When infertile couples sit down for their first counseling session at John Hopkins University's artificial insemination program, they usually have a lot of questions about the sperm donor. Things like height, eye color, religion, intelligence.

But "the first question 90 percent of all couples have," says Dr. William D. Schlaff, "is about AIDS."

Infection of women with the AIDS virus as a result of semen donation was first reported in Australia, where four cases have been documented, and similar cases have been reported in this country, although the exact number is not known. There have been no documented cases of actual AIDS from this cause in either women or their children, however.

At present, only a set of non-binding guidelines protects the public in most parts of the country from AIDS and long-term genetic risks as a consequence of artificial insemination by donor.

Only three states -- Idaho, Ohio and Oregon -- require screening of sperm donors for sexually transmitted disease, according to the American Bar Association Foundation. None of the Washington-area jurisdictions regulates sperm banking at present, although the D.C. City Council is expected to act on a bill early this year {see box}.

Laws or no laws, however, women who are seeking artificial insemination face difficult decisions.

A Popular Technique

Artificial insemination by donor is far more common in the treatment of infertility than all other methods put together, according to the American Fertility Society in Birmingham, Ala. It is used when the male partner has sperm that are defective, or has too few sperm to cause a pregnancy. Less commonly, it is used by unmarried women wishing to become pregnant on their own.

Recently, Episcopal priest Lesley Northrup has attracted the world's attention by becoming a single mother through artificial insemination. She has argued that the technique avoids the church's ban on sex outside of marriage, and her bishop has supported that position. But others have questioned this.

Northrup is one of an estimated 10,000 to 25,000 women who become pregnant each year in the United States by artificial insemination with sperm from men other than their husbands, according to the AFS. The wide range illustrates the uncertainty of all statistics in this field.

Use of concentrated specimens of the husband's own sperm -- successful in some instances -- is far less common. In 1982, the latest year for which figures are available, there were an estimated 150 such births. Physical inability of a couple to have their own child is the usual reason for substitute methods. But in one case cited by Schlaff, a lesbian turned to artificial insemination by donor because she sought to become pregnant without sexual intercourse. Moreover, the woman -- not one of Schlaff's patients -- specified that the donor be a gay man.

Ordinarily, gay men are not permitted to donate semen because theirs is the category at highest risk for acquired immune deficiency syndrome. Centers for Disease Control figures on the AIDS epidemic show that 74 percent of all reported AIDS cases have occurred in homosexual and bisexual males, with heterosexual intravenous drug users -- four fifths men, one fifth women -- making up the second largest group at 16 percent.

The AIDS virus and other viruses can be present in semen, which contains a high concentration of white blood cells.

At Hopkins in Baltimore, where the 35-year-old Schlaff heads the andrology program (andrology deals with male reproductive problems), about 250 to 300 pregnancies a year result from artificial insemination by donor. Costs of the treatment at Hopkins vary, depending on how many times it must be repeated. For a young woman in good reproductive health, about $1,500 is typical. surrogate motherhood (cost of which is a matter of negotiation).

Mainstream insemination programs usually follow widely accepted but voluntary standards set by the American Fertility Society or the American Association of Tissue Banks.

Donors of semen should be even more rigorously evaluated than donors of other tissues, the guidelines suggest. With transfused blood and transplanted organs, for example, a key consideration is that the donated materials be biologically compatible with those of the recipient. With semen donation, the emphasis is on assuring that a donor is healthy, unrelated to the recipient and has had no close blood relative with any hereditary disease.

AFS guidelines for screening prospective donors, therefore, list a long series of disqualifying conditions (juvenile diabetes, high blood pressure or rheumatoid arthritis in the family, as examples) and also include family histories of such ethnically linked disorders as sickle-cell anemia (in blacks) and Tay-Sachs disease (in Jews of eastern European descent).

The Hopkins donor pool is drawn from the medical school community, Schlaff explained: Students and their sexual partners, who must undergo medical examinations and personal interviews and are periodically re-screened.

Hopkins pays donors $35 per donation -- enough, as Schlaff put it, to compensate them "for their time and energy" but not enough to be highly profitable. Donors are primarily motivated by a wish to be of service to others, he said.

Schlaff said his donor list is made up of heterosexual, monogamous men. If a donor divorces or changes partners, he is disqualified for six months and then retested before becoming eligible to donate again.

Dr. Sidney M. Wolfe, head of the Washington-based Public Citizen Health Research Group, questions the adequacy of a six-month quarantine in view of recent findings that the AIDS virus can remain latent for a much longer period before stimulating reactions that produce positive antibody test results.

Fresh or Frozen

The question of AIDS risk hinges to some extent on whether fresh or frozen semen is used. While semen donor services provide fresh semen, sperm banks provide frozen. Some statistics show that fresh semen is used in the vast majority of cases -- 80 percent, according to one estimate.

Schlaff prefers fresh semen because it is 10 to 15 percent more likely than frozen semen to achieve pregnancies.

