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The social and psychological consequences of secrecy in artificial insemination by donor (AID) programmes.

The assumption that secrecy is of paramount importance in AID programmes has arisen in order to protect the three parties involved: donor, recipient couple and offspring. Due to the uncertain legal position, he medical profession has also been concerned to protect itself against possible litigation. Recent calls for an abolition of all secrecy have been motivated by the knowledge and experience of workers in the field of adoption. The similarities and differences between adoption and AID as ways of creating a family are discussed, with the resulting conclusion that, although the two have much in common they do present different experiences and problems for parents and offspring. The experiences of donors and recipient couples are then discussed based on data gathered to date from 67 donors and 93 couples in an AID programme at the Melbourne Family Medical Centre. It is stressed that many statements in the past regarding secrecy have not been informed by the opinions and intentions of participants themselves, and further information is needed in this area. Furthermore, it is clear that all members of a society are affected by the codes of secrecy currently operating and the 'rights' of all members of that society need to be considered.

Adoption↗

Transmission of Ureaplasma urealyticum by artificial insemination by donor.

A case of U. urealyticum transmitted by AID is described. To prevent this complication, the donor must be screened with cultures not only for N. gonorrhoeae but also for U. urealyticum and Chlamydia. Despite the poorer results with frozen sperm, cultures for sexually transmitted disease may in the long term result in fewer reproductive failures and less morbidity.

Adult↗

Timing and frequency of artificial insemination in women under menotropin therapy.

The timing and frequency of AID were reviewed in 36 women who received menotropin therapy. One hundred thirteen treatment cycles were reviewed with AID done once per cycle in 39, twice per cycle in 63, and three times per cycle in 11 cases. The pregnancy rate was 19.5% per treatment cycle, with 21 of the 36 patients (58%) conceiving. No difference in pregnancy rate was found with single or multiple inseminations when AID application included the day of hCG administration. Evidence is presented that suggests that frequently the fertilizing sperm may have resided in the woman for over 30 hours before fertilization occurred.

Chorionic Gonadotropin↗

Recovery of microorganisms from the pelvic cavity after intracervical or intrauterine artificial insemination.

To assess the risk of introducing microorganisms into the peritoneal cavity during intracervical or intrauterine insemination, we cultured the cervix and semen from 19 couples before insemination and the peritoneal fluid from the female partner after insemination. The peritoneal cultures taken before hydrotubation grew organisms in one of ten intracervical inseminations and five of the nine intrauterine inseminations (P less than 0.05). In four of the five positive peritoneal cultures from the intrauterine group, the organism was also cultured from the semen specimen obtained before insemination and not from the cervical sample. Therefore, intrauterine insemination appears to increase the risk of introducing microorganisms into the upper genital tract and the peritoneal cavity. The clinical significance of this finding remains to be established.

Adult↗