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Infertile couples are traditionally a silent and unpublicized American minority. The American Medical Association estimates that roughly 15 percent of all married couples are unable to have children, and an additional 10 percent have fewer children than they wish.
Today, artificial insemination by a donor (A.I.D.) as a procedure for helping a woman with an infertile partner conceive is widely available. This paper will concern itself with the use of A.I.D. by couples—married and unmarried—as a means of having a family. (A.I.D. is also used when the male is a known carrier of a genetic disease and to eliminate Rh incompatibility.)
A recent survey published in The New England Journal of Medicine estimates that each year between 6,000 and 10,000 children are born in this country as a result of artificial insemination. They report that some 12,000 to 15,000 couples request this procedure annually and that at least a quarter of a million children have been born as a result of this medical procedure over the past 20 years.
Infertility in men—whether due to oligospermia (low sperm count) or azoospermia (no live sperm)—is generally unresponsive to treatment. For most couples, A.I.D. is a last resort, a decision that is reached only after years of frustration; of “trying;” of fertility work-ups and, perhaps, surgery; of family and social pressures; and of feeling alone and lost in a maze of medical decisions, anxieties, and fears as time passes and there is no baby to show for their efforts.
Infertility is thus a life-crisis usually dealt with in a psychosocial vacuum. Often it is accompanied by an identity crisis and guilt feelings on the part of the infertile partner. Male infertility is at odds with our cultural designation of the man as procreator and woman as “birther”. Among infertile couples, a new sexual identity must often be created—one that separates sexuality from procreation. Although only one partner may be biologically infertile, both partners have to recognize th