Characterizing the Material

In 1909, a short article appeared in Medical World, a "practical medical monthly." The author, Addison Hard, described a scene from twenty-five years before, when he and fellow medical students were observing Dr. William Pancoast's practice in Philadelphia. The doctor was approached by a wealthy merchant and his wife who confided their difficulties in conceiving a child. After discovering that the merchant had no sperm in his semen, one of the students joked that it was time to "call in the hired man." The doctor requested a sperm sample from the "best-looking member of the class" but did not inform the couple of his plans. He called the merchant's wife into his office, administered chloroform, and inseminated her with the student's sperm sample. She gave birth to a healthy baby boy. Eventually, Dr. Pancoast informed the merchant, who was "delighted with the idea," but both decided not to tell his wife.

Several aspects of this story foreshadow the organization of gamete donation in the United States, including the centrality and power of physicians, the endemic secrecy associated with what was considered a morally questionable practice, and the selection of donors thought to have superior qualities. In tracing the development of the medical market for sex cells, from its earliest incarnations to the present day, focusing on information—what physicians wanted to know about the men and women providing gametes as well as what they shared with recipients—reveals stark differences in the management of sperm and egg donation. In this chapter, I look at how the process of characterizing reproductive material and the people donating that material have changed over time.

SPERM: FROM MEDICAL SERVICE TO COMMERCIAL PRODUCT

As the nineteenth century gave way to the twentieth, physicians began coupling the technology of artificial insemination with the use of donated sperm, but they did not trumpet the availability of this service, either to patients or to other physicians. An American doctor writing in the 1930s reported finding just a few scattered articles about this "therapy" for male infertility in the medical literature. In part, this was due to continuing questions about its legality, as there had been court rulings defining the use of donated sperm as adulterous and the offspring as illegitimate. The rulings concerned physicians in the newly formed American Society for the Study of Sterility (later the American Fertility Society and now the American Society for Reproductive Medicine), who singled out artificial insemination as one of the issues they intended to address in the very first issue of their journal, Fertility and Sterility, published in 1950.

In fact, the nascent society had already formed a special committee headed by Alan Guttmacher, who had also been an advocate for access to birth control and abortion. A survey of the society's ninety-six members in 1947 revealed that the majority approved of donor insemination, and the forty-four physicians who reported offering it had inseminated a total of 568 women that year. Just a few years later, the following resolution was overwhelmingly approved by the full membership.

If it is in harmony with the beliefs of the couple and the doctor, donor artificial insemination is a completely ethical, moral, and desirable form of medical therapy. Conditions under which donor artificial insemination is acceptable include:

1. Urgent desire of the couple to have such therapy applied to the solution of their infertility problem.

2. Careful selection by the physician of a biologically and genetically satisfactory donor.

3. The opinion of the physician, after thorough study, that the couple will make desirable parents.

Publicized as one of the society's first major policy statements, it was covered by the New York Times, Reader's Digest, and McCall's.

In defining sperm donation as a medical therapy, physicians sought to dismiss the claims of legal and moral authorities over the procedure in a process that Peter Conrad has labeled "medicalization." Such appeals to the professional and cultural power of medicine were particularly effective in the middle of the twentieth century, a period known as the "golden age" of medicine, when physicians retained wide latitude in defining matters of health and the body, including reproduction.

To find "biologically and genetically satisfactory" donors, physicians generally looked to the ranks of medical students and residents, calling them in as necessary to provide a fresh sample in exchange for a small fee. For each sample, donors were paid around $20 to $35, a rate that did not change much over the course of the twentieth century. In matching donors with recipients, the 1947 survey demonstrated that physicians prioritized "physical resemblance" to the recipient's husband, with "racial identity" at the top of the list while many also attempted "mental similarity" and "religious equality." Physicians undertook these efforts to facilitate the recipient couples' ability to keep donor insemination a secret, and physical resemblance to the husband remained paramount over the years. Additional criteria for the donor eventually came to include minimum sperm count, satisfactory family health history, and tests for sexually transmitted diseases.

Doctors maintained strict anonymity between donors and recipients, leading some support staff, often women working as nurses or secretaries, to conduct surreptitious screening of the men who applied to donate. CryoCorp, now one of the largest sperm banks in the country, was founded by a physician in the 1970s, and here he explains his initial procedures for screening donors.

Founder: We would advertise at [the university], and then I would do a physical on a donor, a history. I would get a sperm count, freeze the sample to see if it was good when we recovered it.

Rene: What kind of things were you looking for in that screening?

Founder: Evidence of congenital anomalies, sexually transmitted diseases, some reason they should not be a donor. Medications, drugs, sometimes arrogance, ugly, father with diabetes or heart attack, sibling that died unexpectedly.

Rene: If they were ugly or arrogant?

Founder: With me, I was working up a donor who seemed acceptable. He was a college student, had a good semen analysis. But when he left my office, the three women working for me at the time put their head in and said, "Doctor, you can accept him, but we're never going to send his sperm out. He's ugly." Okay, something I didn't put on my criteria at the time, but I had three somewhat articulate, vocal, outspoken women that let me know what...