The Genius Factory
Page 18
Meanwhile, doctors facing the practical problem of infertility wondered how to use sperm to help their patients. In the 1770s, the celebrated London physician John Hunter (my father is named after him, incidentally) arranged the first human artificial insemination. Hunter’s patient suffered a penis defect that made it impossible for him to impregnate his wife, but he was still able to ejaculate. Hunter gave the man a syringe, told him to masturbate into the syringe’s barrel, and then inject the semen into his wife’s vagina. It worked. In the mid-nineteenth century, famed New York gynecologist J. Marion Sims used Hunter’s method—along with some very painful surgery—to impregnate women suffering from “hyperesthetic” vaginas with their husbands’ sperm. (The women supposedly had vaginas formed in such a way that they couldn’t have intercourse with their husbands. “Hyperesthetic” is Greek for “Not tonight, dear.”) Sims called his technique “ethereal copulation.” The success rate was low—less than 5 percent of the women got pregnant, probably because menstrual cycles were poorly understood. Condemnation was emphatic. The Catholic Church denounced artificial insemination: be fruitful and multiply, yes, but not this way.
Hard’s 1909 Medical World article was the first public hint that the new technique of artificial insemination could exclude the husband from reproduction. If artificial insemination using a husband’s sperm was morally questionable, artificial insemination by donor (AID, as it came to be known) was anathema. Doctors were outraged by the mere thought of it. Some, with a striking ignorance of human physiology, insisted that what Hard described occurring at Sansom Street Hospital was literally impossible: a woman simply could not get pregnant in this way—certainly not without her husband’s contribution. Others said that it was so immoral that it could not have happened. A doctor as noble as Pancoast would have been incapable of such a monstrous act.
But, immoral or not, AID was real, and it was useful, because it was the first effective fertility treatment. AID established the moral arc that all fertility treatments since—egg donation, in vitro fertilization, sex selection, surrogacy—have followed.
First, Denial: This is physically impossible.
Then Revulsion: This is an outrage against God and nature.
Then Silent Tolerance: You can do it, but please don’t talk about it.
Finally, Popular Embrace: Do it, talk about it, brag about it. You are having test-tube triplets carried by a surrogate? So am I!
With AID, as with the subsequent fertility treatments, three potent forces combined to overwhelm the initial disapproval. First, the distress of the husbands and wives, who would risk anything to have a baby; second, the enthusiasm of doctors to try something new (and profit from it); and third, doctors’ constitutional belief that they, not a backward society, should decide how their patients were treated.
After Hard’s article, AID slowly progressed from the denial phase to revulsion. Then, in the 1930s, revulsion began to give way to silent tolerance. In 1934, Dr. Hermann Rohleder wrote Test Tube Babies, a history of artificial insemination and description of his AI techniques. He initially asserted that the only suitable purpose of artificial insemination was impregnating a wife with her husband’s sperm and that donor insemination was outrageous: “What husband or wife, no matter how intense their longing for an heir, will consent to an injection of strange semen? Thank God that most people still have that much tact, decency, and moral feeling.” Yet just a few pages later, writing as a doctor rather than a moralist, Rohleder conceded that he would impregnate a woman with a stranger’s semen, under the right circumstances—if the husband was so desperate that suicide or divorce was a possibility, if the donor was healthy and unmarried, if the wife consented.
Rohleder’s pragmatism would triumph, and silent tolerance followed for fifty years. The use of sperm donors spread slowly but steadily in the United States and Great Britain, the two pioneering countries. Starting in the 1930s, British doctor Margaret Jackson began discreetly providing freshly donated sperm to patients. Donor insemination took off in the United States after the War. In the Eisenhower era, doctors in the big cities began performing AID regularly. They collected sperm from colleagues, from medical students, and, dismayingly often, from themselves. By 1960, American doctors were creating 5,000 to 7,000 babies a year by donor insemination, up from essentially none a decade earlier.
