- Email: [email protected]
Role of the Husband in Therapeutic Donor Insemination
Role of the Husband in Therapeutic Donor Insemination Fred A. Simmons, M.D.
on the subject of artificial insemination refer to the desirability of making it possible for a childless wife to have a child or children. Only last June (1957) at the American Society for the study of Sterility meeting in New York City, Alvarez stated that anything that made it possible to. put a child in the arms of a barren woman was permissible. Correctly he feels that, if the problem presents itself, the solution and its modus operandi are the business of the couple involved and of no one else. He decried the interference by certain religious affiliations and certain legal rulings. There is no doubt that the decision must be made first and last by the wife and husband of such a barren marriage. But is it not pertinent to weigh the aspect of the husband's responsibility in this type of medical solution to childlessness? Therapeutic insemination, as it is beginning to be called, rather than artificial insemination, after the suggestion of Kleegman of New York City, should be reserved for those cases in which the husband is irrevocably sterile and the wife is within normal limits of fertility. The wife should have the basic tests carried out, including history and physical examination, insuffiation of the fallopian tubes, endometrial biopsy, and basal body temperature curves for 3 or 4 months before treatment is started. The chief causes of the husband's inability to have children are simply azoospermia (absence of sperm), or severe oligospermia (too few sperm) following repeated examinations and recommended therapy. Another category which has some inRACTICALLY ALL WRITTEN AND SPOKEN OBSERVATIONS
------
---
-.--.~----------------------
From the Harvard Medical School, and the Massachusetts General Hospital, Boston, Mass. Received for publication July 12, 1957. 547
548
SIMMONS
Fertility & Sterility
creased importance in this subject are those marriages in which the wife is Rh negative and the husband is Rh positive according to the blood group and following 3 or 4 blighted pregnancies or nonviable births. It is apparent that they cannot have children by this union. In these cases an Rh-negative donor makes it possible for these two married people to have a successful pregnancy. Occasionally there is a serious history of medical disease in the husband's family tree which should make one debate carefully the desirability of his reproducing this taint. In such cases a healthy donor can be employed with the request and knowledge of both partners. TherapeutiC insemination is considered to be superior to adoption, for it is anonymous, the child does not bear the stigma of being known as adopted, it is quicker and probably less expensive, and in proper hands eugenically sound. In many of the Eastern states there are not enough babies available for adoption, particularly for certain racial groups. In Massachusetts, at least, it is necessary for the proposed child to have the same religion as the adopting parents. Therefore, if the parents are of mixed religion (e.g., a Catholic wife and a Jewish husband, a Protestant wife and a Catholic husband) they cannot adopt. It is hoped that these archaic laws may be repealed shortly. Another term for artificial insemination is semiadoption, which is what it really is, since one partner is definitely the parent and the second partner has "adopted." Usually, "adoption" is defined as the act whereby an adult takes a minor into the relationship of a child and thereby acquires the rights and responsibilities of a parent in respect to such a minor. Having interviewed before and after treatment 125 partners of sterile marriages who have been blessed with a child by therapeutic insemination, the writer can state unequivocally that it is successful. Almost all the patients promptly return for another child, and it is frequently the husband who requests his wife to return promptly to add to the growing family. The husband is able to consider the child his for he requests in writing that the doctor make it possible for his wife to have a child by insemination and by the time the child arrives, the husband says to himself: "I asked for this child and it is mine." He feels that he has helped to make his marriage complete, which he was unable to do before. He feels that he has made it possible for his wife to experience the pleasures of normal pregnancy and he, in fact, has shared the pleasures and the problems of the ensuing 280 days of gestation. In the eyes of the community the couple are Mr. and Mrs. X with
Vol. 8, No.6, 1957
HUSBAND'S ROLE IN DONOR INSEMINATIOI'I
549
their child or children, rather than Mr. and Mrs. X with their "adopted" child. It takes a great deal of courage for the husband to see his young wife undergo the changes which pregnancy precipitates. There are trying minutes and hours outside the delivery room while the husband awaits the arrival of his first and subsequent child or children. Becoming a parent is a process which must be carried through by husband and wife. Is it not better that the couple share the opportunities of experiencing the pregnancy together, without the necessary interference of adoption agencies, legal council, and often the whim of the judge? If care is taken in the selection of the couple for this treatment, and the physician has the time and patience to select a donor who resembles the husband as far as color of hair, color of eyes, and general level of education is concerned, eugenically the parents appreciate that they have a better chance of having a normal healthy child than if no studies were made prior to a pregnancy. Farris and Murphy have reported that there are no psychologic bad results in the parents of several cases of therapeutic insemination. The author's opinion is similar to that in the 125 cases mentioned. The following letter sums up well in the patient's own words the reaction of the majority of couples who are faced with therapeutic insemination and accept its consequences. The aid you have given to my wife and me to make our married life complete and living joyous has been the greatest satisfaction that we should wish. We both hoped and prayed for a normal family when we were married for we are both family-loving people. Having gone through a period of disillusionment and despair thinking there was no chance for us to become parents, I feel I can appreciate A.1. and its wonderful results. It has permitted both of us to experience fully the bringing of a child into the world. Certainly, the culmination of experiences that occur during this time are never forgotten and marital bonds are strengthened. My wife and I honor the good you are doing for couples faced with problems like ours. We are both as happy as can be giving and receiving the love of our child. We hold you and your profession in the highest esteem, and wish to go on record in support of A.1. for other deserving couples.
