The Wandering Uterus

Politics and the Reproductive Rights of Women

Cheryl L. Meyer

• Publisher: NYU Press
• Year: 1997
• ISBN:
  9780814796481
• Topic: Social Sciences
• Subtopic: Gender Studies
• Index: Social Sciences

From the FDA review of RU-486 to the recent growth of fertility clinics to the rights of lesbian parents, women's reproductive lives are aggressively regulated by law and medicine. While a great deal has been written on such issues as abortion and postpartum depression, no single volume has offered a broad discussion of the interface between the legal, medical, and political aspects of women's reproduction in a manner accessible and informative to non-specialists. The Wandering Uterus fills that gap. Taking her title from an ancient Greek belief that women's health problems were caused by a wandering uterus that needed to be confined and controlled, Meyer exposes the way in which myths and prejudice about female sexuality continue to influence the practice of law and medicine today.

This book offers new insights and provides a wealth of up-to- date information on a subject that changes every day. The text is divided into three main parts: political issues of pre- conception, the politics of pregnancy, and the politics of motherhood. Throughout, Meyer argues passionately that while technology and medicine must progress, they should not be allowed to do so at women's expense.

[1]
Politics and Reproductive Technologies I: Gamete Donation

Rosanna and Mauro della Corte were devastated when their only child, Riccardo, was killed in a traffic accident at seventeen. Rosanna said, “If you only knew what darkness there is in this house, without a young boy who filled it with his joy and smile. I desire so much to have another face to caress, to be able to hear somebody call me mother.”¹ So the della Cortes decided to adopt a child. However, they were considered too old for adoption. Then Rosanna read an article about Severino Antinori, a gynecologist in Rome, Italy, who could assist Rosanna in becoming pregnant. Antinori fertilized a donor’s egg with Mauro’s sperm and implanted the embryo in Rosanna’s uterus. On 18 July 1994, Rosanna gave birth to a seven-pound, four-ounce son. At sixty-two years old, she is considered the oldest woman in the world to give birth.

Postmenopausal mothers or “Methuselah moms,”² as they have been dubbed, have become a focus of debate relating to advancing reproductive technologies. These technologies have placed the “miracle” of birth under the control of mere mortals. While many laud this development, others sound the alarm, prophesying outcomes akin to that which issued from Dr. Frankenstein’s laboratory.

Sensationalized accounts of reproductive technologies are widely circulated, and virtually everyone has an opinion regarding the morality, ethics, or legality of their use. Yet rarely do those same individuals discuss the impact on women of the new reproductive technologies. While they have definitely provided women (and men) with more ways to acquire offspring, this does not necessarily translate into greater reproductive choice, rights, or control. The focus of this chapter will be on reproductive technologies relating to gamete (egg or sperm) donation, while the focus of the next chapter will be on in vitro fertilization, including surrogate mothering and cryopreservation (freezing) of embryos.

Alternative Insemination

Alternative insemination (or AI, formerly known as artificial insemination) is the most widely practiced, successful, and notorious of the reproductive technologies. It has even been satirized (generally without much success) by Hollywood, as in Whoopie Goldberg’s Made in America. However, lumping AI in with the new reproductive technologies is somewhat misleading.

First, AI does not involve much technology. It didn’t take the wonders of modern science to figure out the process. Secondly, although medically assisted AI has recently become more popular, probably due to purportedly increasing rates of infertility and the advent of cryopreservation of semen, the possibility of alternative insemination was mentioned in the Talmud,³ and animal insemination has been practiced for centuries. The first recorded gestation and delivery of a child conceived through alternative insemination occurred in 1790.⁴ In fact, legend has it that in 1884, one Dr. William Pancoast anesthetized the wife of an infertile man and, without the permission of the man or his wife, inseminated her with semen from the “most handsome man in his class of medical students.”⁵ The husband apparently “received the news with great enthusiasm.”⁶ In short, “by the early 1900’s, the practice of DI [donor insemination] was well under way. Twenty-four articles had been written on the subject of DI in the United States by 1938, and a 1941 survey estimated that almost 3,700 inseminations had occurred in the United States.”⁷ By 1938, the survival of sperm after freezing (cryopres-ervation) was noted and a successful human pregnancy from frozen sperm was recorded in 1953.⁸ What is new is the $164-million-a-year “industry” that has developed from the increasing demand for semen and/or semen storage.⁹

It is impossible to calculate the exact number of sperm banks or physicians who perform inseminations or the number of inseminations which occur annually, because there is no federal registry of providers or recipients. Record keeping is often poor, haphazard, or nonexistent, and physicians continue to do improper follow-up. In Canadian fertility clinics, the success rate cannot be established for in vitro fertilization or AI due to poor record keeping.¹⁰ Anecdotal evidence of poor record keeping made national headlines when a New York woman was inseminated with and impregnated by sperm she thought was from her dying husband. In fact, the semen was from an anonymous donor whose race was obviously different from that of the woman and her husband. The woman sued, maintaining that her daughter was subjected to racial prejudice as a result. The case was settled out of court for $400,000.¹¹ As of 1987, only about half of the physicians regularly performing inseminations in the United States indicated that they had records which would permit them to identify the specific donor for any specific pregnancy.¹²

