Reproductive Tech - Mutiple Issues

[Broomstick]

This item hits multiple topics - you've got technologically assisted reproduction (sperm donation), genetic disease, and possibly genetic mosaicism all bundled together.

Link: http://www.nytimes.com/2006/05/19/healt ... ref=slogin

Sperm Donor Seen as Source of Disease in 5 Children

By DENISE GRADY
Published: May 19, 2006
A sperm donor in Michigan passed a rare and serious genetic disease to five children born to four couples, doctors are reporting today.

The doctor who discovered the cases said that all four couples were clients of the same sperm bank. That bank, the doctor added, assured him that it had discarded its remaining samples from the man and had told him he could no longer be a donor.

It is not known how many children the donor had fathered, whether he knew he carried the disease before he donated sperm, or whether the bank had informed him of his condition after learning about it. The doctor declined to name the sperm bank.

A report on the cases is being published today in The Journal of Pediatrics.

An expert in genetics and reproductive medicine who is not associated with the report, Dr. Joe Leigh Simpson at the Baylor College of Medicine, said that sperm donors are routinely tested for most common genetic diseases, like cystic fibrosis and sickle cell anemia, but not for extremely rare ones like severe congenital neutropenia, the one afflicting the Michigan children.

Children with the disease lack a type of white blood cell called a neutrophil, according to the doctor who discovered the cases, Dr. Lawrence A. Boxer, the director of pediatric hematology and oncology at the University of Michigan, and an author of the report. As a result, the children are highly vulnerable to infections and prone to leukemia.

Without treatment, many die in childhood. But daily shots of a drug called Neupogen can help them make the missing cells and fight off infections. It does not ward off leukemia, though. The drug costs $200 a day, but, Dr. Boxer said, many get it free as part of a study.

"The kids are doing terrific," Dr. Boxer said. "They're all leading healthy lives." But, he added, they have a 50 percent chance of passing the gene and the disease to their own children.

The disease is rare; since Dr. Boxer is an expert on it, families find their way to him, he said. It affects only about one in five million children, and when he encountered three affected families in one year, "it became pretty striking," he said. Then, a fourth family appeared. The families had three sets of twins and one other child from the donor; all told, five children were affected — the single child, one pair of twins and one twin each from the two other sets.

"The mothers, when initially they brought the children to me, volunteered without my asking how they conceived the kids," Dr. Boxer said. To protect the privacy of his patients Dr. Boxer has not revealed their identities, not even to one another.

He asked where they had obtained the sperm, and if they had cards from the sperm bank that would allow tracing of the donor. All produced cards with the same donor number.

Genetic testing showed that all the affected children had the exact same version of the defective gene — and that none of their mothers did. The donor was the only explanation.

Dr. Boxer called the sperm bank and requested one of the donor's samples for testing but, he said, the sperm bank refused, saying the donor had given permission for the sperm to be used only for conception, not genetic testing. Nor would the bank contact the donor to ask for his cooperation, Dr. Boxer said.

"They were fearful, I'm sure, of litigation, though nobody spoke about that," Dr. Boxer said. "The less that was unraveled here the better off they were going to be."

Dr. Boxer said that while he had no information about the donor, he and his colleagues suspected that the man had an unusual condition, mosaicism, in which the mutant gene occurred only in his sperm and not in the rest of his body.

Otherwise, Dr. Boxer said, the donor would have been extremely ill. The sperm bank said he had been healthy. If he did have mosaicism, he would have had no symptoms and there would have been no reason to test him.

Dr. Simpson of Baylor University said he had not heard of a case like this before, but added: "It's not surprising. You have the same risks in sperm donors as when children are naturally conceived. It's not unique to the sperm donor situation."

Just a few random thoughts:

This is an illustration of why it's not a good thing to have one sperm donor be the biological father of too many children - genetic disease is not always apparent. Not to mention every mutation has a point of origin.

Genetic mosaicism used to be in the realm of "theory - but we have no examples". Then it became "very, very rare". Now, with genetic sequencing being easier/cheaper and genetic testing more common, while it's still rare, it's apparently NOT as rare as people used to think it was.

If the donor is not a genetic mosaic, it may simply be that a mutation has occured in his sperm-generating cells, which may well explain his not being affected.

What do you think of the ethical issues involved in either violating the donor's anonymity so other possible suffers can be located vs. keeping him anonymous and possibly missing a correct diagnosis in a child suffering from an easily fatal disease?

