RUBIN, B. (1965). Psychological Aspects of Human Artificial Insemination.

Archives of General Psychiatry, 13(2), 121.doi:10.1001/archpsyc.1965.0173002002

 Artificial human insemination (AI) is an attempt to fertilize a woman by means

other than sexual intercourse.
 Semen may be obtained from the husband and its use in this way is called
homologous artificial insemination (AIH), most commonly tried in conditions of
hypospadias, dysparunia, impotence, etc. Or semen may be obtained from a
third party, or donor, and its use in this way is called heterologous artificial
insemination (AID), often tried in cases of male sterility (azoospermia, dead or
malformed sperm, nonpatent vas, etc), to prevent hereditary disease
transmission, or for eugenic reasons
 male sterility is the most common reason to consider the use of artificial
insemination, AID is the procedure employed and most reacted against, the
principal concerns being the use of a third party (who is usually unknown except
to the physician), and the legal status of a child conceived from AID
 Arguments that marriages without children are more prone to difficulties and
divorce and the partners to suicide, ignore the primary causes of such
childlessness, but have been offered as arguments in favor of artificial
insemination.
 There is evidence, however, that drive organization in the woman is partially
related to the phasic function of the ovaries. There is a psychophysiological
response to the hormonal stimulation which directs the sexual needs of women
toward her reproductive function. This alone gives impetus to the woman's
interest in and wish for artificial insemination as a means of bearing a child.
Insofar as a husband can identify with his wife in pregnancy, too, so he too can
gain some experience of fatherliness during and following his wife's pregnancy
 Physicians and patients echo two recurrent themes in their worry about AID:
o (1) its danger to the family and society, and
o (2) the possibility of unwitting consanguinous marriage of donor and
offspring or half-siblings.
 Concerning the first problem: from the beginning of its use as a medical
procedure, physicians have been attacked for endangering the family and society
 AID "endangers the family" and the "veneer of civilization disappears"; "it lowers
culture," "it is socially monstrous," it endangers "marriage, family; and society." "It
may well lead to radical revolution in which such concepts as father, brother,
family descent, and the like, lose every vestige of their meaning." There were
fears of "an anonymous world"; "it should never be recommended." The British
Medical Association felt it was an "offense against society" while "it does riot
contravene any of the accepted principles of scientific medicine."
 American Medical Association has found itself both for and against this
procedure, and on one occasion suggested that babies conceived by artificial
insemination be adopted by their parents
 in favor of AID, with such statements as "couples with babies" are "all happy and
fine." There are those who would ignore the problem, saying, simply, legal babies
equal biological babies. Many state that it is better than adoption; that it has a
value to society because of the woman's psychological need
 Cary in 1948, reported that immediate psychological results were as satisfactory
as adoption. Haman in 1959, reported a follow up on 216 AID mothers and
children of 303 impregnations, and reports "fewer problems than adoptions."
 Concerning the second problem, less is written since it concerns the personal
feelings of the physician about his role as instrument of the insemination and the
procuring of the semen from the unknown donor.
  From a legal standpoint, jurists and lawyers are as mixed in their opinions as are
physicians. AID raises problems specifically concerning:
o (1)Does it constitute criminal adultery (which appears relatively
insignificant since few states if any actually enforce the statutory
prohibitions against adultery) or the type of adultery which would provide a
ground for divorce.
o (2) Is the child born of AID legitimate or illegitimate.
o (3) Is AID performed without the wife's consent equivalent to rape
o (4) What is the legal responsibility of the physician who performs AID
 The legal concern about the child has two aspects. First, the question of the child
inheritance rights is a problem because of the wording (eg, "heirs of his blood . . .
lawful issue of his body") of English, and therefore, United States law
 Finally, the evidence from the above group of women who had artificial
insemination, as compared with a group of mothers who had children through
natural insemination, indicates little significant difference in terms of childhood
development, attitudes about sexual development and eventual feminine roles,
and in their pregnancies and subsequent care of children. How¬ ever, there is a
significant difference in their fantasies about whom the child resembles after
birth, and a strong need to dissociate from thoughts and concerns about the
meaning of the donor to them, indicating that the actual use of donor semen
makes the breach of the incest barrier a threatened reality which must be
handled by more active defensive measures.
 Artificial human insemination is a legitimate scientific procedure which grew out
of research interests about reproduction. Its use in humans was a natural
outgrowth of such research. At present it is being done by ethical physicians who
are aware of the dangers and need for safeguards in this procedure, and it
seems likely to continue this way
 Women have a psychobiological drive organization directed toward bearing
children, and within a barren marriage due to a husband's infertility, artificial
insemination would offer the most satisfying answer to that drive. While this may
offer some problems for an infertile or sterile husband, the above data would
suggest that a husband's involvement in his wife's pregnancy would enhance his
fatherliness response
 Because of the source of semen from an unknown donor, there is a resonance
with early infantile incestuous strivings which remain to some degree in all
persons and lead to an in¬ crease in the manifestations of the incest barrier
against such strivings: concern, revulsion, expectation of danger to family and
society, fear of consanguinity, a pariah of a child by such a procedure, religious
proscriptions, and the use of inaccurate scientific and social information as
reasons against it.
 It is unlikely that a formal institutionalization of this procedure can occur because
of the particular unconscious wish with which it can resonate, but that this
procedure will probably be used, with continued concern, disapprobation, and
attack. One might predict that in part, the intensity of the response would be
somewhat proportional to the intensity of unresolved infantile sexual strivings
stimulated

