moral issues of artificial insemination essay

Moral considerations on infertility and artificial reproductive technics

Journal of Ethics in Entrepreneurship and Technology

ISSN : 2633-7436

Article publication date: 9 September 2022

Issue publication date: 17 November 2022

The purpose of this paper is to offer a Christian perspective on the ethical issues related to natural procreation and artificial reproduction methods.

Design/methodology/approach

This paper uses descriptive and comparative methodology between the ethical aspects specific to natural procreation and artificial reproduction.

Religious beliefs play a significant role in shaping the moral perspective when an infertile couple is confronted with the choice between natural procreation and artificial reproduction.

Originality/value

This paper survey a broad bibliography and offers a critical evaluation of the moral aspects specific to different methods of reproductive technologies compared to the natural procreation approach.

• Artificial insemination
• Assisted reproduction
• In vitro fertilization
• Intracytoplasmic injection
• Natural procreation

Negrut, P. and Pop, T. (2022), "Moral considerations on infertility and artificial reproductive technics", Journal of Ethics in Entrepreneurship and Technology , Vol. 2 No. 1, pp. 2-22. https://doi.org/10.1108/JEET-04-2022-0009

Emerald Publishing Limited

Copyright © 2022, Paul Negrut and Tiberiu Pop.

Published in Journal of Ethics in Entrepreneurship and Technology . Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence maybe seen at http://creativecommons.org/licences/by/4.0/legalcode

1. Introduction

According to the World Health Organization report, the number of infertile couples (marital infertility) who cannot have children has increased in the recent decades to 48 million couples and the number of individuals who are affected by infertility has increased to 186 million ( WHO , 2020a, 2020b ; Lilienkamp, 1993 ) [ 1 ]. In the same vein, Diana Cocei, an expert in reproductive medicine, claims that in 2019 in Romania, one in four couples faces infertility problems ( Cocei, 2019 ; Association for Human Reproduction in Romania, 2020 ). Hordern points out that although “the pain of infertility is often silent,” the consequences of the negative psychoemotional feelings and spiritual experiences of these families are particularly pressing ( Hordern, 2022 , p. 1). The intensity of the unfulfilled desire to have children is accompanied by a series of deep feelings of pain, guilt or depression, similar to the feelings that we found in the Biblical example of Rachel when she said to Jacob: “Give me children, or I will die!” (Genesis 30:1) [ 2 ]. The inner suffering of a woman who cannot have children is further deepened when she realizes that her friends or acquaintances are happily announcing that they expect a child or have given birth ( Taebi et al. , 2021 ; Hagan, 2017 ).

Although data from recent decades confirm a statistical increase in the number of infertile couples, it should be noted that the moral and spiritual aspects of sterility and infertility are recorded in the Bible from an early age: Abraham and Sarah, Isaac and Rebecca, or Jacob and Rachel, Elkanah and Hannah, Zechariah and Elizabeth are just a few examples ( Hordern, 2022 ; Byron, 2010 ). However, the difference between the early biblical times and our time is not primarily due to the intensity of sufferings and the desires of infertile families, but because contemporary Christian couples who desire to have children are further challenged by the multiple choices offered by the postmodern ethical relativism and the new reproductive technologies that, seemingly, operate beyond the boundaries of their religious and moral frame of reference ( Messer, 2017 , p. 292; Agnew, 2012b , pp. 4–5). Particularly, when talking about reproduction or children's birth in postmodern society, one encounters two equally challenging extremes for the ethical debate. The first extreme advocates that sexual intercourse is an end in itself, separate from reproduction (Fieser, 2021; Heinbach, 2004, pp. 29–37; Cameron, 2000) [ 3 ]. According to this view, partners are open to explore any method to avoid pregnancy, or in other words, to avoid having children ( Kimport, 2018 ; Davis, 2004 ) [ 4 ]. To this end, Kuby argues that the methods they use range from the most rudimentary contraceptive techniques to the new contraceptives promoted by the movement called “Family Planning,” and ending with on-demand abortions performed legally for up to 14 weeks of pregnancy ( Kuby, 2014 , pp. 50–52). Moreover, following recent legislative changes in the USA, the interruption of pregnancy’s normal course can also be performed in the third trimester of pregnancy or even during birth (Cole, 2019; Kuby, 2014 ) [ 5 ].

The second extreme proclaims that regardless of marital status, sexual orientation or age, those who want to have children have the right to resort to any reproduction method available ( Blight, 2019 ; Meilaender, 2000b , pp. 36–39). Currently, the available methods range from medical treatment to stimulate spermatogenesis and ovulation, continuing with new reproductive techniques, and, finally, even human cloning could be an option ( Sun, 2019 ; Bahanondes and Makuch, 2014 ). The statement made by George J. Annas, as early as 1984, clearly illustrates the two facets of the contemporary sexual ethics and reproductive ethics:

Dependable birth control made sex without reproduction possible […] now medicine is closing the circle […] by offering methods of reproduction without sex. ( Annas, 1984 ; Hashami, 2020 )

What are the options for Christian couples who desire to have children?

What are the moral guidelines for those decisions?

2. Natural procreation

Is it moral to resort to artificial means of procreation? And if the answer is Yes, what would they be? ( Rae, 2009a )

Prayer . Braga et al. (2019) point out that “worldwide eight in 10 people identify with a religious group,” and consequently “religion and medicine are two common coping techniques people use to address life challenges.” Moreover, “a growing body of research, from a wide range of disciplines, suggests religion, spirituality, or faith to be an important contributor to health outcome” ( Braga et al. , 2019 ) From a biblical perspective, Christians argue that the omniscient God knows the physiological, emotional and spiritual condition of all people, including married couples. As Stein (2018) and Haas (1989) point out, God precisely knew the physiological, emotional and spiritual situations of Abraham and Sarah (Genesis 15:1-5; 16:2, 17:15-17, 21:1-2), Isaac and Rebekah (Genesis 25:20-21), Jacob and Rachel (Genesis 29:31; 30:1-2, 22-23), Zechariah and Elizabeth (Luke 1:5-7, 13, 23-25) and in His appointed time, He listened to their prayers and gave them children ( Stein, 2018 ; Haas, 1989 ). Melone (2022) and Rae (2009b) argue that this approach is established in the biblical teaching (Genesis 2:24; Matthew 19:5; Ephesians 5:32-6:3) about God's sovereignty and His plan for the heterosexual, monogamous and inseparable family, which He founded and blessed with the possibility of conceiving and raising children ( Melone, 2022 ; Rae, 2009b ). Undoubtedly, there are Christian couples who have faced infertility and who have had children after a shorter or longer period of prayer ( Nagourney, 2001 ). As Rae further notes, this approach provides a natural continuity that cannot be interrupted between marriage, intimate relationships, conception, pregnancy, birth and parenting. This approach's morality is given by the fact that it respects the natural course of conception and birth of children according to the principle of natural law. Thus, children result from spouses' mutual giving in a relationship of love: children being “a gift, not a product” ( Rae, 2009b ). The experience of many families who have fasted and prayed for their children confirms that in Bible times and our day, God hears prayers. However, it should be noted that not all families who believe in the power of prayer have received the desired response ( Wann, 2016 ). In this situation, although “God’s reasons for withholding children from couples remain a mystery”( Arbo, 2018 ), “the fact that God does not give children to families is not the same as the absence of His blessings, but may mean that God has other blessings in mind” ( Lilienkamp, 1993 , p. 18; Arbo, 2018 ).

Medical treatment . From a biblical perspective, Kukin (2021) affirms that “medicine and technology are gifts from God.” Thus, when fertility is impaired by medical issues of an organic or functional nature, the person or couple seeks medical assistance to remove the cause either through drug treatment or various surgeries. In both cases, the doctor does not intervene in the intimate relationship between husband and wife in the fertilization process. As Geisler (2002 , p. 179) notes, such interventions do not present ethical issues for couples of believers because the medical treatment does not intervene to replace the intimate relationship between spouses but only helps the body function normally for reproduction. However, Lilienkamp (1993 , p. 39) points out that some Christian groups reject any medical intervention assuming that true faith excludes any medical act. In reality, as Kukin (2021) points out, such an approach has no biblical basis because “God’s sovereignty does not exclude human responsibility.” Moreover, Jesus Himself stated this principle: “It is not the healthy who need a doctor, but the sick” (Mark 2:17). From an ethical perspective, there is a fundamental difference between medical treatment that helps the normal development of sexual relations between spouses and technologies that replace natural relations between spouses in the procreative process ( Rae, 2009b , pp. 195–196).

Adoption . More (2015) affirms that the doctrine of adoption is at the very center of Christian theology, and it is rooted in God’s decision to adopt sinful people into his family. Furthermore, he points out that whenever Christian couples adopt orphans, they illustrate the heart of the gospel ( More, 2015 ). Similarly, Weaver (2020 , p. 464) underlines that when God adopted sinful men and women into His family, they have received the “spirit of adoption” (Romans 8:15). From a more pragmatic perspective, Nachinab et al. (2018) argue that adoption is a valid moral alternative to infertility because children who were abandoned at birth or orphaned by tragedy opens the possibility of adoption for infertile couples. It is true that when one analyzes the history of adoptions, one may encounter encouraging (success), less encouraging examples or even tragedies. The arguments invoked against the adoption are genetic (genetic diseases or psychoemotional and behavioral predispositions) or relational when the children discover the truth about their adoptive parents ( Casonato and Habersaat, 2015 , p. 25; Lilienkamp, 1993 , pp. 100–107). However, without denying the challenges and the responsibilities of the adopting parents, Christians believe that the Bible provides a solid theological basis for adoption rooted in God's care for orphans (Exodus 22:22; Psalm 68:5; James 1:27), and the fact that God Himself adopted us (Galatians 4:5, Ephesians 1:5 ( Konkol, 2017 ).

Acceptance that they cannot have children . In this case, as Fuller (2016) points out, trust in God's sovereignty and love is the theological basis for accepting “that all things work together for good to those who love God” (Romans 8:28). Even if they are not aware of why God does not give them children, these couples are willing to pay the price of obedience to the One who always chooses the best gifts for His children. However, as Goodwin and Lee point out, accepting God's sovereignty does not exclude but requires balanced biblical counseling to overcome the stages that infertile couples may go through, such as shock/denial, loneliness/depression, panic, guilt and anger/resentment ( Goodwin, 2020 ; Lee, 2019 ; Lilienkamp, 1993 , pp. 108–130). Finally, as Susanta (2021) and Prior (2014) notice, the infertile couple can experience peace and blessings for them in Christ, which bring emotional and relational fulfillment here on earth and hope for the fullness of rewards in glory.

