In the Netflix documentary “Our Father”, a top United States fertility doctor in Indiana is shown to have inseminated multiple women using his own sperm via the in vitro fertilisation (IVF) process.

As a result, at least 94 half-siblings were discovered to be living in the same area, unaware they were genetically linked to the same parent.

This case was a serious breach of trust and medical sexual assault, but the doctor was never truly punished as there was no law or legislation about fertility fraud at the time.

This was not an isolated incident. In Austin, Texas, a woman unexpectedly discovered the truth about her biological father via an online ancestry DNA test. She realised she was not conceived by the sperm donor chosen by her parents, but rather by her mother’s fertility doctor.

In both cases, ethical issues surround the donation of sperm or egg for IVF, also known as gamete donation.

What is gamete donation?

Gamete donation refers to using someone else’s sperm, eggs or embryos to help an intended parent conceive a child. “Intended parent” refers to the person(s) who will bear and/or raise the child, while the donor could be someone close to the intended parent, introduced through a fertility clinic or agency, or anonymous.

Gamete donation usually happens when one or both partners are unable to produce their own sperm or eggs. This might be because of medical issues that result in poor-quality or complete lack of sperm or eggs; the high risk of passing down genetic disease; or social situations involving single male/female or same-sex couples.

Egg or sperm donation provides an opportunity for the intended parent to have a biological link to the child via pregnancy. There is no genetic link, however, with embryo donation, even though the intended parent will still be able to experience pregnancy and childbirth.

Of ethics and consanguinity

Consanguinity refers to two or more people who are related to the same blood or origin. As shown in “Our Father”, if major ethical breaches occur in the course of gamete donation, it increases the odds of unintended consanguineous marriages occurring.

In other words, a couple might not be aware that they are related, which could lead to inbreeding among the genetically linked persons. This, in turn, could result in birth defects and abnormalities in their offspring.

Studies have shown increases in stillbirths, infant mortality rates, frequency of birth defects, as well as risk of autosomal recessive disorder as a result of consanguineous marriages. The probability of offspring receiving one or more harmful recessive genes is greater if there is a biological relationship between the parents.

Furthermore, consanguinity has been linked to mental health issues such as generalised anxiety disorder, social and specific phobias, problems with impulse control, bipolar disorder, depression, separation anxiety, schizophrenia, and personality disorders.

Ethics of gamete donation

Several factors must be considered in the ethics of gamete donation:

1. Donor rights

The donor’s identity should be kept anonymous. Clients have no right to obtain their identity or information, and any biological responsibility for the offspring produced by the sperm should be void.

2. Client’s rights

Clients need to know the risks and limitations associated with gamete donation. Despite undergoing vigorous testing and screening, a person’s donation might not be entirely free from disease or genetic abnormalities.

Hence, clients must be aware they are fully responsible for the offspring conceived using these specimens. An informed consent form has to be signed by the client and verified by their doctor to establish the rights of the donor and recipient.

3. Sperm selection

Different sperm banks have different criteria for donors, with some being more selective than others. But the ethical differences between ultra-selective sperm banks and those that serve a more “normal” population creates concerns of eugenics that have not yet been resolved.

Eugenics refers to the controversial act of arranging reproduction to increase the occurrence of heritable characteristics regarded as “desirable”. Ideally, any type of sperm should be carried by sperm banks as long as they follow proper laboratory standards and respect informed consent.

4. Donation frequency

Consanguineous marriage could occur if the amount of sperm a single man can donate is not controlled. As such, sperm banks should place limitations – for example, by allowing only 10 children to be conceived per donor.

In the United Kingdom, for example, laws allow for sperm from one donor to be used by a maximum of 10 families, but there are no restrictions as to how many times a sample might be used within the same family to produce siblings.

This article was written by DOC2US, a mobile application that allows you to talk to a doctor or any healthcare professionals via text chat at any time and from anywhere.