Brand, H. J. (1987). Complexity of Motivation for Artificial Insemination by Donor.

Psychological Reports, 60(3), 951–955.doi:10.2466/pr0.1987.60.3.951

 Under normal circumstances the experience of parenthood is an important

developmental phase for most emotionally mature married couples. The desire to
create life may be regarded as a basic human need
 Parenthood offers the married couple a unique opportunity for the joint
experience and development of their own marital relationship, as well as for the
expression of emotions such as altruism, empathy, and emotional attachment to
their children. Normally the wife experiences pregnancy as fulfilling and as a
reinforcement of her female identity and self-concept, while the husband is able
to participate in the experience of the pregnancy and share in the joy of the birth
of the child
 For most married couples parenthood is an inevitable stage in life, motivated by a
combination of instinctive, natural and inner needs and of external social,
religious and traditional values
 When a childless couple is confronted with a diagnosis of abnormal
spermatogenesis in the male but normal female internal genitalia, only one of two
alternative choices can be made, namely, adoption or artificial insemination by
donor to overcome the childlessness
 Unlike natural conceptions, where both spouses contribute towards the
pregnancy, there is no definite role for the male partner in conception via artificial
insemination. His function is performed by the donor. Should there be a poor
marriage relationship, there might be a higher risk for conflict to develop. It is
imperative that this be prevented
 the infertile couple experience intense frustration over their need for parenthood.
Some react with feelings of disappointment that they are unable to conceive. A
woman mostly assumes since childhood that she would one day experience
motherhood. If she does not easily have children, her firmly entrenched
expectation of emotional fulfillment may be threatened.
 Sixty percent of the sample gave the hereditary link which the mother and the
stronger emotional and psychological bond which the child as the most important
reasons as to why they preferred insemination to adoption. For more than half of
the men it was important that their partners should go through the full experience
of pregnancy, while their own infertility would remain concealed. In a substantial
proportion of cases it was the cumbersome procedures involved in adoption that
played an important role in their choice of artificial insemination.
 Environmental pressures often play an extremely important role in motivating a
request for artificial insemination by a donor. According to Bwton and Southam (
1958) a mere visit to an infertility clinic is in no sense adequate proof of a
genuine motive to become pregnant. At one clinic it appeared during consultation
that about 25% of their patients did not really want children. Some were
subjected to family pressures, others wished to save unstable marriages or felt it
was a moral duty to have children. Motives in terms of external versus internal
locus of control ought to be examined.
 approach of sterile male patients in three categories, namely, (i) men who tend to
be excessively jealous find the procedure totally unacceptable because for them
it is synonymous with adultery and so aggravates their own sense of inferiority,
(ii) accepting, accommodating men who involve themselves in their wives'
pregnancy and identify well with the baby, (iii) men in whom initial uncertainty
changes to acceptance and who are motivated by the desire to make their wives
happy, to overcome the childless condition and to create life.
 Some patients who do qualify do not consider the possibility of adoption as an
alternative solution at all. Watters and SousaPoza (1966) regard rejection of
adoption as a negative indication regarding motivation for artificial insemination
by a donor. In such cases it is clear that the woman wishes to satisfy her own
maternal instincts ac all costs and is not prepared to accept the man's sterility. In
all probability the wife is the dominant figure in the marriage relationship. In these
cases the nature of noncomplementary and anticomplementary personality traits
 in the spouses ought to be carefully evaluated before the administration of the
insemination
 sometimes the primary motive is sometimes related to the social concealment of
the problem of sterility which is usually accompanied by strong emotional
overtones. Here denial probably indicates an inability to deal with the problem
realistically. An intense need to conform to peer groups may be strongly
manifested in patients and is often related to the concealment of sterility