When frozen semen is used, it is possible to retest the donor for AIDS months after donation -- but before use -- to be sure latent virus was not present. Births have occurred after insemination with donor semen that has been frozen for as long as 12 years in Denmark and up to 10 years in the United States.

Frozen semen has the further advantage of being somewhat more convenient. When insemination is with fresh semen, it is necessary to have the donor available when the woman is at the optimum point of her ovulatory cycle for conception to occur. With frozen semen, the product can be ready for thawing and use on short notice without regard for the donor's whereabouts.

Wolfe and other observers believe that whether fresh or frozen semen is to be used, a prospective donor should be shown not to have AIDS antibodies for two years.

AFS guidelines call for a semen specimen to contain 2 milliliters (about half a teaspoonful) of material with a concentration of 50 million motile (active) sperm per milliliter. Many men produce semen with twice that number of active sperm.

Because few couples trace their fertility problem to a total lack of active sperm in the man's semen, some doctors mix a little of the husband's semen with that of the donor to create the possibility that the sperm cell that actually fertilizes the ovum will be one of the husband's. Schlaff regards this as a gimmick that is unlikely to do good and may, in fact, lessen the chances that artificial insemination will succeed.

The question of paternity rights and responsibilities has been settled in 30 of the 50 states (including both Maryland and Virginia, but not West Virginia and the District, Andrews said). These 30 states recognize the husband as legal father if he signs a statement acknowledging the child. If he does, the biological father has neither the rights nor responsibilities of parentage.

Schlaff explained that the main reason Hopkins does not do artificial insemination for single women is that Maryland law is unclear on paternity questions where there is no husband. Many fertility clinics do accept single female clients, however.

Indeed, an article in the Journal of the American Medical Association on Oct. 16 reported self-insemination by women who, not wishing to have a sexual relationship with a man, manage to obtain semen specimens that they administer to themselves.

"While this may spur visions of a whole series of amusing columns by Miss Manners, there are serious issues involved," the author of the report writes.

Questions of Identity

Semen donor services must also watch out for more subtle problems. For instance, overuse of a single donor in the same community could have long-term adverse consequences.

Because the donor is anonymous to the recipient (though not to those running the service), the concern is that, a generation later, young couples unaware that they are biologically related could, unwittingly, marry and have children.

At Hopkins, said Schlaff, the chances of this happening are minimized by dropping any donor after his semen results in 10 births. If the inseminated woman miscarries or fails to become pregnant -- it often takes two, three or more tries -- the same donor can be used again. But 10 births per donor is the limit.

The bill pending before the D.C. City Council would set a legal limit of one birth per donor.

While the donor's identity is ordinarily unknown to the recipient, his general characteristics, such as race, size, eye and hair color, usually are discussed. Pre-treatment counseling is an integral part of any good infertility program, says Schlaff, in part to learn -- and if possible to accommodate -- the couple's desires.

To the question, "Will the baby look like my husband?" Schlaff explains that physical resemblance does not necessarily go hand in hand with parentage. If possible, most infertility clinics try to match, say, a tall, blond, blue eyed -- or short, dark, brown-eyed -- donor to the recipient's husband.

Some of the "laundry lists" brought along to the first pre-treatment interview run two or three pages, said Schlaff, and some make what might be considered curious demands.

"What I try to keep coming back to with couples is that there's a great deal of uncertainty about what is inherent and what is nurtured," he said. "We don't know whether sailing as a hobby is something that's going to be inherited or nurtured, but it's probably going to be nurtured."

Sailing as a hobby -- on the wish-list for a baby? Absolutely, Schlaff said. "They also say, 'I want somebody who's musical,' or 'I want somebody who can move to the left and really put a basketball in the hoop.' "

It is also common for couples to request a donor who is of the same faith, Schlaff added, although religious preference is a matter of family tradition, not biological heredity.

Competing Concerns

Reflecting public and legislative interest in fertility, the congressional Office of Technology Assessment will publish a report on the subject in March.

Patricia King, an associate professor of law at Georgetown University who served as an adviser to the OTA panel, notes that competing concerns make unconventional participation in reproductive relationships troublesome for society.

"Technology," says King, "is helping people otherwise unable to have children to have them and be reasonably sure they will be healthy. At the same time, these processes and techniques raise serious questions because they give us the capacity to design our future offspring, to some degree."

Noting that there are two sperm banks in California -- one that takes semen only from Nobel laureates and another that is run for feminists, King said: "That sort of thing smacks of eugenics, and we find ourselves confronted with the need to balance the benefits of what we are doing against the risks.

"It's a very narrow line, and one that is not easy to draw."

William Hines and Judith Randal are Washington writers.

More Information

Couples contemplating artificial insemination can get a copy of "New Guidelines for the Use of Semen Donor Insemination: 1986" by writing the American Fertility Society, 2131 Magnolia Ave., Suite 201, Birmingham, Ala. 35256, with $2 for handling.)

Persons who know they were conceived through artificial insemination by donor are being sought for interviews in a study by Catholic University's Dr. Joan Mullaney and researcher Carol Geithner. Call 966-4781.