Men whose sperm is to be used in artificial insemination should be screened as rigorously as blood donors because of increasingly recognized risks of a variety of sexually transmitted diseases, from hepatitis to AIDS, two prominent experts contend.
And in urging greater adherence to standards already available for semen donor programs, the two doctors add that, with the contemporary complexities of diseases that can be sexually spread, "some things in life are not as straightforward as they used to be."
That lament and the urgent call for more stringent surveillance of semen donors appeared last week in the Journal of the American Medical Assn.
Hepatitis Traced to Semen
One of the two experts is Dr. Laurene Mascola, a specialist in disease patterns with the Los Angeles County Department of Health Services.
The editorial message by Mascola and Dr. Mary Guinan, of the federal Centers for Disease Control in Atlanta, accompanied an account by Denver physicians of a case of a woman with hepatitis B--the form of the disease transmitted by a virus--traced to donor semen. The case report added documentation to earlier accounts linking hepatitis to artificial insemination.
The medical journal exchange, moreover, underscored several developments central to a larger dispute over the safety of artificial insemination. It has been linked to the spread of acquired immune deficiency syndrome, gonorrhea, herpes, syphilis, vaginitis, a type of pneumonia, chlamydia and a variety of other infections as well as hepatitis.
These discoveries have provoked a controversy that has raged in reproductive medicine for at least four years, with two major professional organizations issuing standards and guidelines that conflict--at least in part. At the center are these questions:
- Should the use of frozen semen replace fresh, since frozen permits comprehensive testing before attempts to fertilize a woman and fresh is far less testable?
- On the other hand, though, is frozen semen less reliable than fresh in its effectiveness?
Because the practice of artificial insemination is highly fragmented--with many women using large sperm banks and fertility clinics but thousands of others seeking help from gynecologists--there are few reliable figures for the total of inseminations attempted and how many produce pregnancies.
But published figures and estimates by such groups as the American Fertility Society conclude that despite publicity about the possible hazards of fresh semen, it is still used in about 80% of artificial inseminations, with frozen accounting for the rest.
500,000 Babies Since 1890
Last year, Mascola and Guinan--who have warned of the need for better and more vigorous semen screening programs since 1983--estimated that, since artificial insemination was first used in the United States in 1890, 500,000 children have been born through this means. On the average, the two physicians noted, a woman trying to conceive by artificial insemination must undergo six or seven attempts before pregnancy is induced--which could involve semen from different men.
Of 30,000 to 60,000 inseminations each year, the two doctors calculated, 6,000 to 10,000 births occur.
Until recently, artificial insemination was thought to be essentially risk-free. But with the advent of AIDS and a related growing consciousness of sexually transmitted diseases in general, insemination is being viewed increasingly as a process in which careful safeguards are essential but often missing.
"With the latest medical technology, sexual intercourse is no longer a prerequisite for a woman to acquire a sexually transmitted disease," Mascola and Guinan concluded. "Artificial insemination must now be included as a possible source of these infections."
By most calculations, transmission of disease by insemination remains comparatively rare. There have been only a handful of documented reports of AIDS being passed through insemination and fewer than 30 confirmed hepatitis cases. Other sexual infections are somewhat more common, with estimates ranging between 6.7 and 9.4 infections of all types for each 1,000 inseminations.
But Mascola believes that artificial insemination will become an even more important part of American childbearing, particularly with the trend toward conception later in life.
"Just as the American Red Cross and the American Assn. of Blood Banks protect our blood supply, fertility organizations should protect the semen supply," Mascola and Guinan contended. "Artificial insemination should be at least as safe as a blood transfusion.
"All blood used for transfusion in the U.S. is screened for evidence of syphilis, hepatitis B and (the AIDS virus). Why should semen donors be less vigorously screened?"