All or Nothing? The International Debate over Disclosure to Donor Offspring
Nanette R. Elster, J.D., M.P.H.
Spence & Elster, P.C.
1979: “Sperm Donors: Possible Perils,” Newsweek1
1987: “Dilemma is Born: Donor’s Rights vs. Children’s Rights,” Chicago Tribune 2
1989: “King of the Anonymous Fathers: Sperm Donor May Have 40 Children He’ll Never Know,” Los Angeles Times 3
1992: “Breaking the Silence on Donor Insemination: A Growing Number of Parents and Children Want Changes to a Clandestine Medical Practice They Say Ignores Their Long-term Psychological Well-Being,” The Toronto Star4
1995: “When Father Knows Nothing: Why the Kids of Single Mothers Have a Right to Know Who Dad Is,” The Washington Post5
2001: “Sperm Donor Children May Have Fatal Gene,” Sunday Times (London)6
2006: “As the Use of Donor Sperm Increases, Secrecy Can Be a Health Hazard,” The New York Times 7
Quite The headlines appearing in Bio x4 reviews newspapers and magazines during the last three decades provide a time line revealing the range of issues raised by gamete donation and the secrecy that has historically surrounded the practice. The story told through the headlines in the popular press identifies the basic categories of concern with use of anonymous donor gametes and illustrates that the issues under discussion and debate today are in no way new best probiotics for men . The issues include: health risks (to children conceived and recipients of donated gametes); privacy concerns (of donors and recipients); psycho-social concerns (of recipient families and donor children); and concerns for the next generation (risks of inadvertent consanguinity). More importantly, however, the headlines show that these concerns have yet to be addressed in a meaningful and uniform manner nationally and internationally.
Quite recently, the risks of continued secrecy in the use of donor gametes have led to regulatory responses in a number of European nations and Australia. The United States, however, continues to lag behind. This paper will review what regulations have developed internationally, consider some of the reasons why the United States has not yet followed suit and provide suggestions for policy change in the United States that may address the concerns of each of the interested parties. Part 1 of the paper will provide a historical overview of how secrecy came to be the norm in collaborative reproductive arrangements. Part 2 will then discuss the interests of donors, recipients, fertility centers/sperm banks, and children with respect to disclosure. Part 3 will review the regulatory developments internationally regarding disclosure of donor identity in collaborative arrangements, and Part 4 will conclude with suggestions for policy change in the United States.
How did the practice of collaborative Total Restore review reproduction in which donor gametes might be used become shrouded in secrecy? Of the underlying reasons for using donor gametes, infertility and all of its attendant stigma together constitute one of the most significant reasons that this practice began under a cloud of secrecy which continues today despite the ever-changing structure of the family.
A. The Legacy of Adoption
The legacy of adoption provides some insight into how the stigma associated with the inability to have a child created a culture of secrecy. The practice of adoption dates as far back as the Hammurabi Code.8 It would be centuries, however, until adoption statutes such as the ones that we are familiar with today were enacted. Massachusetts enacted the first modern adoption statute in 1851 with the purpose and intent of promoting the welfare of children.9 This benevolent purpose, however, did little to remove the stigma that was often associated with adoption. Until the late 20th century, “each member of the adoption triangle was stigmatized: the birthmother was ‘promiscuous,’ the child a ‘bastard,’ the adoptive parents ‘barren.'”10 Against this cultural backdrop, a number of reasons were provided for ensuring and maintaining secrecy in adoption, including: concern that “natural”parents would reclaim the child or blackmail adoptive parents; the need to assure adoptive parents that their family would be secure from disruption; “unwed mothers'” insistence on privacy; and an interest of the adoption agencies themselves to promote a level of professionalism.11 During the 1930s and 1940s, social workers and adoptive parents supported legislation limiting access to adoption records,and by 1950, most state laws actually required sealed adoption records.12 Additionally, birth mothers were strong supporters of secrecy. “Desperately wanting to start a new life, fearful that the stigma of bearing an illegitimate child would destroy their chances for marriage, single mothers dreaded public revelation of their pregnancy and the familial and public obloquy that was sure to follow.”13 Thus, the practice of secrecy, largely an outgrowth of social attitudes about family, continued until the late 1970s when the Adoption Rights Movement began to take hold and adult adoptees began the quest for their biological heritage.14 Despite the active pleas, research and poignant stories of adoptees needing to know about their birth parents, it would be another decade until the policy and legislative shift toward opening records and developing sealed records occurred. The most controversial legal actions were taken by Tennessee and Oregon in the late 1990s. Both states allow adult adoptees and, in some instances, other interested parties, such as children of the adoptee or siblings of the adoptee, to gain access to the previously sealed adoption record, including identifying information contained therein.15
While the practice of adoption may be making strides in recognizing the significance of sharing information, the practice of gamete donation in the United States continues to support secrecy.
B. Donor Gametes and the Veil of Secrecy
Unlike adoption, which actually began as a fairly open process16 and is gradually reverting back to such openness, gamete donation emerged with the utmost secrecy, which continues today. So clandestine was gamete donation that, in one of the first reported cases of artificial insemination by donor performed by Dr. William Pancoast in 1884 in which a married woman was inseminated with the sperm of a man other than her husband, the woman was anesthetized and unaware of the procedure being performed.17 The rationale for secrecy very much mirrored that of the “adoption triad.” “Secrecy . . . benefited the physician, the woman receiving the sperm, any child born as a result of the procedure (who were called artificial bastards’) by some critics and the husband whose infertility needed to be masked from public view.”18 And, much like the secrecy surrounding adoption, the interests of the child were among the last to be considered. More often than not, the goal was to protect the recipient’s interest in avoiding stigma of infertility and the risk of alienation by the child; the donor’s interest in maintaining privacy and avoiding legal obligations to children s/he did not desire to parent; and the sperm bank or medical program’s interest in having an adequate supply of donors to satisfy the needs of their client/patient base.
The lack of consideration of the child was made clear in a 1979 study published by Currie-Cohen, Luttrell, and Shapiro in the New England Journal of Medicine.19 In that study, it was revealed that fewer than one-third of the practitioners surveyed held permanent records on the donors.20 While the idea may have been that this promoted the child’s sense of belonging to his or her family, it certainly ignored the reality that medical information may be of some importance to the child in the future for his or her own health purposes or the for the health and well being of his or her offspring.