Ombelet, W., & Van Robays, J. (2015). Artificial insemination history: hurdles and
milestones. Facts, views & vision in ObGyn, 7(2), 137-43.

 artificial insemination was originally developed to help couples to conceive in

case of severe male factor subfertility of a physical or psychological nature.
Nowadays artificial insemination with homologous semen is most commonly
used for unexplained and mild male factor subfertility. In the previous century
donor insemination was mainly used for male infertility due to azoospermia or
very low sperm count and for inherited genetic diseases linked to the Y-
chromosome. Nowadays donor insemination is more commonly used in women
with no male partner (lesbians or single women).
 In the early days the ejaculate of the husband was inseminated intrauterine
without preparation resulting in uterine cramps and increasing the probability of
tubal infections. With the arrival of IVF, semen preparation techniques were
developed and IUI regained its popularity, being more safe and painless.
 As a consequence of these improved sperm selection techniques, the use of
artificial insemination became very popular as a first line treatment procedure in
case of unexplained and mild male factor infertility. At this moment AIH is
probably one of the most applied assisted reproductive techniques worldwide.
Nevertheless, there is still an on-going debate whether or not AIH is an effective
treatment option for various indications. Controversy remains about its
effectiveness, particularly in relation to IVF and ICSI
 An increasing number of studies highlight the value of AIH and support the belief
that artificial insemination with husband’s semen will remain a widely used
treatment option for many couples with cervical factor subfertility, physiologic or
psychological sexual dysfunction, mild to moderate male subfertility and
unexplained infertility with an unfavourable prognosis
 Catholic Church objected to all forms of artificial insemination, saying that it
promoted the vice of onanism and ignored the religious importance of coitus. The
main criticism was that artificial insemination with donor semen was a form of
adultery promoting the vice of masturbation. Other critics were concerned that
AID could encourage eugenic government policies.
 After the first successful pregnancy from frozen sperm, reported in 1953, the
development of a thriving sperm-bank industry starting in the 1970s and the
commercialization of AID became unavoidable. The growing number of AID‘s
raised new concerns leading to new regulations. Because of the possible
transmission of sexually transmitted diseases, including HIV, when using fresh
sperm screening for infections of donors became mandatory. The use of fresh
donor semen samples almost disappeared.
 Sociocultural concerns with biological paternity and the maintenance of the
heterosexual, married couple as the basis of the family remain important in many
countries. A lot of countries all over the world have not approved the use of AI
with donor semen for single women and lesbian couples yet. Another point of
 debate is whether the donor has to be anonymous or non-anonymous, and when
to inform and what to tell AID children about their biological parentage, if non-
anonymous donors are used. Is it possible and/or advisable to use sperm of
relatives, such as brothers or the father? Whether or not to pay the donors and
sexing of sperm by DNA quantification using flow cytometry instrumentation
became a point of discussion.
 Intrauterine insemination with husband’s sperm turned out to be a valuable first
choice treatment before starting more invasive and more expensive techniques
of assisted reproduction for many subfertile patients.