Artificial Insemination

Artificial insemination refers to the techniques of fertilization employed for reproductive purposes by means other than sexual intercourse. Artificial insemination began in the 1700s and in most cases was used for livestock reproduction. The first attempt at human artificial insemination took place in 1780, when the Scottish surgeon John Hunter impregnated a woman by transferring semen from husband to wife with a syringe. Later attempts were relatively unsuccessful until the 1940s because little was known about the female reproductive cycle. Not until 1936 did the scientist C. G. Hartman determine that the menstrual cycle of a female is approximately twenty-eight days, with the most fertile period occurring eleven to fourteen days after the first day of the cycle. That knowledge greatly increased the odds of fertilization, and by 1955 approximately 55,000 women had become pregnant through artificial insemination despite the fact that the practice was condemned by religious institutions as unnatural and immoral.

THE FOUR TYPES OF ARTIFICIAL INSEMINATION

Artificial insemination (AI), or assisted reproductive technologies (ART), continues to become more sophisticated. By 2006 artificial insemination took the form of four medical procedures, with each progressing to a more invasive form: intravaginal (in the vagina), intracervical (in the cervical canal), intrauterine (in the uterine cavity), and intratubal (in the fallopian tubes).

Intravaginal insemination (IVI) is the least invasive artificial insemination technique although it is not often performed in fertility clinics due to the ease of performing the technique at home. Semen is placed directly into the vagina using a sterile syringe. There it enters the cervical opening, traveling through the cervix, uterine tract, and fallopian tubes to the egg waiting for fertilization, replicating to a certain degree the process that occurs during sexual intercourse. IVI is most often used in cases where women choose to become pregnant using donated sperm, or in cases where the male partner is not able to sexually perform.

Although not the least intrusive method, intrauterine insemination (IUI) usually is considered the most common method because of its success rate. This procedure bypasses the cervical opening by using a surgical catheter and places the sperm directly into the uterine tract to increase the chances that the sperm will reach the egg (ovum) and achieve fertilization. Six attempts may be required for fertilization to take place.

Intracervical insemination (ICI) is another common procedure for artificial insemination. Sperm is placed directly into the cervix to increase the chance that the sperm reaches the ovum. This technique is most successful when there is no underlying medical issue contributing to infertility in the woman. Those using sperm donors in the absence of or due to a fertitlity problem in the male partner often utilize ICI. This procedure is painless and non-invasive.

Intratubal insemination (ITI) places sperm directly into the fallopian tubes in order to increase the chance the sperm reaches the ovum. ITI is the least performed artificial insemination technique due to the level of invasiveness and expense. It is performed either through the insertion of a surgical catheter through the vagina, cervix, and uterine tract into the fallopian tubes, or through a laparoscopic procedure where an incision is made in the abdomen and guided by a surgical camera to allow the surgeon to insert the sperm directly into the fallopian tubes. This procedure is more painful than IUI or ICI and is most often recommended after IUI or ICI have failed.

IN VITRO FERTILIZATION (IVF)

If artificial insemination procedures are unsuccessful, in vitro fertilization (IVF) is usually the next step. In vitro means "in the lab," and babies conceived by this means have been commonly referred to as "test tube babies." IVF is most often used in conjunction with fertility drugs to produce multiple mature eggs during ovulation. These eggs are then surgically removed from the ovaries and fertilized with sperm from the male partner/donor in a petri dish. When embryos are produced, the embryos are surgically implanted into the uterus of the female in hopes that at least one of the embryos will remain viable and produce a child. Most often embryos are cultured three to five days before being implanted. While IVF is one of the most utilized of procedures, it is also the most controversial.