The best recent estimates regarding insemination practices are from an Office of Technology Assessment (OTA) report, which indicated that approximately 172,000 women underwent medically supervised AI in 1987, resulting in 65,000 births. Most major hospitals claim to have an infertility program involving some aspect of alternative insemination, and an estimated 11,000 physicians perform AI occasionally. There are approximately 150 sperm banks in the United States,¹³ supplying semen to physicians, hospitals, or in some cases, private individuals. Sometimes semen from husbands or partners is used. For example, if a man has a low sperm count, semen specimens may be accumulated and frozen, then used during a woman’s fertile period. In other cases donor semen is provided.

Donors are paid an average of fifty dollars per ejaculate. If the semen is to be frozen, the ejaculate is generally combined with a preservative (and perhaps other products to prevent the formation of ice crystals) and divided into three or four vials. The vials are cooled, then placed in a liquid nitrogen tank for storage. Sperm can be stored up to ten years, perhaps longer, and still retain effectiveness. Vials sell for an average of $100 to $140 per vial.

Women (and their partners, if they are part of a couple) seeking pregnancy through alternative insemination ordinarily select donors from profiles provided by the sperm bank, hospital, or physician. These profiles may be very cryptic, with little background information about the donor, or may include extensive information, including physical characteristics and family medical history. At least one bank provides an option wherein the patient can select either an anonymous donor or a donor who has signed an “identity-release policy.”¹⁴ Donors signing this release policy agree to allow any child conceived by insemination to learn the identity of the donor when the child turns eighteen. This latter option is appealing to many prospective donors as well as recipients.

In a typical program, patients are encouraged to keep track of their menstrual cycles in order to anticipate ovulation. When ovulation does occur, physicians recommend two to three inseminations per cycle, generally twelve to twenty-four hours apart. The semen is thawed (if frozen), drawn into a syringe, and placed near the cervix (or in the uterus if the insemination is intrauterine).

Fresh sperm is more motile and therefore provides a higher rate of conception than frozen sperm. Additionally, using fresh semen can virtually eliminate medical intervention. Quite simply, after the donor ejaculates, the semen is immediately used for insemination. However, choosing frozen semen over fresh has numerous benefits. One is a lower incidence of birth defects.¹⁵ Evidently, healthy sperm have a greater likelihood of surviving the freezing process. In addition, donor semen is sometimes tested and rejected for genetic defects. Another benefit cryopreservation provides is greater flexibility in the AI process. Previously, donors had to be available when ovulation occurred in order to donate. Now, the donor doesn’t even have to be present. Nor does a physician.¹⁶ If the health care provider is amenable, and the woman has learned the insemination procedure, the semen specimen can be placed in a portable liquid nitrogen tank or in a cooler of dry ice and insemination can take place at home.

But the most important benefit of cryopreservation is safety. A donor can now be tested for the presence of infectious diseases such as HIV upon donating, and his semen can be quarantined until he is retested six months later. Unfortunately, this is not necessarily standard operating procedure. Physicians still continue to use fresh semen samples and untested donors, disregarding health and safety concerns.

In February 1992, the infamous “love doctor,” Cecil Jacob-son, was brought to trial for fraud and perjury.¹⁷ Apparently, Jacobson had used his own sperm to inseminate and impregnate female patients while telling them that the semen was obtained from anonymous donors. He reportedly “fathered” seventy-five children through such deception. Jacobson was able to perpetrate such fraud because semen, semen donors, and semen providers are not regulated by any federal agency. Therefore, semen providers, such as sperm banks or private physicians, are not required, under federal law, to follow any standards for record keeping. Nor are they required under federal law to screen semen donors in any way, even for infectious diseases like human immunodeficiency virus (HIV) or genetic conditions like Huntington’s disease. Even though screening blood donors for the presence of HIV has been federally mandated since 1985, no such regulations exist for semen donors. The risk of transmitting infectious disease should have always been a concern when inseminating. Even veterinarians were warned, in 1985, of the risks of diseases transmissible by semen transfer in animals. AIDS has made insemination potentially deadly.

The transmission of HIV through donor semen has been documented in research¹⁸ and anecdotally. The first lawsuit in the world filed by a woman who became HIV-infected through donor semen came to trial in 1991, in British Columbia, Canada.¹⁹ Kobe ter Neuzen was in her thirties, had a career as a psychiatric nurse, and wanted to have a baby. However, she had not met the right partner, and since her proverbial biological clock was ticking, she decided to try insemination. Her attempts began in 1981 and continued through 21 January 1985. She had decided this, her thirty-fifth, would be her final attempt. Unfortunately, on this final attempt, she was inseminated with and infected by HIV-positive semen. The donor had been used to inseminate thirty-five other women over a fourteen-month period. One of those patients, who did not join in the suit, also tested HIV-positive. The physician had been using only fresh semen and had not warned his patients of any risks associated with insemination.