AID was the only fertility treatment that actually worked, and parents were grateful for it. Still, it remained a secret and shameful ordeal. Most patients went to one doctor to get sperm, then another for the pregnancy and delivery, so that the doctor delivering the baby never knew that the father wasn’t the biological father. Some doctors mixed sperm from the donor with the non-performing sperm of the father, so that the dad could pretend that his sperm had actually done the job. Doctors practicing AID usually kept no records at all, so there could be no chance of anyone finding out the truth. Doctors routinely signed false birth certificates, asserting that the sterile dad was the real one. The law encouraged such perjury: AID was technically adultery (still a crime in many states), and thus any child of AID was illegitimate.
In this first generation of AID, doctors tyrannized their patients. When a red-faced couple appeared at the office, mumbling about infertility, the doctor told them he would take care of everything. Mothers were discouraged from asking questions about the donor. The doctor did a little poking around for a suitable donor—often the closest medical student at hand. The doctor would make sure the donor was the right skin color—white patients got white donors. If the doctor was feeling benevolent, he would also try to match the eye color of the father. (Oddly, another trait that doctors sometimes tried to match was religion, as though it had some genetic component.)
If the pregnancy took, doctors instructed parents—and husbands redoubled the instructions to their wives—that they were not to tell the child anything. They must pretend to everyone that little Jill was Daddy’s girl, no matter how different father and daughter might look. The parents were told not to discuss it between themselves. They were even advised not to think about it. Fathers were ordered to behave toward the donor children exactly as they would behave toward their own biological children—advice that, not surprisingly, proved sadly impossible to follow.
This repression took its toll on families. Barry Stevens, conceived from AID more than fifty years ago, made a wonderful documentary, Offspring, about his search for his donor father. Stevens included clips of his own home movies, which show him, his mom, and his sister walking happily together and his sad-eyed dad trailing ten feet behind. His father, Stevens said in the movie, was always the family shadow—separate and unequal. The genetic disparity—mother connected by blood, father not—brought many DI kids closer to their mothers and drove fathers away. Most DI children never discover that their dad is not their dad. But those who do are rarely surprised; they always felt something wasn’t right.
When I started writing about the Nobel sperm bank, my inbox clogged with e-mails from kids of the first big wave of AID. Now in their forties and fifties, many were sad and bitter. They told me the same story: Dad wasn’t like a real dad. When Dad died, Mom finally spilled the secret. Now I want to find my donor dad. Their searches for their dads always fail. They just hit dead ends. They find that the doctor who inseminated their mom is dead. So are the nurses. The records have vanished or never existed. When they asked me for help, I always disappointed them. The best I could suggest was to advertise in the alumni magazine of the medical school where their mom got treated, because the donor might have been a student. But that has never worked either, as far as I have heard.
As AID became more common in the fifties, it started to poke its head out into the open, and society struggled with whether to welcome it or chase it back into its hole. Chasing was the first response. In the early fifties, a British parliamentary commission proposed criminalizing AID. The pope declared it a sin and recommended prison for doctors who performed it. In 1954, an Illinois state court rule
d that AID—even with the husband’s consent—was “contrary to public policy and good morals and constituted adultery on the mother’s part.” Thus, any DI child was illegitimate. (A 1959 British movie, A Question of Adultery, hinged on whether donor insemination counted as cheating on your husband.) But public policy gradually caught up with popular behavior. As American society loosened in the 1960s, attitudes toward sperm changed, too. In 1964, Georgia became the first state to legitimize DI kids. In 1968, the California Supreme Court held that a father who consented to AID for his wife couldn’t later duck his paternal responsibility: he had become the child’s legal father by signing his name to the AID contract. It did not matter that he had contributed no DNA. “Since there is no ‘natural father,’ we can only look for a lawful father,” the court wrote. In 1973, the American Bar Association approved the Uniform Parentage Act, a model state law confirming that a husband is the legal father of a child conceived with AID.
