Donor-insemination in SMCG/MCK between 1977 and 2003

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

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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?

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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).

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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.
  

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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

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Heritage of Leiden clinic to MCK fertility centre
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Content of the database
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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.

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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.

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3 groups of mothers

• Mothers in a heterosexual relationship
• indication infertility problem, other
• ? Mothers in a lesbian relationship
• Single mothers

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Children and their mothers 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

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Characteristics of mothers during three periods
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Donors , intake 1976 and 2003
Involved in birth of children Used in inseminations but no births Only intake or not used
246 79 gt200
Nr families per donor Nr of children per donor Guidelines
1105/246 4,5 1465/246 6,0 25 CBO, 1992
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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 (B?A) 2 Around 2002
Result at this moment 194 52
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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

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Requests by mothers and children(infertility
group)
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Requests by mothers and children(single mothers)
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Comparison of 2 groups of mothers
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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?

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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..

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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
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Special Thanks

• Erica de Reus
• Anne Brewaeys

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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