With each IVF procedure, multiple embryos are produced while only two to five embryos are implanted in the uterus. Often couples will preserve a few extra embryos in case they choose to expand their family at a later date. Additional embryos either become the property of the clinic where the IVF procedure was performed, are destroyed or donated to other infertile couples. Religious leaders, ethicists, and some science communities view the destruction of embryos as the destruction of a living human being, often equating the act as equivalent to abortion, or more extreme, as genocide. As property, embryos are often used for genetic and stem cell research, which brings up ethical issues around the preservation of human life as well as issues surrounding the selection of desired characteristics and the elimination of others through genetic modification methods currently being researched using these embryos. These issues also extend to the couples using IVF.

While the hope is that the couple undergoing IVF will have at least one embryo implant and develop into a full pregnancy, with better retrieval, culturing, and transfer techniques, many couples are confronted with multiple embryos implanting and developing. Couples are confronted with having to choose between having multiple births or selecting certain embryos/fetuses to abort and determining the criteria by which to eliminate. Many factors weigh in on these decisions including religious, political, economic, and social pressures.

ETHICAL ISSUES

When artificial insemination became a medical practice in the 1940s, controversy arose over the fact that the act of fertilization occurred outside the act of coitus. The use of donor semen (artificial insemination donor) was deemed a form of adultery and any offspring resulting from the procedure were considered illegitimate despite its use solely in cases of a husband's infertility, with written consent from both the husband and the wife. One way of bypassing this condemnation was by mixing the sperm of the husband with that of the donor in an artificial insemination center (AIC) so that the paternity of the offspring was uncertain.

State court cases began surfacing in 1964 when Georgia became the first state to declare a child legitimate if the husband gave written consent. In 1968 People v. Sorensen held that a man who had been convicted for not supporting a child conceived with his consent through donor insemination was legally obligated to support the child, relieving the donor of any financial responsibility. In 1973 the American Bar Association adopted the Uniform Parentage Act, which viewed the woman's husband as the natural father of a child conceived with donor insemination if the husband consented and if it was done under the supervision of a physician. The use of donor sperm in unmarried women did not occur until the 1970s.

The women's liberation movement of the 1970s ushered in a new wave of women's independence. As women started to question and challenge the roles and expectations of their sex, many women began to redefine what it means to be a woman. Unmarried women who desired children but not the marriage that traditionally preceded it, as well as lesbian couples, sometimes resorted to a home-based method of artificial insemination. Using a turkey baster or a syringe with a donor's semen, women would impregnate themselves. By the late 1970s sperm banks allowed unmarried women to receive sperm from an unknown donor.

LEGAL ISSUES

Although purchasing sperm remains a relatively easy task, finding a specialist to perform the insemination is more difficult. The decision whether to inseminate an unmarried woman, regardless of her sexual orientation, resides with the individual physician. Physicians in private practice have the right to refuse to serve any individual. The right to refuse under the Hyde-Weldon Amendment signed unto law under the 2005 Omnibus Appropriations Bill (HR 4818) extends the "conscience clause" to apply to any public health entity from health management organizations to individuals working for a public health service to refuse to perform services such as birth control, abortion, eugenics, and infertility services on the basis of religious or moral objections. The attention given to this clause has been focused mainly on birth control and abortion, but the clause also affects the ability of unmarried and nonheterosexual people to receive insemination services. These obstacles can be circumvented through home-based artificial insemination, but the complex legal issues that surface in cases of nontraditional insemination are becoming more politically charged.

Same-sex parenting and adoption, surrogate rights as well as the rights of a couple using a surrogate, legal protection of known donors, and the rights of offspring to receive donor identity are issues that have begun to surface in the courts and vary from state to state. For example, in a 2002 Pennsylvania case, Ferguson v. McKiernan, which was granted an appeal by the Pennsylvania Supreme Court in 2005, the lower court found McKiernan responsible for the support of two children he had fathered through donor insemination. The courts decided that the "rights" of an interested third party (the children) cannot be "bargained away" even if the third-party interests are not present at the time the contract is made. The ramifications of this ruling could extend to sperm bank donors as well as known donors and surrogates. A donor's right to anonymity also has been challenged; in 2006 only eight states recognized the parental rights of a nonbiological parent besides the stepparent in a heterosexual marriage, granting sole custodial rights to the biological parent or, in the case of the death or disability of that parent, to a family member of the biological parent rather than the same-sex partner even if the children were conceived as a couple. The relative ease of artificial insemination has created complex social issues that have begun to surface in public debate.