[DesertFly]

I think it's wrong for anonymity at sperm banks anyway, but that's just me. If you're going to be spreading genes around, I think there should definitely be some way to track who contributed them.

[Broomstick]

I find it interesting that I can post a thread, get a hundred or so views, and virtually no comments.

I was hoping for a discussion - maybe about the morality of assisted reproduction, how many genetic diseases can be screened for, who pays for it, do you screen for everything or just the common stuff, everyone's got bad genes but not everyone has genetic illness, etc., etc., but if not.... oh, phoo, I'll have to go find an argument-in-progress or something...

[DesertFly]

I tried, I really did! I offered up a controversial opinion, hoping that someone would be offended. No dice, I guess I must be losing my touch...

[Broomstick]

I found it somewhat interesting that on one of the talking head shows this morning the TH interviewing various parties seemed to want to hold sperm donors to a higher standard than - dare I say the phrase? - more traditional fathers. Both the medical specialist and the sperm bank rep pointed out that perfect children are not guaranteed by ANY method of reproduction and one does take a certain risk with any conception.

Apparently, the sperm donor in this case has left Michigan and provided no forwarding address, so the sperm bank in question (which did not appear on TV, but issued a prepared statement) has no way to contact this man and inform him that ANY child he fathers has a 50/50 chance of inheriting this disease.

Perhaps they are publicizing this case in part in hopes some former-resident-of-Michigan-sperm-donor re-contacts the sperm bank in question. Kind of sticky situation.

[Simplicius]

Dr. Boxer called the sperm bank and requested one of the donor's samples for testing but, he said, the sperm bank refused, saying the donor had given permission for the sperm to be used only for conception, not genetic testing. Nor would the bank contact the donor to ask for his cooperation, Dr. Boxer said.

It seems absurd that a donor can place a use restriction like that on his sperm; perhaps the analogy is incorrect but it seems akin to GM saying that their automobiles are only for purchase, and not for crash-testing. Given the possible health consequences, testing would seem proper prior to use of any donation, just as the Red Cross tests donated blood.

Similarly, in circumstances where a matter of health is concerned, donor anonymity should not take precedence to the point of the bank's uncooperativity here. There should be some kind of doctor-bank-donor line of communication for circumstances just like this.

I found it somewhat interesting that on one of the talking head shows this morning the TH interviewing various parties seemed to want to hold sperm donors to a higher standard than - dare I say the phrase? - more traditional fathers. Both the medical specialist and the sperm bank rep pointed out that perfect children are not guaranteed by ANY method of reproduction and one does take a certain risk with any conception.

I have to say, it makes sense to hold donors to higher standards because one can hold donors to higher standards; that is, there is a greater element of control over conception afforded by the process of donation and artificial insemination which is not present in the case of two people conceiving in private, particularly when that conception isn't anticipated on their part.

[Tsyroc]

It seemed a little odd that the sperm bank was being so careful when a legitamit medical professional was asking for their help. I don't see any reason why they shouldn't have been willing to contact the guy on the doctor's behalf if they knew how to do so.


When I was in the Navy I knew a few guys who donated at sperm banks in the SF Bay area because they could get some money out of it. I would imagine that if there were any question about their donations that they woudl be difficult for the banks to track down.

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[Tsyroc]

I find it interesting that I can post a thread, get a hundred or so views, and virtually no comments.

I was hoping for a discussion - maybe about the morality of assisted reproduction, how many genetic diseases can be screened for, who pays for it, do you screen for everything or just the common stuff, everyone's got bad genes but not everyone has genetic illness, etc., etc., but if not.... oh, phoo, I'll have to go find an argument-in-progress or something...

I can't say that I have a problem with sperm or egg donor type of assisted reproduction since in theory it's passing on relatively good genes, except it isn't as simple as it would seem. My nephew was conceived via donated sperm but my sister still had to give herself shots of fertility drugs and go through multiple visits at the fertility clinic before she finally got pregnant.

I think my nephew is great, and he might be the only one to carry anything close to my genes into the next generation, but if it was that difficult for him to be conceived I'm even more warry of other types of assisted reproduction.

I guess I tend to look at the world as being overcrowded or gettting that way and when people who can't have children without medical help go through some procedure and then end up having multiple children at once I end up scratching my head about what this might be doing to our gene pool.

