When both partners are presumed to be fertile, artificial insemination (AI) can be attempted with sperm from the male partner (AIH - husband) if there is an anatomic defect in either partner that prevents the sperm from being deposited near the cervix. These defects include hyposadias (abnormal position of the urethral opening) in the man and an abnormal position of the cervix in the woman.

Artificial insemination also may be necessary in certain types of sexual dysfunction. If the male partner is not fertile but the woman is presumed to be, artificial insemination is attempted using sperm from a donor (AID), usually anonymous. The donor, generally matched to the partner in coloring and body build, is found by the woman's physician, either personally or through a sperm bank. The semen from a nonpartner must be screened for a variety of sexually transmissible diseases, including HIV infection, gonorrhea, syphilis, herpes, hepatitis B and chlamydia.

Freezing of sperm decreases the likelihood of infection and allows more time for testing of the donor. This is being used increasingly. At the time of ovulation, the sperm is injected into the woman's vagina at the opening of the cervix. In some cases a newer artificial insemination procedure called intrauterine insemination (IUI) is used. The insemination catheter is placed directly into the uterus and bypasses the cervix.

Artificial insemination, which has been practiced for about two hundred years, was successfully used in the United States in 1884 for the first time. By 1990, this increasingly popular procedure accounted for the birth of thirty thousand babies annually, assisted by eleven thousand private doctors, four hundred sperm banks and over two hundred fertility centers. It should be noted that there are fewer than one percent birth defects when donor sperm are used, compared to six percent in the general population.

With few children available for adoption today, artificial insemination is the simplest way that some couples can have a child. However, it is not something to be undertaken lightly because it raises countless psychological, moral, religious and legal questions. Some men cannot cope with the fact that they are not the biologic father of their child, while other men feel that a child who has their wife's genes and whom they have raised is as much theirs as any child can be.

Couples who choose artificial insemination do not always have the support of others. In fact, because some major religious groups feel that artificial insemination with donor sperm is the equivalent of adultery, many couples who choose this procedure for achieving parenthood do not tell even their families or closest friends.

There are many legal questions about these children that have not yet been answered. Some courts in the United States, England and Canada have held that they are illegitimate, while other courts have held that a husband who agrees to the artificial insemination of his wife has an obligation to support the child. A few states have passed laws to attempt to clarify the legal position of these children, but further legislation is sorely needed. In the meantime, in increasing numbers, donor-inseminated offspring and some donors are trying to find their genetic kin.

Michael Russell
Your Independent guide to Infertility

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