Bianca Voss reeled in shock when her daughter, Roberta, told her the results of the 23andMe genetic test she took last fall. It indicated that the fertility doctor who had artificially inseminated Voss in 1983, enabling her to give birth to Roberta, had secretly used his own semen.
"I am angry that I was violated in this manner," Voss said during a late May online news conference to announce a federal lawsuit against the doctor, Martin D. Greenberg, who worked in New York City during the 1980s and now lives in Aventura, Florida. "How could I have picked such a criminal and immoral physician who would do such a thing to me?"
Her daughter was angry, too. Roberta Voss had tried to contact Greenberg through his 23andMe account, but it was deleted after she messaged him. "He knew he was caught, and he was trying to cover it up," she said in an interview with USA TODAY.
Bianca Voss is the latest among dozens of women who have alleged they were duped by fertility doctors they trusted to inseminate them with sperm from anonymous or chosen donors. They discovered the deceptions decades later when their children took popular, at-home DNA tests.
Increasingly, the parents, their children and lawmakers are fighting back. Families have sued former doctors for what they allege were fraudulent inseminations decades ago. Six states have enacted laws against so-called fertility fraud, and other states are considering similar statutes.
One of the lawyers representing Bianca Voss says tougher oversight is overdue for what he characterized as the lightly-regulated fertility industry.
"In the majority of states, and at the federal level, it's the Wild West," said attorney Adam Wolf, a shareholder of the national law firm Peiffer Wolf Carr Kane & Conway. He predicted additional fertility fraud cases will emerge.
Why some doctors allegedly overrode their patients' family planning choices is unknown. One law professor who has researched the issue said there appear to be common characteristics among doctors who have been accused, such as enjoyment of esteem from being considered among the top in their medical field. But there are no clear, common motives.
It has proven difficult to police fertility fraud because few states have criminal or civil statutes that are on point.
And no law can address the pain, stress and emotional issues confronted by children who learn their biological father is their mother's fertility doctor.
"I'm in turmoil about who I am, what this means, and what kind of person would do this," Roberta Voss said. "And is that a part of who I am? And what about my son?"
Greenberg did not respond to a voicemail left at his home.
Treatment for women yearning to be mothers
Artificial insemination is a treatment for women who have been unable to conceive children. It involves placing donor semen in a woman's cervix or in some cases directly in the uterus. The procedure may be performed by an obstetrician or gynecologist who has been trained in fertility medicine or reproductive endocrinology.
The procedure became widespread in the United States during the 1970s, with the establishment of commercial sperm banks that accepted donor semen, froze it, and made it available to doctors who treated fertility problems.
Although the procedure produced many happy births, one scandal erupted during the 1980s. Female patients of Dr. Cecil Jacobson, a northern Virginia fertility specialist, complained that he had tricked them into believing they were pregnant when they were not.
A federal criminal investigation substantiated the allegations and produced evidence that Jacobson also had used his semen to inseminate patients. Prosecutors said DNA tests showed that Jacobson was the biological father of 15 of 17 children tested during the investigation, The New York Times reported when Jacobson was found guilty of 52 counts of fraud and perjury in 1992.
Jacobson was sentenced to five years in prison. He was ordered to pay $116,000 in fines and restitution to former patients.
The case was an early harbinger.
Starting in roughly 2014, many Americans began taking at-home DNA tests such as 23andMe and AncestryDNA. For some, the results upended long-held beliefs about their family histories.
In some cases, the tests provided evidence that doctors had surreptitiously used their own semen, instead of that from a husband or an anonymous donor. In some cases, the DNA tests told of unexplained siblings; in others, they directly linked the doctor.
Some of the people who took the tests knew they'd been conceived through artificial insemination. For others, it had been a family secret.
Jody Lyneé Madeira is a professor at Indiana University's Maurer School of Law who has researched fertility fraud. She wrote a 2019 Columbia Journal of Gender and Law article on some of her findings.
"These men and women love the children they conceived, birthed, and raised, but remain adamant that they would never have consented to use their physicians' samples," Madeira wrote.
Cases and lawsuits multiply
Besides Jacobson and Greenberg, at least 10 other U.S. doctors have been accused of fertility fraud in civil or criminal court, according to Madeira's research, court records and media reports.
In Colorado, former doctor Paul Brennan Jones awaits an April 2022 civil trial on allegations he used his semen to inseminate some patients. A former patient, Cheryl Emmons, and her husband, John Emmons, allege that Jones secretly used the procedure to father the couple's two daughters.
The family learned of the deceptions through at-home DNA tests. Jones has denied the allegations. Without acknowledging any wrongdoing, he relinquished his medical license in November 2019. Jones did not respond to a text message seeking comment.
