Where Did I Come From?

Aug. 30, 2000 -- When a child asks where babies come from, the answer may no longer be a simple response about "the birds and the bees." Advances in reproductive technology have changed the face of childbirth and given us not only babies but complex issues to grapple with. Whether to explain the circumstances of a high-tech conception to a child is an area of great controversy, but many experts now think it may be best, in the long run, for children to know the whole truth about their origins.

Two European studies, both published in a recent issue of Human Reproduction, examine issues surrounding children conceived through donor insemination. Donor insemination (DI) is a procedure in which a woman is impregnated by sperm from a donor, usually anonymous. It's one of the oldest techniques in reproductive medicine, but little consensus has been reached on what -- if anything-- to tell the children who result.

In the first study, Swedish researchers found that despite legislation giving children conceived through DI the right to information about the sperm donor when they reach adulthood, the majority of parents had not yet told their children about the origins of their birth. Only half either had told, or intended to tell, the truth to their children.

"It's a basic truth of how they came about, and in most situations, the child will appreciate knowing the truth," says William Bernet, MD, who reviewed the studies for WebMD. "There are a lot of problems when you don't tell people the truth, and there has been a lot of work done on how family secrets are damaging." Bernet, an associate professor of psychiatry at Vanderbilt University Medical Center in Tennessee, says the situation is similar to adoption, in that people need to be told where they come from.

The Swedish researchers, from the Karolinska Institute in Stockholm, sent a questionnaire to 194 couples who had conceived a child by DI after the sperm-donor-information legislation went into effect. At the time of the survey, 89% of the couples responding had not yet told their children, and a number of them said they had no intention of ever telling them.

"It is very difficult to estimate the impact of the Swedish legislation in itself," says study author Frank Lindblad, MD, director of the National Institute for Psychosocial Factors and Health at the Karolinska Instituet. "Most attitudes have been changing over time independently of the law. Nevertheless, we believe that the law has had some effect."

The researchers note that during the period between 1983-1986, before the legislation went into effect, only 6% of parents told their children about donor insemination. The number then shot up to 19% for those born between 1987 to 1990.

In the second study, researchers from the University of Surrey in Great Britain tried to find out how adults who had been conceived by donor insemination were affected by the experience, and also to consider the need for psychological counseling and therapy to resolve the issues they faced. Sixteen study participants, recruited through DI support groups in various countries, were sent questionnaires, and their responses were evaluated.

The researchers found that a number of the adult offspring (aged 26-55) reported a lack of trust with their family, felt a lack of genetic continuity, were frustrated by their futile search for a biological father, and needed to discuss these issues with someone who could empathize.

The sample size was small, acknowledges study author Adrian Coyle, CPsychol, AFBPsS, a senior lecturer from the Department of Psychology, but he says studies involving elusive populations -- such as people conceived through donor insemination -- will always have difficulty in recruiting enough participants.

Many of the participants said they were shocked when they discovered they were products of donor insemination and thought they had a right to know their genetic backgrounds. Several expressed a sense of loss because they would never know the identity of the donor, and some fantasized about who he might be. Others had made attempts to locate the donor. One woman, upon finding her biological father, was angered by his disinterest in her.

"The urge to know their biological father seems to stem from a sense of incompleteness in their ideas about who they are -- a perceived gap in their personal history," Coyle says. Identity is not just about the present, he adds, but we also need to know where we have come from.

The authors did note that the fact that they recruited participants from support groups may have meant that these particular offspring were more likely to have identity issues they needed to resolve. Other DI offspring, they write, may feel differently.

One reason parents need to be honest with their children, Bernet believes, is the growing interest in genetics, with all of its health and other implications: "I think children will be very aware in the future about the genetic implications of their personal characteristics, and it is important that they know if they are genetically related to their parents."

But not all experts think it's necessarily important for parents to tell children they were conceived through DI. Cappy Rothman, MD, a leader in the field of sperm banking since the 1970s, tells WebMD he believes these couples should be free to do "whatever is comfortable. No one should tell [other people] how, when, or whether to have children." It's a personal decision, he says, and this goes for disclosing information about egg and embryo donors as well as about sperm donors. Rothman is co-owner and medical director of California Cryobank, a Los Angeles-based sperm bank that distributes specimens globally.

Most sperm banks, Rothman says, adhere to strict guidelines in selecting donors and exclude men with conditions known to be inheritable. They also ask that parents or physicians inform them about any health problems that arise in children conceived by donor insemination.

Coyle says that this complex issue involving a child's right to know, a donor's right to anonymity, and parents' rights to decide what is best for their children has no easy solutions, and it may be difficult to find a balance.

"On one hand, we want to encourage donors to donate sperm in order to assist couples with infertility, and on the other, help meet the desire for identity completion that was expressed by the DI offspring in our study," he says