By 1986, however, the American Fertility Society, currently the American Society for Reproductive Medicine (ASRM), issued guidelines that not only recommended taking a genetic history of donors and providing certain genetic tests to potential donors, but also that the genetic information collected (without identifying information) be available upon request to the recipient couple and the resulting child.21 In fact, the most recent ASRM guidelines state:
It is essential to maintain permanent records about each donor’s initial selection process and subsequent follow-up evaluation. To the extent possible, clinical outcome should be recorded for each insemination cycle. A mechanism must exist to maintain the records as a future medical resource for any offspring produced.22
Identical language is also included in the guidelines for oocyte donation as well.23 These, however, are only recommendations and thus do not have the same force and effect as law. Several states do have some record-keeping requirements. In New York, for example,
each reproductive tissue bank shall maintain applicable donor/client-depositor records which include:
(1) for donors, pertinent family history of any genetic disorders;
(2) documentation of donor and client-depositor written informed consent;
(3) for semen donors, outcome of any prior artificial insemination or other assisted reproductive procedures, if known, including number of successful pregnancies, if any, and any reports from insemination/implantation sites which would affect the donor’s acceptability.24
Ohio also has a law regarding record-keeping, and it addresses the information exchange in artificial insemination, provides for disclosure of certain information to the recipients but not to the child. The law requires that, upon request of the recipient, the physician provide:
(a) The medical history of the donor, including, but not limited to, any available genetic history of the donor and persons related to him by consanguinity, the blood type of the donor, and whether he has an RH factor;
(b) The race, eye and hair color, age, height, and weight of the donor;
(c) The educational attainment and talents of the donor;
(d) The religious background of the donor;
(e) Any other information that the donor has indicated may be disclosed.25
Another interesting facet of the Ohio law, which is reflective of the current norm in gamete donation, is a requirement that the informed consent process include:
[A] statement that the donor shall not be advised by the physician or another person performing the artificial insemination as to the identity of the recipient or, if married, her husband and that the recipient and, if married, her husband shall not be advised by the physician or another person performing the artificial insemination as to the identity of the donor.26
Developments in the practice of gamete donation indicate that a small shift may be occurring that acknowledges the importance of information in such collaborative arrangements. For example, a number of U.S. sperm banks are providing an option to select identifiable donors;27 voluntary registries are emerging;28 children of gamete donation are forming support groups;29 and children of gamete donation are waging and winning court battles to gain access to their donor’s identity;30 and European nations are eliminating donor anonymity through the legislative process.31 To understand this disclosure movement, so to speak, a description and analysis of the interests of all of the stakeholders is important.
III. STAKEHOLDER INTERESTS IN THE DISCLOSURE DEBATE
The disclosure debate is really a two-fold issue: first is the question of disclosing the nature of conceptions and second is disclosure of information, identifying or non-identifying, about the donor. This distinction is very important with respect to the development of policy in this area and does influence the perspectives of the many stakeholders involved in this process.
A. Recipients of Donor Gametes
The infertility process is costly emotionally, physically, and financially for individuals and couples. The need to involve a third person in the reproductive process further confounds this difficult process. For many who undergo this process, there is a strong desire to maintain the appearance of a natural family,32 and this is completely possible with gamete donation, unlike with adoption. With gamete donation, the woman will gestate the child just as if she had conceived using her egg and her husband’s sperm. With the exception of the treating physician, no one need ever know otherwise, and research indicates that the vast majority of parents choose not to disclose their use of donated gametes to their children.33 One article reviewing the literature found that studies have found that more than 90% of parents in the United States, Australia, and several European nations have opted to maintain secrecy.34 A study of Australian families found that only 38 of 293 children conceived through donor insemination had been told of their origins.35
Numerous reasons are given for explaining parents’ unwillingness or reluctance to disclose the nature of their child’s conception. First, however, it must be acknowledged that “[i]n no country are parents legally obliged to reveal a child’s origin, whether it was by adultery, common law relationship, or insemination.”36 In the United States, for example, the right to the care, control, and upbringing of one’s children is considered to be fundamental. This was affirmed by the U.S. Supreme Court in Troxel v. Granville, in which the Court held “the interest of parents in the care, custody, and control of their children -is perhaps the oldest of the fundamental liberty interests recognized by this Court.”
Why, though, are parents reluctant to share the information about conception with their children? One reason expressed is that parents have little information to share and, therefore, they consider it better not to discuss use of a donor rather than to provide incomplete information about the donor.38 This theory is supported by research indicating that couples who have more information about their donor are more likely to disclose the origin of conception to the child.39 Another reason parents may not want to disclose to their children is the potential threat to the non-genetic parent-child relationship.40 For example, if a sperm donation is used a means of conception for a heterosexual couple, the parents may be concerned that the father and child will not bond if the child knows of his/her donor origins.
Stigma or embarrassment present yet another reason why parents may not wish to disclose the use of donated gametes; this may, however, be more of an issue in the context of sperm donation than egg donation as Brewaeys, et al. suggest.41 In their article on Dutch parents’ views on donor anonymity, they assert that “[m]en, more than women, seem to associate their problem with serious doubts about their masculinity and sexual adequacy.”42 This is a concern that may very well be reinforced by cultural norms and social attitudes.
Another reason that may explain parents’ decision not to disclose is that they have been encouraged to maintain their silence regarding the method of conception. Firstly, “[m]edical authorities advised recipients not to tell anyone that the semen of an anonymous donor had substituted for that of the man who, for all intents and purposes, would be the child’s father.”43 Practices, such as sperm mixing, in which the intended father’s sperm is mixed with the donor sperm, so as not to be certain who is actually the progenitor of the child, seem to encourage this notion.44 Additionally, in the early years of donor insemination, the child born may be considered to have been born of adultery, raising questions of legitimacy, and the donor may have been found to have rights and responsibilities for the child.45
Increasingly, parents are warming to the idea of openness as several studies have indicated.46 Some parents have come to believe that, “if they kept the nature of the conception a secret, they would, by implication, be accepting that what they had done was shameful, and they would be reinforcing the stigma associated with male infertility and DI.”47 One study found that those parents who choose to disclose held a “strong belief that the child had a right to know about the circumstances surrounding his/her conception.”48 In another study, the researchers found that of those parents who did choose to disclose to the child the nature of his or her conception, none had any regrets.49 The question remains whether society is ready to accept the use of donor gametes as a way to build families and, thus, eliminate the need or desire for secrecy.
Donors also have a stake in the disclosure debate. To date there is little if any research examining the impact of disclosure on donors. This lack of research might explain why, unlike information about the parents and children of donor conception, much of the writing about donors and their attitudes are found in the popular press as opposed to academic journals.
Secrecy may have been an initial concern for sperm donors as the process itself was considered rather sordid. An inquiry committee set up in the United Kingdom during the 1960s found that sperm donation was, “‘an activity which might be expected to attract more than the usual proportion of psychopaths.'”50 That perception of sperm donation may have changed and has certainly not been the case regarding egg donation; nevertheless, donors may want to maintain their privacy and anonymity because of society’s perception of donors as just looking to make some “quick and easy cash.” Undoubtedly, the money may be a factor, but other factors may come into play, as well, such as the desire to help others. Nevertheless, to date, the altruism of donors and the amazing gift that they provide to countless families is never highlighted, and, thus, the need for secrecy or the expectation of it is perpetuated.