Along those same lines, I also know people who've kept churning out kids because they don't believe in birth control because of their religion. That concerns me for other reasons.

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Incidently, the procedure my sister went through is rather expensive. Each try at getting her pregnant cost in the thousands of dollars. At the time it was covered by her insurance which is probably not the case for most people. That could lead to some other morality issues. Should reproductive assistance be available to everyone? Should the government pay for these kinds of procedures for people who can't afford them themselves, or is limiting this sort of thing to people who can pay a way of keeping the poor from out reproducing the rich by an even wider margin than they already are?

[Darth Wong]

I imagine that sperm donors insist on anonymity because they just want the money, and they don't want some offspring tracking them down someday. In that context, the anonymity is necessary because without it, the availability of this service would decline (ie- fewer donors).

However, one of the unfortunate side effects of the sperm donor concept is that a single individual can father whole hosts of children, thus spreading his genes far and wide even if they're not very good.

As for the question raised later about whether insurance should pay for reproductive therapy, I would personally put a cutoff on age for it. If a 25 year old woman can't get pregnant, there's something wrong with her (or her husband) and "something wrong" is what medical coverage is for. But if a lifelong career woman suddenly decides at 40 that she wants to have a baby and can't, that's not something wrong with her body; that's her being an idiot and expecting to be able to ignore medical realities because she has a corner office. That has to fall into the "stupid elective" category of procedures which I don't really believe insurance should cover (for the sake of everyone else's costs).

[Broomstick]

Dr. Boxer called the sperm bank and requested one of the donor's samples for testing but, he said, the sperm bank refused, saying the donor had given permission for the sperm to be used only for conception, not genetic testing. Nor would the bank contact the donor to ask for his cooperation, Dr. Boxer said.

It seems absurd that a donor can place a use restriction like that on his sperm

their help. I don't see any reason why they shouldn't have been willing to contact the guy on the doctor's behalf if they knew how to do so.

To be fair, the donor probably didn't add that restriction.

Current US law regarding health privacy assumes non-consent as the default. If the consent form the donor signed (and he might have signed it years ago) only said "_____ consents to use of his sperm for reproductive purposes" and nothing else, then the only consent is for that. If it doesn't include "genetic testing" in the consent, then consent is not given. The penalities for violating HIPAA are quite steep, steep enough that no one in their right mind wants to risk running afoul of the law.

Remember, genetic testing is pretty new. It is entirely possible that no one involved in this sperm donating business had considered it when drafting the consent forms.

And, as already mentioned, it's not that the sperm bank won't contact the donor -- it appears that they can't because they've lost contact with him.

I have to say, it makes sense to hold donors to higher standards because one can hold donors to higher standards; that is, there is a greater element of control over conception afforded by the process of donation and artificial insemination which is not present in the case of two people conceiving in private, particularly when that conception isn't anticipated on their part.

It is only recently - within the past few years - that we have been ABLE to hold anyone to a "higher standard. It is possible that this man donated before most of the current tests were available. Entirely possible that he was thoroughly screened at the time of donation but the screening/testing procedures were unable to detect this genetic quirk.

Aside from that - there is, at present, no test for this particular genetic disease. If he walked in the door today his genetic flaw wouldn't be detected with current tests, either.

And if you do hold donors to the "higher standard".... what is to stop society from imposing those standards on everyone? In the early 20th Century people were sterilized involuntarily to prevent them passing on perceived inheritable defects. Should we do the same to those who are carriers of genetic disease? And where do you draw the line? It is believed everyone has several genes that, in double-dose, would be fatal or crippling if the person in question had a double-dose... and if you sterilize everyone the human race is extinct.

We can't afford to require pre-implantation screening for everyone. We can't detect all possible genetic defects. Carriers of traits like sickle cell or cystic fibrosis are entirely healthy - and too numerous to sterialize all of them without massive societal disruptions. Should society test everyone for the more common genetic diseases and forbid marriage between carriers? Or impose other restrictions?

I guess I tend to look at the world as being overcrowded or gettting that way and when people who can't have children without medical help go through some procedure and then end up having multiple children at once I end up scratching my head about what this might be doing to our gene pool.

That has a lot to do with why I never got too worked up over the Other Half and I not being able to reproduce without high tech assistance - it's not like we have a people shortage!

