Back to Chapter 4 Genetics & Reproductive Medicine
Opinion 4.2.3

Therapeutic Donor Insemination

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Therapeutic donor insemination using sperm from a woman’s partner or a third-party donor can enable a woman or couple who might not otherwise be able to do so to fulfill the important life choice of becoming a parent (or parents).

However, the procedure also raises ethical considerations about safety for the woman and potential offspring, donor privacy, and the disposition of frozen semen, as well as the use of screening to select the sex of a resulting embryo.

Physicians who choose to provide artificial insemination should:

  1. Provide therapeutic donor insemination in a nondiscriminatory manner. Physicians should not withhold or refuse services on the basis of nonclinical considerations, such as a patient’s marital status.
  2. Obtain informed consent for therapeutic donor insemination, after informing the patient (and partner, if appropriate):
    1. about the risks, benefits, likelihood of success, and costs of the intervention;
    2. about the need to screen donated semen for infectious disease agents and genetic disorders when an individual proposes to donate sperm specifically for the patient's use in therapeutic donor insemination;
    3. about the need to address in advance what will be done with frozen sperm (if any) from a known donor in the event the donor dies;
    4. that state law will govern the status, obligations, and rights of the sperm donor, known or anonymous, in relation to a resulting child.
  3. When sperm is collected specifically for use by an identified patient, obtain informed consent from the prospective donor, after informing the individual:
    1. about the need to test donated semen for infectious disease agents and genetic disorders;
    2. whether and how the donor will be informed in the event the semen tests positive for infectious disease or genetic disorder;
    3. that state law will govern the status, obligations, and rights of the donor in relation to a resulting child.
  4. Counsel patients who choose to be inseminated with sperm from an anonymous donor to involve their partner (if any) in the decision.
  5. Provide sex selection of sperm only for purposes of avoiding a sex-linked inheritable disorder. Physicians should not participate in sex selection of sperm for reasons of gender preference.
AMA Principles of Medical Ethics: I, V
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Preserving opportunity for physicians to act (or to refrain from acting) in accordance with the dictates of conscience is important for preserving the integrity of the medical profession as well as the integrity of the individual physician; Physicians’ freedom to act according to conscience is not unlimited; They are expected to provide care in emergencies, honor patients’ informed decisions to refuse life-sustaining treatment, respect basic civil liberties and not discriminate against patients on the basis of arbitrary characteristics.
Opinion 2.2.1

Pediatric Decision Making

In giving or withholding permission for medical treatment for their children, parents/guardians are expected to safeguard their children’s physical health and well-being and to nurture their children’s developing personhood and autonomy; Physicians should evaluate minor patients to determine if they can understand the risks and benefits of proposed treatment; The more mature a minor patient is, the better able to understand what a decision will mean, and the more clearly the child can communicate preferences, the stronger the ethical obligation to seek minor patients’ assent to treatment.
Opinion 4.2.1

Assisted Reproductive Technology

Assisted reproduction offers hope to patients who want children but are unable to have a child without medical assistance. In many cases, patients who seek assistance have been repeatedly frustrated in their attempts to have a child and are psychologically vulnerable. Those patients whose health insurance does not cover assisted reproductive services may also be financially vulnerable. Candor and respect are thus essential for ethical practice.