Donor insemination and the dilemma of the “unknown father”.

Abstract

As has been the pattern worldwide, the provision of donor insemination (DI) - and subsequently other forms of donor conception - in the UK has traditionally been characterised by withholding the identities of donors and recipients and of donors and their donor-conceived offspring from each other. Furthermore, recipients of donor gametes were frequently advised not to tell anyone, including their children, of their recourse to donor conception.1 Inter-related factors promoting such practices include: • the dubious legal and moral status of donor conception (including explicit disapproval from several major world religions) – with consequent concerns about the impact on the child and other family members if knowledge of donor conception became “common knowledge”.2 • suspicions about sperm donors’ personality and motivation.3 • recipients’ ambivalence about the use of donor conception – especially DI.4 • uncertainties about the impact on the child of knowledge of the circumstances of their conception (or assumptions that such knowledge would be damaging).5 • uncertainties about the donor’s legal or financial responsibilities towards the child and to protect them from unintended/undesired contact or responsibilities. 6 • uncertain legal status of the child – and fears of prosecution/conviction for falsification of birth registration information.7 • stigma associated with male infertility in particular and families desires - and the opportunity - to “pass as normal”.8 • potential consequences of the parents’ imbalanced genetic relationship with the child and fears of the child’s rejection of the non-genetic parent.9 • fears of unwanted intrusion by the donor in family affairs.10 • initial reliance on fresh sperm, requiring management of the geographical and temporal proximity of donor and recipient.11 • parents’ uncertainties about the timing and method of telling their child and the lack of information to give the child, making “not telling” – at least superficially - an easier option.12 • physicians’ concerns about their potential exposure to critical external scrutiny, including risk of claims of unprofessional/illegal practice.13 • need to maintain donor services in the face of the assumed adverse impact of disclosure on supply.1