If my sisters had not had children I might have felt more of a need to have children of my own, but they did, and that's good enough for me. I'm not such a sterling example of human physical excellence that the species overall will suffer greatly because I didn't have children of my own.

Incidently, the procedure my sister went through is rather expensive. Each try at getting her pregnant cost in the thousands of dollars. At the time it was covered by her insurance which is probably not the case for most people. That could lead to some other morality issues. Should reproductive assistance be available to everyone? Should the government pay for these kinds of procedures for people who can't afford them themselves, or is limiting this sort of thing to people who can pay a way of keeping the poor from out reproducing the rich by an even wider margin than they already are?

I could see society paying for several attempts for someone to have one child... but there has to be a limit. And I could see availability being restricted based on the technology required. Sperm donation, for example, is relatively cheap. Maybe a limit isn't required on that. But in vitro fertilization with sperm injection and pre-implantation genetic analysis is outrageously fucking sky-high expensive... and perhaps that should be a case of "if you want it, you have to pay out of your own pocket" situation because, frankly, the success rate is exceedingly low. Some of these techniques have a 5% success rate. That's not 5% per attempt... it's 5% total, after multiple attempts.

At present, the State of Illinois mandantes insurance covers reproductive technology.... but I think they cap it at four cycles. Which is fine if you have insurance. Even so, the co-pays can be steep and people can still wind up paying into the six digits for children. These limitations may also prompt doctors to implant multiple embryos, in hopes of improving the odds of a "take". This can, of course, lead to multiple births which can be an additional burden on both the family and society.

However, one of the unfortunate side effects of the sperm donor concept is that a single individual can father whole hosts of children, thus spreading his genes far and wide even if they're not very good.

Many places are now imposing limits on how many children donors can father - they're allowed only so many, after which remaining samples are destroyed. There is also the issue of father multiple children in a limited geographic area, raising the possibility of half-siblings unknowingly marrying each other. Sperm donation turned out to be a little more acceptable than anticipated, and society is still working out some of the details. Donor anonymity may be essential to have the service at all... but it may be in the best interestes of the children produced to know who their half-siblings are.

As for the question raised later about whether insurance should pay for reproductive therapy, I would personally put a cutoff on age for it. If a 25 year old woman can't get pregnant, there's something wrong with her (or her husband) and "something wrong" is what medical coverage is for.

Even when it's a matter of a young couple being unable to concieve, there still needs to be a limit. Sometimes, it's not in the best interests of anyone for a conception to take place, and sometimes it just ain't gonna happen. Some women simply can not conceive, and others can not carry a baby to term. Just as some folks (such as the Other Half in this marriage) turn out to be sterile with no clear reason. It can suck, but life is messy like that.

No one is ENTITLED to children. Some folks just aren't going to be biological parents, even with sperm and egg donation being pretty viable these days. And some folks probably should try either one of those technologies rather than struggling for years to have 100% there own DNA. For that matter, if both parents are sterile/have other negative factors it's possible to adopt embryos, allowing a woman to experience pregnancy (if that's what she wants) and give birth to what is, essentially, an adopted child..

And like I said - the tech required is also a factor. There are some problems that are relatively quick/cheap fixes, so much so I won't be bothered by medical coverage for them even for a woman in her 40's. Others probably shouldn't be covered even for a woman of 22, they're just that out there and expensive and experimental.

I'm not entirely opposed to reproductive technologies, but I don't think any society at this time has really dealt with and worked out the ramnifications of these techniques.

[Darth Wong]

I could see society paying for several attempts for someone to have one child... but there has to be a limit. And I could see availability being restricted based on the technology required.

Perhaps a "no heroic measures" restriction is needed. I don't have a problem with helping people try to have children, but I wouldn't want to think that this endeavour is starting to vacuum up enough money to cost society a lot of money.

Many places are now imposing limits on how many children donors can father - they're allowed only so many, after which remaining samples are destroyed. There is also the issue of father multiple children in a limited geographic area, raising the possibility of half-siblings unknowingly marrying each other. Sperm donation turned out to be a little more acceptable than anticipated, and society is still working out some of the details. Donor anonymity may be essential to have the service at all... but it may be in the best interestes of the children produced to know who their half-siblings are.

It would be interesting to know what effect the loss of anonymity would have on the likelihood of sperm donation, but I don't know how you could really test that. If you just made one sperm bank which required donors to waive their anonymity, they would just go to another one. That doesn't necessarily mean they would call off the whole thing if all of the sperm banks made them waive their anonymity.