What may begin as a young man or young woman’s way of earning a bit of extra money for college and/or a way to help others may, 18 years down the line, be an unexpected, if not unwelcome, surprise of having contributed to the creation of five, 10, 15 or even one 100 offspring. In a 1989 account in the Los Angeles Times, one donor claims to have donated sperm 300 times over an eight-year time period, which he estimates resulted in approximately 40 children.51 More recently, one donor, who appeared on ABC’s Nightline, claims that he donated for 16 years, and estimates that he has produced hundreds of offspring.52 How would the life of the donor and his family be impacted if his identity was released? For example, if he was an unmarried college student when he donated, as most donors are, how might his spouse and/or children react to the news that he has sired dozens of children?
Donors may also have legal concerns, such as child support obligations or inheritance rights of children conceived from their gametes. The law in the vast majority of states releases sperm donors from such obligations and vests all legal rights and responsibilities for the child in the consenting husband and/or the woman inseminated.53 In contrast, however, only a handful of states have enacted legislation protecting egg donors from such claims.54 These laws, though, do not address a donor’s rights and/or obligations in the event s/he passes on a genetic or other health problem to the child. This issue came to the fore in Johnson v. Superior Court.55 In this California case, a child suffered from a rare kidney disease allegedly transmitted from a sperm donor. Her parents sought to depose the sperm donor to learn more information. The California appellate court ultimately held that “the alleged sperm donor in this case must submit to a deposition and answer questions, as well as produce documents, which are relevant to the issues in the pending action, but that his identity should remain undisclosed to the fullest extent possible.”56 In dicta, however, the court did indicate that under some circumstances anonymity may not be protected and the donor’s interest in privacy may give way to the child’s best interests.
While in most situations the donor’s genetic and medical information may be furnished without the need of disclosing the donor’s identity, there may be other situations that require disclosure of the donor’s identity in order to obtain the needed information. In either event, a contract that completely forecloses the opportunity of a child conceived by artificial insemination to discover the relevant and needed medical history of his or her genetic father is inconsistent with the best interests of the child.57
One aspect of this not addressed and which impacts donors greatly is their need with regard to information about the health of offspring. Is there a concomitant right of the donor to contact the child or the parents of the child to learn more information about a health condition he may later discover or that may be discovered in his own children? Additionally, if donors are to be contacted about health histories due to conditions expressed in their offspring, will mechanisms be in place to appropriately inform the donor? Will genetic counseling be provided to the donor in advance of disclosing to him/her that offspring resulting from the donation suffer from a genetic condition?
Despite these unanswered questions and an analysis or survey or donor views on the issue of disclosure, recent attitudes and practices do suggest that donors may not all be opposed to openness. In 1992, a former donor, Robert Owen was quoted in the Boston Globe as saying “At the time I was a donor, I thought I might have children some day. It didn’t happen. Now I’m sort of an unclaimed father. I’ve often looked at my students in class and wondered about the children I’d fathered . . . Were they happy? Were they loved? Were they successful? I don’t know.”58 Attitudes such as those expressed by Mr. Owen and the fact that sperm banks now offer the option of donors willing to be identified or contacted in the future and the fact that donors themselves are posting and responding to queries on the Donor Sibling Registry, suggest that some donors do not insist upon anonymity to continue to assist in the family building process and may even welcome such openness.
C. Children of Gamete Donation
Children are the one group of stakeholders in this debate whose involvement is not by choice; therefore, as these children come of age, it is not surprising that we are beginning to see them start to have a voice in this process. As with recipients of donor gametes, the disclosure issue falls along two distinct lines: disclosure of the conception with donated gametes itself and disclosure of information about the donor. If, however, a child does not know of the circumstances of his/her conception, s/he does not know to ask questions about the donor. Resolving this first issue is truly in the hands of their parents. The United Nations Convention on the Rights of the Child, though, does recognize the significance of children knowing who they are and where they have come from. In Part I, Article 8, the Convention states:
1. States Parties undertake to respect the right of the child to preserve his or her identity, including nationality, name and family relations as recognized by law without unlawful interference.
2. Where a child is illegally deprived of some or all of the elements of his or her identity, States Parties shall provide appropriate assistance and protection, with a view to speedily re-establishing his or her identity. 59
It is application of this section of the Convention that led to a court decision in the United Kingdom that found that children of donation have an interest in learning information about their history and identity.60 The court did not determine whether identifying or non-identifying information should be disclosed, it merely determined that there was applicability of this section of the Convention on the Rights of the Child.
Learning about one’s biological heritage is important for many reasons, including medical, psychological, and social reasons. The information may not only prove important for the health and well-being of the child, but also for the children of the child created through donated gametes. As genetic medicine continues to burgeon, the desire and need for this information will only become more critical.61
The psychological impact of this imposed, if not, sanctioned secrecy in donation is also apparent. The feelings of resentment and anger expressed by one woman, who at 40 years old learned that she was a child of artificial insemination, seem to be the norm for those who learn of their conception later in life. 62
People worry so much about women wanting babies – doctors are so caught up playing God – but they never think about the children themselves. It’s time they did and realized how hard it can be to have a whole part of your life blocked off . . . . It also cheated me out of the right to know my biological father, my family and my real roots.63
Additional psycho-social harms might come in the form of the impact on the family relationship. Bill Codray, who at 37 learned of his donor origins, claims to have always felt like a stranger in his family, looking different than the other members of his family, and having different interests and talents.64 This made him feel isolated from his family, and filmmaker Barry Stevens, who created a documentary about his search for his donor, expressed that the palpable secrecy in his household created distance between him and his father.65 To him, the process itself was (and is) unfair; “I never entered into a contract with these folks. I had no voice. I had no choice in the matter. I don’t feel bound by a contract made by a doctor with this donor.” 66 The impact of the secrecy and the uncertainty arguably presents negative consequences for donor children. According to McWhinnie,
[n]ot knowing 50% of your biological origin and antecedents has social consequences and can cause those who experience it great emotional pain, made worse by their awareness that this was not accidental happening but set up intentionally to mask their parents’ infertility and is sanctioned by current legal provisions. 67
Turner and Croyle’s research on adults conceived by donor insemination supports this, finding that, among these adults, there was a mistrust within the family, a lack of genetic continuity, and even frustration in the search for their progenitor.68
Recognition of the harm or potential harm to families and individuals by socially, if not legally, imposed secrecy has come to light. Children of gamete donation are mobilizing to form support groups and to support one another in their quest for learning about their genetic origins and forming family relationships with half-siblings. In addition, parents are disclosing more often and at earlier ages, and society is gradually accepting this shift in family building, which can be seen in any number of newspaper and television news stories in just the past six months. Additionally, as the next section will discuss, regulations are being developed to ensure that children, who know of their donor conception, are no longer in the dark about the characteristics, and, at times, the identity of their donor.