3. Assisted reproductive technology

If the answer to the question of the morality of using artificial methods of reproduction is Yes, then ethical issues are more intricate. On the one hand, we have reproductive techniques that do not involve genetic intervention on embryos, and on the other hand, we have techniques that involve genetic manipulation – so-called genetic engineering. In this maze of options facing infertile couples, ethical debates about the morality or immorality of specific techniques face moving targets/sands as they operate in the realm of ethical pluralism and relativism, not within the confines of biblical ethics ( Klitzman, 2018 ; Greggo and Tillet, 2010 , p. 249; Schenker, 1992 ). However, the religious moral values cannot be completely overlooked because, as Sallam and Sallam (2016, p. 33) argue, “human response to new developments regarding birth, death, marriage and divorce is largely shaped by religious belief.”. In the same vein, Iglesias (2000, pp. 91–112) points out that Christian belief plays a significant role in ones approach to artificial reproduction technology. Thus, from a biblical perspective of “one body,” heterosexual and monogamous relation between spouses, in this paper, we will point out to some moral issues related to artificial reproduction techniques that do not involve genetic material modification. Particularly, we will look at:

3.1 Artificial insemination by husband (homologous insemination)

This procedure is used if the husband suffers from oligospermia (low sperm count). Sperm is collected from the husband, usually by masturbation, and in some particular cases, surgically, by direct extraction from the testicles (testicular sperm extraction or testicular sperm aspiration). The sperm thus harvested in laboratory conditions are then introduced with a needle-free syringe into the woman’s uterus ( Trolice et al. , 2017 ). This method is frequently used and morally justified by a growing number of Christian ethicists on the grounds that the sperm is from the husband, it provides the genetic relations of both parents to the offspring, and the costs of medical procedures are much lower than in the case of other techniques ( Grudem , 2021a, 2021b ; Geisler, 2002 , p. 187; McFaden, 1967 , p. 60) [ 6 ].

However, Pacholczyk argues that the ethical issues in such cases refer to the morality of masturbation and the replacement of the intimate marital act with the doctor and medical intervention as a means of procreation. More precisely, through masturbation, the intimate relationship between the spouses is replaced by a mechanical self-arousal. The sperm becomes a laboratory product (commodity), and the doctor replaces the husband with the help of mechanical means of introducing sperm into the uterus ( Pacholczyk, 2014 ). Therefore, out of the desire to have children at any cost, the spouses give up the intimacy and uniqueness of sexual intercourse and open the door for a third party who facilitates fertilization through mechanical laboratory procedures ( Meilaender, 2000a , p. 44). No matter how much some try to outbid the morality of the fact that the sperm is from the husband, Kiyaschenko et al. (2019) and Anderson and Walker (2019) notice that instead of the intimate framework of the husband–wife relationship established by God, the couple adopts an unnatural model orchestrated by man ( Kiyaschenko et al. , 2019 ; Anderson and Walker, 2019 ). As Rae (2009b , p. 196) points out, with the help of reproductive technology, man changes the divine order of procreation, masturbating or surgically removing sperm, replacing the intimate relationship between spouses, and by mechanical insemination performed by the doctor replaces the blessing of being “one body” in the process of conception. Another aspect that comes to the forefront of the moral reflection is the stability or instability of a family environment when the insemination was performed with sperm harvested from the impotent husband ( Indiana Law Journal , 1953 , p. 624). Moreover, artificial insemination opens the door for posthumous assisted reproduction, with its ethical dilemmas of the deceased husband gametes treated as “souvenir,” a child born “on demand,” orphaned by a father, and above all, the best interest of the child is overlooked ( Iliadis et al. , 2019 , p. 166; Shapiro and Sonnenblick, 1986 ; Cusine, 1977 ). Alternatively, Velez (2013 , p. 64) argues that NaProTechnology is an ethical method that “incorporates many conventional treatments for infertility such as ovulation induction or surgery for endometriosis […] and NFP (Natural Family Planning) fertility intercourse” that upholds the unitive dimension of the marital act in procreation ( Velez, 2013 ).

3.2 Artificial insemination by donor – heterologous

This method differs from artificial insemination by husband (AIH) in that the sperm is obtained from a donor who may be known or anonymous ( Zhang et al. , 2019 ). In this case, as Anderson (2021) and Robertson (1988 -89) argue, the ethical aspects are complicated not only by separating intimate relations between spouses from reproduction, but also because the genetic material (semen, seed) used for the birth of a child is from a third party. As Robertson points out, artificial reproduction “raises profound questions about the procreative liberty and family privacy, the welfare of the offspring, the meaning of the family, and the moral tone of society” ( Robertson,1988 -89, p. 2; Anderson, 2021 ). Thus, the husband is no longer the genetic, natural father of the child but only an adoptive father, and the mother has no intimate relationship with the donor, who becomes the biological father. Moreover, the born child is no longer the fruit of the intimate union of the parents, but a “laboratory product” made through financial transactions and mechanical medical procedures ( Valjy, 2010 ; Hollinger, 2000 , p. 87). In addition, the genetic asymmetry between the two spouses related to the child’s genetic identity gives rise to multiple ethical, psychoemotional, heritage and legal challenges regarding the child’s future ( Moscovitch, 2021 ; Gong et al. , 2009 ; Meilaender, 2000b ).

Bearing in mind the best interest of the child, as Rae and Thornton argue, the biblical approach to procreation offers a much better milieu where children are conceived, born, and raised in the heterosexual, monogamous and indissoluble family, a family that respects the continuity between marriage, procreation and parents’ quality ( Rae, 2009B , p. 197; Thornton, 1986 , p. 66).

3.3 Donation of eggs

It is a technology similar to sperm donation, except that the donor woman undergoes hormonal treatment to hyper stimulate ovulation ( Christianson and Bellver, 2018 ). Then the surgically taken eggs are donated to the infertile couple to be combined with the sperm, either by intrafallopian gamete transfer (GIFT) or by in vitro fertilization (IVF) ( Kolibianakis et al. , 2010 , pp. 2407–2408). The ethical aspects of this procedure are similar to those mentioned in artificial insemination with a donor, in the sense that mechanical laboratory procedures replace the intimate relationship between spouses. The sperm and eggs become “products” or “laboratory material” independent of the two spouses. Moreover, as Lenow points out, there is a significant difference between procreation and reproduction. In his view, procreation occurs within the intimate relationship between husband and wife, while reproduction takes place in the laboratory. The participation of the third, fourth or even fifth person in the act of reproduction, extends the framework of sexual intercourse between husband and wife to indirect sexual intercourse in the group. While underlying the distinction between a direct and indirect sexual intercourse, Lenow argues that since one is dealing with sexual reproductive techniques, gametes (sperm and eggs) are involved in an indirect sexual process of insemination. In other words, the use of gametes taken from other platforms (known or anonymous) paves the way for what Lenow calls “indirect adultery” ( Lenow (2016 , pp. 41–57). Edwin Hui emphasizes another ethical aspect of this procedure, namely, the biological relationship between parents and children. Gametes are not ordinary somatic parts of the body but are germ cells – life-giving – a new life. Gametes carry the individual and specific genetic heritage of each person. Thus, on the one hand, donation or acceptance of gametes implies the genetic discontinuity between the children and the “receiving parents,” and on the other hand, there is a discontinuity of the psychosocial relations between the “donor parents” and the children resulting from this transaction ( Hui, 2002b , pp. 178–180). In addition, the “donation contract” between donors and receivers violates human dignity by transforming human gametes into “things, objects” opened for market transaction ( Osuna et al. , 2012 , p. 1). These transactions opened the door for legal battles concerning future disclosure of medical outcomes when confronted with genetic or life-threatening disorders of the offspring ( Resler et al. , 2012 ).

3.4 Gamete intrafallopian transfer

This procedure is used when the sperm and egg cannot reach the fallopian tube where fertilization and the first stages of cell division occur. The procedure involves a hormonal treatment to hyper stimulate the donor woman's ovulation, and the eggs are taken in the laboratory. In turn, the collected sperm (by masturbation or surgery) is enriched in the laboratory and inserted with the eggs into the fallopian tubes of the woman who wants to have children. In this case, fertilization occurs in the woman's body, not in the test tube ( Mastroyannis, 1993 , pp. 389–402). The ethical aspects of the GIFT procedure are similar to those of artificial insemination with a donor, or egg donation, in the sense that the intimate relationship between spouses is replaced by mechanical procedures and other people’s intervention (donors, doctor) in the reproduction process. Also, the genetic relationships and psychosocial differences between parents of genetics/children, on the one hand, and foster parents/children, on the other hand, are eliminated. As Iglesias notes, identity and human dignity are seriously affected because gamete donors can have many children about whom they know absolutely nothing and for whom they have no responsibility. Children born with this procedure may never know their biological parents or possible stepbrothers/stepsisters ( Iglesias, 2000 , pp. 91– 112).

3.5 In vitro fertilization

This procedure is similar to GIFT in the sense that after the hormonal treatment for the hyperstimulation of ovulation, the eggs are collected from the wife and the sperm from the husband. IVF has paved the way for known or anonymous sperm or egg donors, either out of compassion for family or friendships or financial reasons of donors with commercial interests. Sperm and egg banks offer “their products” to all people who want to have children, regardless of their marital status or sexual orientation. The eggs and sperm are placed together in a special Petri dish/test tube for fertilization ( Anderson and Walker, 2019 ). The eggs thus fertilized begin to divide (into two, four, eight cells), growing from the fertilized zygotes to embryos, and after 12 weeks, fetuses. Usually, this method fertilizes several eggs, after which the doctor will take several embryos resulting from fertilization and insert them into the woman's uterus with the hope that at least one will be successfully fixed and produce a pregnancy ( Ankeny, 2017 , pp. 297–300). In many cases, however, the attachment of several embryos produces multiple pregnancies ( Genuis, 1992 , p. 143). Other similar procedures are intrafallopian transfer of zygotes (zygote intrafallopian transfer [ZIFT]), and prenuclear stage tubal transfer (PROST). The ZIFT procedure is a combination of IVF and GIFT. Fertilization occurs in the test tube according to the IVF method, then the zygote (fertilized egg) is introduced laparoscopically into the fallopian tubes from where it will move to the uterus for implantation ( Zhu, 2011 ). In the PROST procedure, fertilization takes place in vitro (IVF), and the fertilized eggs are introduced into the fallopian tubes before cell division occurs ( Silber, 2020 ).

