The TV show portrayed the psychological effects of recourse to artificial insemination on a husband and wife. After the child is born, the husband recalls the child's relationship to another man whenever he sees it. The mother then meets the intern who donated the sperm. Moreover, when the intern learns that the child is a part of himself, affection develops in his heart.
Gynecologist Yu Chen-huan, commenting on this scenario, explains that all the applicants for artificial insemination are carefully screened. The doctors explain beforehand every possible effect - before any agreement is signed - so that husbands will not casually fall into the psychology of rejecting their new babies.
Actually, as the TV show indicated, most of the semen used is donated by interns. But, he says, the hospital closely guards data on the donors. Even the donors themselves cannot identify the source of any batch of semen. Moreover, artificial insemination usually cannot succeed with a single treatment.
Since the bank was established in April 1981, 270 women have utilized its services, resulting in 41 pregnancies and 8 births. Of the eight babies, only one is the natural child of the husband. The mothers of the remaining seven broke contact with the bank immediately after pregnancy.
Taiwan registers about 100,000 new marriages a year. Of the new brides, 10 to 15 percent do not become pregnant.
They are qualified to visit hospital gynecologists as outpatients. For this fraction of the 100,000 couples with actual fertility problems, the Retired Servicemen’s General Hospital established the first sperm bank last year; the National Taiwan University Hospital followed suit this year. Most registered "fertility" patients are women, but men account for at least one third of the causes of infertility in marriage. While it is easy to carry out fertility checks on men, they will not usually come to the hospital for a check up until their wives have first undergone all the tests.
When artificial insemination is performed, either fresh or frozen semen can be used. Most gynecologists do not like the term "sperm bank" because the "deposit" in the "bank" tends to diminish and bears no "interest." “It is not a bank because not everyone can make a 'deposit,'" says gynecologist Li Tzu-yao of the National Taiwan University Hospital. Also, only infertile couples can benefit.
After the semen is collected, it is liquefied for 10 to 30 minutes, then subjected to quick freeze for another 30 minutes at a temperature of 85°C below zero. The frozen containers of semen are submerged in liquid ammonia at 196°C below zero, and can be kept that way for dozens of years. Freezing, however, may at times damage or destroy the sperm.
Many cases of female infertility result from the scarcity or inactivity of the husband's sperm. The "bank" can solve the problem of scarcity, because a husband may "deposit" his own sperm a little at a time for later "withdrawal" as a "lump sum." His sperm may be combined with other's sperm to boost the chances for successful pregnancy.
"Scarcity and inactivity of the sperm are the two sides of this coin. If the sperm is inactive, the increase in numbers cannot help," says Dr. Lin Yu-chun.
"Mixing of sperm can give the husband a sense of participation, but is not especially useful," says Dr. Li Tzu-yao. Dr. Lin Yu-chun objects to the practice of mixing one man's sperm with another's because, he argues, the different materials may generate antibodies and each adversely affect the other. Besides, if the husband's sperm is not strong, other sperm cannot help propel it toward the egg. "The husband who harbors the idea of mixing his semen with another's is actually psychologically unprepared, so he would be better off not to sign the agreement to have his wife receive artificial insemination."
The use of another man's semen for artificial insemination poses a constant barrier. The Chinese people are obsessed with the domination of man in genealogy. A child sired by a family member with a woman other than his wife would be accepted as a member of the family, but a child born to his wife by another man would be considered alien by female as well as male members of the family. One woman cried unrestrainedly in the presence of the doctors when she learned that there was no sperm in her husband's semen.
Strong bonds between husband and wife are imperative if another's semen is to be utilized, especially because of un expected complications. In one case, a couple gave birth to a daughter via another man's semen without the knowledge of parents and parents-in-law. The husband adored the baby, perhaps even more than the wife. But the wife revisited the doctors recently as a result of her parents'-in-law insistence on a baby boy.
Most women cannot expel anxiety about the possible weakening of conjugal love after giving birth to a child with another's semen, knowing that the child will bear little resemblance to the husband. A wife may also worry whether her "link" to the semen donor may engender a subtle extra-marital affection.
In foreign countries, bright and healthy men are sought as semen donors - in actuality, they are mostly medical students, who are intelligent and can understand the consequences. The donors, of course, must be free of venereal diseases and have blood types identical with those of the prospective recipients' husbands. They should also bear some physical resemblance to the husband; otherwise, the child may arouse suspicion among relatives. It is generally accepted that the story should never be told to the child.
At the Retired Servicemen's General Hospital, most donors are the hospital's interns, who are bright and aware. Identification of blood type is imperative. The doctors insist on keeping from a woman the identity of a semen donor, and keeping from the donor the identity of the recipient.