BIBLIOGRAPHY

Carbone, June. 2005. "The Legal Definition of Parenthood: Uncertainty at the Core of Family Identity." Louisiana Law Review 65: 1295-1334.

Fader, Sonia. 1993. Sperm Banking: A Reproductive Resource. Available from http://www.crybank.com.

Human Rights Campaign. "Donor Insemination Laws: State by State." Available from http://www.hrc.org.

Shapo, Helene S. 2006. "Assisted Reproduction and the Law: Disharmony on a Divisive Social Issue." Northwestern University Law Review 100(1): 465-497.

                                         Regina M. Salmi

ARTIFICIAL INSEMINATION

The process by which a woman is medically impregnated using semen from her husband or from a third-party donor.

Artificial insemination is employed in cases of infertility or impotence, or as a means by which an unmarried woman may become pregnant. The procedure, which has been used since the 1940s, involves injecting collected semen into the woman's uterus and is performed under a physician's supervision.

Artificial insemination raises a number of legal concerns. Most states' laws provide that a child born as a result of artificial insemination using the husband's sperm, referred to as AIH, is presumed to be the husband's legal child. When a child is born after artificial insemination using the sperm of a third-party donor, referred to as AID, the law is less clear. Some states stipulate that the child is presumed to be the legal child of the mother and her husband, whereas others leave open the possibility that the child could be declared illegitimate.

Artificial insemination has grown in popularity as infertility becomes more prevalent and as more women opt to become single mothers. Eighty thousand such procedures using donor sperm are performed each year, resulting in the births of thirty thousand babies. By 1990 artificial insemination was a $164 million industry involving eleven thousand private physicians, four hundred sperm banks, and more than two hundred fertility centers.

The practice of artificial insemination is largely unregulated, and secrecy surrounding the identity of donors and recipients is the norm. Surveys of parents indicate that most do not plan to tell their children the circumstances of their births. This raises ethical questions about the right of an individual to be informed about his or her heritage. People who inadvertently discover they were conceived through artificial insemination often experience distress and feelings of confused identity. Many doctors compound the problem by failing to keep records on the identities and medical histories of donors.

The legal minefield created by artificial insemination continues to erupt with new and unprecedented issues. In 1990, Julia Skolnick sued a fertility clinic and a sperm bank for negligence and medical malpractice, charging that they mistakenly substituted another man's sperm for that of her late husband. The woman, who is white, gave birth to a child with African American features, and DNA analysis confirmed that her husband, who was also white, could not have been the child's father. In another case, Junior Lewis Davis sued to prevent his ex-wife, Mary Sue Davis Stowe, from using or donating fertilized embryos the couple had frozen for later use. The Tennessee Supreme Court held that individuals have "procreational autonomy" and have the right to choose whether to have a child (Davis v. Davis, 842 S.W.2d 588 (Tenn. June 1992). Arthur L. Caplan, former director of the Center for Biomedical Ethics at the University of Minnesota, commented, "In this case, the court said that a man cannot be made to become a parent against his will." The Davis case raises the question of the right of a sperm donor to prevent the use of his sperm by specific individuals.

Serious health questions also surround the issue of artificial insemination. AIDS, hepatitis, and other infectious diseases pose risks to women undergoing the procedure and their potential children. Although the American Fertility Society recommends that donors be tested for infectious diseases, the guidelines are not binding. In fact, some doctors merely request that donors answer questions about their health history and sex life, and only a handful of states require testing. This casual approach to donor screening can lead to disaster. In 1994, Mary Orsak, of Downey, California, sued the Tyler Medical Clinic, in Westwood, California, for negligence when she discovered she was HIV-positive as a result of artificial insemination with donor sperm. In at least six other cases, HIV transmission through artificial insemination has been confirmed.