D. Fertility Programs/Sperm Banks
The other stakeholder in this debate about openness is the fertility center or the sperm bank, and, while this group may be the least emotionally involved, it does hold an enormous amount of control over what information is available, to whom it is available, and when. A newspaper account in 1987 revealed just how much control the sperm banks had. One physician was quoted as saying, “‘[w]e automatically destroy the records after a year or two . . . . All of our donors are identified by code; we change the code, and later we throw everything away so there is no way to identify them. We promised them that . . .'”69 In that same article, a sperm bank director was quoted as saying, “‘Anonymity is very, very, important . . . . Couples want anonymity; they insist upon it. Donors want anonymity; they insist upon it.”70 This is the legacy of Dr. Pancoast, who not only selected the donor himself, but did not even disclose to the woman inseminated that she conceived with the sperm of a donor.
What are the advantages of this total secrecy? One advantage may be freedom from the burdensome process of record keeping and the attendant liability if adequate records are not maintained. Another advantage is not having to be the intermediary in this ever-changing triad of recipient, donor, and child. And, still another advantage is the simplicity of this practice. Programs fear that, without a guarantee of anonymity, donors will disappear. One lab director in 1991 stated that donors “would not, in general, participate if their identities were divulged . . . . They’re worried about harassment or being sued for support.”71 With the majority of states relieving sperm donors of any support obligations by statute, this is one less concern for donors. But, without guidelines or uniformity, what exactly should be expected of sperm banks or fertility centers? What information should be collected? How long should it be maintained? What information should be accessible and to whom? How should the information be disclosed? What obligation, if any, is there to update donors or children of the health status of the other? With such little guidance, it is not surprising that there is a continued reluctance to move forward in a completely open mannerŠnot to mention the very real concern that both patients and donors may be put off by a mandated policy of openness.
Much like the other stakeholders discussed, the fertility centers and sperm banks are also coming around to a new way of thinking. They now offer both identifiable and anonymous donors. In addition, they provide a range of non-identifying information to recipients. Some are even setting up their own sibling registries.72 And probably one of the most significant developments is the issuance of an Ethics Committee report from the ASRM, which supports disclosure, stating that “disclosure to offspring of the use of donor gametes is encouraged . . . . Programs and sperm banks should gather and store medical and genetic information concerning donors.”73 This is a first step in changing the practice of gamete donation and the policies surrounding it. Countries other than the United States have taken policy change one step further through either legislative or other regulatory means.
INTERNATIONAL APPROACHES TO DISCLOSURE
The elimination of donor anonymity began in Europe in the late 1980s and may, in part, be a reflection of the United Nations Convention of the Rights of the Child discussed above. The approaches taken by each country differ in several ways; however, the one commonality is a recognition of the importance of protecting the interests of the child.
Sweden was the first country to mandate open-identity gamete donation. In 1985, legislation was enacted giving children of a mature age access to identifying information about sperm donors.74 The law does not require parents to inform their children that they are, in fact, borne of donor gametes, but, if a child is told when he or she is “sufficiently mature” s/he may learn identifying information about the donor. The initial, expected response to this legislation was that there would be a significant drop in available donors and while recruitment efforts were initially thwarted, numbers began to increase again.75 A briefing paper written by professor Eric Blyth confirms this asserting that “[t]he current level of donor recruitment is about the same a before the abolition of anonymity.”76
A study published in 2001 examined the impact of the legislation on couples’ attitudes toward disclosure and found that, by and large, legislation alone is not sufficient to change the practice of secrecy.77 The study did, however, indicate that the frequency of disclosure increased from 6% to 18%.78 One explanation for this increase, the authors surmise, is that identifying information about donors is available and “[t]elling a child about DI treatment without having information about the donor may be more difficult.”79 As more and more Swedish children conceived through gamete donation become “sufficiently mature,” the full impact of this innovative legislation may be realized.
The State of Victoria in Australia in 1998 also enacted legislation that requires all donors to be identifiable to offspring.80 The law also allows for donors to contact the state Infertility Authority and ask to be put in touch with offspring.81 This legislation replaced existing law, which did establish a registry that allowed donor’s to maintain anonymity but allowed offspring to learn non-identifying information about donors.82 As with Sweden, an initial decline in donors occurred but later equalized.83
This month, the first group of children covered by this legislation will turn 18. Not all of these children will have been informed by their parents of their donor conception; however, if their donor has contacted the state’s Infertility Treatment Authority seeking to meet the child, the Authority will send a letter to the adult child to inquire about his/her willingness to meet the donor.84 So, without ever knowing that s/he was conceived from donor gametes, a young adult might receive an official inquiry letter from the state government that would not only disclose the fact of his/her conception but also that the donor is interested in meeting. Despite the Authority’s “Time to Tell” campaign, the question remains as to whether this type of legislation goes to far into intruding on family privacy. The government, however, believes that it is acting in the best interests of the child and hopes that parents will be encouraged to tell their children.85 According to a press release issued by the Authority, a range of resources are being developed to assist parents in telling their children, and support is being offered to parents, children, and donors.86
How this campaign and this practice will impact future donor use of donor insemination, as well as all of the currently interested parties, remains to be seen; however, this certainly reflects an approach that attempts to address not only the child’s interest in future contact but also the donor’s interest.
C. United Kingdom
In recent months and after much debate and discussion, the United Kingdom has changed its policy with respect to donor anonymity. Until last year, donor anonymity in the United Kingdom was protected. Children, however, at age 18 or 16, if they had plans to marry, could determine if they were on the registry maintained by the Human Fertilization and Embryology Authority (HFEA), and in turn, they could gain access to non-identifying information about the donor. According the HFEA:
The amount of non-identifying information available varies as it was not initially compulsory for donors to provide it, but some individuals gave a description of themselves, stated whether they had children, or listed their interests.