Dr. Lin Yu-chun says, "We cannot afford to always think of the bright side of the matter," Dr, Li Tzu-yao agrees with Dr, Lin's views on keeping the donor and recipient always in the dark. Among other things, this policy can reduce problems in inheritance and divorce, One sterile man asked to use his brother's semen to fertilize his wife, but Dr, Lin rejected the request to avoid possible latter-day troubles. Most women fertilized artificially give birth in other hospitals to assure their secret.
Numbers and vitality of sperm are crucial to male fertility. (File photo)
What are the feelings of the donors? One intern says, "I feel as if I have helped someone, and nothing else," At the Retired Servicemen's General Hospital, even the doctors do not know whose semen is used for whom, but their policy is to use semen from a single source for each woman. They will, however, switch to semen from another source after two or three failures. After a woman has given birth, it is impossible for her to locate more semen from the original source for another fertilization.
Once the hospital's semen supply ran short, and it had to advertise for new sources. Many applied, some apparently for the NT$1,200 (about US$30) offered as a "nutritional" stipend. Most could not pass the strict examination and were rejected. A good many offered to donate, including one blonde man. But, in the end, the hospital authorities decided to solicit the interns for help. The National Taiwan University Hospital is reluctant to obtain semen from outside sources.
Because of the lack of legal coverage, artificial insemination programs have been carried out with extreme care. Enactment of supplemental legislation is absolutely necessary to ensure the child's status. In the American state of Oregon, an agreement for artificial insemination signed by a couple must be registered with a court of law and be kept in seal. Oregon law also provides that the donor is exempt from any obligation of support to the child. The couple in question must also go through consultation procedures to ensure psychological acceptability. No such legislation exists in the Republic of China, but the donors and couples are still required to sign agreements. A woman who cannot obtain her husband's agreement - or an unmarried woman who wants to bear a child - will not be qualified for artificial insemination. Nevertheless, little legal protection is provided for the child - for example, how can a controversy over inheritance be solved if it arises?
For the responsible gynecologists, artificial insemination also involves the specter of possible falsification of documents. The law requires the true names of the father and mother to be entered on the child's birth certificate. The Retired Servicemen's General Hospital has carried out a number of artificial inseminations, but it is not aware how the birth certificates are filed, because the women give birth in other hospitals. Actually, a doctor cannot assure accurate identification of a father even in a normal birth. The father's name is registered in such cases based on the mother's account.
Another topic of discussion concerning insemination programs is whether blood relatives could be involved. Actually, the possibility is considered to be very remote. In normal cases, a sperm bank does not collect semen from a donor more than one time. The National Taiwan University Hospital seldom uses one man's semen for a second case even after it knows it has successfully impregnated a woman. This is a control on the possibility of later marriage between unknowing blood relatives.
Since giving birth is, at least, troublesome, why don't childless couples just adopt one? Dr, Lin Yu-chun says, "At least, a child born through artificial insemination can be regarded as half of one's self." Compared with adoption, the child is more closely linked to its parents. As the donor of semen is unknown to the parents, they can better keep secret the details of the birth and need not worry about property inheritance problems.
Men prefer, of course, to sire children with their own sperm. One man, suffering from a scarcity of sperm, had failed to sire a child after four years of marriage. He resorted to the technique of "sperm isolation." After his semen was diluted and adulterants removed, the remaining sperm could be seen to be brisk and vigorous under the microscope. Now, to his joy, his wife has been pregnant for five months.
Sperm isolation is a good technique for artificial fertilization. The inventor, Dr. R. Ericsson, used semen protein liquid to filter sperm, It was found later that this method can boost the rate of male births to as high as 78 percent, because the sperm with the male Y chromosome are lighter and can swim more swiftly. Of the sperm collected after having passed through the diluted liquid, 80 percent have the Y chromosome.
The technique was introduced to Taiwan last year by gynecologists Lin Yu-chun, Chen Hung-ming, Chou Sung-nan and Shih Po-yuan. At first, they knew only that the method might satisfy Chinese traditional aspirations for male offspring, overlooking its value as a "cure" for infertility. In the past, semen containing only 10 million sperm per cubic centimeter was rejected by sperm banks. It is acceptable now after the introduction of the new technique. There are eight sperm isolation centers in the world. Establishment of the Taiwan center was authorized last April; it is charged with serving patients from Asia (including Hong Kong, Singapore, Sri Lanka, Malaysia, Thailand, Japan, Australia and New Zealand). It is also responsible for training doctors, who are eager to acquire competence in the new technique.
Despite the worldwide population explosion, artificial insemination is no mockery of birth control efforts. Birth control is meant to space out births. Artificial insemination can improve the health potential of children in certain cases, as well as provide the closest possible experience to couples who cannot conceive children by the natural way. Both are intended to better fulfill the long-range aspirations of young couples.