Other legal pitfalls open up as technology makes artificial insemination more sophisticated and more available. Now that sperm can be frozen for future use, a woman can be impregnated at any time, even after her husband's death. In 1990, Nancy Hart and Edward Hart, of Covington, Louisiana, anticipating that Edward might not survive his bout with cancer and knowing that chemotherapy might leave him sterile, decided to place a sample of his sperm in a New Orleans sperm bank. Edward died in June 1990. Three months later, Nancy underwent artificial insemination using his sperm, and on June 4, 1991, their daughter Judith was born. Under Louisiana law (L.S.A.C.C. Art. 185), the state would not acknowledge Edward as the child's father because she had been born more than three hundred days after his death. As a result, Nancy was unable to receive social security survivors benefits for her daughter. She sued both the state of Louisiana and the federal government. In June 1995 Administrative Law Judge Elving Torres ruled that the Social Security Administration (SSA) must pay Judith a $10,000 lump sum and $700 per month in survivor's benefits. According to Torres, the dna evidence presented to him proved that Judith is Nancy and Edward Hart's child.

Medical technology now allows recipients of artificial insemination to select the sex of their offspring, which raises still more ethical questions. Some religions condemn this practice as unnatural, although other theologians disagree. Some commentators have even suggested that it is unethical and exploitative to offer expensive, difficult, painful, and frustrating fertility procedures to desperate people when there may be little chance that a successful pregnancy will result.

The legal, ethical, and medical quagmires created by artificial insemination have not deterred thousands of couples and single women from seeking the procedure. Artificial insemination is sometimes the best, if not the only, solution for a person determined to achieve pregnancy.

further readings

Bernstein, Gaia. 2002. "The Socio-Legal Acceptance of New Technologies: A Close Look at Artificial Insemination." Washington Law Review 77 (October): 1035–120.

Goldstein, Karen L., and Caryn H. Okinaga. 2002. "Assisted Reproductive Technology." Georgetown Journal of Gender and the Law 3 (spring): 409–37.

Gunning, Jennifer, and Helen Szoke, eds. 2002. The Regulation of Assisted Reproductive Technology. Burlington, Vt.: Ashgate.

Ross, Jane O. 1999. "A Legal Analysis of Parenthood by Choice, Not Chance." Texas Journal of Women and the Law 9 (fall): 29–52.

cross-references

Family Law; Illegitimacy; Parent and Child; Reproduction.

Artificial Insemination

Artificial insemination is the mediated use of sperm to impregnate a woman. The term has historically been used in cases where this procedure is done under medical supervision, socially legitimized as a medical treatment for infertility. It has required medical legitimization because in most cases the sperm used is from a man who is not the woman's partner (artificial insemination by donor, or AID). Artificial insemination, likely practiced outside the medical setting for much of history, was first reported in the medical literature by John Hunter in 1790. In the early twentieth century, its popularity grew, and its moral and social implications were debated in both the medical and popular press in the United States starting in 1909, and in Europe by the 1940s. Supporters pointed to the joy of parents who were able to bear children thanks to the procedure. Critics believed that AID was a form of adultery, and that it promoted the vice of masturbation. The Catholic Church objected to all forms of artificial insemination, saying that it promoted the vice of onanism and ignored the religious importance of coitus. Other critics were concerned that AID could encourage eugenic government policies.

As popular concerns about AID faded in Europe and the United States, the demand for donor sperm increased tremendously. In 1953, the first successful pregnancy from frozen sperm was reported, leading to the development of a thriving sperm-bank industry starting in the 1970s and the commercialization of AID. While a 1941 survey estimated that 3,700 inseminations had been performed in the United States, by 1987 U.S. doctors performed the procedure on about 172,000 women in a single year, resulting in 65,000 births. The growing number of AID pregnancies has raised new concerns, and in many places sparked new regulation. Because fresh sperm can be a source of sexually transmitted diseases, including HIV, testing of donors and donations has become routine in many clinics, and is required by many local and national governments. In addition, because the privacy of the donor is generally protected and it is physically possible to donate semen many times, in many places clinic policies and/or government regulations tightly restrict the number of times a single donor's semen may be used, in order to diminish the chances of unknowing marriage of biological siblings among AID children.