No one is ENTITLED to children. Some folks just aren't going to be biological parents, even with sperm and egg donation being pretty viable these days. And some folks probably should try either one of those technologies rather than struggling for years to have 100% there own DNA. For that matter, if both parents are sterile/have other negative factors it's possible to adopt embryos, allowing a woman to experience pregnancy (if that's what she wants) and give birth to what is, essentially, an adopted child.

I suppose my perspective as a father of two biological children is that I'm more sympathetic to people who want to do the same but can't. But I would agree that society has no obligation to go to great lengths to help people in this endeavour.

And like I said - the tech required is also a factor. There are some problems that are relatively quick/cheap fixes, so much so I won't be bothered by medical coverage for them even for a woman in her 40's. Others probably shouldn't be covered even for a woman of 22, they're just that out there and expensive and experimental.

True, I suppose I'm just assuming that a woman in her 40s would automatically require some of those "heroic measures".

I'm not entirely opposed to reproductive technologies, but I don't think any society at this time has really dealt with and worked out the ramnifications of these techniques.

We generally don't work out the ramifications of what we're doing on a social scale, and we can't really afford to do so before we take action.

[Broomstick]

And like I said - the tech required is also a factor. There are some problems that are relatively quick/cheap fixes, so much so I won't be bothered by medical coverage for them even for a woman in her 40's. Others probably shouldn't be covered even for a woman of 22, they're just that out there and expensive and experimental.

True, I suppose I'm just assuming that a woman in her 40s would automatically require some of those "heroic measures".

I've known several woman in the age 40-45 range who conceived without any assistance required. In fact, one of them who is a current co-worker of mine, has had two children past 40 with no fertility issues (other, perhaps, than being a little more fertile than she'd like - I'm pretty sure #2 was not something she planned). I believe some women are capable of natural reproduction past 50, although that's rare.

It's one of those things that's enormously variable from individual to individual.

And it's a problem, as my co-worker has mentioned. Women who want children should start having them well before 35 and should not look to women such as her as an example. My co-worker is the exception, not the rule. She's also an unusually healthy and youthful woman for her age, which may or may not have any bearing on her extended fertility.

I'm not entirely opposed to reproductive technologies, but I don't think any society at this time has really dealt with and worked out the ramnifications of these techniques.

We generally don't work out the ramifications of what we're doing on a social scale, and we can't really afford to do so before we take action.

True. But I was thinking about how most cultures develop customs and traditions around certain life events.

As an example (about a relatively minor matter), I remember when knowing the gender of an unborn baby was impossible. You discovered what you were having when the little bundle of joy was handed to you. Now, that knowledge is routinely available. Thus, when the "mother hens" of a workplace start organizing a baby shower for a co-worker there's the question of "what is she having? Does she know, and does she want to know?" The question is getting standardized, and gifts for the party typically proceed based on whether we know or don't know.

Parents now name children even before they're born - there have been other cultures that don't assign a name until the child is a year old. Quite different things are implied by that. Societies that name children late are typically associated with a high infant mortality rate. In our society, where children are sometimes named months before their first breath, the expectation is that every child lives. With ultrasound images, hearing the baby's heartbeat, and so forth parental attachments prior to birth can be much more intense. This can increase the distress if the baby doesn't survive, and miscarriage becomes more like infant death. In fact, women nowadays, particularly those involved in reproductive technologies, can be aware of miscarriages that, in the past, would never have been known as such. While the science lurches forward the social rituals are flailing to some extent - if a woman is struggling to conceive and loses the baby, do you send a sympathy card? These are not the most earth-shaking questions, but they are part of the social context in which we all live.

You can also see the evolution of these things in the language we use. I am old enough to remember a time before "biological father" was a common phrase, much less a contraction such as "bio-dad". I've noticed a tendency over the past couple decades for "Dad" to refer to the man that acted in a parental role, with other male figures involved being hyphenated - "biological father", "step-father", etc. There's a also a growing custom for children of single parents to honor that parent on both the "parent days", in recognition that a single parent fills both traditional parental roles.

Society comes up with rules and customs in part to ease social relations. They allow us to know what to do in a particular situation without having to laboriously re-calculate each time. They also provide a baseline, which is important in a multicultural society, a default value that minimizes the chances of giving inadvertant offense or hurt.