Kobe ter Neuzen sued the physician, Dr. Gerald Korn, and the donor, Eric Kyle, who could not be found for trial. Dr. Korn’s screening procedures had consisted of an interview only. He sometimes tested semen for the presence of venereal disease but never screened for HIV. Korn claimed he was unaware at the time (1985, the same year the Red Cross mandated testing of the blood supply) that HIV could be transmitted through donor semen used in insemination. At trial, experts presented conflicting testimony with regard to whether Korn could have been unaware of a link, but the jury found Korn negligent and guilty of breaching warranty of quality goods, awarding ter Neuzen $883,800 in damages. Korn appealed the finding of negligence and the amount of damages awarded, and the appeals court ordered a new trial on these issues.

At least five women in the United States, four women in Australia, and two women in Canada have reported contracting HIV through inseminations. Two of the five American women, Mary Orsak and Cynthia Hallvik, were infected through semen obtained from the same donor.²⁰ The donor’s semen had been used to inseminate fifty-three women, six of whom have not been tested for HIV. Orsak and Hallvik have both brought suits against the physician and clinic involved, the first lawsuits filed in the United States by women infected with HIV through donor semen.

It is difficult to determine how many women have contracted HIV through insemination. Some may not be able to isolate the cause of the infection. Others may not report the cause to the Center for Disease Control (CDC). It is also difficult to determine how many women have been exposed to HIV through inseminations because record keeping for donors and recipients is often inadequate. At least one woman who was exposed to HIV (but did not contract the virus) filed a lawsuit.²¹ Diane Brown was inseminated twice each month from August 1986 through April 1987. The physician, Dr. Sander Shapiro, alternated each month between fresh and frozen semen, using fresh for the last two inseminations. After the last insemination, the donor tested positive for HIV. Although Diane Brown tested negative for HIV, she and her husband sued Dr. Shapiro for negligence, medical malpractice, and infliction of emotional distress. The jury found Dr. Shapiro was not negligent, and the verdict was upheld on appeal. It is possible that other women who have been exposed or infected have filed lawsuits but that these suits have not come to the attention of the media and were settled out of court or have not been appealed, which makes them difficult to track.

Many women have risked exposure to HIV from semen that has undergone a controversial “sperm-cleansing” procedure (also referred to as the “swim-up” method). In sperm cleansing, the semen of an HIV-positive man is centrifuged, and the motile sperm which swim to the top are incubated, washed, and collected for insemination.²² Using this method, many HIV-discordant couples, where the man is HIV-positive and the woman is not, could theoretically have a healthy child.

Some women have reportedly conceived and given birth to healthy babies using this method, without becoming HIV-positive. In 1989, the University of Milan, reported that fifteen out of twenty-nine women became pregnant through “processed” semen.²³ Ten healthy babies were born, and all continue to test HIV-negative. Conversely, that same year a woman in the United States became HIV-positive after being inseminated with “cleansed” sperm. She did not report engaging in any other high-risk activities. Her physician was fined five thousand dollars and reprimanded by the Virginia State Board of Medicine. The CDC cautions against this technique, but it is not regulated.²⁴

In addition to HIV, other sexually transmitted diseases have been transmitted through donor semen. Women have been infected with herpes, hepatitis B, gonorrhea, trichomonas vaginalis, cytomegalovirus (CMV), group B streptococci and chlamydia trachomatis.²⁵

State Regulations

Recently, some states have begun to regulate semen providers. Of course, state regulations, by their very nature, are not uniform. Most state statutes contain some provisions regarding donor screening. Some require that the donor be initially tested for HIV infection;²⁶ others require both this and other tests.²⁷ However, these statutes do not stipulate restrictions regarding the use of fresh semen, which means that HIV could still be transmitted if the donor’s blood had not seroconverted²⁸ from HIV- to HIV+ at the time of donation. Some states require freezing and quarantining of semen for six months until the donor can be retested for HIV.²⁹ A few states allow various exemptions from these provisions for spouses or mutually monogamous partners.³⁰ At least two states require physicians to warn recipients about the risks inherent in the insemination process.³¹ Some states require sperm banks operating within the state to be registered with the department of public health. Illinois and Delaware fine banks which are not so registered.³² Unfortunately, the statutes do not require the registration of private facilities or private practitioners, who can be the worst offenders when it comes to the careless screening of donors.

Violators of state statutes may incur a fine,³³ civil liability,^3...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Dedication
• Contents
• Acknowledgments
• Introduction: The Wandering Uterus
• 1. Politics and Reproductive Technologies I: Gamete Donation
• 2. Poitics and Reproductive Technologies II: The Legacy of IVF
• 3. Politics and the Control of Women’s Bodies
• 4. Politics and Reproductive Issues in the Workplace
• 5. Politics and Reproductive Choice
• 6. Reproductive Interventions
• 7. Back to the Future?
• Notes
• Index