Some of the following non-identifying information about donors will be available to people conceived with gametes donated between 1991 and July 2004:
- Physical description of donor (height, weight, eye and hair colour, skin colour)
- Year and country of the donor’s birth
- Donor’s ethnic group
- Whether the donor had any children
- Any other details the donor may have chosen to provide, such as their occupation, religion, interests and skillsAdditional information collected from July 2004:
- Donor’s parents ethnic group
- Whether the donor was adopted
- Donor’s marital status
- How many children the donor already had (if applicable) and the gender of those children
- Details of donor screening tests and medical history
- A goodwill message88
As of April 2005, after two years of extensive review, the United Kingdom changed its policy, however, and donors are no longer allowed to remain anonymous. So in 2023, children of donor conception will not only be able to access non-identifying information but donor identities, as well. 89 Given that one of the overarching principles of HFEA is that any fertility clinic in the United Kingdom offering treatment services “[m]ust take into account the welfare of any child born as a result of treatment . . . .”90 McWhinnie asserts that, “in the long-term[,] it is the offspring who have to carry the burden of their parents’ infertility and their secrecy about it and of the clinicians’ earlier interventions and decisions about the use of anonymous donor gametes.”91 That, combined with much research being published about the importance of children having access to donor information,92 the dangers of secrecy,93 and the 2002 case discussed earlier regarding the applicability of the United Nations Convention on the Rights of the Child,94 suggests that eliminating anonymity in gamete donation is one way to accomplish the imperative set out in HFEA. This response is not without its questions and controversies, including the concern that the donor pool will greatly diminish. But, like Sweden and Australia, time will tell.
D. The Netherlands
In 2004, the Netherlands joined the ranks of other European nations and introduced legislation that would give children of gamete donation the right to learn the identity of the donor.95 The debate about removing donor anonymity had begun nearly a decade earlier. If there is a successful birth, the professional performing the insemination must report information to an independent national foundation, which maintains the registry.96 The data to be reported and maintained for 80 years includes:
the data relating to the identity of the woman who has given birth after DI treatment, the day and place of the DI treatment, the term of the pregnancy, the information identifying the donor used, an overview of his physical, social and psychological characteristics [such as marital status, children, education, profession, motivation), a self-description of the donor, and medical characteristics that might be relevant. . . .97
Children, at age 16, if they know or suspect that they are donor conceived, may contact the registry for identifying information about the donor. The donor will be contacted to determine his willingness for contact. If he is unwilling, his interests will be balanced against the child’s with a presumption favoring the child.98 The donor, however, is not required to meet the child.
The legislation in the Netherlands is premised on the interests of the child, and, unlike the law in Australia, does not provide a back-and-forth exchange of information. It is too early to tell what approach will work best for all concerned, but with continued research and evaluation of these programmatic shifts will hopefully provide valuable information.
E. New Zealand
Unlike the countries discussed thus far, New Zealand has not legislated openness in donor arrangements; however, this has become the operational mode. Legislation regarding a centralize registry has been discussed, but, currently, the system is informal. In New Zealand, most programs have decided to only recruit donors with a willingness to be identified.99 As this is voluntary, there is no obligation on the part of the donor to reveal information about himself; however, denials of requests for information have been rare. 100
The system in New Zealand raises the question of whether a voluntary or a mandatory system is more effective. In part, the answer might turn on whose interests are being protected and what consensus can be reached among the stakeholders. A voluntary system seems to take into account the interests of all participants; however, the thorny question still exists regarding if children are informed of their conception in the first place. Ken Daniels of New Zealand continues to do research in this area and has published extensively on the advantages of disclosure, including a 2001 article on the preferred approach to disclosure.101 With recent legislative shifts in other countries, it will be interesting to see if Daniels’ family-building approach to disclosure is employed.
F. Other Nations
Not all nations favor disclosure. In Israel, donor conception is “in the hands of the medical profession. The physicians are the only ones who determine whose spermatozoa and ova will be used and who actually know whose child the pregnant woman carries.”102 The continuation of anonymity in Israel, however, is under debate with a new law allowing for release of donor identities being debated.103 In Cameroon, research from a decade ago reveals that cultural norms suggest that secrecy is necessary for donor insemination, and currently no policies or laws exist governing the practice. “Infertility is not socially acceptable in Cameroon.”104
The issue of donor disclosure is a moving target with the last decade seeing enormous shifts in policy and practice worldwide. Has the time come for a uniform international standard? That question remains. With differences in culture and religion as vast as they are worldwide, it is unlikely that any “one-size-fits-all” solution exists; however, the continued research on the impact of secrecy and openness on all participants in the donor gamete process can provide insight and help to guide the way through the intricacies of this family-building web.
V. RECOMMENDATIONS FOR CHANGE
As more and more children of sperm and now egg donation come of age in the United States, their concerns and interests must be explored and addressed. Already children are curious. Teenager Ryan Kramer was instrumental, with his mother’s help, in establishing a Donor Sibling Registry,105 and another teenager even went so far as to trace his anonymous donor through a genetic service called FamilytreeDNA.com.106 Children from the first U.S. identity-release sperm donor program at Sperm Bank of California have learned the identities of their donors.107 This is more than just a trend. It is a way of life for more and more families, both traditional and non-traditional. Addressing the needs of this Internet-savvy, curious generation, while, at the same time, respecting their parents’ and the donors’ interests, is going to require quite a balancing act. An important first step, however, is determining whose interests should be the focal point. I would argue that the child’s interests should be the focus, because the child is the only one who did not participate in the gamete donation process voluntarily.
A number of questions are raised, and, as has been discussed, a number of approaches can be taken to respond to the issue of disclosure in gamete donor arrangements. One approach that seems to be in place in most of the countries considered and was even in place in the United Kingdom prior to lifting anonymity is a centralized registry. Creation of a registry: would allow for sharing of pertinent, current medical, health, and genetic information; may help to avoid the identity issues or familial disconnect of children; would be useful in avoiding inadvertent consanguinity; would enable ART programs to share information with one another about donors; and could facilitate outcomes/epidemiological research, which would be so critical in evaluating the effectiveness of such a mechanism.
Why? How? What? Where? and When? These are relatively standard questions for any inquiry, and they must be addressed in considering whether a registry is appropriate to meet the needs of all concerned. This is an issue that has ramifications for many people beyond those directly involved in the donation arrangement, such as spouses and children of gamete donors, and children of children born through gamete donation.
A number of reasons can be articulated for disclosure in gamete donation arrangements, including: the need for medical information, an issue relevant for not only the child, but the donor, children of the donor, and any half-siblings of the child. Similarly, reproductive decision-making impacts each of these groups, as well. Psychological well-being is another reason for disclosure; numerous studies mentioned previously discuss the dangers of secrecy for the child, as well as the family structure, and the 1989 book Lethal Secrets: The Shocking Consequences and Unsolved Problems of Artificial Insemination by Baran and Pannor delves deeply into the issue.108 And still another persuasive reason for all concerned is preventing inadvertent consanguinity. With the proliferation of donors, this is an issue that cannot and should not be ignored. Other reasons why disclosure is necessary include the increasing demand for information from intended parents109 and from donor offspring, not to mention a lingering curiosity on the part of some donors.
