COMMENTARY

Was It Wrong for a Fertility Doc to Secretly Donate Sperm?

Arthur L. Caplan, PhD

Disclosures

April 23, 2018

Hi. I'm Art Caplan, head of the Division of Medical Ethics at the NYU School of Medicine.

Thirty-six-year-old Kelly Rowlett got some very surprising news after she sent a DNA sample to ancestry.com, one of the DNA sites that advertises that it can get you information about who your ancestors are. They frequently advertise on television and social media. It's the kind of information that physicians may get questions about. "Is this a good idea? Is it something I should do?"

Kelly got a surprise. It turns out that a match was found with a physician maybe 500 miles away in Idaho. The ancestry.com folks suggested that she had a father that she didn't know about in Idaho. This physician, apparently, used his own sperm to help create Kelly because her parents were having a hard time conceiving. They used a donor, but her parents didn't know it was going to be this physician.

There are a number of interesting ethical issues that arise from Kelly's case. Obviously, anybody who's going to act as a sperm donor, if they're going to be anonymous, needs to assure a couple that they're truly going to be anonymous. Just saying, "I'm not going to use my name as the treating physician" is not going to work.

We've had cases such as one that occurred 30 years ago, where Dr Cecil Jacobson got hundreds of women pregnant at an infertility center, using his own sperm. It's clearly wrong. You can't do that. You have to make sure that if you are the sperm donor, the couple has given their consent.

It's also important to realize that with DNA testing, when we say that someone is going to stay anonymous, that may not prove to be true. DNA testing may turn out, as it did with this young woman, to give information about who the donor was—whether the donor likes it or not, whether or not the donor ever gave consent.

I can say with some authority that if somebody chooses to pursue finding out who their biological parents are and they go to court to get the right to look at records, or see information from the infertility clinic, they are very likely going to win that right.

We've seen in many adoption cases where people have been promised anonymity if they put a child up for adoption, and decades later, the children show up and say—psychologically or for medical reasons—that it's important for them to know who their biological parents are. They win those cases. I think we're going to see the exact same thing take place with respect to infertility treatment and donors of sperm, eggs, and embryos.

Perhaps the most interesting issue to come out of this is, if you're asked about these tests, what should you say? If somebody asks about, 23andMe, ancestry.com, or many other direct-to-consumer genetic testing services that are advertised, I think you have to warn people who are thinking about taking these tests. They may find out that their [ancestors are from countries that they didn't expect, or other information that they didn't anticipate.] Even those claims are somewhat controversial. Genetic testing from these companies is not always 100% accurate. Some of the ancestry claims aren't well grounded in knowledge about where people were in the past in terms of where they migrated or where they come from.

Maybe you'll find out something, maybe you won't; but there are other dangers. You may find out that you were born from an infertility treatment that your parents never told you about. You could find out information about incest. Genetic commonalities that shouldn't be there may hint that something happened in the past. [People aren't always] aware that they can find out these types of things. You could find out that the racial or ethnic group you think you're from isn't the one that you are actually from, and that can cause issues and problems depending on how that sorts out.

Ancestry testing may sound like fun. There was a lot of advertising promoting it as a fun holiday or Christmas gift last year: Give a kit; let people have a good time doing—what I call—recreational genetics. There are consequences and potential downsides, and people need to know that. When asked, physicians need to inform people that there may be facts in the genetic weeds that you really don't want to find out, or that you need to be prepared to confront.

I'm Art Caplan at the NYU School of Medicine. Thanks for watching.

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