Legal and social questions surrounding AID in many countries reflect cultural concerns with biological paternity and the maintenance of the heterosexual, married couple as the basis of the family. The Catholic Church and many interpreters of Islam consider AID to be adulterous, and as of 1990, it was banned in Brazil, Egypt, and Libya. Ireland, Is-rael, Italy, and South Africa restricted its use to married couples and many more countries have not approved its use by lesbian couples. While a number of European countries have instituted regulations legitimizing AID children as the offspring of the mother's husband or partner, providing he had given written consent, in many places the law remains ambiguous. While many clinics and some governments deny clinical AID services to single women and lesbians, some feminists have organized to demedicalize AID and provide services to women creating nontraditional families. Debates rage about what to tell AID children about their biological parentage. AID is one of several new reproductive technologies which challenge the "naturalness" and inevitability of identifying social kinship with biological kinship.

See also: Adoption; Conception and Birth; Egg Donation; Fertility Drugs; Obstetrics and Midwifery; Surrogacy.

bibliography

Arditti, Rita, Shelley Minden, and Renate Klein. 1984. Test-Tube Women: What Future for Motherhood? Boston: Pandora Press.

Meyer, Cheryl L. 1997. The Wandering Uterus: Politics and the Reproductive Rights of Women. New York: New York University Press.

Pfeffer, Naomi. 1993. The Stork and the Syringe: A Political History of Reproductive Medicine. Cambridge, MA: Polity Press.

Strathern, Marilyn. 1992. Reproducing the Future: Essays on Anthropology, Kinship, and the New Reproductive Technologies. New York: Routledge.

Lara Freidenfelds

ARTIFICIAL INSEMINATION

ARTIFICIAL INSEMINATION . Following earlier experiments on animals, the first human baby produced through artificial insemination on humans was born in the United States in 1866. Since then, particularly in recent decades, tens of thousands of children have been conceived artificially by a physician injecting the husband's or, more usually, a donor's semen into the mother's tract. Such operations are now commonplace, though mostly clandestine, in many countries, including Israel. They raise grave moral, religious, and legal problems. According to the preponderance of Christian teaching and of Western legislation as currently interpreted by the courts, a married woman's recourse to artificial insemination by donor constitutes adultery and any offspring so produced is illegitimate.

A major principle determining the attitude of a Jewish law is enshrined in a talmudic passage which is by far the first literary reference to the feasibility of an impregnation without any physical contact between the parents – a possibility evidently unknown to the Greeks or other nations of antiquity. Discussing the biblical law requiring a high priest to marry a virgin (Lev. 21:13), a third-century sage asked whether a pregnant virgin would be qualified for such a marriage, the pregnancy being explained as due to an accidental impregnation after she bathed in water previously fertilized by a male. The question is answered affirmatively (Ḥag. 15a). This indicates that a conception sine concubito does not compromise a woman's legal status as a virgin. Several medieval sources further imply that no bastardy (mamzerut) attaches to children born in this way of parents who, had they had normal relations with each other, would have committed adultery or incest (Alfa Beta de-Ben Sira, in J.D. Eisenstein (ed.), Oẓar Midrashim (1915), 43; and R. Perez of Corbeil, Haggahot Semak, see Turei Zahav on yd, 195:7). These references are so singular that one of them was quoted as "a legend of the rabbis" by the 16^th-century physician *Amatus Lusitanus to clear a nun who had miscarried from the suspicion of fornication.

