Secrecy: an unresolved issue in the practice of donor insemination.

There is a paucity of information on the well-being of the families created through artificial insemination with donor sperm despite its widespread availability for more than a generation. Physicians who practice donor insemination have historically supported or encouraged secrecy while observing that couples are satisfied and well adjusted after the birth of their donor insemination offspring. However, from the perspective of the child's best interests, it has been argued that accurate genealogic knowledge should be a "right" and that an ethical conflict exists if the practitioner and the couple act together to deceive the child about his or her true genetic identity. The recognition that secrecy raises difficult social, psychologic, and ethical questions while holding considerable practical and emotional appeal for the couple is a major unresolved issue in the practice of donor insemination. It is suggested that further study and evaluation of donor insemination families is needed if accurate counseling and advice are to be provided to couples considering the option of donor insemination.