I guess I tend to look at the world as being overcrowded or gettting that way and when people who can't have children without medical help go through some procedure and then end up having multiple children at once I end up scratching my head about what this might be doing to our gene pool.

I'm revisiting this briefly, because I forgot one point last night.

As long as the percentage of people conceived by these technologies remains low, the net effect on the human race is pretty much nil. With billions of people in this world, a few thousand indulging in non-stop reproduction will be balanced out by those who can't or choose not to have children. Likewise, the ocassional first-cousin (or even full-sibling) marriage is not going to cause the end of the world. There might be local problems with inbreeding, but even in communities with small founder populations most individuals are healthy. There is a certain resiliance built into biology.

It's only when you get a LOT of people going a particular route that you have to worry. I'm not overly concerned (at this point) with long term effects on the gene pool. As a society, we're wealthy enough to take care of a few bad outcomes. What I AM concerned about:

1) Exploitation of desparate people who aren't thinking rationally. Let's face it, humans are not Vulcans, and even Sarek admitted that his logic was "uncertain" when concerning his son. Where I work (remember, I work for the health insurance industry, where costs are certainly considered) there are currently discussions about rating reproductive medical centers. After all, if we're going to pay for it, let's pay for what works, right? The best centers have remarkably low success rates for many procedures, but hey, we are talking about the difference between 20-25% conception rates and NO conception at all. There are centers with a 1-2% success rate or even lower. The latter serve only to part the desparate from their money. This is wrong.

2) If we're going to do this, let's do it correctly. Perfect safety can not, of course, be guaranteed in these matters. However, proper screening of donors for what we can test for is essential. Really basic stuff, like STD's and major abnormalities of sperm, there are some genes we can test for now... I don't think society should go up to, say, a dwarf and say "You can't reproduce", but neither is society obligated to distribute genes that are problematic. There will, of course, be arguments about where to draw the lines sometimes but life is messy like that.

This also extends to proper lab procedures. Aside from the obvious, like maintaining sterility, eggs, sperm, and embryos should be handled carefully to minimize possible damage. Those with obvious chromosomal defects should not be used. And there should be strict limits on the number of fertilized embryos that can be implanted in a woman. Humans do not naturally have litters. Twins are managable, even triplets, but quads, quints, and higher numbers should be avoided because of the danger to both mother and children.

3) The children produced need accurate information. There needs to be a way of conveying relevant medical information to the people produced by these methods. When the anonymous sperm donor thing was set up, society was operating under the fiction that there wasn't a relationship between donor and child. There is. It's genetic and biological and it's important. A person has the right to know if they have a biological suspectibility to certain diseases, even if he or she doesn't have a right to know the name and face of the man who provided the sperm for his or her conception.

Likewise, I think such children have a right to know who their half-siblings are. Again, originally there was this polite fiction that these relationships did not exist outside the recipient nuclear family. They do. That doesn't - and shouldn't - mean these people are obligated to "be a family", socialize, or have anything to do with each other (although they may choose all of that). But they do need some reassurance they aren't inadvertantly dating/having sex with/marrying a brother or sister.

[Darth Servo]

As for the question raised later about whether insurance should pay for reproductive therapy, I would personally put a cutoff on age for it. If a 25 year old woman can't get pregnant, there's something wrong with her (or her husband) and "something wrong" is what medical coverage is for. But if a lifelong career woman suddenly decides at 40 that she wants to have a baby and can't, that's not something wrong with her body; that's her being an idiot and expecting to be able to ignore medical realities because she has a corner office. That has to fall into the "stupid elective" category of procedures which I don't really believe insurance should cover (for the sake of everyone else's costs).

What about the woman who couldn't find a man until she was 40?

[Broomstick]

Sperm banks and turkey basters, baby!

Seriously, though - women DO have a deadline men don't. Any woman for whom having their own babies is a Major Life Priority has to think about getting started on this before 35. Preferably before 30. That's just biological reality. Peak human female fertility is somewhere between 18 and 25. Yes, you heard that right - a woman's fertility starts to drop in her twenties.

If a woman hits the age of 30, hasn't reproduced yet, but feels having babies is Very Important she really needs to start considering her alternatives. She might to reasses her standards in a mate - many women still have this meme that the man has to earn more than woman. No, he doesn't, and frankly she'd be much better off with a supportive spouse who is reliable and good parenting material even if he earns substantially less than she does - in fact, opting for the Mr. Mom approach might work well. And so on and so forth. Some people set such high standards for a mate that no one can meet expectations and they either need to get a grip on reality or remain single.