In Idaho, a civil lawsuit against retired gynecologist Gerald Mortimer was dismissed before trial in April as part of what appears to be an out-of-court settlement. Filed by Kelli Rowlette and her parents, Sally Ashby and Howard Fowler, the lawsuit accused Mortimer of using his own semen to inseminate Ashby.
Rowlette discovered that Mortimer was her biological father after taking a DNA test. In a sworn 2018 deposition, Mortimer acknowledged he used his semen to inseminate patients. "It was not something that I did for a lot of patients. ... I wish I hadn't done it," he testified.
Indiana had the largest known fertility fraud case in the U.S. in terms of children fathered. As of 2019, Dr. Donald Cline had more than 60 children conceived through artificial insemination, with additional offspring continuing to come forward, according to Madeira's research. His conduct was uncovered after one woman took a DNA test that produced evidence Cline was her biological father.
Cline pleaded guilty in 2017 to two counts of obstruction of justice for lying to investigators. He was sentenced to one year in jail on each count. But the sentences were suspended, sparing him from time behind bars.
Cases settled before going to court
There are almost certainly more cases.
Wolf, the attorney for Bianca Voss, said his law firm has handled roughly two dozen allegations of fertility fraud in recent years. All but three of the doctors involved agreed to settlements without going to court, he said.
Wolf's law firm represents Beverly Willhelm, a California woman who in September filed a lawsuit in San Diego against Dr. Phillip Milgram. She said Milgram treated her for fertility problems in 1988 when he was in private practice as an obstetrician and gynecologist.
The lawsuit alleges that Milgram used his own semen without authorization to help Willhelm conceive her now 32-year-old son, James Mallas. He learned about the deception after taking a 23andMe test.
"I expected to learn something new and exciting about who I am when I took this test. But instead, I learned something that's revolting," Mallas said during an online news conference when the lawsuit was filed.
Milgram has denied the allegations. His attorney, Curtis K. Greer, did not respond to an email and voicemail.
Wolf's law firm also represented Katherine Richards, who made similar fertility fraud allegations against Dr. Michael Kiken in a California federal lawsuit filed in September. The lawsuit alleged that Kiken secretly used his semen to become the biological father of Richards' daughter and son.
She and Kiken agreed to a private settlement in December, and the lawsuit was dismissed, a court filing shows. Kiken's attorney, John Simonson, did not respond to an email seeking comment.
Decades later, few laws and fewer answers
Some children of doctors accused of fertility fraud have found it difficult to get answers about what motivated the doctors. Madeira interviewed several people who learned that Cline was their biological father. Six had met with him to discuss what happened. They came away largely dissatisfied by Cline's "very evasive" answers, Madeira wrote.
After the meeting, Cline phoned one of the siblings, Jacoba Ballard, and said her investigation into what he'd done was "destroying his marriage," Madeira wrote.
Cline told Ballard he regretted his actions. But he also quoted the biblical prophet Jeremiah, who was told by God: "Before I formed you in your mother's womb, I knew you," Madeira recounted in her 2019 study.
"Ballard felt he was using her faith to try to manipulate her," Madeira concluded.
A legal crackdown
Lawmakers in Indiana, Colorado, California, Texas, Arizona and Florida enacted laws against fertility fraud in recent years.
Colorado lawmakers enacted a statute in July in response to the pending case against Jones, the doctor accused of secretly fathering a former patient's two daughters. The law bars health care providers who assist patients with fertility problems from using reproductive cells from a donor without a patient's express consent.
The law makes it easier for patients to sue providers, and it authorizes $50,000 in damages. However, the statute cannot be applied retroactively to Jones, whose trial is scheduled in 2022.
Indiana's law was enacted in 2019 with input from people who discovered that Cline is their biological father. The law made it a felony for someone to misrepresent an element of a medical procedure that involves human reproductive material. The law also makes victims of fertility fraud eligible to recover $10,000 in civil damages.
The law addressed a problem faced by Tim Delaney, the prosecutor who handled the Cline case. During an interview with Madeira, Delaney voiced dissatisfaction that Indiana's laws at the time left him unable to charge Cline with anything other than obstruction of justice.
"I know that people feel that obstruction of justice is not a terribly sexy thing, but it was what was available to us," he told Madeira.
Continuing emotional damage
New laws don't necessarily help the mothers or children of fertility fraud – a sisterhood and brotherhood of uncertainty and pain.
"It's experienced like a rape ... but they don't know about it until years later. And when they find out, it's the child telling the mother," Madeira said in an interview.
For Roberta Voss, the discovery that Greenberg is her biological father has forced her to navigate a difficult emotional landscape. She hoped DNA testing would tell her more about herself and her family. Instead, it so far has raised questions without answers.
"Now I am haunted by the idea of a medical rapist being my father," she said, "and the enormous deceit that went into my own conception."
This article originally appeared on USA TODAY: Fertility fraud: Doctors used their sperm in artificial insemination