How should a registry be structured? The intricacies of this are a subject for another paper; however, some of the factors to be taken into account include: whether it should be voluntary or mandatory; maintained by the government (state or federal) or a private entity; and how will it be regulated. Given the U.S. medical culture regarding privacy and autonomy in decision making, a voluntary registry would seem most palatable to the most people. With a voluntary registry, a norm can develop in a manner that suits the needs of the participants, including the fertility centers and sperm banks. The professionals in the field are the ones with the information and, therefore, are integral to the effectiveness of a registry. Once a registry has been in place and its use becomes more routine through use, then regulations can be adopted that provide oversight and guidance.
Other procedural questions must be considered, as well – such as how should the data be collected and communicated. In order for a registry to accomplish its goals, the data must be collected in some uniform way. The communication of the data has both practical and emotional aspects. Whether it is on paper and through the mail, in person, or by telephone are the practical concerns, but the preparation of the recipient of the information is an emotional concern that must be considered, so that learning the information does not cause more harm than good.
What information should be collected? What should all parties be told about records retention and anonymity? What should be disclosed? What are the obligations of each party to report information to the registry, if any, and what obligation does the registry have to report information learned? These are pretty tough questions and might suggest some insurmountable obstacles for fertility centers or sperm banks, but some uniform guidelines would help to ease the burden. The information to be collected might change over time, and the practitioners are the experts to guide the determination of what information is relevant to maintain and what is necessary to disclose.
Both donors and recipients, through the informed consent process, should be informed about what information is available, what is collected, and why. In fact, ASRM supports exactly this; “[c]ounseling and informed consent about disclosure are essential for the donor and recipients.”110 Counseling, one might argue, should also include the child at some point and should continue at the time of any disclosure.
This last question addresses the issue of the duties of donors, recipients, and even offspring to keep the registry updated regarding health status, name changes, address changes, etc. And, if reports are made back to the registry about health and medical concerns, then the obligation, if any, of the registry to contact and report the information to those impacted becomes an issue. The recent situation in Michigan where it was discovered that a sperm donor had passed on a rare genetic disease to several offspring111 illustrates the necessity of addressing these questions.
The next questions ask who: Who should collect and maintain records? Who should have access to records? Who has the authority to disclose and to whom? The likely collector and repository for records would be the fertility centers and/or the sperm banks as they are the ones that initially have the information about both the donors and the recipients. Access to the records is a bigger question. Should this be only for the child’s benefit? Or is the State of Victoria in Australia taking the right approach by making access to records a two-way street? Arguably, all of the participants may have a need for the information at some time or other. In addition, family members of donors and offspring may also have a need for information. Clarity is required to avoid any unnecessary intrusions into privacy and to ensure that all participants know what to expect. Finally, the one making the disclosure should be clearly identified to ensure whatever policies and protocols that may be in place are followed and that accurate records of contact and the information disclosed can be maintained.
This is a logistical question that considers the location of such a registry. Having something centralized is one way to ensure some uniformity and accessibility. But the question remains should the data be collected and stored at the physician’s office, at the sperm bank, or somewhere else.
The timing of collection and release of data are important considerations as is evidenced by the international response. In the Netherlands, for example, data about the donor and recipients must be reported to the registry within 60 weeks of conception. When the data is collected may be significant as to how accurate it is. When to release the data is another issue. In most countries, to release the information to the child, the child must be at least a mature minor or have reached majority. Another consideration is whether certain health considerations may allow for release of information in a different time frame.
A registry is certainly complex and undoubtedly poses a number of risks, including: a decrease in available donors, especially if it provides identifying information as is seen in the United Kingdom, and initially in Sweden and Australia; potential disruption of families; difficulty in centralizing data collection; difficulty in maintaining privacy; and inadequate emotional/psychological preparation for parents disclosing and for children receiving the information, as well as for donors and their families. The benefits, however, cannot be overlooked.
G. A Registry Need Not Be an All or Nothing Proposition
In many circumstance disclosure, of non-identifying information may be sufficient to meet the needs of the inquiring party. The existence of a registry does not necessarily mean the disappearance of anonymous donation; it does, however, mean that, if and when information is desired or needed, it will be available. It may also provide an opportunity to open donor relations through mutual consent as has been done in the adoption context. The other advantage of a registry is that it is one more step toward eliminating the stigma of gamete donation by formalizing and acknowledging this unique and special way of building families.
The use of donated gametes in building families is here to stay. For many, including this author, whose infertility may have precluded their having a child, this is truly a gift – one that should not be a secret, but rather a celebration. To continue a culture of secrecy shuns, rather than celebrates, the children born of such arrangements and the donors who made their births possible. The demand for information from recipients and children of donation, and the willingness of donors to be identified as evidenced by the increase in identifiable donors in commercial sperm banks and donors participation in sibling registries, suggests that the time has come to begin to raise the veil of secrecy. Disclosure may not be for everyone and should not be forced upon them; however, it is a choice that should be available to those who desire it.
1Matt Clark with Dan Shapiro, “Sperm Donors: Possible Perils,” Newsweek, March 26, 1979 at 72.
2Timothy McNulty, “Dilemma is Born: Donor’s Rights vs. Children’s,” Chicago Tribune, August 10, 1987 at 1.
3Beth Ann Krier, “King of the Anonymous Fathers: Sperm Donor May Have 40 Children He’ll Never Know,” Los Angeles Times, April 21, 1989 at 10.
4Louise Kinross, “Breaking the Silence on Donor Insemination: A Growing Number of Parents and Children Want Changes to a Clandestine Medical Practice They Say Ignores their Long-Term Social and Psychological Well-Being,” Toronto Star, July 25, 1992 at G1.
5“When Father Knows Nothing: Why the Kids of Single Mothers Have a Right to Know Who Dad Is,” Washington Post, January 29, 1995 at C04.
6Lois Rogers, “Sperm Donor Children may Have Fatal Gene,” Sunday Times (London), September 23, 2001, at Home News.
7Denise Grady, “As the Use of Donor Sperm Increases, Secrecy Can Be a Health Hazard,” The New York Times, June 6, 2006 at 5.
8Ann Lamport, “The Genetics of Secrecy in Adoption, Artificial Insemination, and In Vitro Fertilization,” 14 Am. J. L. and Med. 109, 110 (1988).
9G. Kelly, “Getting to Know You: Disclosure of Information Contained in Sealed Adoption Records Under Connecticut Public Act 87-555,” 5 Conn. Probate L. J. 81 (1989).
10J. Dickson, “The Emerging Rights of Adoptive Parents: Substance or Specter?,” 38 UCLA L. Rev. 917 (1991).
