An article by Mary Barton in The Manchester Guardian, about Artificial Insemination by Donor (AID).
The proper and improper uses
I write as a physician who has taken the responsibility of administering artificial insemination by donor to a number of women. In this respect I differ from most of those who have taken part in this lively discussion of the subject, on this page and elsewhere; and I should like to give some facts to correct the rather emotional surmises which have been published.
Couples requesting A.I.D. are usually of excellent character, above average in intellect whatever their social class and fully aware of the difficulties. Each partner is interviewed separately. If there is any suspicion that one spouse is not wholeheartedly desirous of A.I.D I reject the couple. The indiscriminate gift of a child to the childless could be bad for society; as in adoption it is the duty of a doctor to reject unsuitable parents.
A sound background
I accept only organic causes of defect in the husband for requesting A.I.D. – such things as the total absence of sperm by reason of disease, accident, irradiation and the like. I do not usually accept impotence as a sound reason for A.I.D.; the failure of the husband to satisfy the wife sexually must produce tensions in the marriage which must in turn produce an unsound psychological background for the child. Many of the cases which have come to the courts are those where impotence has been the main factor for seeking A.I.D., and I would require very strong reasons indeed for performing either A.I.H or A.I.D. in such cases.
Donors are usually obtained from among the fertile normal husbands of ex-patients formerly infertile who, having suffered for many years from this want, know only too well what it means to them. No one who has children or who has never wanted them can appreciate the feelings of those to whom children have been denied. All donors are voluntary, are not paid, act with the consent of their wives, have their own families and feel that they are doing a service to humanity in exactly the same way as blood donor’s do. They are men of the highest character, integrity and intelligence.
The outcome in all of the cases with which I have dealt for over ten years, and which have been followed up, has so far been good. Indeed many patients have requested a second and sometimes a third child by the same donor. In my experience the child has always been fully accepted by both partners as a complete member of the family and as their own child. The donor should not be related to the couple. (This is so that there would be no disruptive emotional contact between donor and child later in life. Secrecy is essential………… maintained in the case of a relative).
The doctor’s first consideration should be the background into which this child should be born. To perform A.I.D. in order to hold together a marriage which is already strained is in my view unpardonable. Exactly the same precautions in assessment of the family background should be taken (perhaps even more) as in adoption Certainly no doctor should ever perform A.I.D. without the written consent of both parties. The work should not be done in an occasional case by a general practitioner but only by those experienced in fertility work. For example two thirds of those referred to me for A.I.D. when examined by modern diagnostic methods are found not to require it. There is a false impression current about the ease with which conception takes place. My own figures suggest a success rate of not more than 56 per cent. My colleagues in other centres with a larger series of cases have a similar experience. Moreover, although occasionally conception has occurred after only one insemination, the average case takes four our five; some have been up to two years before success has been achieved. In half of the cases I have seen, the wives themselves have an important factor of infertility in addition to their husband’s absence of sperm, and they would require treatment even if their husband were fully fertile.
Child’s future
A child obtained by A.I.D. is in my view the crowning happiness of a marriage which would go on reasonably well in any case. Indeed this is the first and most important question I try and determine for each couple. The safeguarding of the child’s future weighs far more heavily with me than the need to satisfy the maternal or paternal instincts of the couple. I have studied the law reports of those cases which have reached the courts in this and other countries and would say that most are cases in which A.I.D should never have been attempted – for example without the husband’s consent or because the husband was impotent. Both parents must desire a child for valid reasons; for example I would not accept as a reason that the woman wants a baby because all her friends or relatives have one! Husbands often prefer A.I.D. because they can be sure of the qualities of at least one parent. Many want their wives to experience maternity and feel that they are denying their wives something which they should do all in their power to put right. The wife is driven by the more simple and understandable biological urge to ………. her own child. I can quote one case in which a woman had already adopted two children and was still not content until she had produced her own (by A.I.H. incidentally).
I keep in touch with all my cases, as do a number of my colleagues, and over a period of many years we have not found any defect in the children. They are all perfectly sound physically and mentally and a high proportion have turned out to be above the average in intelligence a school, several being gifted either musically or as artists. At the time of conception all the couples were living together as man and wife; and all husbands without exception decide to register the children in their names and the children are not therefore told that they are not the natural children of their parents. I would refuse A.I.D. for a spinster or a couple of mixed colour or even of mixed religious denomination. I feel that the tensions in parental background in such circumstances would increase the hazards which are present even in normal marriage and one should not expose the child to such additional risks. I and my colleagues have no evidence whatsoever that the use of A.I.D. distupts the family or produces psychological problems and I am sure that this is because the candidates are selected with care as of course are the donors.
Registration
Undoubtedly the novelty of the idea cuts across deep seated habits of emotion and rhythms and people tend to make up their own minds and then find reasons for so doing. The word “artificial” emphasises this novelty; perhaps “therapeutic” would be better.
I believe there is a place for A.I.D. in certain special cases so long as the doctor and the parents are fully aware of the difficulties and conscientiously try to meet them. Whether registration would assist or impede such a process is open to discussion, nor am I sure it would bring about any safeguards greater than those available by the character of the doctor performing the operation.
Finally, as Dr Soper has said “A.I.D. is here to stay” The whole danger lies in the varying standards of ethics and the philosophical principles of the parties concerned. It is important that we should, if possible detach our personal emotions in discussing this very difficult problem and try to see it from the point of view of the welfare of the child and the alleviation of the very great misery with which childlessness causes to couples who are often highly suitable from every point of view to become parents. Only those who see and talk to these childless couple can know how deep this misery can be. It is because they are some of the best potential parents in our community that I have endeavoured and will………..