If she hasn't found a man she wants to spend the rest of her life with (or even just a few decades) she can go the single-parent route. In many ways it is a much harder form of parenthood but with a good social support system and/or money it is a viable alternative. In which case where she obtains the required sperm can range from a one night stand (which, personally, I'm not really in favor of), to an accomodating friend, to a commercial sperm bank. In particular, a woman with a high income of her own, who sets out to conceive in a very thoughtful manner, can have good success with this method, which is in contrast to the poverty-stricken "oops" that is the stereotype. Huge difference when the mother can, for example, hire a nanny if needed vs. being unable to pay for a baby sitter.

And for some women, reaching 30 or 40 without children makes them realize that you don't have to have a baby to have a good life. There is immense social pressure for women to reproduce, and I think without it somewhat more would choose not to do so. There still remains the biological urge to reproduce, and all the "ooo! kitchee-kitchee-kitchee- coo!" responses evolution has programmed into us, but on the flip side, I've encountered many mothers who (usually after being up all night with vomiting kids or in similar exhausted states) who express an ocassional viewpoint on how life might have been different/better without children. Doens't mean they don't love the little monsters, just that life involves choices and there will always be a "what if--?" lingering in your mind now and again.

Personally, now that I'm past 40 - an age at which a certain portion of society throws up their hands and spouts opinions as to the state of your withered womb and ovaries gone off - and there's a perception that I've "missed" my chance to have kids it's been a bit of a relief. I still get the ocassional nosey busy-body screaming "IT'S NOT TO LATE! YOU STILL MAYBE MIGHT BE ABLE TO GET PREGNANT!!!" but the frequency has dropped off a lot. I find I prefer being an "old hag" to being a bipedal womb, thank you very much. I don't know why these folks can't understand that I made my decision about 15 years ago when the husband and I had a talk about whether to go forward with the technological approach (he knew he was sterile long before we met, much less married) or to decide to remain childless. "Pro-Choice" means supporting just that - choice. Even choices that are outside the mainstream or aren't choices that you, personally, would make. The husband and I made our choices a long time ago, and I find it really rude other people - often people who barely know us - presume to pass judgement or meddle in our business.

Of course, that's why sperm donation used to be treated as a dirty secret, even more shameful than adoption -- the judgement of others and the way people feel somehow entitled to interfere in the reproduction of other people.

And then there are the Fundy types, who feel everyone without exception should follow the exact same life script... but that could be a whole 'nother thread.

[Tsyroc]

To be fair, the donor probably didn't add that restriction.

Current US law regarding health privacy assumes non-consent as the default. If the consent form the donor signed (and he might have signed it years ago) only said "_____ consents to use of his sperm for reproductive purposes" and nothing else, then the only consent is for that. If it doesn't include "genetic testing" in the consent, then consent is not given. The penalities for violating HIPAA are quite steep, steep enough that no one in their right mind wants to risk running afoul of the law.

I wouldn't think the lab contacting and asking the donor would be in violation of HIPAA as long as they did give any of his information out, including his whereabouts, without his permission.

I really wouldn't be too surprised if the banks don't keep anything that would normally be used to identify a donor. It just seems like it would be safer all around for them if they didn't have the guy's name or address. If they don't have that on record they can't be made to give it out at a later date.


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On the sibling front, my sister and her husband are paying to store the sperm of the same donor which was used in conceiving my nephew. They would like to have another child and thought it would be best if their two children would be full blood brother and sister.

My sister will be 35 this year and her son will be two, which may seem like she got started a little late with this but she and her husband have been married for over 10 years and had been trying to have children for quite some time before the sperm donor thing became their last resort.

Both of them went through lots of tests before it was determined that my brother-in-law was definately shooting blanks. Then he was resigned to not having any children at all while my sister was determined to have kids even if she had to adopt. For some reason my brother-in-law was against adoption so they ended up doing what they did.

I'm not fully up on all of the specifics because I've been getting this stuff second hand since the last I heared I'm probably not supposed to know this stuff.

[Tsyroc]

Isn't there information coming out now showing that while men are pretty much fertile all their lives it is also better for us to father children when we are younger? It had something to do with our genetic material degrading as we age and that impacting the health or genetic well being of our children in at least some statistically noticeable maner.