11See, e.g., E. Wayne Carp, Family Matters: Secrecy and Disclosure in the History of Adoption, 102-137, Harvard University Press: Cambridge, Massachusetts and London England, 1998.
12S. Goodman, “Adoption of What? Information Policy for Records of the Adoption of People in the U.S.,” 27 Records Management Quarterly 3 (1993).
13E. Wayne Carp, Family Matters: Secrecy and Disclosure in the History of Adoption, 111, Harvard University Press: Cambridge, Massachusetts and London England, 1998.
14See, e.g., id. at 138- 166.
15Tenn. Code Ann. § 36-1-127 (2005), ORS § 432.240 (2006).
16See, e.g., Cynthia Daniels and Janet Golden, “Procreated Compounds: Popular Eugenics, Artificial Insemination and the Rise of the American Sperm Bank Industry,” 38 Journal of Social History 5 (2004).
17Id. omitting citation.
18Currie-Cohen, Luttrell and Shapiro, “Current Practice of Artificial Insemination by Donor in the United States,” 300 New Eng. J. Med. 585 (1979).
20The Ethics Committee of the American Fertility Society, “Ethical Considerations of the New Reproductive Technologies,” 46 Fertility and Sterility 835-845, Supp. 1 (1986).
21Emphasis added. American Society for Reproductive Medicine, “Guidelines for Sperm Donation,” 82 Fertility and Sterility S8-S12, Supp. 1 (2004).
22 American Society for Reproductive Medicine, “Guidelines for Oocyte Donation,” 82 Fertility and Sterility S13-S15, Supp. 1 (2004).
2310 NYCRR § 52-8.9 (2006).
24ORC Ann. 3111.93 (2006).
26See, e.g., www.thespermbankofca.org, http://www.fairfaxcryobank.com
27See, e.g., www.donorsiblingregistry.com, www.cryobank.com/sibling_registry2
28See, e.g. The Donor Conception Support Group at http://www.members.optushome.com.au/dcsg/
29See, e.g., R (on the application of Rose and another) v Secretary of State for Health and another, 3 FCR 731, 69 BMLR 83 (2002).
30See, e.g., The Human Fertilisation and Embryology Authority at www.hfea.gov.uk/Home
31See, e.g., Lucy Frith, “Gamete Donation and Anonymity,” 16 Human Reproduction 818-824 (2001).
32See, e.g, Glenn McGee, Sarah-Vaughan Brakman and Andrea Gurmankin, “Gamete Donation and Anonymity: Disclosure to Children Conceived with Donor Gametes Should not be Optional,” 16 Human Reproduction 2033-36 (2001), citing S. Klock and D. Maier, “Psychological Factors Related to Donor Insemination,” 56 Fertility and Sterility 489-495 (1991).
33Eva Durna, et. al., “Attitudes of Parents of Donor Insemination Children to Disclosure and Donor Registries,” 10 Reproductive Technologies 224-230 (2000).
34Id. at 228.
36Troxel v. Granville, 530 US 57 (2000).
37Eva Durna, et. al., “Attitudes of Parents of Donor Insemination Children to Disclosure and Donor Registries,” 10 Reproductive Technologies 224-230,229 (2000).
38See, Dorothy Greenfeld and Susan Klock, “Disclosure Decisions among Known and Anonymous Oocyte Donation Recipients,” 81 Fertility and Sterility 1565 (2004).
39See, A Brewaeys, et. al., “Donor Insemination: Dutch Parents’ Opinions about Confidentiality and Donor Anonymity and the Emotional Adjustment of their Children,” 12 Human Reproduction 1591-1597, 1595 (1997); also see, J. Schieb, et. al., “Choosing Identity-Release Sperm Donors: The Parents’ Perspective 13-18 Years Later,” 18 Human Reproduction 115-1127, 1125 (2003).
40See, A Brewaeys, et. al., “Donor Insemination: Dutch Parents’ Opinions about Confidentiality and Donor Anonymity and the Emotional Adjustment of their Children,” 12 Human Reproduction 1591-1597, 1595 (1997); also see, Andrea Wren, “Dad’s Secret: Infertility,” 37 Psychology Today 30 (2004).
41Id. at 1591.
42Frances, Price, “Who’s Sperm is it Anyway?” New Scientist, July 18, 1998 at 4848.
43See, e.g., Joseph Davis and Dirck Brown, “Artificial Insemination by Donor (AID) and the Use of Surrogate Mothers: Social and Psychological Impact,” 141 Western Journal of Medicine 127 (1984).
44See, e.g., Lucy Frith, “Gamete Donation and Anonymity: The Ethical and Legal Debate,” 16 Human Reproduction 818-824 (2001).
45See, e.g., J. Schieb, et. al., “Choosing Identity-Release Sperm Donors: The Parents’ Perspective 13-18 Years Later,” 18 Human Reproduction 1115-1127 (2003).
46K. Daniels and P. Thorn, “Sharing Information with Donor Insemination Offspring: A child-Conception versus a Family-Building Approach,” 16 Human Reproduction 1792-1796 (2001).
47Claire Murray, et. al., “Egg Donation Parents and Their Children: Follow-Up at Age 12 Years,” 85 Fertility and Sterility 610 – 618 (2006).
48Myra Hunter, et. al., “Donor Insemination: Telling Children about Their Origins,” 5 ChildPsycholgoy and Psychiatry Review 157 (2000).
49Lucy Frith, “Gamete Donation and Anonymity: The Ethical and Legal Debate,” 16 Human Reproduction 818-824 (2001), quoting Earl of Feversham’s Report, “Report of the Departmental Committee on Human Artificial Insemination,” (1960).
50Beth Ann Krier, “King of the Anonymous Fathers: Sperm Donor May have 40 Children He’ll Never Know,” Los Angeles Times, April 21 1989 at 10.
51“Confessions of a Sperm Donor,” abcnews.com, May 20, 2006.
52See, e.g., Lori Andrews and Nanette Elster, 21 The Journal of Legal Medicine 35-65 (2000).
54Johnson v. Superior Court, 80 Cal. App. 4th 1050 (2000).
57Nathan Cobb, “Who is my Donor Dad?” The Boston Globe, September 10, 2002 at 85.
58United Nations Convention on the Rights of the Child, Part 1, Article 8 (1989).
69See, e.g., R (on the application of Rose and another) v Secretary of State for Health and another, 3 FCR 731, 69 BMLR 83 (2002).
60See, e.g., Glenn McGee, Sarah-Vaughan Brakman and Andrea Gurmankin, “Gamete Donation and Anonymity: Disclosure to Children Conceived with Donor Gametes Should not be Optional,” 16 Human Reproduction 2033-36 (2001).
