Podcast Review: The Immaculate Deception

The widespread availability of home DNA testing has revealed a disturbing trend in cases of fertility fraud, where fertility doctors use their own sperm for donor inseminations instead of sperm from the partner or a donor. While DNA testing has brought to light new cases, this technology has only exposed activities that had been ongoing for decades (as reported in BioNews). With the evidence provided by DNA tests, some patients and donor-conceived people have chosen to pursue doctors through the courts.

Through her interviews with donors, donor-conceived people, recipients, and others involved in cases of fertility fraud, in the podcast, The Immaculate Deception, journalist Jenny Kleeman explores why fertility fraud is not always against the law, even though intuitively, it feels so wrong.

This thought-provoking nine-part podcast focuses on the case of Dr Jan Karbaat. For decades, Karbaat ran a successful fertility clinic in the Netherlands providing donor insemination. Although some parents and donor-conceived people suspected him of using his own sperm, it was only proved after his death in 2017, when 21 of them went to court to obtain his genetic material for DNA testing.

We discover as the series goes on that Karbaat had at least 22 children with five different wives, as well as children born from numerous affairs, and at least 60 donor-conceived children. Journalist Kamil Bałuk interviewed Karbaat some years before the court case, and reported that Karbaat told him he also supplied sperm to clinics in the US, Denmark and Germany; so many more donor offspring may yet be identified.

While an extreme instance, the Dutch Karbaat case is not unique. Kleeman looks at several cases of fertility fraud in the US where, because fraudulently inseminating women is not a crime in any state, donor-conceived adults and their parents have had to resort to using civil laws, such as 'lack of informed consent', 'medical malpractice' or 'consumer protection', often finding that the statute of limitations passed well before the fraud was discovered.

Dr Jody Madeira, a lawyer and academic who researches fertility fraud and campaigns for adequate, appropriate legislation, remarks that governments are 'slower to acknowledge these [behaviours] as gross violations when they involve reproductive care'. The law trails behind the use and abuse of the technology – sperm donation has been practised for decades and, as donor-conceived people have been quick to point out, it has not always been conducted ethically. Yet there seems little movement to legislate on this issue, while reproductive issues such as abortion or the status of the embryo have been addressed much more promptly.

Underlying this, Kleeman argues, is a pronatalism magnified by assumptions that the recipients of donor sperm should be grateful to have a child, and the donor-conceived offspring should be grateful to be born. As a result, fertility doctors are treated as heroes, and are given a status which makes them very hard to challenge. Moreover, infertility is a stigmatised condition, and the fathers of children conceived by fertility fraud, in particular, are unwilling to discuss it. These factors have combined to silence some of those most vulnerable in cases of fertility fraud. As an example, Kleeman interviews Lidia, who had three children through Karbaat's clinic after she and her husband found that he was infertile. She talked of feeling cheated, dirty and abused, describing what Karbaat did as 'medical rape', and recalls her suspicion (also mentioned by other mothers), that the warm sperm sometimes used in her treatment was being produced by Karbaat in the adjoining room.

Many of the adult so-called 'Karbaat kids' have also struggled to come to terms with the implications of finding out they are 'doctor-conceived'. For some, existing family relationships completely broke down, while other donor siblings forged bonds across families. Peter, for example, who felt like he didn't really fit in with his birth family, found a sense of belonging with his donor siblings. While some 'Karbaat kids' weren't bothered by the revelation, for many, the discovery was traumatic. Joey realised that Karbaat had lied to his mother, having promised her that he would use her husband's sperm. Inge struggled with rage when she found out what Karbaat had done, as well as with finding out that she was not related to her much-loved dad.

While the range of experiences of the children are helpfully compared and contrasted, the comparisons between different sperm donors lacked nuance. In one interview we meet Louis, a longstanding 'superdonor' at Karbaat's clinic who claims to have fathered 100 offspring. Louis is open about and proud of his donations, having met 45 adults conceived from his sperm. Karbaat, by contrast, destroyed records, obstructed DNA tests, and refused to provide information to any of the involved parties. The comparison between these two very different cases threatens to clump all sperm donation under the same category of malpractice, rather than bringing to light exactly where Karbaat erred.

Overall, however, The Immaculate Deception is well researched, easily accessible to someone unfamiliar with the topic, yet contains enough to interest those who work or volunteer in the field. Kleeman puts forward voices which are not always heard and does a great job at conveying the complexity of the topic and the range of reactions to it. There were moments of fun and laughter which helped to lift what is otherwise a heavyweight topic. The notable omissions are the 'missing men': the doctors and the fathers of donor conceived children. The series is also relatively long, at a half-hour per episode. At the time of writing it is still running: we may yet discover what Karbaat's children think.

For me, the podcast highlighted an important legal gap: the problems caused when families tried to obtain legal remedy. Currently, even where donation is anonymous, recipients put considerable thought into choosing their donor. The bigoted idea that any sperm will do for a desperate woman means that the damage caused by fertility fraud both to parents and donor-conceived people has been minimised. We changed the law on anonymity in the UK because of the impact it had on donor-conceived people, as well as for ethical reasons. In an era of easily-available DNA testing, it is certainly possible that more cases will be uncovered. We would do well to consider how they should be handled – fertility fraud should not be treated as a consumer rights complaint.