These techniques further complicate the ethical aspects as fertilization generates more embryos that are “laboratory-derived products” and stored in the test tube. Some of these embryos are injected into the woman’s uterus or fallopian tubes, the others are frozen or destroyed. From a biblical perspective this procedure is morally unaccepted because life begins at the time of fertilization and the “embryo is a person ” that “deserves loves and respect” ( Anderson and Walker, 2019 ). Yet, in this case, in the test tube, the fate of these beings is at the discretion of the doctor and the spouses ( Jones, 2018 ). Furthermore, if the death of one of the spouses occurs, or divorce, the future of these embryos becomes subject to legal proceedings regarding paternity (whom they belong to), genetic inheritance (inheritance) rights if they are adopted (purchased) or about freezing or destroying them. The conception of children is no longer a result of the spouses’ intimate union, but the result of medical maneuvers and financial transactions regarding the fate of some embryos (children in the test tube) who are considered “goods” with a financial market value. As early as 1970s in the study Fabricated Man: The Ethics of Genetic Control , Paul Ramsey pointed out that in the moment when the mechanical medical act replaces the love expressed in the intimate relationship between husband and wife in the act of procreation, man moves away from his true identity as a being created out of love, in the image and likeness of God ( Ramsey, 1970 , p. 38). In the same vein, O’Donovan pointed out that the relationship between spouses is emptied of the transcendent dimension of their union, and “life is stripped of its sanctity” and transformed into an “impersonal market product,” at the value of the market transaction between supply and demand. Once this “artificial baby industry” is accepted, embryos can be bought by those interested – including gay and lesbian couples. If the market is oversaturated with frozen embryos, they can be destroyed like any other worthless commodity or obsolete commodity ( O’Donovan, 1984 , p. 39). In the same vein, Salter (2022) notices that there is a global market of assisted reproductive technology (ART) with an ART demand–supply chain of estimated profitable value of US$21bn and a growth rate of 10% in 2017 ( Salter, 2022 ).

From a Christian moral perspective, Anderson and Walker (2019) argue that by separating conception from sex, IVF redefines the biblical teaching about sex, marriage and family by separating what God has joined together. Furthermore, they affirm that, “IVF is not a medical treatment for infertility, but a way of sidestepping the appropriate use of one’s own reproductive organs and the limits of one’s bodily life” ( Anderson and Walker, 2019 ). In addition, the involvement of multiple parties in conceiving life reconfigures the way people think about their bodies and reproductive capacities. Especially, the expert’s presence in the process of fertility implies a grading of embryos for their viability followed by the decision to implant, freeze, use for research or discard them. Moreover, IVF technology poses a high risk to the women’s health due to the side effects of hormonal hyperstimulation to produce more eggs, the damages produced by the invasive process of harvesting the eggs and multiple pregnancies ( Anderson, 2021 ; Aznar and Tudela, 2020 , p. 11; Anderson and Walker, 2019 ).

3.6 Intracytoplasmic sperm injection

The procedure involves injecting sperm into each egg under a microscope in infertility cases due to oligospermia or azoospermia when the sperm does not have enough force to penetrate the egg membrane and fertilize the egg ( Mansour, 1998 , pp. 43–56). The procedure involves collecting sperm (by masturbation, surgery) and selecting in the laboratory the sperm that have the highest mobility. The eggs are also surgically taken and positioned with a pipette to perform the intracytoplasmic injection. With the help of this procedure, only one viable sperm (with motility) is injected into each egg, and then the zygote (fertilized egg) is inserted with the help of a syringe into the woman’s uterus ( Mansour, 1998 , p. 47). From an ethical point of view and in addition to the aspect mentioned in the other procedures, there are certain specific bioethical aspects related to both the inferior quality of sperm and the fact that the needle can damage the egg during this invasive procedure used to inject the sperm. The specialized literature mentions the possibility that the embryos that result through this procedure lead to the birth of children with major genetic diseases, which can generate tensions and guilt between the parties ( Thomas, 2020 , pp. 49–50; Mansour, 1998 ).

3.7 Surrogate mother or surrogacy

In this case, spouses who cannot have children turn to another women (a third person), who rent out their uterus to become a surrogate mother or a pregnant woman on behalf of the mother or woman who wants children ( Aznar and Tudela, 2020 , pp. 25–27). Hui presents several alternatives to surrogacy: eggs and sperm from “biological parents,” only sperm from “biological father” and egg from “carrier mother” (which in this case also becomes biological mother), eggs and sperm from known or anonymous donors (in which case we have biological parents, adoptive parents and surrogate mother), embryo from specialized laboratories without knowing the identity of the “biological parents” ( Hui, 2002a , pp. 204–217). To illustrate the complexity of ethical issues, Pillai considers the situation in which the surrogate mother is artificially fertilized with sperm from the husband of the one who cannot have children. In this case, the surrogate mother has a genetic connection with the child she is carrying in her womb, but at birth, she will cede her genetic rights to the child of the family that rented her. Another variant is the gestational surrogate mother, in which the surrogate mother does not have a genetic connection with the child because both the eggs and the sperm are from the infertile couple. Fertilization occurred in vitro , and the embryo is implanted in the “rented uterus” of the surrogate mother. At birth, when the lease ends, the surrogate mother will transfer all maternal rights to the family with whom she signed the contract ( Pillai, 2020 ). As Pillai points out, the ethical aspects of this procedure are further complicated by the fact that in addition to replacing the intimate relationship between spouses with mechanical and impersonal aspects of medical procedures, the production of embryos in the test tube, the complexity of genetic and psychosocial relationships between gamete donors, or embryos and resulting children, overlaps the transaction that assumes that the uterus becomes a space for rent. This rental agreement eliminates all moral, emotional and genetic aspects. In these ethical conditions, Hui (2002a , 2002b , p. 207) states that we are witnessing the painful degradation of the human race, which, in the name of the desire to have children at any cost, has turned the woman who rents her womb into a “baby-making machine.” Everything becomes a transaction and impersonal (mechanical) medical procedure within an industry that produces children. The psychoemotional aspects of the surrogate mother have no value, and the resulting children are subjected to a process of alienation by both the biological parents and the surrogate mother ( Hui, 2002a ). Moreover, as Aznar and Tudela (2020 , p. 25) observe, the children's parental relational dimension resulting from this procedure is replaced by a commercial transaction which considers the body of the women and the resulting children as objects, or commodities, incompatible with human dignity ( Aznar and Tudela, 2020 ). Children are reduced to objects without genetic identity and without the right to know their personal genetic history. From this perspective, as Aznar and Tudela observe, there is no difference between the altruistic (no financial transaction) and nonaltruistic surrogacies because the fragmentation of the child's identity between genetic parents, surrogate mother and social parents can have psychoemotional and social consequences on the child’s development compared to children who have the identity and continuity of a family in which the genetic, gestational and social dimension are not fractured ( Aznar and Tudela, 2020 , pp. 26–27; Hui, 2002a , pp. 209–211).

4. Conclusions

The Conservative ethics advocates that procreation must be exclusively reserved to the conjugal intimacy of the heterosexual family created by God. The moral values that undergird this approach, as Scarnecchia (2010 , pp. 157–158) points out, are:

“[…] a) the right to life and physical integrity of every human being from conception to natural death; b) the unity of marriage and the right within marriage to become a father and a mother only together with the other spouse; c) the specifically human value of sexuality which require that the procreation of a huma person be brought about as the fruit of conjugal act specific to the love between spouses.” ( Scarnecchia, 2010 )

In addition, Nyong and Ben (2021, p. 11) argue that the theological foundation for the Conservative ethics approach is the doctrines of the sovereignty, love and the goodness of God:

“The most explicit teaching of the scripture is that God is sovereign over his entire creation. In other words, he has absolute authority and rules over his creation. Meaning that since he is sovereign, he is all-knowing, all-powerful, and free […]. Recourse to technological means […] may not be in God’s plan for the couple. Sarai’s turning to ‘representational begetting’ as a solution to barrenness was a socially acceptable practice but was not the will of God for her or Abraham, and this had far-reaching consequences (Gen. 16:1-12, 17:19-21). ( Nyong and Ben, 2002 )

Consequently, any reproduction technology that substitutes the “one body” sacred marital relation between spouses and make room for a third-party intrusion in the act of procreation must be avoided on moral grounds ( Callaham, 2009 , p. 79). The morally accepted alternatives for the infertile couples are prayers, medical treatment, NaProTechnology (natural procreation technology), adoption and the acceptance of the sovereignty, the goodness and the love of God beyond the circumstances of family conditions ( Ben and Ben, 2021 ).

