Reuters

Sperm donation offers a tidy solution to an aggravating problem: When a person or a couple wants a baby and needs a different ingredient than what they’ve currently got to make one, a man with viable sperm swoops in to help.

The process can look like a seamless way to create a family, and for many, it is. That’s a big reason why it has gained so much popularity in the past half century, a period when it’s gone from being a niche practice to being responsible for tens of thousands of births. In 2010, the most recent year for which good data is available,  some 30,000 to 60,000 babies born in the United States were conceived through sperm donation, out of approximately 4 million American babies born that year.

As simple a transaction as sperm donation can seem to be, though, some find it to be stressful or isolating—and because assisted reproductive technology is a relatively new, rapidly developing field, the social and emotional challenges that can arise between the participants in a sperm donation are, for many, uncharted. There are two well-established ways to go about the process of sperm donation: Prospective parents can use a sperm sample from a friend, acquaintance, or family member (often called a “known” or “directed” donation) or arrange to use a (usually heavily vetted) stranger’s sample through a sperm bank or fertility clinic. Even decades after these practices have become common and their intricacies should theoretically be common knowledge, many of those who opt for sperm donation are still consistently surprised by all the ways it can shape—in some cases straining and, in others, enhancing—family dynamics.

One such consistently surprised group is made up of infertile men. Aaron Buckwalter, a Los Angeles-based marriage and family therapist, has spent 15 years specializing in fertility challenges and what he calls “men’s issues.” His job often includes helping men cope with the cultural expectations attached to traditional manhood in the context of reproduction.

One good way to make sense of infertility, Buckwalter says, is to acknowledge that there’s grief and loss involved. “You’re constantly confronted with what you thought you would have, and thought you could have so easily,” Buckwalter says. “There has to be acceptance that you’re in a new stage.” Often, though, Buckwalter finds male partners within heterosexual relationships struggling to conceive are more likely to “white-knuckle” through the process: The men he tends to work with “treat it as a task that needs to be completed, or a plot to figure out. ‘We’ve got to win.’ They get pulled in competitively, and they lose track of what they’re actually up to—that being the actual goal of creating a family and creating intimacy, creating connection. ‘Just get through it and on the other end we’ll have the prize and everything will be fine.’” It’s not until it’s over “that they actually have some kind of emotional realization of what has gone on”—and by that point, Buckwalter says, if they’re unable or unwilling to process what they're experiencing, “it can damage their relationship with their spouse and ultimately their attachment with their child.”

When Buckwalter counsels heterosexual couples who are weighing their options as they deal with infertility, he finds male partners to be “much more attached to these ideas of ownership and [the child being] ‘mine,’ and much more tied to the genetic connection in terms of what it means psychologically or what it means emotionally” than female partners considering egg donation. These men are often grappling with the question, Is this my child or someone else’s? “That's a tough struggle for a lot of guys when I meet them,” Buckwalter says.

One reason for that may be that it’s the female partner who has a biological connection to the child, through pregnancy. Buckwalter also mentions a sort of “primordial jealousy” that can arise when men are unable to procreate—one based in an evolutionary response to the threat of another male impregnating their partner or mate. This seems entirely natural, and so, Buckwalter says, many men have to make an effort to shake it off: “Oh, I’m being a Neanderthal here. I shouldn't think this way.

Again, in many cases the proceedings leading up to and following donor insemination go smoothly. For many families, sperm donation is a miracle, not an ordeal. But Buckwalter says men should be encouraged to acknowledge any anxiety, pain, or shame they feel throughout the process. “I wish there were a way that people could have a sense of that without meeting with a therapist,” he adds. “But my hope is that people think about how this is more than a transaction.”

One family I spoke to found that out firsthand. Their story centers around two brothers, and the family asked not to be named, because of the sensitivity of their situation. The donor brother and the recipient brother, now both in their 40s, were never the closest of siblings. Growing up in England, they often ended up in scuffles over toys and territory, and in adulthood, they’d still been known to get quietly testy—over who had the more successful career, who had the more elegant wedding, who was beating whom in the family game of croquet.

So when, a decade ago, the younger brother visited the elder at his home in the United States and asked him to donate his sperm so he and his wife could start a family, the older brother hesitated at first. After a few years of trying, the younger brother and his wife had discovered that they were unable to have children of their own; the older brother remembers his younger brother weeping at the table as he explained to his brother and sister-in-law that his body produced no sperm at all.

“This sort of scared me. It’s a big thing,” the elder brother recalls. But after discussing it with his wife, they went ahead with it. Maybe, they reasoned, the older brother helping his only sibling start a family would bring them closer.

