Some attitudes to artificial insemination by donor

A preliminary survey to assess and quantify attitudes to Artificial Insemination by Donor (AID) has been conducted with the aid of an article in a national magazine. The consensus of 375 individuals (mostly with a vested interest in infertility) concerning their attitudes to semen donation, hypothetical receipt of donor semen, legal aspects and the keeping of donor records, etc., have been analysed and their answers correlated to their age, sex, ethnic grouping, educational level, religion, and marital and fertility status as well as their place of residence. Within the limitations of this study, three major conclusions can be drawn. Firstly there are probably many potential semen donors in the general community and recruitment techniques need to be improved to capitalize on this source. Secondly, a centralized non-identifying National Register of donor information may be tolerated, and finally, the couples questioned felt an AID child should not be likened to one received through adoption. These and other findings would suggest that attitudes towards AID are changing and consequently some of the practices within AID programmes may need to be altered. Further statistically conducted surveys are warranted to determine these current attitudes.

Characteristics, attitudes and personalities of AI donors

The first 50 men recruited to an artificial insemination by donor (AID) programme have been assessed for their attitudes and characteristics using a basic questionnaire and a standard well evaluated personality inventory. The results have shown that donors can be characterized as stable and moderately extroverted people who come from a wide range of occupations. Their marital and parental status had no particular relationship to their desire to donate and most of them volunteered for altruistic reasons, financial remuneration being a poor inducement. Most subjects lived within the close environs of the Westmead Centre and preferred to donate during normal working hours. The inconvenience of donating appeared to be the most important factor in considering new approaches to recruiting semen donors.

Attitudes regarding utilization of artificial insemination by donor in Huntington disease

We report on a study of attitudes toward artificial insemination by donor (AID) of persons at risk for Huntington disease (HD). The subjects of the study were 91 at risk persons and 68 matched controls. Both groups were divided by sex and age (45 yr less than or equal to vs greater than or equal to 46 yr). Demographic data included age, occupation, marital status, religion, education, ethnic background, and family size. We recorded 1) attitudes toward reproduction, 2) nature of contact with affected family member(s), 3) effects of HD on family planning, 4) attitudes toward AID, and 5) concern about donor selection criteria. Results suggest that 1) men and women differ in several ways with regard to their views about AID, and 2) that more vigorous educational programs might increase utilization of AID for the prevention of not only HD, but other human genetic diseases as well.

Social and environmental factors as criteria for success in artificial insemination by donor (AID)

This study analyses the first 366 couples attending the AID Clinic at Nottingham and outlines those social factors which appear to have some bearing on the success of AID treatment. Residence close to the clinic, social class and the employment of the wife all appear to affect success rates.

The psychosocial impact of infertility

I would like to conclude this article by making a special appeal to nurses and related health care professionals to appreciate the special needs of the infertile couple. In being denied a pregnancy and parenting experience when they truly desire it, they are faced with a life crisis of major proportions. It is the goal of the person who counsels infertile couples to help them resolve the crisis positively, and to develop new insights and strengths as a result. The infertile couple who so earnestly desire a family deserve respect and attention. They should be seen as having a legitimate health problem which has attendant emotional issues and overtones. Though they are rarely physically ill and do not usually find themselves incapable of performing their work and living functions, this neglected population suffers an enormous toll in the quality of their life. Health care professionals must be aware of the special feelings and issues of the infertile couple.

Psychological and legal aspects of artificial insemination (A.I.D.): an overview

The psychological and psychodynamic determinants and end-products of A.I.D., both of a positive and negative nature, are reviewed. Studies do not support the contention that a decision to participate in artificial insemination, in itself, is indicative of an emotional disturbance. There is no justification for the automatic requirement of psychological or psychiatric examinations of couples requesting this procedure. Some legal issues are reviewed.

Psychological aspects of donor insemination

This survey of the psychological literature on Artificial Insemination by Donor (AID) pays particular attention to the secrecy. Studies of couples beforehand do not arrive at criteria for choosing psychologically suitable couples. Follow-up questionnaires are superficial and cannot inform us which couples and what percentage of couples encounter psychological difficulties. Case reports of couples who encountered difficulties are too few to permit generalization and cannot specify AID's role in generating symptoms. A second look at the data suggests that, although overlooked, the secrecy surrounding AID may create psychological difficulties, a view supported by the findings at our clinic. A plea is made with specific recommendations to create an ambience in which openness is possible, and which will allow in-depth research of the psychological aspects of AID.

A survey of patient attitudes towards artificial insemination by donor

The psychological characteristics of a consecutive series (n = 58) of women attending an AID clinic have been examined. Women were assessed prior to treatment on a number of attitudinal and acceptability measures, as well as required to complete personality and martial adjustment inventories. At the time of each insemination, over 6 successive cycles, state anxiety was assessed. Following an interval of 6 months women were reassessed on an acceptability measure. The results showed generally positive attitudes at the outset. No systematic trends in anxiety were identified, with no differences between women becoming pregnant and those continuing in treatment. At follow-up women acknowledged the strain involved in timing the insemination to coincide with ovulation, with both pregnant and nonpregnant women attributing outcome to their psychological and emotional state at the time. The implications of these results are considered in terms of the characteristics of women requesting AID and the ways in which clinics can attend to the psychological states of the patients.

