Woman’s Dream Could Turn to Ashes: AIDS by Insemination : Medicine: Laguna Niguel mother, one of five who contracted HIV through procedure, is suing a West Los Angeles clinic.

Joshua’s big blue-green eyes looked into hers. “Mommy,” the 6-year-old asked softly as she tucked him into bed, “do you have AIDS?”

She stopped dead. My God, she thought, he knows.

It was then that Mary and Joe Orsak sat down with their adopted son, who already knew more than a small child should. Mommy didn’t have AIDS, they told him, but she did have the virus that causes it.

Mary Orsak was infected by the sperm of a stranger. She belongs to a group of heterosexual women numbering in the tens of thousands who have never been publicly warned they may be at risk for AIDS.

In last-ditch efforts to conceive, up to 80,000 women each year resort to artificial insemination with donor sperm. But 13 years into the AIDS epidemic, the increasingly popular fertility business remains largely unregulated and unmonitored, even though it traffics in semen, long known to be one of two main HIV transmission routes.

Medical and public health experts agree artificial insemination is an HIV risk that somehow fell through the cracks of public education and health regulations. They insist, however, that the risk is low.

Tell that to Mary Orsak.

Two years ago, long after she had been unsuccessfully inseminated 26 times, she received a call from Dr. Jaroslav Marik, who supervised her insemination in 1984 and 1985 at the Tyler Medical Clinic in West Los Angeles.

“He said that one of my donors had AIDS,” she recalled. “And that I should come and be tested.”

An upper-middle-class suburban housewife married to the same man for 12 years, Orsak said she never has used intravenous drugs, never had a blood transfusion and never cheated on her husband, who is not infected.

The Orsaks have sued Marik and his clinic, contending “very little or no screening procedures” were used on donors.

In the course of their battle, they learned of another couple who had filed a similar lawsuit.

Cynthia Hallvik of San Luis Obispo, Calif., received sperm from the same donor as Mary Orsak during unsuccessful fertility treatments in 1983.

They are two of the five women in the United States reported to the Centers for Disease Control and Prevention as contracting the virus through artificial insemination with donor sperm.

“I think the risk is still out there,” said Hallvik, who learned she was infected in 1991 when she banked her blood for surgery and it was routinely tested. “I don’t think that people realize that it’s a possibility.”

Only a handful of states, including New York, California, Ohio, Illinois and Michigan, require AIDS testing of semen donors. There are no federal regulations.

“In most states, if I wanted to get a liquid nitrogen tank and open a sperm bank in my garage, I could,” said attorney Lori Andrews of the American Bar Foundation, who specializes in reproductive issues.

“Couples don’t think to ask about donors. You just assume that the safety and efficacy of the procedure has been shown,” she said. “Some physicians have had the nerve to say to me, ‘Well, I didn’t screen my wife before I had a baby with her, why should I screen donors?’ ”

In 1988, then-U.S. Sen. Al Gore (D-Tenn.) commissioned the Congressional Office of Technology Assessment to complete the most exhaustive survey ever of the fertility industry.

The study--still the most recent one taken--revealed that more than half of 1,558 physicians questioned did not check prospective donors for the AIDS virus, even though the antibody test had been made available three years earlier. All 15 commercial sperm banks surveyed, however, did test donors for HIV.

Medical experts contend that voluntary industry and CDC guidelines issued in 1988 now are standard practice. Those recommendations include testing donors twice, at three-month intervals, for HIV and quarantining frozen semen for six months.

“We think adequate safeguards are in place now,” said CDC spokesman Kent Taylor. Mass testing of women who received donor sperm “is probably not warranted,” he said.

The five women reported to the CDC all received donor sperm before the HIV antibody test was licensed in 1985. All are living, and none conceived from infected sperm.

Dr. Laurene Mascola, head of infectious diseases for the Los Angeles County Health Department, located 46 of the 53 women who received sperm from Mary Orsak’s donor. Only Orsak and Hallvik tested positive.

“All women should be aware that this could be a potential hazard and that they should be tested,” Mascola said. “In general, the risk is low.”

The U.S. Food and Drug Administration has debated fertility industry regulations for at least six years, but issued none. Dr. Jay Epstein, the FDA’s acting director of Blood Research and Review, said the agency continues to study the issue and “may very well try to regulate this.”

In 1990, Gore accused the agency of moving “at a glacial pace” in drafting requirements. It also has been criticized by others as moving too slow in directing widespread testing of blood, the other primary AIDS transmission route.

In a brief interview, Dr. Marik said his clinic has always tested donors for HIV as technology permitted.

“You can imagine that this is a tragedy for everyone concerned,” he said. “That donor was used in the early 1980s. There was no way to test him.”

It never occurred to the Orsaks to ask about screening.

“All I wanted was a baby,” Mary Orsak said. “The thought that a world-famous clinic would not take care of that never entered my mind.”

“You’re so involved in trying to have a child,” said her husband, “you’re not doing a whole lot of rational thinking.”

It was the second marriage for both. Mary, now 41, heard the deafening roar of her biological clock. Joe, after months of trying to get his new wife pregnant, learned his sperm was not capable.

So Mary, then a 5th-grade teacher, dutifully began long, weekly treks to the clinic.

“Then we had this beautiful little miracle appear,” she said, beaming. The miracle was Joshua, whom they adopted privately at birth from an unwed mother.

Seven years later, in 1992, they moved 70 miles south from the Los Angeles suburb of Downey to upscale Laguna Niguel, where Joe had a new job as vice president of an area hospital and served as president of the Laguna Beach Chamber of Commerce.

Life was good. Mary was happy, in perfect health, teaching school and rearing her precocious son.

Then, with one phone call, their lives were changed forever.

After her HIV tests, Mary cried a lot. Joe was stunned, then angry, and still struggles with guilt because he is virus-free. For a long time, the couple told only family and a few friends.

Until that night two years ago when Joshua looked up and guessed the truth. Mary still has no idea what prompted it; he had been told only that Mommy’s immune system was sick and she could easily catch cold.

“He looked at me and said, ‘Are you going to be here when I’m 14?’ I lost it at that,” Mary said, wiping away a tear. “I still lose it when I think of that.”

But she remains in good health. Her attitude is radiant. She has been through spiritual healing and support groups. Now, she relies on a special diet, the AIDS drug ddI and the love and support of those around her.

Along with Joe, she has started to talk publicly, and her message is simple:

“It can happen to you. Nobody ever told me that you can get it this way. Someone’s got to tell these women to get tested.”