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
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