I mentioned some religious types who don't believe in birthcontrol in a previous post. Well, this one couple I know had their fourth child when the woman was 40. Their oldest was just hitting high school age and along comes another kid.

[Broomstick]

Isn't there information coming out now showing that while men are pretty much fertile all their lives it is also better for us to father children when we are younger?

Yes.

It had something to do with our genetic material degrading as we age and that impacting the health or genetic well being of our children in at least some statistically noticeable maner.

Yes.

Aside from the inevitable errors arising from multiple copying of cells, there is also the matter of a lifetime accumulation of environmental insults such as pathogens, toxins, and radiation to contend with. Older men have more sperm with defects, and they father more children with genetic-based problems. It's not a HUGE problem, and men in their 90's have fathered healthy children (hello, Tony Randall) but between that and the odds of penis/testes/etc malfunction going up as a man ages, overall yes, the boys are better off fathering children at younger rather than older ages.

It still remains, though, that men have a longer reproductive life than women.

I mentioned some religious types who don't believe in birthcontrol in a previous post. Well, this one couple I know had their fourth child when the woman was 40. Their oldest was just hitting high school age and along comes another kid.

That's called an "oops" and they've been noted for millenia. When a woman gets near menopause her cycles become irregular. Some women discontinue birth control under the mistaken impression they can no longer get pregnant. They can. And sometimes they do.

My point about getting started early is that no woman knows if she's going to be fertile past the age of 40. Some are, some aren't. There's no way to know in advance. If you wait and wait you're taking a big risk.

[Darth Wong]

It's also noteworthy that the reproductive organs seem to continue functioning longer if you've already had children. A woman having her fourth child at 40 is less surprising than a woman having her first child at 40.

[Aaron]

As for the question raised later about whether insurance should pay for reproductive therapy, I would personally put a cutoff on age for it. If a 25 year old woman can't get pregnant, there's something wrong with her (or her husband) and "something wrong" is what medical coverage is for. But if a lifelong career woman suddenly decides at 40 that she wants to have a baby and can't, that's not something wrong with her body; that's her being an idiot and expecting to be able to ignore medical realities because she has a corner office. That has to fall into the "stupid elective" category of procedures which I don't really believe insurance should cover (for the sake of everyone else's costs).

There is a limit, at least in the US. My sister in law is currently trying invitro-fertilization for the third time and it's her last kick at the cat. Her husbands insurance won't pay for more and the doctors won't try anymore for her. They say that there's no more reasonable chance of success. Shes 33 years old.

[Darth Servo]

It's also noteworthy that the reproductive organs seem to continue functioning longer if you've already had children. A woman having her fourth child at 40 is less surprising than a woman having her first child at 40.

The old "use it or lose it" trait that is so common in many biological systems.

[Simplicius]

And if you do hold donors to the "higher standard".... what is to stop society from imposing those standards on everyone? In the early 20th Century people were sterilized involuntarily to prevent them passing on perceived inheritable defects. Should we do the same to those who are carriers of genetic disease? And where do you draw the line? It is believed everyone has several genes that, in double-dose, would be fatal or crippling if the person in question had a double-dose... and if you sterilize everyone the human race is extinct.

We can't afford to require pre-implantation screening for everyone. We can't detect all possible genetic defects. Carriers of traits like sickle cell or cystic fibrosis are entirely healthy - and too numerous to sterialize all of them without massive societal disruptions. Should society test everyone for the more common genetic diseases and forbid marriage between carriers? Or impose other restrictions?

(By 'everyone' I assume you mean all of society, not just all donors...)

Well, if human reproduction as a whole ever becomes as subject to procedure as it might in a bad sci-fi movie, it would be an approriate time to think of the genetic future of the species and look at testing from a cost-benefit and ethical perpective. By the time human reproduction mostly moved out of the beddroom and into the lab, our knowledge of genetics would probably have increased enough to make such a discussion practical.

However - please correct me if I'm wrong - at present, donorship and artifical insemination is merely a reproductive choke point through which a minority fraction of the population passes. So, if cost permits, I see no reason why the opportunity afforded by procedural reproduction to perform what tests can be performed can't be taken advantage of. It doesn't seem unethical to provide a service beneficial to some, provided that the costs aren't astronomically out of proportion to that benefit.