One of their insemination attempts resulted in a viable pregnancy. “We were all very optimistic that things would work out great,” the older brother, the donor, says now. (The younger brother could not be reached for an interview.)

“I think when things started to fall apart was when their first child was born,” the donor’s wife remembers. She and her husband made their first visit to their new niece just after she was born. The aunt remembers feeling unwelcome, getting an uneasy sense that the new parents didn’t want them to see their baby. She says that at one point, in a quieter moment, the younger brother had remarked, with sadness, that he wished he and his wife could have just had kids “like normal people.” On another occasion during the visit, the older brother recalls, the younger brother lashed out at him and his wife, and abruptly stormed out of a gathering. The couple returned home to the U.S., tensions unresolved, and in the following months, the younger brother reached out less and less. Any communication at all became “very formal.” “I felt this had wrecked my family,” the older brother says.

A matter of months later, the donor’s wife learned from a reproductive specialist that this was a common reaction among recipient dads; the specialist suspected that the donor’s brother felt threatened, as though the visit represented the donor swooping in to claim the baby as his own.

“I was just like, ‘Gosh, why hasn’t someone told us?’ Why was nobody saying, ‘This is a big deal, and it's going to test the limits of your relationship’?” the donor’s wife wonders. “No doctor working at the cryogenic bank, nobody—nobody said, ‘Hey. Sit down. Think about the relationship and what's gonna happen.’”

Occasionally, tales with that message pop up in advice columns and on support-network forums, but in general they are not exactly saturating the culture. Lisa Cholodenko’s film The Kids Are All Right, which tells the story of the family upheaval that ensues when two donor-conceived kids born to lesbian moms hunt down their sperm donor, is one of the few well-known fictional explorations of the many emotions that can arise from sperm donation.

Additionally, one children's book, The Pea That Was Me: A Sperm Donation Story, by the psychotherapist Kimberly Kluger-Bell, has been lauded by parents and psychologists for how it deals with the emotional side of sperm donation. In the book—the second in what’s now a series of eight children’s books about various assisted-reproduction technologies, including surrogacy and egg donation—Kluger-Bell explains the sperm-donation process as follows: When you put sperm (from a man pea) together with an egg (from a lady pea), generally speaking, “it grows into a tiny pea, inside the lady’s tummy.” When the sperm from the man pea doesn’t work, however, a “very good doctor” can help the couple find a “very kind man” to share some of his working sperm and help. (Kluger-Bell has since released two additional versions of the sperm-donation story, in which the baby pea is born to a pair of pea-moms and to a lady pea raising her baby pea on her own by choice.)

For many reasons, the law has not caught up with the practice of sperm donation. In the United States, the laws governing it vary by state, and as Susan Crockin, an adjunct professor at Georgetown Law and a co-author of Legal Conceptions: The Evolving Law and Policy of Assisted Reproductive Technologies, says, a majority of states have only baseline provisions to govern sperm-donation practices. Most adhere to the Uniform Parentage Act, which establishes that when a man donates sperm to a consenting married couple, the donor is not a parent; paternity rights belong to the husband of the impregnated woman. (In the states that haven’t adopted the same law in full, a sperm donor could theoretically claim to have paternity rights to a child, or be ordered to pay child support.) In 2017, in light of the legalization of same-sex marriage, two of the states that have adopted the Uniform Parentage Act enacted an update making the spouse of the sperm recipient, regardless of gender, a legal co-parent as long as they consent to the procedure.

The formation of any lay consensus about sperm-donation best practices also trails behind the uptake of the practice—even though experts have a somewhat clear understanding of how people should go about it. The closest thing to a regulatory body overseeing sperm donation throughout the U.S. is a nonprofit called the American Society of Reproductive Medicine. The ASRM has a set of recommendations that physicians, fertility specialists, and sperm banks are encouraged to follow. For example, the ASRM puts out guidelines on questions like whether to tell one’s donor-conceived kids about their origins (“strongly encouraged”) and how much information to reveal to children about their anonymous sperm donors (“under continued study, but support has grown in recent years for ... allowing access to non-identifying information about donors to offspring who request it”).

The ASRM also recommends setting a limit of 25 births per donor within a population of 800,000, in order to lower the risk of accidental incestuous relations. In many other countries, there are laws putting caps on the number of births per single donor within populations of a certain size, but the U.S. doesn’t have any such law.