New science also encouraged the spread of AID. In the first generation of AID, physicians relied on fresh semen, collected moments before from convenient interns and medical students. In 1949, a British researcher accidentally discovered that sperm frozen with glycerol could survive freezing and thawing. In the 1950s and ’60s, American cryobiologists perfected the freezing process. They mixed the fresh sperm with a solution of glycerol, salt water, and egg yolk, then gradually cooled it down to minus 196 degrees centigrade in liquid nitrogen.
Fresh sperm had advantages: it was easy to handle, and it was very potent: women got pregnant from it pretty easily. But frozen sperm could be shipped. Even more important, frozen sperm meant you didn’t have to rely on whatever donor was handy. Instead, you could stockpile the seed of all different kinds of men. You could have a bank.
Frozen sperm enabled AID to become a business. In the early 1970s, a few companies in big cities began collecting and freezing sperm in bulk and selling it to doctors who didn’t want to wrangle donors themselves. From the start, sperm banking was a cowboy industry. The federal government didn’t regulate it; neither did states. Anyone could open a sperm bank and usually did. Sperm banks were started not only by doctors but also by technicians, salesmen, and activists. Robert Graham—who called himself Dr. Graham—was an optometrist, as much a “doctor” and as much a fertility expert as I am. In most states, nothing stopped you from opening Fred’s Sperm Bank and Delicatessen.* 2
Amateurs went into sperm banking in part because banking and donor insemination were so easy. To open a bank, you needed a minimally equipped lab and some liquid-nitrogen tanks. And it was just as simple for customers. Doctors, trying to preserve their monopoly on insemination, had fostered the myth that AI was a complex procedure that only trained medical professionals could perform. In fact, it was a cinch. Anyone could do an insemination with a little training. You thawed the sperm, put it in a syringe attached to a “tomcat” catheter, threaded the catheter deep into the vagina (in some cases all the way into the uterus), and injected. Do-it-yourself inseminations—resulting in what were nicknamed “turkey baster babies”—had a brief vogue among feminists in the 1970s and ’80s. Adrienne Ramm, the mother of three kids from the Nobel sperm bank, was inseminated by her husband at home. She said, “It was very important for us to make it a ritual at home, very important not to go to a doctor’s office. It was a very mystical experience for my husband to plant that seed.” (The Nobel sperm bank used to teach its clients the procedure. If a customer visited the Repository in Escondido, one of Graham’s assistants might give her an impromptu lesson, right in the office, using a mirror and a few handy instruments—a Pederson vaginal speculum, a Makler insemination cannula, and a syringe. “So many women would tell me, ‘That’s the first time I have ever really seen myself,’ ” said Julianna McKillop, who directed the bank in the mid-1980s.)
Frozen sperm finally supplanted fresh sperm with the advent of AIDS. Some doctors who used fresh semen had collected from infected men; at least one woman contracted HIV from donor sperm. In the age of AIDS, the greatest advantage of frozen sperm turned out to be the delay it permitted between donation and insemination. Banks could test the donor when he gave the sample, store it for six months, then test the donor again to make sure he was still disease-free, thus ensuring that the frozen sperm was clean.
But even AIDS didn’t prompt the government to pay attention to sperm banks. There were compelling political reasons why neither party wanted to start regulating fertility medicine. Lefties didn’t want to tamper with sperm banking and fertility, because that would imply a government right to control what women could do with their own bodies. Abortion rights advocates feared that precedent. And the Right tended to ignore sperm banking and fertility because, although they were medicine, they looked like commerce. The free market was providing services that women wanted: Why mess it up?