Following these precedents, virtually all rabbinic rulings on artificial insemination by a donor have refused to brand the act as adultery or the product as a bastard (*mamzer), with the notable exception of the very first responsum on the subject dated 1930 (J.L. Zirelsohn, Ma'arekhei Lev (1932), no. 73). Nevertheless, rabbinic opinion utterly condemns the practice, mainly on moral rather than purely legal grounds. The Jewish conscience, it is emphasized in numerous responsa, recoils in horror from reducing human generation to such artificiality, arbitrariness, and public deceit, from placing into doubt the paternity of children (those conceived by artificial insemination being fraudulently registered in their putative fathers' names, thus investing all paternity claims with some uncertainty), from the resultant risk of incestuous marriages between blood-relations (conceived by a common donor) unknown to each other, from depriving fathers (i.e., the donors) and their natural children of their mutual rights and duties (e.g., maintenance, honor, inheritance), and from many other abuses which would inevitably become rampant.

On artificial insemination from the husband, usually indicated when some impediment in the wife renders a conception by the natural act impossible, most rabbinic authorities adopt a more lenient view, permitting the practice under certain conditions if the duty of procreation cannot otherwise be fulfilled.

The more recent issues of surrogacy and cloning present more complex problems that rabbinic thought is just beginning to contend with.

bibliography:

I. Jakobovits, Jewish Medical Ethics (1966³), 244–50; idem, Journal of a Rabbi (1967²), 162–3; idem, in: Essays… I. Brodie (1967), 191–2; Oẓar ha-Posekim, Even ha-Ezer, 1 (1947), 11–12; M.S. Kasher (ed.), in: No'am, 1 (1958), 111–66; 6 (1963), 295–9; 10 (1967), 57–103, 314ff.; A. Joel, in: Hebrew Medical Journal, 26 pt. 2 (1953), 190ff.

[Immanuel Jakobovits]

ARTIFICIAL INSEMINATION

Artificial insemination is a procedure in which sperm obtained by masturbation or other methods of mechanical stimulation are deposited in the vagina, cervix, or uterus of the female by means other than natural intercourse, with the specific intent to achieve pregnancy. Artificial insemination is a brief office procedure that may be performed using the fresh sperm of the male partner or the frozen/thawed sperm of an anonymous sperm donor, and involves injection of the sperm into the female through a thin tube. Intrauterine insemination requires preliminary processing of the semen sample to isolate the sperm for insemination since seminal plasma cannot be directly injected into the uterus. To be effective, insemination must be performed in close proximity to the time of ovulation (release of an egg) in the female as both sperm and eggs have a relatively short lifespan. Situations in which artificial insemination may be a recommended procedure include: (1) anatomical problems that prevent effective natural intercourse or interfere with normal sperm movement through the female reproductive tract; (2) poor semen quality with an abnormally low sperm count and/or poor sperm motility (ability to move); and (3) "unexplained infertility" in which the purpose is to increase the probability of pregnancy by introducing more than the usual numbers of sperm, typically in a cycle involving stimulation of the female with fertility drugs in efforts to cause release of more than a single mature egg.

See also:BIRTH

Bibliography

Friedman, Andrew J., Mary Juneau-Norcross, Beverly Sedensky, Nina Andrews, Jayne Dorfman, and Daniel W. Cramer. "Life Table Analysis of Intrauterine Insemination Pregnancy Rates for Couples with Cervical Factor, Male Factor, and Idiopathic Infertility." Fertility and Sterility 55 (1991):1005-1007.

Shenfield F., P. Doyle, A. Valentine, S. J. Steele, S. L. Tan. "Effects of Age, Gravidity and Male Infertility Status on Cumulative Conception Rates Following Artificial Insemination with Cryopreserved Donor Semen: Analysis of 2,998 Cycles of Treatment in One Centre Over Ten Years. Human Reproduction 8 (1993):60-64.

Wilcox Allen J., Clarice R. Weinberg, Donna D. Baird. "Timing ofSexual Intercourse in Relation to Ovulation—Effects on the Probability of Conception, Survival of the Pregnancy, and Sex of the Baby."New England Journal of Medicine 333 (1995):1517-1521.

MarcFritz