The shocking news highlights uncomfortable, if less obvious, developments surrounding third-party gamete donations
It was this time _The New York Time_s that, in two articles within a few days, featured the subject of fertility providers, secretly, using their own semen, rather than third-party-donor semen, in treating their infertility patients.
This is, of course, not the first time that this subject has attracted media attention. The case that comes immediately to mind is that of Cecile Byran Jacobson, MD, a general obstetrician/gynecologist who in the 1980s operated a reproductive genetics and infertility center in Virginia. In the late 1980s he was accused of having fathered over 70 children by using his own semen in place of donor semen and, at least in one case, also in place of husband semen.
Studying his professional life, Jacobson must, however, be viewed as a sociopathic personality and serial criminal. While head of a reproductive genetics program at George Washington University School of Medicine in Washington, DC, he made the bizarre claim of having impregnated a male baboon by placing a female baboon’s eggs into the male’s abdominal cavity. Without offering any evidence, he further claimed to have terminated the pregnancy at four months.
In later years, when offering private fertility services, he claimed to “support” early pregnancies with injections of the pregnancy hormone, human chorionic gonadotropin (hCG), but then turned around and tested these patients for pregnancy by evaluating their hCG levels. They, of course, had positive pregnancy tests because of the injections they received, and Dr. Jacobson further misled them by claiming to see those non-existing pregnancies on ultrasound examinations. Use of his own semen was accidentally discovered during investigations of his other fraudulent activities. Though he maintained his innocence regarding all of these allegations, he was convicted in court of 52 counts of mail fraud, wire fraud and perjury and was sentenced to five years in prison. In addition, he, of course, also lost his medical license and, fortunately, no longer practices medicine.
On August 30, 2018, Mihir Zaveri, a New York Times writer published an article under the heading, “A Fertility Doctor Used His Sperm on Unwitting Women. Their Children Want Answers.” In this report a fertility doctor in Indianapolis, Indiana, by the name Donald Cline, MD, acknowledged deceptively using his own semen, and is now believed to have fathered 61 children according to an article by Hannah Smothers in _COSMOPOLITAN _on August 22, 2019.
On Wednesday, August 21, 2019, the writer Jacqueline Mroz penned an article in The New York Times under the title, “Their Mothers Chose Donor Sperm. The Doctors Used Their Own,” subtitled, “Scores of people born through artificial insemination have learned from DNA tests that their biological fathers were the doctors who performed the procedure.”
Dictionaries define “scores” as “large numbers.” Mroz in her article describes approximately 20 cases worldwide, where physicians have been accused of fraudulently using their own semen in place of third-part-donor semen. Twenty such cases, of course, are 20 too many; but 20 cases worldwide do not represent “scores” and, most certainly, also do not reflect “a generalized practice of deception,” as a prominent law professor and ethicist from the San Diego University School of Law in California by the name of Dov Fox claimed, as quoted in the recent New York Times and _COSMOPOLITAN _articles.
Crazy and/or dishonest, people exist in every profession. Medicine and the infertility field are, obviously, no exception. At the same time, the attention apparently given to this subject by the media seemingly primarily during the month of August, may suggest that it is more the doldrums of summer that bring this subject to the forefront than real concern about an “epidemic” of dishonest fertility specialists.
Both recent articles did, however, serve one very important purpose: They very clearly pointed out that confidential and anonymous third-party gamete donations, whether of semen or eggs, no longer exist. While fertility centers like CHR remain absolutely committed to anonymous third-party donations, the reality of direct to consumer genetic testing through such companies as 23andMe, makes it not only possible to trace criminals through family connections but also gamete donors.
The real story The New York Times and _COSMOPOLITAN _magazine, therefore, brought us over the summer, was not, as claimed by Professor Fox, “a generalized practice of deception,” but an end to anonymous gamete donation with potentially very important consequences for fertility practice. CHR, therefore, has amended all consent forms regarding gamete and/or embryo donations, to point out to donors and recipients, alike, the possibility, even likelihood, that the days of donor and recipient anonymity have passed. While CHR remains fully committed to confidentiality of the medical record and anonymity of all patients, CHR can only be responsible for sequestration of medical records at CHR. CHR and other IVF centers are, however, powerless in preventing, especially gamete donors, from losing their anonymity simply through genetic associations of close relatives, which now often can be freely accessed on the Internet through companies that sell direct-to-consumer genetic testing.
Recipients of donor gametes, therefore, likely no longer have free choice of telling or not telling their offspring where the gametes came from that created them. It appears increasingly obvious that parents must tell their children before they discover the truth accidentally on their own. Donors of gametes, therefore, should not be surprised if, one day a genetic offspring suddenly contacts them, just as offspring should not be surprised if a genetic father or mother unexpectedly enters their lives. Donor and/or recipient anonymity no longer exists!
Both above quoted recent articles on the subject of fertility docs being their own semen donors emphasized this point and correctly predicted that there, likely, will be, indeed, a few more cases discovered around the world; but to expect “scores” of cases, as suggested by The New York Times in above cited article, is an obvious exaggeration. Even “The Gray Lady,” apparently, these days must foster sensationalism to sell newspaper. How else can responsible editors allow a headline that equates 20 cases worldwide with “scores.”
And when it comes to law professors and ethicists: Dov Fox is the Herzog Endowed Scholar, Professor of Law; Director, Center for Health Law Policy & Bioethics at University of San Diego School of Law, where he directs the Center for Health Law Policy & Bioethics. A Rhodes scholar, he graduated from Harvard College, Yale Law School, and the University of Oxford, where he received a doctorate in political philosophy. More evidence that even very smart people at times can say stupid things and that behind every opinion there is self-interest. What the two writers that quoted him as an “expert” did not disclose to readers, is that in his book, Reproductive Negligence, Professor Fox strongly promoted a “newly recognized tort of reproductive negligence,” which, of course, is great new candy for plaintiff attorneys and will make Professor Fox a very valuable expert witness in court cases.
The public is also not told in these articles that, in the U.S., any third-party donation (eggs, semen, embryos) is strictly regulated by the Food and Drug Administration (FDA) under rules that follow organ-donation requirements. Fertility centers accredited by the FDA to use donor gametes and embryos are subject to unannounced inspections by FDA inspectors, who in detail review every such donation that has taken place since the last inspection. In addition, most states, New York included, have strict third-party state donation laws. New York State, for example, mandates that every frozen sperm and egg bank that offers samples to fertility clinics in the state, be licensed by the New York State Department of Health, wherever the bank may be located. Fertility centers in New York State, in addition, must have individual written contracts with all sperm and egg banks they are doing business with, and all of this is subject to regular inspections by investigators from the New York State Department of Health on both sides of the transaction.
Laws and regulations, of course, per-se do not prevent individuals from breaching them; but with the establishment of commercial frozen sperm banks and of frozen commercial egg banks over the last decade, third-party gamete and embryo donations have become part of a rather well-designed regulatory review framework that, under law, basically must include every such donation. Existence of such a system, of course, does not preclude breaches; but if such breaches were to occur in the U.S., it appears inconceivable that this would happen in reputable fertility centers, usually licensed and inspected by the FDA, often also by the College of American Pathologists (CAP) and local state departments of health. CHR, of course, is licensed and regularly inspected by all three of these certifying agencies.
This is a part of the September 2019 CHR VOICE.
Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned specialist in reproductive endocrinology, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.
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