This husband finds that therapeutic insemination has helped "to make his married life complete." It has "permitted hoth of them to experience fully the bringing of the child into the world." Surely the husband's emotional and familial wants are satisfied in a relatively normal manner by this simple
550
SIMMONS
Fertility & Sterility
yet effective treatment for otherwise childless couples. The husband is able to take his place in the community as the normal head of a normal family. He is frequently the one who encourages his wife to return promptly for a second child, and, sometimes, even three or four children by this method. In one case there were already three children when the husband acquired bilateral mumps orchitis with subsequent sterility. He applied for more children, considering thoroughly the fact that the family would then be mixed. Suffice it to say that discouragement was presented to these two people, since they already had a fairly large family with its attendant economic and emotional responsibilities. They still wished to go ahead, and it was satisfactory to all, for the fourth child proved to be male where the preceding three were girls. By insufflation of the tubes followed by appropriate shoulder pain, one can diagnose that the wife is within normal limits as regards her tubal patency. If she ovulates and menstruates regularly and has patent tubes, the chances of conception run in the order of 65 to 80 per cent in the ensuing 6 to 12 months of insemination. Rubin would be the first to say that one must keep an open mind on this subject. It is impossible for those who have children or who are not married to put themselves in the position of the childless couple. Two years ago the American Society for the Study of Sterility voted: "If it is in harmony with the beliefs of the couple and the doctor, donor insemination is a completely ethical, moral, and desirable form of medical therapy." M. Edward Davis, editor of FERTILITY AND STERILITY, says: "Our voice of approval should echo through the courts of laws, the temples of religions, and the halls of science." There are no more grateful patients, and particularly husbands, than those who write to thank one for the successful outcome of treatment by therapeutic insemination. Ethnologically, adoption is defined as the receiving into the clan or tribe of one from outside, and treating him as one of the same blood. The role of the husband in therapeutic insemination is simply that. 275 Charles St.
Boston 14, Mass.
on the subject of artificial insemination refer to the desirability of making it possible for a childless wife to have a child or children. Only last June (1957) at the American Society for the study of Sterility meeting in New York City, Alvarez stated that anything that made it possible to. put a child in the arms of a barren woman was permissible. Correctly he feels that, if the problem presents itself, the solution and its modus operandi are the business of the couple involved and of no one else. He decried the interference by certain religious affiliations and certain legal rulings. There is no doubt that the decision must be made first and last by the wife and husband of such a barren marriage. But is it not pertinent to weigh the aspect of the husband's responsibility in this type of medical solution to childlessness? Therapeutic insemination, as it is beginning to be called, rather than artificial insemination, after the suggestion of Kleegman of New York City, should be reserved for those cases in which the husband is irrevocably sterile and the wife is within normal limits of fertility. The wife should have the basic tests carried out, including history and physical examination, insuffiation of the fallopian tubes, endometrial biopsy, and basal body temperature curves for 3 or 4 months before treatment is started. The chief causes of the husband's inability to have children are simply azoospermia (absence of sperm), or severe oligospermia (too few sperm) following repeated examinations and recommended therapy. Another category which has some inRACTICALLY ALL WRITTEN AND SPOKEN OBSERVATIONS
------
---
-.--.~----------------------
From the Harvard Medical School, and the Massachusetts General Hospital, Boston, Mass. Received for publication July 12, 1957. 547
548
SIMMONS
Fertility & Sterility
creased importance in this subject are those marriages in which the wife is Rh negative and the husband is Rh positive according to the blood group and following 3 or 4 blighted pregnancies or nonviable births. It is apparent that they cannot have children by this union. In these cases an Rh-negative donor makes it possible for these two married people to have a successful pregnancy. Occasionally there is a serious history of medical disease in the husband's family tree which should make one debate carefully the desirability of his reproducing this taint. In such cases a healthy donor can be employed with the request and knowledge of both partners. TherapeutiC insemination is considered to be superior to adoption, for it is anonymous, the child does not bear the stigma of being known as adopted, it is quicker and probably less expensive, and in proper hands eugenically sound. In many of the Eastern states there are not enough babies available for adoption, particularly for certain racial groups. In Massachusetts, at least, it is necessary for the proposed child to have the same religion as the adopting parents. Therefore, if the parents are of mixed religion (e.g., a Catholic wife and a Jewish husband, a Protestant wife and a Catholic husband) they cannot adopt. It is hoped that these archaic laws may be repealed shortly. Another term for artificial insemination is semiadoption, which is what it really is, since one partner is definitely the parent and the second partner has "adopted." Usually, "adoption" is defined as the act whereby an adult takes a minor into the relationship of a child