ABSTRACT: The proliferation of third party conceptions has answered the prayers of some infertile couples for a child. At the same time it has created a variety of profound biological, ethical, legal, social and psychological problems. In this paper an attempt is made to explore specifically the psychological issues consequent to the use of AI, IVF and surrogate motherhood.
Society has traditionally supported procreation within the family unit, i.e., a man legally married to a woman. Children born out of wedlock as well as their parents were strongly discriminated against in the past.
Today the family is still the principle focus for childbearing and childrearing. But many people who are single or practice alternative lifestyles want to have children. Scientific advances in reproductive technology now allow for these people to have a child in an almost infinite variety of ways in many cases without sexual intercourse.
I would like to discuss some of the psychological issues that arise when procedures such as in-vitro fertilization (IVF) better known as test tube babies, surrogate motherhood and artificial insemination by husband (AIH) or by donor (AID*) are used.
I refer to these procedures as "third-party conceptions" because conception is achieved with the assistance of one or more persons other than the two people in the primary relationship.
The oldest and best known of these procedures is AI. Unlike test tube babies and surrogate motherhood AI has been studied for many years. I propose to examine the major psychological aspects consequent to AI and then those that follow the more recent reproductive techniques.
ARTIFICIAL INSEMINATION BY DONOR (AI)
Where there is a powerful desire to bear a child rather than to just rear a child and where the parents want to be biologically linked to their child, the use of AI appears to be a reasonable course of action.
Psychology and Fertility
We know that psychological factors can influence the function of all our bodily systems including the reproductive system. In order for AI to be successful the woman needs to have a functioning ovary, oviduct and uterus.
There are reports in the literature1 of women ceasing to ovulate once they commence treatment and of men becoming impotent. Judging by the much higher rate of success in veterinary medicine one must conclude again that in humans psychological factors may hinder pregnancy.
Furthermore, the considerable stress inherent in the AI procedure and the preceding often long period of investigations for infertility may adversely affect the reproductive system of either or both partners.
Indications for AI
The accepted indications for AI are male sterility due to lack of viable sperm, hereditary disease in the husband and RH factor incompatibility.
About 10,000 children are born yearly by way of AI, 1/4 million have been born over the past 20 years. Depending on how one measures pregnancy rates they vary from 60 to 85%. Pregnancy rate drops with increased age of women.
AI has been regarded as an alternative to adoption and as a procedure to be used predominantly by a married woman. It has been seen as a therapy for infertility and therefore, administered by medical doctors.
Comparison with Adoption
- AI implies sterility by husband, adoption carries no such implication.
- AI child is genetically related to mother but not social father, adopted child is not related genetically to either social parent.
- Adoptive parents are screened at length by adoption agencies, AI parents receive no such screening or counseling.
- Adoptive parents can usually inspect the child they wish to adopt, AI parents cannot.
- AI couples experience a normal pregnancy and delivery, adoptive parents do not.
No comparative studies between AI and adoption outcomes have ever been done. …