61See, e.g., A. Turner and A. Coyle, “What does it Mean to be a Donor Offspring? The Identity Experiences of Adults Conceived by Donor Insemination and the Implications for Counselling and Therapy,” 15 Human Reproduction 2041-2051 (2000).
62Sarah Ebner, “At 41 I Finally Learned Why I Always Believed I had no Father . . .,” Daily Mail, February 6, 1997.
63Louis Kinross, “Braking the Silence on Donor Insemination,” The Toronto Star, July 25, 1992, at G1.
64“Keeping a Secret,” 60 Minutes, July 13, 2003 at http://www.cbsnews.com/stories/2003/07/11/60minutes/main562830.shtml
66A. McWhinnie, “Gamete Donation and Anonymity: Should Offspring from Donated Gametes Continue to be Denied Knowledge of their Origins and Antecedents?,” 16 Human Reproduction 807-817 (2001).
67A. Turner and A. Coyle, “What does it Mean to be a Donor Offspring? The Identity Experiences of Adults Conceived by Donor Insemination and the Implications for Counselling and Therapy,” 15 Human Reproduction 2041-2051 (2000).
68Timothy McNulty, “Dilemma is Born: Donor’s Rights vs. Children’s,” Chicago Tribune, August 10, 1987 at C1.
70David Streitfeld, “Secrecy & the Sperm Donor: Should Kids Conceived by Artificial Insemination Know Their Biological Dads?” The Washington Post, November 28, 1991 at C5.
71See, e.g. California Cryobank at http://www.cryobank.com/sibling_registry2/faqs1.cfm
72Ethics Committee of the American Society for Reproductive Medicine, “Informing Offspring of Their Conception by Gamete Donation,” 81 Fertility and Sterility 527 (2004).
73SFS, Swedish Law – formal Statute, p. 1140 (1984).
74See, e.g., Ken Daniels and Othon Lalos, “Ethics and Society: The Swedish Insemination Act and the Availability of Donors,” 10 Human Reproduction 1871-1874 (1995).
75Eric Blyth, “The Recruitment of Identifiable Sperm Donors: Messages from Overseas,” at http://www.basw.co.uk (2003).
76Claes Gottlieb, et. al., “Disclosure of Donor Insemination to the Child: The Impact of Swedish legislation on Couples’ Attitudes,” 15 Human Reproduction 2052-2056 (2000).
77Id. AT 2054
79Eric Blyth, “The Recruitment of Identifiable Sperm Donors: Messages from Overseas,” at http://www.basw.co.uk (2003).
80See, Simon Lauder reporting on “Concerns over Victorian Donor Changes,” May 15, 2006 at http://www.abc.net/ua/pm
81Eric Blyth, “The Recruitment of Identifiable Sperm Donors: Messages from Overseas,” at http://www.basw.co.uk (2003).
83See, Simon Lauder reporting on “Concerns over Victorian Donor Changes,” May 15, 2006 at http://www.abc.net/ua/pm
84Leslie Cannold, “Time to Break the News to Your Children,” The Age, May 11, 2006 at http://www.theage.com.au
85Infertility Treatment Authority Press Release at www.ita.org.au/secure/downloadfile.asp?fileid=1001493
86Myra Hunter, et. al., “Donor Insemination: Telling Children About Their Origins,” 5 Psychology and Psychiatry Review 157 (2000).
87HFEA Register, Introduction, at www.hfea.gov.uk/Home
90A. McWhinnie, “Gamete Donation and Anonymity: Should Offspring from Donated Gametes Continue to be Denied Knowledge of their Origins and Antecedents?,” 16 Human Reproduction 807-817 (2001)
91See, e.g., Myra Hunter, et. al., “Donor Insemination: Telling Children About Their Origins,” 5 Psychology and Psychiatry Review 157 (2000), A. McWhinnie, “Gamete Donation and Anonymity: Should Offspring from Donated Gametes Continue to be Denied Knowledge of their Origins and Antecedents?,” 16 Human Reproduction 807-817 (2001), A. Turner and A. Coyle, “What does it Mean to be a Donor Offspring? The Identity Experiences of Adults Conceived by Donor Insemination and the Implications for Counselling and Therapy,” 15 Human Reproduction 2041-2051 (2000).
92See, e.g., A. Turner and A. Coyle, “What does it Mean to be a Donor Offspring? The Identity Experiences of Adults Conceived by Donor Insemination and the Implications for Counselling and Therapy,” 15 Human Reproduction 2041-2051 (2000).
93R (on the application of Rose and another) v Secretary of State for Health and another, 3 FCR 731, 69 BMLR 83 (2002).
94See, e.g., Janssens, et. al., “A New Dutch Law Regulating Provision of Identifying Information of Donors to Offspring: Background, Content and Impact,” 21 Human Reproduction 852-856 (2006).
98Eric Blyth, “The Recruitment of Identifiable Sperm Donors: Messages from Overseas,” at http://www.basw.co.uk (2003), also see, K. Daniels and P. Thorn, “Sharing Information with Donor Insemination Offspring,” 16 Human Reprodution 1792-1796 (2001).
100K. Daniels and P. Thorn, “Sharing Information with Donor Insemination Offspring,” 16 Human Reprodution 1792-1796 (2001).
101Ruth Landau, “The Management of Genetic Origins: Secrecy and Openness in Donor Asisted Conception in Israel and Elsewhere,” 13 Human Reproduction 3268-3273 (1998).
102Netty Gross, “A Shpritz or a Dad?” The Jerusalem Post, July 11, 2005 at 15.
103O. M. Njikam Savage, “Secrecy Still the Best Policy: Donor Insemination in Cameroon,” 14 Politics and the Life Sciences 87 (1995).
105Alison Motluk, “Anonymous Sperm Donor Traced on Internet,” New Scientist, November 3, 2005.
106Linda Villarosa, “Once-Invisible Sperm Donors Get to Meet the Family,” The New York Times, May 21, 2002 at F5.
107Annette Baran and Reuben Pannor, Lethal Secrets, Warner Books, New York: NY (1989).
108See, e.g., J. Schieb, et. al., “Choosing Identity-Release Sperm Donors: The Parents’ Perspective 13-18 Years Later,” 18 Human Reproduction 1115-1127 (2003) indicating that 80% of recipients at the Sperm Bank of California wanting identifiable donors.
109Ethics Committee of the American Society for Reproductive Medicine, “Informing Offspring of Their Conception by Gamete Donation,” 81 Fertility and Sterility 527 (2004).
110See, e.g., Tamara Audi, “Sperm Donor Passes on Rare Disease to Children,” Detroit Free Press, May 20, 2006, at 3.
111Janssens, et. al., “A New Dutch Law Regulating Provision of Identifying Information of Donors to Offspring: Background, Content and Impact,” 21 Human Reproduction 852-856 (2006).