In 1987 and 1988, at the urging of then-senator Albert Gore, the Office of Technology Assessment surveyed the American sperm industry—the only time then or since that the government has studied it. According to OTA’s count, there were hundreds of sperm banks and more than 11,000 doctors performing inseminations. OTA estimated that 30,000 children per year were being born from anonymous donor sperm—which suggests that by now, there are about 1 million AID kids in the United States alone. OTA also found that only half of doctors kept any records of donor inseminations; and 2 percent of doctors admitted to having inseminated patients with their own semen.
Doctors could get away with inseminating patients with their own sperm, because fertility was still a field characterized by domineering physicians and timid patients. This became glaringly obvious in the “Sperminator” case of the late 1980s. Federal prosecutors indicted Dr. Cecil Jacobson of northern Virginia, aka “The Sperminator,” on dozens of counts of fraud. Jacobson, one of the leading fertility specialists in the United States, was wildly popular with patients. But it turned out that he was giving infertile patients hormone therapy that made them register false positives on pregnancy tests. The women got their hopes up, only to discover they weren’t really pregnant. He gave some women as many as ten false pregnancies. That was bad enough, but what really appalled the public was something else: Jacobson had also promised patients he would find them sperm donors who matched the characteristics they sought. Instead of doing that, he had simply inseminated them with his own sperm. Jacobson had fathered as many as seventy-five children this way. Patients were so awed by Jacobson that they didn’t realize he was scamming them. (He was the very model of the authoritarian fertility doctor, prone to saying such endearing things as “God doesn’t give you babies; I do.”) Perhaps the most amazing fact about the Jacobson case was that inseminating seventy-five women with your own semen wasn’t even a crime. In 1992, Jacobson was convicted on fifty-two counts, but self-propagation was not one of them. He surrendered his medical license and was sentenced to five years in prison. The fate of his children, whose identities were protected by the court, remains unknown.
The Sperminator case sparked enough interest in regulating sperm that the feds finally acted. In 1993, the Food and Drug Administration finally drafted regulations for sperm banks, requiring them to register with the FDA and screen donors for risk factors. But the first of those regulations did not take effect until 2004—eleven years later. Some of the regulations are still not in effect.
Robert Graham strolled into the world of dictatorial doctors and cowed patients and accidentally launched a revolution. The difference between Robert Graham and everyone else doing sperm banking in 1980 was that Robert Graham had built a $70 million company. He had sold eyeglasses, store to store. He had developed marketing plans, written ad copy, closed deals. So when he opened the Nobel Prize sperm bank in 1980, he listened to his customers. All he wanted to do was propagate genius. But he knew that his grand experiment would flop unless women wanted to shop with him. What made people buy at the supermarket? Brand names. Appealing advertising. Endorsements. What would make women buy at the sperm mark
et? The very same things.
So Graham did what no one in the business had ever done: he marketed his men. Graham’s catalog did for sperm what Sears, Roebuck did for housewares. His Repository catalog was very spare—just a few photocopied sheets and a cover page—but it thrilled his customers. Women who saw it realized, for the first time, that they had a genuine choice. Graham couldn’t guarantee his product, of course, but he came close: he vouched that all donors were “men of outstanding accomplishment, fine appearance, sound health, and exceptional freedom from genetic impairment.” (Graham put his men through so much testing and paperwork that it annoyed them: Nobel Prize winner Kary Mullis said he had rejected Graham’s invitation because he’d thought that by the time he was done with the red tape, he wouldn’t have any energy left to masturbate.)
It wasn’t just that Graham offered choices, it was that he offered the best—the Godiva of sperm, prime cuts of American man. In Graham’s catalog copy, the men were irresistible. He made them sound like men you could imagine talking to, men you could imagine taking a class from, and—above all—men you could imagine seducing. The physical descriptions included perfect, enticing details: “rosy cheeked, beautiful teeth.” A donor’s personality wasn’t merely “happy,” it was “happy and radiant.” One of Graham’s slyest marketing techniques was to scrawl handwritten comments on a catalog page—like throwing in the rustproofing for free: “Almost a superman!” he wrote on one.