While some people try to avoid having babies, one of every six couples of childbearing age can't conceive a pregnancy after one year of trying, or can't carry a pregnancy to live birth.
At least 10 million people have an infertility problem, according to Resolve, a national, non-profit organization that offers counseling, referral and support groups for infertile people.
Some barren couples opt for artificial insemination. From 6,000 to 10,000 children are born in the United States each year to women made pregnant with sperm from anonymous donors, according to a recent University of Wisconsin study headed by geneticist Martin Curie-Cohen
Infertility of the husband, according to the study, is the primary reason for administering donor insemination. Some doctors provide the service for other reasons, including the husband's fear of transmitting a genetic disease or a single woman's desire to have a natural child.
The University of Wisconsin study, which chastises doctors who do not ensure that sperm-donors are genetically healthy, also recommends the establishment of guidelines limiting the number of pregnancies by a single donor, to avoid accidental incest among offspring with the same father.
A couple choosing artificial insemination should have a strong motivation for parenthood since moral, ethical and religious considerations are involved in this procedure, cautions the American Fertility Society.
Most patients who get pregnant do so in the first six months of treatment, according to AFS figures. The success rate with fresh semen is roughly 70 percent and with frozen semen about 50 percent.
Area costs for artificial insemination by donor run about $55 to $100 per insemination, with two inseminations per cycle. If no pregnancy occurs within three to six months, reevaluation is usually in order.
The beauty of the system is that virtually all people come back for a second child by donor," notes Dr. Jay Grodin, co-chairman of the division of reproductive endocrinology and infertility at George Washington University.
For anyone considering artificial insemination, experts offer this advice:
"Make sure the man settles his feelings about not being the genetic father," says Resolve executive director Barbara Eck Manning. "If he feels ambivalent, it's not a good idea to go ahead until it's something both partners want. A professional counselor may be helpful." The man and woman each should sign a consent document.
Decide what degree of confidentiality you prefer. Some people advocate telling the family, friends and the child, particularly if the child will need to know his medical heredity. Others feel there is no benefit in telling anyone, since a responsible physician screens donors to avoid the possibility of genetically-transmitted disease.
Consult a lawyer, suggests Wisconsin geneticist Curie-Cohen. Only 14 states (including Virginia) have any laws concerning the status of children conceived through artificial insemination. Some people legally adopt the child to protect his or her legitimacy, rights to inheritance and child support.
Ask your gynecologist for a referral, says Dr. John Marlow of Columbia Hospital. Any academic medical center should have knowlege of reputable practitioners.
Ask questions about the donor. Make sure, says Dr. Marlow, he has been screened for venereal disease and any transmittable genetic problems.
Ask how the doctor keeps records. A good system would have donors given an anonymous number, with the corresponding names and numbers destroyed. This way the donor's medical record would remain available, without the problems of identification.
For information on infertility, write Resolve, P.O. Box 474, Belmont, Mass. 02178, or the American Fertility Society, 1608 Thirteenth Ave. S, Suite 101, Birmingham, Ala. 35205.
Dr. Richard Falk will discuss the psychological implications of infertility at the monthly meeting of the Washington metropolitan chapter of Resolve at 7:30 p.m. Sept. 19 in the Bethesda Library, 4900 Arlington Blvd.