The Permissive ethics affirms that in the name of individual autonomy, rights, and liberties, if due process and informed consent are in place, any adult is morally free to choose any reproductive procedure to produce offspring (Lone, 2016, p. 25). In other words, the desires of the infertile couple or individual to have children cannot be restricted by any external moral authority. However, as Cox (2013, p. 6) argues, it must be underlined that technology in general, and ARTs, in special, are not morally neutral. Therefore, any technology needs careful examination of the moral values it promotes, protects, or overlooks ( Cox, 2013 ). For example, Harrison (2018) observes that, to a large degree, the moral values that undergirds the reproduction technologies are shaped by the Western secular worldview. Within this frame of reference, the autonomous human being proclaims the separation of man from God, the sexual relations from marriage and reproduction from the intimate relationship between spouses as the cardinal values of a permissive society ( Studlar and Burns, 2015 ). Furthermore, Lones (2016 , p. 26) notices that due to the lack of external criteria to balance their moral compass, a growing number of people operates with “default values” – that is, flexible values that minimize the tension between spiritual beliefs, emotional preference, cultural and relational pressure. Thus, the unbridled desire of the adults operating within the relativistic and utilitarian ethical systems offers the cultural milieu for the flourishing of ART industry of “child production” regardless their marital status, age and sexual orientation ( Salter, 2022 ). Once this “industry” was accepted, the intimate life of the spouses, the birth of children as a “divine gift” in the context of the loving relationship consecrated by the marriage covenant, the dignity of human being from conception to natural death and the sanctity of life were replaced with the moral values of the market economy, and with the promises of the new technologies and their laboratory products – sperm, eggs and embryos. The collection and storage of these laboratory products in sperm, egg and embryo banks has become a thriving industry with the help of new reproductive techniques ( Lones, 2016 ). As Salter (2022, p. 4) points out, there is a global market of ART with an ART demand–supply chain of estimated profitable value of US$21bn and a growth rate of 10% in 2017.” This market chain:

“[…] embraces a variety of techniques and products that naturally activate important values concerning the status of the physical components of the body involved in reproductions (gametes, embryo, womb) and the social structures involved in reproduction (family, marriage, motherhood, fatherhood, inheritance, preferred gender of the child.” ( Salter, 2022 , p. 5)

Because the moral values of the ART market are culturally and socially determined, the demand–supply chain functions according to the power game between various social actors and power structures. Salter points out that the global consumer market works with commodities – “bodily commodifications – namely, the packaging and selling of gametes and other body parts for the purpose of reproduction and medical research.” Thus, the biogenetic substances move from one place to another on the market as “products” not as persons ( Salter, 2022 , pp. 6–9) [ 7 ]. Furthermore, Salter affirms that because ART allows the third party to interfere with the “natural” relationship between biology of reproduction and the traditional understanding of kinship the reality is:

“[…] ideologically reformulated, so that the nature of parenthood is seen as a matter of consumer choice and the role of society as facilitating that choice and perhaps ensuing the quality of the product. The dominant norm of heterosexual parenthood and marriage is destabilized when a given society accords legitimacy to the reproductive demands of nonmarried couples, single women and men, lesbians and gay men for donor insemination and gestational surrogacy. ( Salter, 2022 , p. 12)

In the same vein, Salter continues:

Motherhood is deconstructed from unified biological and social entity into a plethora of genetic, birth, adoptive, and surrogate maternities each with its own ART commodity, or sets of commodities, designed to enable its realization.” ( Salter, 2022 , p. 13)

One may argue that such critique disregards the fact that the ARTs have given hope to millions of couples affected by infertility. However, Aznar and Tudela (2020) put forward the findings of recent studies that evaluate the success of the ART according to the pregnancy rate (PR) and live birth rate (LBR). Thus, since between 1997 and 2010 the PR varied between 22.8% and 29.2%, and between 13.07% and 22.4% for LBR, they conclude that the success rate is rather lower than expected ( Aznar and Tudela, 2020 ). In addition, other studies draw attention to the fact that ART has generated countless ethical, medical, legal and social challenges, such as multiple gestations and births, a fertility market (commodification of gametes and embryos), embryo selection and reduction, fertility preservation, the anonymity of the donors, the fragmented genetic history of the child, the legal, emotional and genetic aspects of the intricate relations of all the parties involved in surrogacy and gestational arrangements, the legal/moral status regarding the future of the cryopreserved embryos (discard, donated to research, indefinite storage, donation to other couples for IVF) in addition to the risks of higher morbidity reported in children born as a result of ART (congenital abnormalities and imprinting errors) ( Brezina and Zhao, 2012 ).

The Modified permissive ethics attempts to offer a limited middle ground between Conservative and Permissive views. Thus, on the one hand, affirms that procreation must be reserved only to heterosexual couples within a marriage relationship, while on the other, endorses ART procedures such as GIFT, AIH, embryo adoption, prefertilization genetic screening for genetic diseases and IVF providing that it is limited to married couples and all the embryos must be replaced in the uterus. At the same time, IVF with selective reduction, artificial insemination by donor (AID), surrogate motherhood and cloning are considered morally unacceptable ( Grudem, 2018 ; Hordern, 2022 ; Sallam and Sallam, 2016 ). More recently, Geisler (2002 , pp. 186–189) and Wayne Grudem, among other Evangelicals, shifted toward the Modified permissive ethical approach at the cost of redefining the doctrine of God’s sovereignty, the morality of masturbation and of the third party involvement in the process of conception [ 8 ]. As a theological background for the Modified permissive ethical view, Grudem puts forward two presuppositions/principles: a) overcoming fertility is pleasing God since infertility is one of the disabilities and diseases that entered humanity after the fall of Adam and Eve, and b) medicine is morally good and a divine blessing because it overcome diseases that God desire to heals ( Grudem, 2019 , 2021a , 2021b ). Grounding his moral theology on these two principles, Grudem draws two conclusions: a) IFV is a natural process because the laboratory equipment used for IVF are made from resources God planted on earth, and similarly, the medical researchers and medical technicians with their wisdom and skills are part of God Creation, and b) IVF does not separate sex from conceptions as they are already separated by infertilely and, IVF overcomes exactly the infertility. Moreover, Grudem affirms that as “there is no biblical command that says, “conception must only be the result of sexual intercourse,” sex and procreation can be separated, and children could be made outside the intimate conjugal act between husband and wife ( Grudem, 2019 ). However, Grudem’s arguments seem to be unconvincing for Anderson (2019) : “May I suggest, then, that Grudem’s ‘biblicism is not merely superficial, but that it is deeply – unbiblical?’”. Alternatively, if Grudem’s arguments are biblically and morally valid, then as Anderson (2019) observes, the logical conclusion is that everything modern medicine does could be labeled as “natural” and “a divine blessing that’s morally good.” Once such a moral statement is accepted as theologically legitimate, then the sanctity of marriage, the intimate loving union of husband and wife in the act of procreation, the sanctity of the embryo and the dignity of human life are downplayed, and the door is wide open for a full swing Permissive ethical approach. Thus, by redefining both biblical view on “one body” approach to procreation and the distinction between “natural” and “artificial,” Gresham (2020 , p. 8) affirms that the Modified permissive ethics succumb under the psychoemotional and social pressures of a secular culture, ends up in rewriting the order of the relationship between the created human beings and the Creator God.

Finally, from the perspective of biblical ethics, Christians are called to distinguish between medical procedures that protect and help God-given life and those that aim to replace God with reproductive technologies; that is, to produce life outside the biblical context of the natural family ( Anderson and Walker, 2019 ; Geisler, 2002 , pp. 181–182). Therefore, knowledge of the doctrines of God's sovereignty over life, the dignity of the human being and the sanctity of life from conception to natural death is essential to making moral decisions when faced with the complex problems of infertility and new reproductive technologies that replace the sovereignty of God. In addition, Gresham points out that although the desires for children are good:

[…] when they replace God as priority, it becomes sinful idolatry […]. So, while children are indeed a blessing from the Lord, they are not a right that a Christian can demand, or even expect from God. God alone give gifts, in accordance with his good and perfect will, which for the believer does not guarantee health, wealth, or fertility. ( Gresham, 2020 )

By absolutizating technological progress that circumvent the divine moral frame of reference, the Permissive and the Modified permissive ethical approaches run the risk of paving the way for a new Tower of Babel in which, Imago Dei becomes Homo Deus ( Harari, 2017 ). However, Scripture teaches that there is only one true God to whom we owe worship in spirit and truth, obedience and acceptance of His plan for our life and eternity. Infertility is only one of the fields where we demonstrate obedience or disobedience to God. This perspective will become more visible as we witness the rapid advancement of medical research in deciphering the human genome, the stem cells and the induced pluripotent stem cells, the artificial gametes and embryos, genetic diagnoses and genetic treatment, genetic engineering, human cloning, etc., realities that confront Christians with new biotechnologies that provide somatic and germlines cell gene therapy that modify the genetic material. Such technologies will continue to challenge Christianity to articulate a well-informed, balanced and responsible perspective regarding the relation between religion, technology and moral choices.

World Health Organization (2020a) . In his work ( Carl, 1993 ), Lilienkamp presents statistical data from the USA regarding infertility, analyzing psychoemotional, medical and theological perspectives from a Christian perspective.

For a more comprehensive description of the psychoemotional and social aspects related to infertility, see Simionescu et al. (2021) .

For an analysis of the Conservative, the Liberal and the Middle Ground views see Fieser (2021) . For an analysis of the implications of reproduction and sex separation, see Heinbach (2004) and Cameron, N.M.D.S. (2000) .

Kimport (2018) and Davis (2004) present a historical perspective on contraception thoughts and methods from the liberal Presbyterian point of view.

The governor of Virginia has promoted a law that allows abortion in the third trimester, or even infanticide. See Devan (2019) .

From the perspective of Catholic ethics, any intervention in the natural process of procreation within the intimate relationship between husband and wife is considered unethical. See McFaden (1967) . On the other hand, several protestant authors influenced by Humanism and Enlightenment philosophies have a permissive attitude toward AIH. Wayne Grudem presented his view on the morality of AIH in an interview with Scott Rae and Sean McDowell (Grudem, 2021a; Geisler, 2002 ).

Salter (2022) states that “The ART commodities include, but are not limited to, intrauterine insemination (IUI), IVF and embryo transfer, intracytoplasmic sperm injection, tubal embryo transfer, gamete and embryo cryopreservation, oocyte and embryo donation and gestational surrogacy” (p. 9).

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Further reading

Ezeome , I.V. , Jegede , A.S. and Ezeome , E.R. ( 2021 ), “ Reception of key ethical issues in assisted reproductive technology (ART) by providers and clients in Nigeria ”, International Journal of Women’s Health , Vol. 13 .

Mansour , R. ( 1989 ), “ Intracytoplasmic sperm injection: a state of the art technique ”, Human Reproduction Update , Vol. 4 No. 1 .

Corresponding author

About the authors.

Paul Negruț (PhD 1994, London Bible College, Brunel University; PhD 2012, National School of Political and Administrative Studies of Bucharest) is a Professor of Systematic Theology, Spiritual Counseling, and Christian Ethics at Emanuel University of Oradea, Romania.

Dr Tiberiu Pop (Associate Professor) is a Chief Physician of the OB IV Section, Inpatient III, Emergency County Clinical Hospital, Oradea, Romania.