The ASRM advises, additionally, that physicians offer anyone involved in a sperm donation psychological counseling before proceeding, and it specifies that “programs that choose to participate in intra-familial arrangements should be prepared to spend additional time counseling participants and ensuring that they have made free, informed decisions.” These consultations, per the ASRM, should happen before the donation process begins, should not be rushed, and should include the parents-to-be, the donor, and any surrogates, as well as each of their partners and children. The committee even specifically advises that these consultations focus on “how participants will cope with the unique aspects of the proposed arrangement and on the consequences for the prospective child,” and reminds practitioners that “the involvement of professionals representing multiple disciplines, including physicians, nurses, and counselors, should be anticipated for a thorough assessment.”

The presence of an expert can get people to have crucial conversations they wouldn’t otherwise have. Andrea Braverman, a clinical professor of obstetrics and gynecology as well as psychiatry and human behavior at Thomas Jefferson University, often counsels couples before (and sometimes after) the sperm donation process. For non-anonymous donations, she meets with the donor and their partner, the recipient and their partner, and then the whole group together to talk about “expectation of roles” and “how this information is going to be handled: Is it going to be shared or not shared, with the child? With the extended family? With the world? And when?” She says even a one-hour, one-time session can make a difference.

Braverman also asks everyone to talk through the possibility that over time, the relationship between the donor and recipient could change. But telling someone that at the time, especially in a known-donor situation, “I’m sure they would say, ‘Ah, we’re fine. What are you making us go see that person for?’” she says. Plus,  some people already feel sad or ashamed to have to go this route in the first place, and counseling can make them feel like they’re being scrutinized or judged. “I think that’s, quite frankly, why a lot of practices and a lot of physicians don’t require it. Because they get that pushback,” Braverman says.

It’s not uncommon for counselors to refer patients to lawyers, though there are disagreements about whether this is prudent. “Many say that if it's a familial-donation circumstance, they love each other and they don't need the extra expense of a separate lawyer,” says Susan Crockin, the Georgetown professor. Crockin, however, has argued that a lawyer could help families account for possible future scenarios, especially ones they might not want to consider. “The lawyer’s job is to be the advocate of their client, asking them, ‘Are you sure? Do you want this to be a forever limitless donation, or do you want the option of saying, I've changed my mind and I need my sperm back because I happen to be infertile now, or, I want my new wife, who wasn’t in the picture before, [to have a say]'?”

Counseling, of course, can’t magically turn every family situation into a healthy environment for a gamete donation. Talking for a few hours with a professional third-party mediator can help untangle many interpersonal problems, maybe even most, but some families—like those with deep-seated personality incompatibilities, for example, or a long history of emotional unavailability—just may not be great candidates for intrafamilial sperm donation.

And not every sperm donation needs professional intervention to be a successful and happy one, either. For Rebecca Helgerson, a teacher in Washington, D.C., a simple and thorough conversation with her donor—a man she was introduced to after telling her friends that she was looking to have a baby—established what she’s found in the five years since her daughter was born to be an effective and fair set of ground rules.

“I wanted it to be a comfortable relationship, where they knew each other but didn't have any formal expectations,” Helgerson says. “We do all know each other, we do all spend time together. But I wanted really clear lines about who's the parent and who's not. I was not interested in, and he was not interested in, any kind of formal time together. No You spend a weekend together, this often. Nothing like that.”

Today, Helgerson, her daughter, Helgerson’s partner, the donor, and the donor’s female partner all go on vacation together each year. The biggest complications that befall them as a group happen in the security line at the airport, where Helgerson says TSA agents get confused as to which adults to group with the kid.

Some experts, though, like Crockin, believe all participants are better off with more extensive precautions—and that the law should say so, too. In Crockin’s view, “If you go to a doctor and say [you’re getting a sperm donation from a relative], then that should set in motion a very standard recommendation that each of the donors and the recipients, together as a couple, but separately from the other couple, have at least a psycho-educational counseling session.” But legally, in the United States (unlike other countries), there’s no requirement that donors and recipients participate in counseling, or that fertility clinics or sperm banks comply with the ASRM’s guideline recommending it.

As for what a better possible future for American sperm donation looks like, Crockin points to the United Kingdom’s “very comprehensive regulation.” In 2008, just as the two English brothers’ families were starting to navigate the sparsely mapped sperm-donation landscape of the U.S.—whose laws applied to their situation, as the sperm was collected on American soil—the United Kingdom passed the Human Fertilisation and Embryology Act (HFEA), which established a nationwide governing body to oversee all gamete donation and other assisted-reproduction techniques. That law required sperm donors, recipients, and their partners to attend counseling beforehand—something that might well have changed the course of the two families’ lives.

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