Donor-insemination in SMCG/MCK between 1977 and 2003 (Leiden Clinic)

Donor-insemination in SMCG/MCK between 1977 and 2003

(Leiden Clinic)

DI in the Netherlands: it is time to produce data!

• How did our population of women asking for DI change in the 1977 – 2003 time-frame;

• What data do we have about the mothers and the children born in this period;

• The donors during this time frame, did they react on the discussions in society about anonymity?

Medisch Centrum Kinderwens

Acceptance of D.I in the mid- seventies

• First reports on DI in 1948 (Levie)

• DI for non-married women is to be rejected (Resolution KNMG, 1962)

• DI for women in an infertile relationship could be tolerated under strict conditions

• ‘In 1960 in the NL, 90% of all gynaecologists opposed DI as treatment for infertility, in 1970 40% of them still did so’ (Hoogerzeil, 1985).

Medisch Centrum Kinderwens

Conditional acceptance

• Non-disclosure about the way of conception from the parents to the child was the prevailing norm. Anonymity until infinity of the donor is the logical consequence.

• In his 1975 publication for dutch practitioners, Levie elaborated on contra indications for DI. He wrote: … ‘we think that knowledge by any person outside the directly involved medical team about the intention to have DI is a contra-indication to start DI treatment.’

Medisch Centrum Kinderwens

DI in NL : the ‘seventies’ and early ‘eighties’

• In 1985 Hoogerzeil writes:’… in the DI program of the AZUA the question of confidentiality was always left for the couple to decide’.

• At the start of the DI clinic in Leiden Single women and Lesbian couples were welcome from the start in 1977 : confidentiallity has a different perspective in such treatments…

Medisch Centrum Kinderwens

Heritage of Leiden clinic to MCK fertility centre

Medisch Centrum Kinderwens

Content of the database

Children born after treatment between 1977 - 2003

• Women : 1105 pregnancies leading to a first birth of at least one child;

• 273 women had two successive births, 26 had three births, in 1 case was even a fourth birth

• In total 1365 singletons, 47 twins and 2 triplets, adding up to 1465 children.

• From these 1465 we could record the sex of 1431 children (98%). This is the group under study in this presentation.

DI from 1977 and 2003 : 3 periods

• 1977 - 1984, anonymity and secrecy, insemination partly with fresh sperm and several inseminations per cycle

• 1985 - 1993, discussions on anonymity and secrecy are opened; insemination mainly with cryopreserved sperm, introduction of IVF.

• 1994 – 2003, introduction of ICSI (!), trend to voluntary non-anonymous donors, TV-publicity and discussions on secrecy, bill on regulated artificial fertilization passed in june 2002 and became the Law.

3 groups of mothers

• Mothers in a heterosexual relationship;

indication: infertility problem, other;

Mothers in a lesbian relationship;

• Single mothers

Children and their mother’s relationships in 3 periods

period Infertility 2 women Single women total

1977-1984 337 66 56 459

1985-1992 283 101 91 475

1993-2003 110 187 200 497

Characteristics of mothers during three periods

Donors , intake 1976 and 2003

Involved in birth of children

Used in inseminations but no births

Only intake or not used

246 79 >200

Nr families per donor Nr of children per donor

Guidelines

1105/246 = 4,5 1465/246 = 6,0 25 CBO, 1992

246 donors involved in pregnancies

Anonym (A) Not Anonym (B) Comment

Status at intake 216 30 From 1977 upto 2003

Change from A B 24 Mainly in or after 1993

Fixation of A status 4 In or after 1993

Reversal of B (BA)

2 Around 2002

Result at this moment

194 52

Requests for non identifying donor information

Requests of mothers for non-ID info (‘donor pasport’), after birth; Requests of children;

• Mother and child come with a request

• Only the child comes with a request

• Only the mother comes with a request

Requests by mothers and children(infertility group)

Requests by mothers and children(single mothers)

Medisch Centrum Kinderwens

Comparison of 2 groups of mothers

Medisch Centrum Kinderwens

Sex of the children who ask

• 72 children who requested donor information

• 30 were male, 42 were female

• Are girls more inclined to search for this information?

Conclusions about disclosure ? - In the oldest group of children with a social father

(29 - 36 yrs) only 4% of the children make a request themselves;

- In the youngest group (10 – 19 yrs) many more mothers (20% vs 7%) make a request for a ‘donor pasport’ than in the oldest group;

- In general mothers are much more active in this respect than children;

- In the group without a social father 20 – 30% of the children request for donor info..

General conclusions on DI between 1977 and 2003

• DI became an accepted treatment mode for infertility and unvolontary childlessness in the Netherlands;

• Also lesbian relationships and single women as candidates for DI became widely accepted;

• The landscape in relation to the DI candidates changed drastically :

- the ‘classical’ infertility cases now logically prefer IVF or ICSI, if needed in combination with PESA or TESE.

- a limited group of severe azoospermia still remains indicated.

- single women and lesbian couples are a large group in DI programs

Symposium MCK 2013

Special Thanks

• Erica de Reus

• Anne Brewaeys

Medisch Centrum Kinderwens

Thanks to many colleagues and staff members from Leiden Clinic

• Willem Beekhuizen

• Kees van Schie

• Hanna Bonink

• Renske v.d. Baan

• E. Tellegen

• J. van de Noort

• Carla van Gerwen

• Mirjam Denteneer

• Maria Noboa

• Elly van der Kwaak

• Ingrid Heijnsbroek

• Lies ter Haar

• Gerda van Niekerk

• Jacqueline Heemskerk

• Maureen Roos

• Present secretarial staff MCK

• Present medical staff MCK

• Present laboratory staff MCK