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An overview on ethical issues about sperm donation

1 Renji Hospital, Shanghai Human Sperm Bank, Shanghai Institute of Andrology, Shanghai Jiaotong University School of Medicine, Shanghai 200001, China

2 Harvard College, Harvard University, Cambridge, MA 02138, USA

Zhong Zheng

Yi-fei tian.

3 Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China

Beyond the scientific progress in assisted reproductive technologies (ART), it is necessary to discuss the ethical considerations behind these advances. Ethical issues concerning sperm donation have been considered and discussed by government and non-governmental agencies, the public, media and academic institutions in many countries. Recommendations and guidelines concerning sperm donation issues vary from country to country and between professional groups within countries. This paper attempts to present an overview of findings and reports from various agencies concerning the ethics of sperm donation. The following topics are considered: limiting the number of donor offspring; minimizing risk of infection and genetics from sperm donors; age requirements for sperm donors; and anonymity versus non-anonymity of sperm donors. The diversity of policies shows that each country has its unique set of guidelines tailored toward its own specific needs. Similarly, countries designing their own procedures and guidelines concerning reproductive medicine must tailor them toward their own needs and practical considerations. In Mainland China, the anonymous policy for sperm donation should still be carried out, and the number of donor offspring should be revaluated. ART procedures must be conducted in a way that is respectful of those involved. Ethical principles must respect the interests and welfare of persons who will be born as well as the health and psychosocial welfare of all participants, including sperm donors.

Introduction

Assisted reproductive technology (ART) has become increasingly popular over the past several decades. The advances in human sperm cryopreservation in the past 50 years and the creation of sperm banks have facilitated the increase in artificial insemination with donor sperm (AID) 1 , 2 . In cases of severe male infertility, the use of donor sperm is the only approach to infertility treatment 3 . Although the ethical concern with introducing a third party into the fertilization procedure by means of donor sperm must be considered as controversial, careful counseling and informed consent by all parties related should help to resolve many of the dilemmas. In 2001, the Chinese Ministry of Health established a standard protocol for human sperm banking. Currently, there are 11 sperm banks across Mainland China with licenses from the Chinese government. The advances in sperm cryopreservation have created the opportunity for paternity for many Chinese families.

As ART becomes more popular, ethical considerations surrounding the use of these technologies becomes increasingly important. Ethical issues on sperm donations have been widely discussed in literature. European Society of Human Reproduction and Embryology (ESHRE) stated that gamete donation should focus on the issues raised by the meaning of genetic links, regulation and the necessity for taking into account the welfare of the donor children. Relevant specific aspects concern anonymity, compensation for donation, and the consent, screening and assessment of donors and recipients 4 . Much of the ethical considerations pertain on an individual basis to the definition of parental responsibility. Even in countries in which sperm donation guidelines have been well established, surveys of private citizens have been conducted to assess feedback on current ethical guidelines, leading to our understanding that counseling has a beneficial impact on donors 5 , 6 , 7 . Although most guidelines come from governmental, non-governmental or academic institutions, religious organizations can also offer opinions that the public will value. For example, Catholic teaching on infertility treatment and reproductive technology emphasized the ethical need for children to be conceived and born of the marriage union 8 . As the ethical issues are multi-faceted and complicated, recommendations and guidelines concerning reproductive issues are variable from country to country, and between professional groups within countries. Most developing countries, including Mainland China, should learn the lessons from developed countries when designing their own guidelines on sperm donation, but they must also take into consideration cultural tradition, public or patients' opinions, opinions of different religions, economy development and population numbers. An attempt looking at international gamete transactions between countries has been done in the past as an attempt to bridge guidelines between different countries 9 . This review overviews findings and reports from various agencies concerning the ethics of sperm donation. Topics of limiting the number of donor offspring; minimizing the risk of infection and genetics from sperm donors; age requirements for sperm donors; anonymity versus non-anonymity of sperm donors are reviewed. We suggest that the ethical issues on recommendation of sperm donation in Mainland China should be updated to match infertile couples' need for AID or ART, the anonymity policy for sperm donation should still be carried out, the number of donor offspring should be revaluated and medical standards for sperm donors should be improved according to WHO (World Health Organization) laboratory manual for the examination of human semen and sperm–cervical mucus interaction, fifth edition, which will be published in 2009. Ethical principles must respect the interests and welfare of persons who will be born as well as the health and psychosocial welfare of all participants.

Limiting the number of donor offspring

The importance of limiting the number of donor offspring from a single sperm donor relates to preventing accidental consanguinity between donor offspring. All countries agree that the potential for consanguinity is a problem, but different countries have developed different guidelines for limiting the number of donor offspring. Considerations include the size of the country's population, density of population and mobility of population. For example, in Mainland China, each sperm donor can only impregnate five women through AID or in vitro fertilization (IVF), whereas the American Society for Reproductive Medicine (ASRM) recommends a limit of 25 children per population of 800 000 for a single donor.

The International Federation of Gynecology and Obstetrics (FIGO), the key organization that brings together professional societies of obstetricians and gynecologists on a global basis, provides a general guideline on limiting the number of donor offspring. FIGO recommends that the number of donations from any single donor should be limited to avoid the future danger of consanguinity and/or incest 10 . Current standards or recommendations on donor limits by country are shown below.

United States

In the United States, there is no federal or state law limiting sperm donation. ASRM recommends that institutions, clinics and sperm banks should maintain sufficient records to allow a limit to be set for the number of pregnancies for which a given donor is responsible. It is difficult to provide a precise number of times that a given donor's sperm can be used because one must take into consideration the population base from which the donor is selected and the geographic area that may be served by the donor. It has been suggested that in a population of 800 000, limiting a single donor to no more than 25 births would avoid any significant increased risk of inadvertent consanguineous conception. This suggestion may require modification if the population using donor insemination represents an isolated subgroup or if the specimens are distributed over a wide geographic area 11 .

United Kingdom

The Human Fertilization and Embryology Authority (HFEA) is the UK's independent regulator overseeing the use of gametes and embryos in fertility treatment and research. It requires that gametes (or embryos created using gametes) from an individual donor should not be used to produce children for more than 10 families, as a result of licensed assisted conception services. Notwithstanding the foregoing, gametes (or embryos created using gametes) from an individual donor may be used in any licensed assisted conception treatment for the purpose of producing a genetically related sibling for an existing child of the family of the woman to be treated 12 . Currently, an individual donor may only be used to produce 10 live birth events (with some exceptions). Multiple simultaneous births all count as one “live birth.” The most common exception is when there are more than 10 live birth events from a donor to provide genetically related brothers or sisters for children previously born from a donation. In addition, donors may set their own lower limits on the use of their gametes 13 . Although it was noted that the statistical risk of consanguinity would support a limit much higher than the 10 live birth events specified in current HFEA guidelines, concern was expressed about the emotional and psychological effect on donor-conceived people of the knowledge that there may be a large number of half-siblings. Although a higher sperm donor limit would increase the availability of infertility treatment, there was general support for maintaining an upper limit rather than removing it entirely. An HFEA Steering Group proposed that the HFEA's policy be amended so that the limit is calculated in terms of families using a given donor rather than live birth events. This approach was supported, although there was no consensus on the limit to be adopted. Limits of four families (as in New Zealand) and 10 families (the maximum currently possible in the UK) were suggested 14 .

Different regions of Australia have different limitations on the number of donor-conceived children from the same donor depending on population density and sparseness. In Western Australia, under the Human Reproductive Technology Act of 1991, each donor may contribute to a maximum of five recipient families including donations made to families that reside outside Western Australia, unless the council has given specific approval. However, there is no limit to the number of children to be donor-conceived within each family. This limit is, in part, to minimize the risk of genetic disease arising from the inadvertent marriage of half-siblings in later life, and also to limit the number of families that donor-conceived people would be related to. Feedback from donor-conceived adults suggests that it may be less bewildering to know that you are related to others in up to five other families 15 . In Victoria, current regulations set a maximum of 10 families per donor (that is, there may be more children within the 10 families) 16 .

Mainland China

Donor sperm banks also have a crucial role in Mainland China to improve the development of reproductive medicine in China. The Chinese Ministry of Health has published guidelines for screening and testing anonymous donors for sperm donation. In Mainland China, each sperm donor can only impregnate five women through AID or IVF. Sperm banks are required to follow-up with AID or IVF results, and keep its records to limit the number of pregnancies with the same donor. A computer management system is used to record this data. Even though the population in Mainland China has exceeded 1.3 billion, many couples who suffer from serious male infertility are seeking AID or IVF procedures. However, qualified sperm donors are in such limited numbers that infertile couples often wait for long periods before receiving donor sperm. Data from the Department of Reproductive Medicine at Renji Hospital, Shanghai Jiao Tong University School of Medicine, showed that over 1000 couples wait for 1 to 2 years before undergoing AID treatment (unpublished data). In Beijing, Guangzhou, Nanjing and other large cities across Mainland China, over 10 000 couples hope to undergo AID as soon as possible. To overcome this challenge of increasing the supply of donor sperm, one method is to permit more than five women to become pregnant using a single donor's sperm. Considering Mainland China's enormous population, the number of donor offspring should be reevaluated. It is suggested that Mainland China carry out the same policy as recommended by ASRM in the United States: limiting a single donor to no more than 25 births would avoid any significant increased risk of inadvertent consanguineous conception.

Minimize the risk of infection and genetics from sperm donors

There is general agreement among different agencies that sperm donors should undergo rigorous medical evaluation or screening to ensure that no diseases (specifically, sexual or genetic diseases) are passed on to potential offspring. The screening process usually includes taking a medical history from the donor and performing laboratory tests on the semen sample. FIGO recommends that donors of genetic material should be healthy persons of normal reproductive age who are free from sexually transmitted diseases and hereditary disorders. Members of a medical team involved in the management of a gamete recipient should not be donors.

