1 Center for Reproductive Medicine of Thrace, 18 Ionos Dragoumi str., 681 00 and 2 Laboratory of Reproductive Physiology-IVF, Faculty of Medicine, Democritus University of Thrace, Dragana, 681 00 Alexandroupolis, Greece
3 To whom correspondence should be addressed. e-mail: nnikolettos{at}hotmail.com
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Abstract |
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Key words: ART/ethics/intrafamilial/sperm donation
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Introduction |
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Sperm donation is one of the oldest and most common procedures in assisted reproduction. Despite the lack of official data, in Greece, more than forty private sperm banks offer cryopreserved sperm for IVF procedures. Donors are required to be anonymous, healthy individuals, <40 years old. Nevertheless, sperm donation entails great psychological implications for the couple, as it raises ethical and existential dilemmas which are difficult to overcome (Klock and Maier, 1991; Klock et al., 1994
; Marshall, 1998
; David, 2000
; McGee et al., 2001
; Patrizio et al., 2001
). For males especially, sperm donation is hardly an acceptable solution, as there is a complete separation between biological and social filiation (David, 2000
). On the other hand, females consider sperm donation a less dramatic separation; the genetic dissociation is partial and the pregnancy creates and maintains a strong biological bond between mother and child (David, 2000
). Quite often, couples confronted with such problems and dilemmas become unwilling to receive sperm donation. Another alternative, preferred by a few couples, is father-to-son sperm donation. This type of donation maintains some genetic link and in this way seems to tone down the stresses that these couples face (Marshall, 1998
).
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Our experiences |
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The motives of recipients and donors |
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Their choice is hard to explain. The two couples did not easily discuss their thoughts and feelings on these issues during the interviews with the medical doctors or the psychologist. For example, they did not give reasons for their refusal of anonymous donation. The same was also true for the donors and the other family members. The unwillingness for discussion seems to be a common phenomenon in couples receiving gamete donation (Klock and Maier, 1991; Klock et al., 1994
; Adair and Purdie, 1996
; Brewaeys et al., 1997
). As McWhinnie (2001
) states..."the secrecy is central to these families functioning".
We can approach the couples choice of donor by considering the four following reasons: firstly, the origin of gametes was known and the genetic link was maintained. Secondly, there was a strong emotional bond between fathers and sons. Thirdly, the age of fathers seemed to be a determinant factor: An old grandfather could hardly claim the role of the father for the prospective offspring. This risk was diminished by his limited life expectancy. Last but not least, the possibility for future negative fatherdaughter-in-law relations was negligible because of the donors age. With father-to-son sperm donation, the couples seemed to secure the future stability of their families.
Questions also arise regarding the motives of the donorsthe husbands fathers. Both donors refused to discuss these matters during the interviews. Even though all risks were repeatedly explained the donors refused to express their opinions. It seems rational that the two fathers saw the sperm donation as a parental offer; a gift to their sons.
Unfortunately, the views of donors wives are not known, as they did not appear during the counselling meetings.
The available literature is very poor regarding intrafamilial sperm donation. Therefore, a discussion on the motives of recipient couples and donors becomes difficult. Similar attitudes have been reported in studies regarding oocyte donation. In a study carried out in the Centre for Reproductive Medicine at the Free University of Brussels, the majority (68.8%) of recipient couples of oocyte donation clearly preferred persons from family and friends as donors (Baetens et al., 2000). Fear associated with the unknown origin of the genetic material and the acquaintance of the donor were the two main reasons for this preference (Baetens et al., 2000
). Adair and Purdie (1996
), in a study with 46 recipients and donors participating in personal donor programmes, reported that recipients preferred personal donors on the basis of knowing the donors background and, for related couples, having a common genetic origin. The similar genetic background appears to be more important for men than women. The genetic/medical background of the donors is reported as a major concern among donor insemination families, too (Klock and Maier, 1991
; Klock et al., 1994
; Brewaeys et al., 1997
).
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Potential risks |
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The impact of disclosing this information to the offspring is unknown (Marshall, 1998). But it is also true, that most couples who receive gamete donation, prefer to keep this information secret, not only from the offspring, but also from close friends and relatives (Klock and Maier, 1991
; Klock et al., 1994
; Cook et al., 1995
; Brewaeys et al., 1997
; Baetens et al., 2000
; David, 2000
; Gottlieb et al., 2000
; Daniels and Thorn, 2001
; McGee et al., 2001
; Patrizio et al., 2001
). Many opinions have been expressed to explain this attitude: Many infertile couples consider the males infertility as a handicap and therefore prefer to keep it secret (Cook et al., 1995
). Nondisclosure of gamete donation is a way to maintain the normal bonds between the child and the parents, to avoid distressing the child and to establish a normal family (Cook et al., 1995
; Frith, 2001
). Brewaeys et al. (1997
) state that fathers more often than mothers are secretive with regard to the use of a donor and are more in favour of donor anonymity. In cases of intrafamilial sperm donation, where the donor is a close relative, it is possible that all the above considerations are stronger. Another argument is that a child has the right to know her/his origin for ethical and medical reasons. Under what circumstances should nondisclosure prevent the childs right to know the identity of his biological father? Nondisclosure violates the childs rights to autonomy. In many cases, nondisclosure creates family tension detectable by the child and the disclosure of the childs origin either accidentally or intentionally later in life causes distress and challenges the family relationships (McGee et al., 2001
; McWhinnie, 2001
). However, Brewaeys et al. (1997
) found there was no association between secrecy and the emotional or behavioural adjustment of children.
Today, a broad discussion exists on donor anonymity (Cook et al., 1995; Brewaeys et al., 1997
; Gottlieb et al., 2000
; Daniels and Thorn, 2001
; Frith, 2001
; McGee et al., 2001
; McWhinnie, 2001
; Patrizio et al., 2001
). Whether children should have access to information about the method of conception, the name of donor and medical information concerning the donor is still a matter of debate. Irrespective of the future conclusions of this discussion, assisted reproductions scientists have already gained a valuable profit from it, as they have started focusing not only on the infertility problem itself, but also on the long-term outcome and consequences of assisted reproduction. However, this ongoing discussion has not considered intrafamilial donations.
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Lack of law and lack of studies |
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We believe that a rational approach of such cases on behalf of the IVF centres should include an extensive discussion on the medical risks and a clear understanding of the complicated relationship between the donor and the offspring. Psychologists should emphasise the right of the offspring to know her/his genetic origin. It is true that it is not always possible to have broad discussions with couples and relatives, but it is very crucial to make them aware of all consequences, because only then they make reasonable decisions.
Of course, apart from the couples and the relatives, it remains for society and the scientific community to take a stand on this subject.
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Conclusion |
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References |
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