and thereby acquires the rights and responsibilities of a parent in respect to such a minor. Having interviewed before and after treatment 125 partners of sterile marriages who have been blessed with a child by therapeutic insemination, the writer can state unequivocally that it is successful. Almost all the patients promptly return for another child, and it is frequently the husband who requests his wife to return promptly to add to the growing family. The husband is able to consider the child his for he requests in writing that the doctor make it possible for his wife to have a child by insemination and by the time the child arrives, the husband says to himself: "I asked for this child and it is mine." He feels that he has helped to make his marriage complete, which he was unable to do before. He feels that he has made it possible for his wife to experience the pleasures of normal pregnancy and he, in fact, has shared the pleasures and the problems of the ensuing 280 days of gestation. In the eyes of the community the couple are Mr. and Mrs. X with
Vol. 8, No.6, 1957
HUSBAND'S ROLE IN DONOR INSEMINATIOI'I
549
their child or children, rather than Mr. and Mrs. X with their "adopted" child. It takes a great deal of courage for the husband to see his young wife undergo the changes which pregnancy precipitates. There are trying minutes and hours outside the delivery room while the husband awaits the arrival of his first and subsequent child or children. Becoming a parent is a process which must be carried through by husband and wife. Is it not better that the couple share the opportunities of experiencing the pregnancy together, without the necessary interference of adoption agencies, legal council, and often the whim of the judge? If care is taken in the selection of the couple for this treatment, and the physician has the time and patience to select a donor who resembles the husband as far as color of hair, color of eyes, and general level of education is concerned, eugenically the parents appreciate that they have a better chance of having a normal healthy child than if no studies were made prior to a pregnancy. Farris and Murphy have reported that there are no psychologic bad results in the parents of several cases of therapeutic insemination. The author's opinion is similar to that in the 125 cases mentioned. The following letter sums up well in the patient's own words the reaction of the majority of couples who are faced with therapeutic insemination and accept its consequences. The aid you have given to my wife and me to make our married life complete and living joyous has been the greatest satisfaction that we should wish. We both hoped and prayed for a normal family when we were married for we are both family-loving people. Having gone through a period of disillusionment and despair thinking there was no chance for us to become parents, I feel I can appreciate A.1. and its wonderful results. It has permitted both of us to experience fully the bringing of a child into the world. Certainly, the culmination of experiences that occur during this time are never forgotten and marital bonds are strengthened. My wife and I honor the good you are doing for couples faced with problems like ours. We are both as happy as can be giving and receiving the love of our child. We hold you and your profession in the highest esteem, and wish to go on record in support of A.1. for other deserving couples.
This husband finds that therapeutic insemination has helped "to make his married life complete." It has "permitted hoth of them to experience fully the bringing of the child into the world." Surely the husband's emotional and familial wants are satisfied in a relatively normal manner by this simple
550
SIMMONS
Fertility & Sterility
yet effective treatment for otherwise childless couples. The husband is able to take his place in the community as the normal head of a normal family. He is frequently the one who encourages his wife to return promptly for a second child, and, sometimes, even three or four children by this method. In one case there were already three children when the husband acquired bilateral mumps orchitis with subsequent sterility. He applied for more children, considering thoroughly the fact that the family would then be mixed. Suffice it to say that discouragement was presented to these two people, since they already had a fairly large family with its attendant economic and emotional responsibilities. They still wished to go ahead, and it was satisfactory to all, for the fourth child proved to be male where the preceding three were girls. By insufflation of the tubes followed by appropriate shoulder pain, one can diagnose that the wife is within normal limits as regards her tubal patency. If she ovulates and menstruates regularly and has patent tubes, the chances of conception run in the order of 65 to 80 per cent in the ensuing 6 to 12 months of insemination. Rubin would be the first to say that one must keep an open mind on this subject. It is impossible for those who have children or who are not married to put themselves in the position of the childless couple. Two years ago the American Society for the Study of Sterility voted: "If it is in harmony with the beliefs of the couple and the doctor, donor insemination is a completely ethical, moral, and desirable form of medical therapy." M. Edward Davis, editor of FERTILITY AND STERILITY, says: "Our voice of approval should echo through the courts of laws, the temples of religions, and the halls of science." There are no more grateful patients, and particularly husbands, than those who write to thank one for the successful outcome of treatment by therapeutic insemination. Ethnologically, adoption is defined as the receiving into the clan or tribe of one from outside, and treating him as one of the same blood. The role of the husband in therapeutic insemination is simply that. 275 Charles St.
Boston 14, Mass.