The ASRM 2006 Guidelines for Gamete and Embryo Donation provides guidelines for selection of a donor 11 . The main qualities to seek in selecting a donor for AID are an assurance of good health status and the absence of genetic abnormalities. Although there are no uniformly accepted standards, minimum criteria for normal semen quality can be applied. (WHO) suggests that several samples be examined before proceeding with a more extensive evaluation 17 . The sample should be examined within 1–2 h after ejaculation into a sterile container. ASRM publishes minimal semen parameters recommended for donors 18 . The Chinese Ministry of Health has published its own “Screening and Testing Program for Sperm Donors” to establish guidelines for screening and testing of sperm donors. WHO will publish the fifth edition of the Laboratory Manual for the Examination of Human Semen and Sperm–Cervical Mucus Interaction in 2009 with updated semen parameters.

Genetic screening for heritable diseases should also be performed on potential sperm donors. In the United States, testing for cystic fibrosis carrier status is performed on all donors. Other genetic testing should be performed, as indicated by the donor's ethnic background in accordance with current recommendations. Some institutions perform chromosomal analyses on all donors, but such evaluation is not required. In Mainland China, the chromosomal karyotype analysis on all donors is required, but cystic fibrosis carrier status should not be performed on all donors because cystic fibrosis is rare in the Chinese population. Genetic consulting should be performed after screening family history. In addition to adequate history taking and exclusion of individuals at high risk for human immunodeficiency virus and other sexually transmitted infections, laboratory testing should be conducted to ensure that infectious agents will not be transmitted by donor sperm sample 19 .

Age requirements for sperm donors

The United Kingdom, Canada and the United States all specify that sperm donors must be of legal age. In the United Kingdom, HFEA requires that “Gametes should not be taken from anyone under the age of 18 for the treatment of others” 20 . The Canadian ART Act stipulates that sperm or ovum donors must be 18 years old: “No person shall obtain any sperm or ovum from a donor under 18 years of age, or use any sperm or ovum so obtained, except for the purpose of preserving the sperm or ovum or for the purpose of creating a human being that the person reasonably believes will be raised by the donor” 21 . In the United States, ASRM guidelines state: “The donor should be of legal age and, ideally, less than 40 years of age, because increased male age is associated with a progressive increase in the prevalence of aneuploid sperm.” The guidelines for selection of anonymous sperm donors in China has been carried out since 2001. Sperm donors should have good health status and no genetic diseases in their family, whose age should be over 22 years and fewer than 45 years, because male aging is associated with a progressive increase in the number of aneuploid sperm. However, as the number of qualified sperm donors is limited for AID or IVF in Mainland China, we recommended that donors' age should be lowered according to ASRM or HFEA. It is important to recruit more donors for sperm banks in China to meet the demands from infertile couples.

Anonymous versus non-anonymous sperm donation

Anonymous versus non-anonymous sperm donation is an important issue to both the recipient and the donor. Sometimes, donors will try to find out who the recipient will be. More often, recipients want to know as much about the donor as possible before undergoing AID. Donor offspring may later inquire about the identity of his or her genetic father as well. A key but long unresolved question in sperm donation is whether the offsprings should be informed of their biological or genetic father and, if so, how much and when the information about donors should be revealed. Parents, donors and offspring may have different interests and views on anonymous versus non-anonymous sperm donation. The practical approach about double track should be considered, which was recommended by ESHRE 4 .

Anonymous sperm donation

Those who support anonymous sperm donation insist that anonymity is beneficial to the donor, the recipients and the donor offspring. They express concerns that telling the child of his or her birth by sperm donation will subject the child to social or psychological disorders, which can be especially unsettling if the child wants to find out more information about the donor but cannot. Some studies of children have shown that they are not harmed psychologically by anonymity or nondisclosure, although the children studied may be too young for researchers to draw convincing conclusions 22 , 23 . In addition, anonymous donation allows parents to maintain the issue of infertility as a private matter, which may be vital to them for a variety of reasons. For example, they may be concerned that the child will reject the non-genetic parent, or they may wish to conceal the fact of donation from disapproving family members, especially those from cultures less accepting of sperm donation 24 , 25 . In recent years, the question of continued use of sperm from anonymous sperm donors for insemination in couples and the question of insemination of single and lesbian women has been vividly debated. Ernst et al. 26 reported in their survey conducted in Denmark that in 2002, 25% (19% approved; 35% non-approved) of donors stated that they would continue as donors if anonymity was abolished, whereas in 1992 the number was 32%. When donors were asked whether they would accept contact from the children, 22% agreed in 1992, but only 13% agreed (15% approved; 10% non-approved) in 2002. From their survey, the authors argued that maintaining anonymity was still important for the vast majority of the donors. Onah et al. 27 investigated the knowledge, attitude and practices of a sample of Nigerian medical students toward sperm donation. With respect to the participants' views on identity disclosure, 35 (90%) of the 39 respondents willing to donate sperm objected to their identities being disclosed to the recipient couples. Although proponents of non-anonymous sperm donation look to the issue of adoption for support for greater disclosure, Patrizio et al. 28 argued that non-anonymous donation distinguishes gamete donation from adoption. They thought it was both wrong and discriminatory to force potential parents to tell their child of his/her genetic origin as a requirement for admission into an AID program. In addition, comparing the practice of using donor semen to conceive a child with adoption was incorrect. Mandatory disclosure was both inappropriate and intrusive, and the presently available data do not justify a rigid position. Furthermore, no reasonable, practical system can be envisaged to guarantee compliance with mandatory disclosure. They argue that, in sperm donation, the rearing mother was usually also the genetic and biological mother, whereas the rearing father was the social father who preferred to keep the donation private.

In the United States, ASRM recommended anonymous or directed (non-anonymous or known) sperm donation 18 . Anonymous donors had traditionally been used, but non-anonymous donation was acceptable if all parties agreed. Directed or non-anonymous donors should undergo the same evaluation as anonymous donors. Both specimens must be quarantined for a minimum of 180 days after donation. The donor must be retested after the required quarantine interval, and specimens may be released only if the results of repeat testing are negative. In Mainland China, only an anonymous sperm donation policy was carried out because traditional Chinese culture or philosophy paid special attention to a child's genetic or biological origin. When parents have children through AID, they prefer to keep this procedure secret from other related parties, including their AID child. It is important to understand that Chinese citizens' have different beliefs on family values compared with the Western society, thus there should be continual support for anonymous donation in the future.

Non-anonymous sperm donation

In recent years, a strong tendency in favor of non-anonymous sperm donation has emerged in Europe and Australia. Several countries have enacted laws or are taking into consideration permitting AID children to gain access to information about their genetic fathers. Sweden was the first country to pass legislation about disclosure by establishing a child's right to find out the identity of the gamete donor once the child has reached maturity 29 . The Australian Government published ethical guidelines on the use of ART in clinical practice and research in 2004, which was issued in accordance with the National Health and Medical Research Council Act 1992. People conceived using donated gametes were entitled to know their genetic patents. On request, clinics must arrange for either a medical practitioner, or an appropriately qualified health professional, to provide the donor's information to a person conceived through ART procedures, provided that he or she had either reached the age of 18 or acquired sufficient maturity to appreciate the significance of the request. In 2005, UK legislation was changed requiring any donor of sperm used in AID or IVF to agree to the disclosure of their identity to any offspring reaching the age of 18 30 .

Proponents of non-anonymous sperm donation argued that human beings have a fundamental interest, and perhaps even a legal right, to know their biological origins. Not telling the child of his or her origins violates that child's autonomy. Disclosure was a key part of open and honest communication with children, which helped to avoid secrets in the family that can damage family relationships and generate possible strain and anxieties.

Recent findings 31 , 32 showed an increase in donor programs that offer open-identity between donors and offspring. The psychological wishes of sperm donors and their attitudes toward non-anonymity and disclosure are increasingly given consideration. The majority of prospective parents have stated their intention to disclose the method of conception to their children even before the legal changes. Possible influences on intentions included: the culture within the center, movements toward openness within the wider society and parents' lack of confidence regarding how to go about disclosure.

Follow-up studies are needed to improve under-standing of whether influences on decision making carry through to patterns of actual disclosure; whether involvement in counseling affects outcomes; and whether access to professional assistance at the time of planned disclosure is helpful. Jadva et al. 33 presented findings from a large sample of donor offspring who are aware of the nature of their conception. Offspring of single mothers and lesbian couples learned of their donor origins earlier than offspring of heterosexual couples. Those told later in life reported more negative feelings regarding their donor conception than those told earlier. Offspring's feelings toward their parents were less clear, with some of those told later reporting more positive feelings and others reporting more negative feelings. Offspring from heterosexual-couple families were more likely to feel angry at being lied to by their mothers than by their fathers. The most common feeling toward fathers was “sympathetic.” Age of disclosure is important in determining donor offspring's feelings about their donor conception. It seems that it is less detrimental for children to be told about their donor conception at an early age.

Svanberg et al. 34 had investigated attitudes toward gamete donation among Swedish gynecologists and obstetricians. Among 1 230 eligible gynecologists/obstetricians, 854 (69%) answered the questionnaire. In general, the majority of Swedish gynecologists/obstetricians had positive attitudes toward gamete donation. Although a majority advocated openness regarding informing the child that he or she was conceived by gamete donation, ∼40% opposed allowing the child to receive any information about the donor when the child has reached maturity. Even though Swedish legislation has allowed sperm donation to lesbian couples since July 2005, one-third of the gynecologists/obstetricians opposed donation to lesbians. The results indicate that the gynecologists'/obstetricians' negative attitudes toward disclosure may influence patients' ability to discuss their thoughts and feelings about donation. This may also have a negative impact on donor recruitment as well as on the extent of methods made accessible within ART.

Research on how parents of donor offspring make decisions about disclosure reveals that even when couples are initially opposed to disclosing to their offspring, most ultimately come to a united disclosure decision. Shehab et al. 35 had studied how parents whose children have been conceived with donor gametes make their disclosure decision. In total, 95% of couples came to a united disclosure decision, some “intuitively,” but most after discussions influenced by the couples' local sociopolitical environment, professional opinion, counseling, religious and cultural background, family relationships, and individual personal, psychological and ethical beliefs. The sperm bank should use an open and consistent approach to ethical issues in the complicated process.

