reflect
those situations in which there is conflict, there are many recipients of
donor insemination who maintain very positive relationships with the
donor, who may be known to the child and be an active and positive part
of his or her life.
These are just a few of the questions which remain, the answering of
which will help open the door on this practice, which has been in use for a
long time but is still veiled in secrecy.

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Judith N. Lasker

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Families created through donor insemination
Robert and Elizabeth Snowden

Introduction

Most people would accept the proposition that sexual relationships, the
birth of children and the nurture of infants and young children are normally contained within the set of relationships we call the family. In many
respects the family is an elusive concept which describes relationships with
which we are all familiar but which, on closer examination, we find difficult
to define with precision. Because of our close personal experience of family
life we are apt to assume we know what we mean when we speak of the
'family'. Moreover, it is usual to assume that the word has the same
meaning for us that it has for others and that our experience is similar to
that of other people. However, while the recognition that family members
have a special relationship with each other appears to be ubiquitous, the
form and quality of these relationships vary between and within societies
and even in the same family group over time.
What makes the study of these relationships even more difficult is that the
thoughts one brings to bear on such a study have largely been structured by
the very relationships being studied. The subjective nature of family relationships is one which is not readily amenable to objective assessment or
measurement using the traditional tools of science and for this reason their
detailed study remains either neglected or problematic.
In our personal lives most of us are exposed to the importance of subjective experiences; indeed, it is these positive or negative feelings which
tend to hold most meaning for us. While attempts have been made to scale
or measure such subjective feelings, these attempts have generally not succeeded beyond what most researchers would regard as a superficial level.
However, this inability to assess the impact of subjective experiences in a
way which permits objective measurement should not be allowed to diminish the significance of these experiences or lead to an underestimation of
their value.
While the special group of people described as family members exerts
deep and significant subjective influences of a very pervasive kind, the
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Robert and Elizabeth Snowden

concept of the family also describes an institution which socialises individuals to become members of a particular society through the inculcation of
society-specific values which maintain that society both in the present and
from one generation to the next. The birth of children and their socialisation as members of a given society has been, and continues to be, an underlying co