A study of parental attitudes after donor insemination (AID)

Artificial donor insemination (AID) is important in the treatment of infertility when the couples' wish for a family is denied because of male sterility. However, very little is known regarding the continued development of AID families and their attitudes to insemination after the child is born. The study is based on a questionnaire anonymously completed by 92 couples returning to obtain a second child by insemination. None of the parents regretted his or her decision regarding insemination and the majority were prepared to recommend the method to other couples in the same situation. Apart from one couple the parents intended to withhold the truth from the child regarding its origin. The majority of parents chose not to inform anyone else regarding the child's conception. The parents were therefore anxious that case notes and details concerning insemination were treated with the utmost discretion and confidentiality. The parents in this study clearly indicated they preferred insemination to adoption. A large proportion of the parents who already had a child as a result of insemination returned to the clinic for a second child.

Fathers anonymous: beyond the best interests of the sperm donor

Current AID practices are based primarily on consideration of protecting the interests of practitioners and donors rather than recipients and children. The most likely reason for this is found in exaggerated fears of legal pitfalls. It is suggested that policy in this area should be dictated by maximizing the best interests of the resulting children. The evidence from the Curie-Cohen survey is that current practices are dangerous to children and must be modified. Specifically, consideration should be given to the following: 1. Removing AID from the practice of medicine and placing it in the hands of genetic counselors or other nonmedical personnel (alternatively, a routine genetic consultation could be added for each couple who request AID); 2. Development of uniform standards for donor selection, including national screening criteria; 3. A requirement that practitioners of AID keep permanent records on all donors that they can match with recipients; I would prefer this to become common practice in the profession, but legislation requiring filing with a governmental agency may be necessary; 4. As a corollary, mixing of sperm would be an unacceptable practice; and the number of pregnancies per donor would be limited; 5. Establishment of national standards regarding AID by professional organizations with input from the public; 6. Research on the psychological development of children who have been conceived by AID and their families. Dr. S.J. Behrman concludes his editorial on the Curie-Cohen survey by questioning the "uneven and evasive" attitude of the law in regard to AID, and recommending immediate legislative action: The time has come--in fact, is long overdue--when legislatures must set standards for artificial insemination by donors, declare the legitimacy of the children, and protect the liability of all directly involved with this procedure. A better public policy on this question is clearly needed. I have suggested that agreement with the need for "a better public policy" is not synonymous with immediate legislation. The problem with AID is that there are many unresolved problems with AID, and few of them are legal. There is no social or professional agreement on indications, selection of donors, screening of donors, mixing of donor sperm, or keeping records on sperm donations. Where there is agreement, such as in requiring the signature of the donor's wife on a "consent" form, the reasons for such agreement are unclear. It is time to stop thinking about uniform legislation and start thinking about the development of professional standards. Obsessive concern with self-protection must give way to concern for the child.

Infertility. A psychiatrist's perspective

This paper discusses issues relevant to psychiatrists working in a reproductive biology unit: 1. The couple's anxiety. 2. The question of whether psychological conflict can cause infertility. 3. Dealing with the outcome of the workup. 4. Donor insemination. The anxiety of couples applying for an infertility workup can usually be countered by supportive and educative measures. More problematic sources of anxiety that require psychiatric consultation are: 1) Fear that the workup may shatter a myth that explains the infertility, a myth reinforced by unconscious conflicts; 2) An untenable wish that having a child will repair problems in the marriage or in the sense of relief. The psychiatrist is often asked whether psychological conflicts can cause infertility. The most understandable manner in which they do is by their effect on sexual performance. Where there is no sexual performance problem, psychotherapy can be offered if one or both partners experiences psychological pain, but with the understanding that therapy cannot be expected to cure the infertility. Psychiatric consultation at the end of the workup is indicated 1) where irreversible infertility is discovered and mourning is excessive, 2) where a myth to explain the infertility has been shattered, 3) to reassess sexual performance and to deal with the uncertainty, where no physical cause has been discovered. Donor insemination (AID) is fraught with legal and ethical problems. There are no criteria for selecting donors or recipient families, and there is concern that AID may lead to genetic engineering. The psychological effects of AID are uncertain. A study at our clinic suggests that the pursuit of AID involves a two-stage process: first, dealing with the outcome of the infertility workup and second, confronting AID itself; and that the secrecy that surrounds AID obstructs resolution of conflict.

Complications and pitfalls of artificial insemination

Pregnancy resulting from AID procedures compares favorably with pregnancies occurring in the general population. However, it seems advisable to start a concerted effort to learn more about AID techniques in order to offer a more reliable and safe procedure. Thus, it may be possible to increase the overall success rate and to better define the conditions that determine its failure in apparently normal women.

Couples' reactions to male infertility and donor insemination

The author interviewed 16 couples after the husband had been diagnosed as infertile. Eleven husbands experienced a period of impotency. Fourteen of the women experienced anger toward the husband, psychiatric symptoms, and/or dreams about their concern for the husband, a wish to be rid of him, and guilt over this wish. Ten couples had decided to pursue donor insemination; 6 had delayed 1 3/4 to 4 years after the diagnosis of infertility and had a better adjustment than 3 of the 4 couples who did not. The author believes that the total secrecy involved in donor insemination inhibits the working through of conflicts about infertility and donor insemination itself.