Conclusion and policy suggestions

This article presents an overview of ethical regula-tions for sperm donation that are in place from various governmental and non-governmental agencies. From these extensive guidelines, it is clear that the application of sperm donation should concern not only the scientific advances that enable the use of these reproductive technologies but also the ethical considerations and guidelines that should govern sperm donation. For any donor, it is necessary to consider limiting the number of donor offspring, testing the donor and donor sperm for diseases, age requirements and the role of anonymity and non-anonymity. In Mainland China, the anonymous policy for sperm donation should still be carried out, the number of donor offspring should be revaluated, medical standards for sperm donors should be improved according to WHO Laboratory Manual for the Examination of Human Semen and Sperm–Cervical Mucus Interaction, fifth edition, which will be published in 2009.

As developing countries begin to design their own procedures and regulations surrounding reproductive medicine, it will be important to keep in mind these pre-existing policies, and to tailor them toward protecting the welfare of all involved parties. It will be necessary to find a balance between both practicality and fairness when designing guidelines for sperm donation. Lastly, sperm donation procedures must be conducted such that the welfare of all participants—the donors, recipients and offspring—are all respected.

Donors must consider (1) why they agreed to help the recipient, (2) how many families or offspring they are willing to help conceive, (3) who will have access to their sperm, (4) what information the offspring should know about the donor, (5) whether they want to be contacted by the recipient or offspring and (6) what they will tell their own children. Recipients must consider (1) whether their partners have agreed to use donor sperm, (2) whether their fertility situation has been properly assessed, (3) what they will tell the child, (4) how much interaction they want the donor to have with the child and (5) what they will do if donation does not work. Both donors and recipients must consider the feelings of the offspring and whether they should know about the donation procedure 16 . As previous research has showed that the offspring benefits from early disclosure 33 , it is recommended that the offspring learns about being donor conceived from the recipient couple.

Ultimately, the goal of reproductive medicine is to help infertile couples conceive healthy children. To achieve this end, incorporating all participants' perspectives when formulating ethical procedures and regulations will be both healthy and constructive.

Acknowledgments

This review was supported by the China National Key Project on the molecular basis of the health of germ cell related to mother/embryo (The ethical principles on development and reproduction, Number 2006CB944010). We appreciate Prof. Yi-fei Wang, Dr Cappy A. Rothman and Prof. Qing-Li Hu for their critical reading and revisions of our manuscript.

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Ethical considerations of artificial insemination

2011, Journal of Venomous Animals and Toxins including Tropical Diseases

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International Journal of Law, Policy and the Family, Oxford Academic, Volume 35, Issue 1, 2021

GIULIA GIOVANNINI

Marie Meaney

Talk given at National Catholic Bioethics Center, Bishops’ Workshop, Dallas/TX in February 2011. Content can be found on DVD of National Catholic Bioethics Center. In addressing the moral problems surrounding reproductive technologies in front of you today, I want to emphasize that this is not an abstract problem for my husband and me, since we suffered from infertility for over 8 years before having our little Thérèse in September 2009. Infertility causes much pain and is a challenge for the couple, their family, friends, and for their pastors. It can be daunting to have to raise the issues regarding artificial reproductive technologies with people who are suffering intensely from their infertility and to tell them de facto that the seemingly only options available for having a child are not acceptable. The bearer of bad news is never welcome; those telling the couple that they may not use in vitro fertilization (IVF), surrogacy, donor sperm or eggs, may worry about the reactions they will receive. But the infertile couple often does not know what further suffering is awaiting them if they opt for these technologies, and especially what pain they might inflict on their children. Accepting their infertility and exploring morally acceptable treatment options will ultimately allow the couple to grow in many ways while the facile answer of an IVF-child will be fraught with new trauma. There are different ways of approaching the issue and helping infertile couples gain much needed clarity. To show that this is possible from a common sense perspective, using the moral law and medical data, is the purpose of this talk.

Francisco Güell

The aim of this article is to investigate whether techniques used for artificial reproduction safeguard or promote the future child’s welfare, and whether they are capable of offering potential future children the best possible chance for the best life, in keeping with guidelines derived from the Principle of Procreative Beneficence. This analysis will be important for discerning the parental responsibility of couples or single reproducers who plan to use or have used any of these techniques, and also for those who defend the Principle of Procreative Beneficence, which implicitly entails the use of techniques of assisted human reproduction. The paper concludes that prospective parents should be informed not only of the specific level of risk and potential damages associated with each IVF technique, but also of the fact that given the available evidence none of the standard IVF techniques can be considered to be risk free, there is reason to believe that none of these techniques can be reconciled with the responsibility of prospective parents to the promote welfare of future children and/or to offer them the best possible life

Daniela Cutas

This chapter explores current and prospective reproductive technologies and some of their likely implications for reproductive and family ethics and policymaking. The technologies discussed include uterus transplants, mitochondrial transfer, ectogenesis, the development of in vitro gametes, and solo reproduction. The chapter considers the impact of these developments on the content of concepts such as ‘infertility’, ‘mother’, or ‘father’. Another layer to this process of redefinition originates in ongoing socio-cultural changes that shift the focus in parenting from the way in which children have come into the world, to relationships within the family. Considering these scenarios beforehand can help to clarify some of the current challenges in defining and regulating infertility. The chapter therefore aims to raise a number of questions rather than provide answers.

Bailli Egrave Re S Best Practice and Research in Clinical Obstetrics and Gynaecology

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Innovations In Assisted Reproduction Technology [Working Title]

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Background With the development of medical technology, many countries around the world have been implementing ethical guidelines and laws regarding Medically Assisted Reproduction (MAR). A physician's reproductive decisions are not solely based on technical criteria but are also influenced by society values. Therefore, the aim of this study was to analyze the factors prioritized by MAR professionals when deciding on whether to accept to perform assisted reproduction and to show any existing cultural differences. Methods Cross-sectional study involving 224 healthcare professionals working with assisted reproduction in Brazil, Italy, Germany and Greece. Instrument used for data collection: a questionnaire, followed by the description of four special MAR cases (a single woman, a lesbian couple, an HIV discordant couple and gender selection) which included case-specific questions regarding the professionals' decision on whether to perform the requested procedure as well as the following factors: socio-demographic variables, moral and legal values as well as the technical aspects which influence decision-making. Results Only the case involving a single woman who wishes to have a child (without the intention of having a partner in the future) demonstrated significant differences. Therefore, the study was driven towards the results of this case specifically. The analyses we performed demonstrated that professionals holding a Master's Degree, those younger in age, female professionals, those having worked for less time in reproduction, those in private clinics and Brazilian health professionals all had a greater tendency to perform the procedure in that case. A multivariate analysis demonstrated that the reasons for the professional's decision to perform the procedure were the woman's right to gestate and the duty of MAR professionals to help her. The professionals who decided not to perform the procedure identified the woman's marital status and the child's right to a father as the reason to withhold treatment. Conclusion The study indicates differences among countries in the evaluation of the single woman case. It also discloses the undervaluation of bioethics committees and the need for a greater participation of healthcare professionals in debates on assisted reproduction laws.

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Is artificial insemination wrong? Even among married couples?

• Written by  Manager
• FATHER TADEUSZ PACHOLCZYK

Artificial insemination introduces sperm into a woman's body by use of a thin tube (cannula) or other instrument to bring about a pregnancy.

A man also violates his sexuality, as his involvement becomes reduced to "producing a sample," usually by masturbation, which technicians then use in order to impregnate his wife or another woman.

Similarly, any child conceived in this manner is potentially treated as an object or a "project to be realized," rather than as a gift arising from their shared bodily intimacy and one-flesh union.

Moral concerns

Back in 1949, a prescient Pope Pius XII already recognized some of these moral concerns when he wrote:  "To reduce the common life of a husband and wife and the conjugal act to a mere organic function for the transmission of seed would be but to convert the domestic hearth, the family sanctuary, into a biological laboratory.  Therefore . . . we expressly excluded artificial insemination in marriage."

The Catholic Church addressed this matter again in greater detail in 1987 in an important document called Donum Vitae (On the Gift of Life), noting that whenever a technical means "facilitates the conjugal act or helps it to reach its natural objectives, it can be morally acceptable.  If, on the other hand, the procedure were to replace the conjugal act, it is morally illicit [unacceptable].  Artificial insemination as a substitute for the conjugal act is prohibited."

Any exceptions?

Some Catholics have nevertheless suggested that artificial insemination might occasionally be permitted in light of another passage from the same document which they interpret as allowing for an exception: "Homologous artificial insemination within marriage cannot be admitted except for those cases in which the technical means is not a substitute for the conjugal act but serves to facilitate and to help so that the act attains its natural purpose."

These actions fail to respect the most personal and intimate aspects of a woman's relational femininity and her sexuality. She ends up being treated or treating herself as an "object" for the pursuit of ulterior ends.

Interestingly, at the present time, there do not seem to be any real-world examples of insemination technologies that facilitate the conjugal act.  Hence, while the statement above is true in a theoretical way, in practice there do not appear to be any specific technical methods to which the statement would in fact apply, so the claim of some Catholics that an exception exists for homologous artificial insemination does not appear to be correct.

The core problem remains that even if sperm were collected without masturbation, the subsequent steps of introducing a sample into a woman's reproductive tract, through a cannula or other means, would invariably involve a substitution or replacement of the conjugal act, which would not be morally acceptable.

To procure sperm without masturbation, a couple could use a so-called "silastic sheath" during marital relations (a perforated condom without spermicide).  This would allow some of the sample to pass through, and some to be retained and collected, and would assure that each marital act remained ordered and open to the possibility of transmitting the gift of life.

Yet even when using a morally-permissible sperm procurement technique, the subsequent mechanical injection or insemination step itself would raise serious moral concerns.  Clearly, a marital act would not cause the pregnancy, but at best would cause gamete (sperm) collection.  The pregnancy itself would be brought about by a new and different set of causes, whereby the mechanical actions of a technician would substitute for, and thus violate, the intimate and exclusive bond of the marital act.

Homologous artificial insemination, in the final analysis, does not facilitate the natural act, but replaces it with another kind of act altogether, an act that violates the unity of the spouses in marriage and the right of the child to be conceived in the unique and sacred setting of the marital embrace.

The beauty of the marital embrace and the noble desire for the gift of children can make it challenging for us to accept the cross of infertility and childlessness when it arises in marriage, even as it offers us an opportunity to embrace a deeper and unexpected plan of spiritual fruitfulness that the Lord and Creator of Life may be opening before us.

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• Author: Father Tadeusz Pacholczyk

Father Tad Pacholczyk, Ph. D. writes a monthly column, Making Sense Out of Bioethics , which appears in various diocesan newspapers across the country.  This article is reprinted with permission of the author, Rev. Tadeusz Pacholczyk, Ph. D.

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Legal Regulation of Artificial Insemination and the New Reproductive Technologies

The Search for Clarification Continues

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• Joseph M. Healey Jr. 3  

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Concerns about the legal aspects of the new reproductive technologies—artificial insemination, in vitro fertilization, and ovum and zygote transfer—are part of the continuing public and professional discussions about what our societal policy toward these technologies ought to be. The concerns are many and varied and include the desirability and availability of the technologies and the potential liability of those who use them. The desire for a clarification of legal responsibility is especially fueled by a heightened fear of liability, which has contributed to the pressure for straightforward legal answers and for a clear, comprehensive public policy dealing with these technologies. Lawyers know all too well the impatient cries of “Tell us the law, not philosophy.” With respect to one of the technologies, artificial insemination with donor sperm (AID), the search for legal answers during the past two decades has produced a substantial body of law. Yet, even in this area, many gaps remain. More important, there has not emerged a clear public-policy framework within which alternative forms of reproduction can be evaluated. Though this lack of a framework is frustrating to those who want clear legal answers, it is not unexpected and is not entirely bad.

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Healey, J., Legal aspects of artifical insemination by donor and paternity testing in Genetics and the Law (A. Milunsky and G. J. Annas, eds.) Plenum Press, New York (1976), 203.

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Arriving at a complete current list of state statutes is not an easy task. Three recent attempts did not result in identical lists. My own review produced at least one statute not cited by any of the other three authors. See Wadlington, W. Artificial conception: The challenge for family law, Virginia Law Review 69:465, 483 (1983);

Smith, G., The razor’s edge of human bonding: Artificial fathers and surrogate mothers, Western New England Law Review 5:639, 642 (1983);

Andrews, L. The stork market: The law of the new reproductive technologies, American Bar Association Journal 70:50, 54–5 (1984). From these three sources and my own research, the following list has been compiled:

Alaska Stat. Sect. 25.20.045 (1982)

Arkansas Stat. Sect. 61–141(C) (1983)

California Civ. Code Sect. 7005 (1982)

Colo. Rev. Stat. Sect. 19–6–106 (1978)

Conn. Gen. Stat. Sect. 45–69F-W (1981)

Fla. Stat. Ann. Sect. 742.11 (1984)

Ga. Code Ann. Sect. 19–7–21 (1984); Sect. 43–34–42 (1984)

Ill. Ann. Stat. Ch. 40 Sect. 1451 (1983–4)

Kan. Stat Ann. Sect. 23–128 to 23–130 (1983)

La. Civ. Code Ann. Art. 188 (1983)

Md. Est. and Trusts Code Ann. Sect. 1–206(B) (1983): Health Code, Sect. 20–214

Mass. Gen. Laws Ann. Ch. 46, Sect. 4B (1984)

Mich. Comp. Laws Sect. 333. 2824; Sect. 700. 11 (1980)

Minn. Stat. Sect. 257. 56 (1982)

Mont. Code Ann. Sect. 40–6–106 (1983)

Nev. Rev. Stat. Sect. 126. 061 (1979)

Law Sect. 73 (1983–4)

N.C. Gen. Stat. Sect. 49A-1 (1976)

Okla. Stat. Tit. 10, Sect. 551–553 (1983–4)

Or. Rev. Stat. Stat. Sect. 109.239–109.247; Sect. 667.355 to 677.370 (1984)

Tenn. Code Ann. Sect. 53–446 (1982)

Tex. Fam. Code Ann. Sect. 12.03 (1983)

Va. Code Ann. Sect. 64.1–7.1 (1984)

Wash. Rev. Code Ann. Sect. 26.26.050(1984–5)

Wis. Stat. Ann. Sect. 891.40 (1983–4); Sect. 767.47(9)

Wyo. Stat. Sect. 14–2–103 (1984)

See Healey, notes 13, 15, and 16, and Wadlington, pp. 477–479.

See, for example, CM. v. C.C . ,170 N.J. Super. 586, 407A2d. 849 (Juv. and Dom. Rel. Ct. 1979).

Oregon Revised Statutes, Section 677.370 (1984). The issue of screening sperm donors was addressed by the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research in its report Screening and Counseling for Genetic Conditions ,pp. 68–70, U.S. Government Printing Office, Washington, DC (1983). See also Should sperm donors be screened for sexually transmitted diseases New England Journal of Medicine 309:1058 (1983).

Wadlington, pp. 476–7.

For medical examples, see Van den Berg, J., Medical Power and Medical Ethics ,W. W. Norton, New York (1978).

McCormick, R., How Brave a New World Doubleday and Company, Garden City, NY (1981), 334– 335.

For a general discussion of the impact of an increase in the available options upon society, see Berger, P. The Heretical Imperative ,Anchor Press/Doubleday, Garden City, NY (1979), 1–31.

For a contrasting view of the desirability of various reproductive options, see Ramsey, P. Fabricated Man ,Yale University Press, New Haven, 1970.

Hanscombe, G. The right to Lesbian parenthood, Journal of Medical Ethics 9:133–135 (1983)

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Scott, R., The Body as Property ,Viking Press, New York (1981).

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A valuable framework for the development of a comprehensive public policy has been offered by Wadlington, at pp. 487–515.

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Healey, J.M. (1985). Legal Regulation of Artificial Insemination and the New Reproductive Technologies. In: Milunsky, A., Annas, G.J. (eds) Genetics and the Law III. Springer, Boston, MA. https://doi.org/10.1007/978-1-4684-4952-5_12

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Ethical considerations of artificial insemination

LETTER TO THE EDITOR

Avila RE I ; Samar ME II

I School of Medical Sciences, National University of Córdoba, Córdoba, Argentina

II School of Dentistry, National University of Córdoba, Córdoba, Argentina

Correspondence to Correspondence to: Rodolfo E. Avila Pabellón de Biología Celular Ciudad Universitaria, 5000 Córdoba, Argentina Phone: +54 351 4510182 Email: [email protected].

Dear Editor,

After reading your previous editor´s viewpoint, "Integrity in scientific publication", about ethical problems in scientific papers, I started to think one more time of another ethical issue in medicine: artificial insemination (1).

Artificial insemination (AI) is the most simple and oldest method in assisted reproductive technology, which has a low degree of complexity. Essentially, it involves placing sperm -previously prepared in the laboratory - in the female internal genital tract without sexual contact (2). AI carries the associated risk of multiple gestation pregnancies, since before the procedure women are given drugs that induce ovulation. This also leads to the possibility of a superovulation (ovarian hyperstimulation syndrome).

If the fertilization of several eggs really occurs, selective fetal reduction may be necessary, which comprises a paradoxical situation for women eager to have a child. Moreover, there must be an informed consent signed by women providing information on side effects of the technique, such as nausea, vomiting, ovarian enlargement and the possibility of occurrence of ovarian cysts (3).

The first question that arises from assisted reproduction is that it involves a type of human procreation dissociated from sexual partners. In addition, it is not therapeutic in its nature and do not cure infertility or reverse this situation (4).

Interestingly, the controversy or legitimacy of assisted reproduction techniques relies particularly on women. It may follow different positions according to the concept of family. Several people consider that the concept of family includes even those constituted by a single woman and her children. Consequently, this statement legitimizes the desire of single women for assisted reproduction methods. This situation creates a paradox since the right to reproduction is not an exercise of individual persons, but of a couple.

An argument against AI of single women is the welfare of the child, who has the right to fit into a comprehensive family relationship (with a mother and a father). Regarding the artificial insemination donor (AID), important questions arise. Should the identity of the donor who provided sperm for couples be revealed? What information will be given to the child in the future?

The legal and ethical questions are amplified in cases of post-mortem insemination, and sperm donor replacement without the consent of the spouse or steady partner. The son born after post-mortem insemination is called posthumous child. Defenders of this technique agree that the sperm donor must leave a written approval for the use of his sperm after his death. However, others claim that the child loses his inheritance rights. Another dilemma arises in cases of divorce or separation of the couple before the death of the father.

The use of a donor in AI introduces new genetic material into a family, which is foreign to the couple. There is a great chance that, in a sperm bank, the same material will be used for multiple inseminations; therefore, those children will be half-brothers. Furthermore, there may be consequences of consanguineous marriages of half-brothers that are unaware of their own condition. Tests should be performed on semen to certify its quality according to the standards of the World Health Organization. Among the questions that artificial insemination raises are: What are the criteria for choosing a donor?, What is his relation with the unborn child?, Should the husband or partner give a formal consent that the woman will be inseminated with donor semen? (5).

It is a new type of family, a "pluriparental" one, comprised of biological mother, legal father, sperm donor (biological father) and child. The inseminated woman is the biological mother; consequently, her rights and duties in relation to motherhood remain unchanged. However, if the woman is in a stable relationship and did not ask her partner for his consent regarding AI, she committed a serious mistake.

Submission status

Received: October 29, 2011.

Accepted: November 3, 2011.

Full paper published online: November 30, 2011.

Conflicts of interest

There is no conflict.

• 1. Rode SM. Integrity in scientific publication. J Venom Anim Toxins incl Trop Dis. 2011;17(2):118.
• 2. Avila RE, Samar ME. La telemedicina y el embrión humano como paciente: implementación de nuevas metodologías en la enseñanza de la embriología humana. Informed J. 2004;III(IV).
• 3. Avila RE, Samar ME, Ferraris RV. El embrión como persona y paciente. Córdoba: Editorial SeisC; 2008.
• 4. Samar ME, Avila RE, Ferraris R. Etica en reproducción asistida en los albores del siglo XXI. Rev Med Córdoba. 2001;89:34-43.
• 5. Samar ME, Avila RE. Problemática jurídico-legal de la fertilización asistida. La persona y el comienzo de la vida. Claves Odontol. 2002;49:7-9.
• Correspondence to: Rodolfo E. Avila Pabellón de Biología Celular Ciudad Universitaria, 5000 Córdoba, Argentina Phone: +54 351 4510182 Email: [email protected] .

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