12 Mar 2021 Why Is There a Shortage of Black Egg Donors and Black Sperm Donors?
All too often, Black women who seek treatment for infertility and Black intended parents who seek to create families via assisted reproductive technology (ART) encounter an unexpected barrier to access: A shortage of Black egg donors and sperm donors.
After struggling with infertility, Rhonda Spencer, a producer at West Michigan ABC affiliate WZZM13, and husband Jamal were saddened to learn that, in order for Rhonda to have a child, they would need an egg donor. They were further crushed to discover there were no Black egg donors available to them. “As a Black woman, I want to have a Black child,” Spencer said in a WZZM13 report. “It was a hurdle that I hadn’t even thought about.”
Robin Strouse, RN, donor coordinator at Fertility Center in Grand Rapids, Michigan, told WZZM13 that of 1,000 egg donor applicants over a three-year period—only a portion of whom make it through the application process—just 15 percent were Black and only 5 percent Hispanic; 80 percent were white non-Hispanic. At the time of a 2018 report by Rewire News Group, California Cryobank—one of the nation’s largest sperm banks with labs in Los Angeles; Los Altos, California; Manhattan and Cambridge, Massachusetts—offered only 17 sperm donors identified as Black or African American.
In a series originally published in 2019, The New York Times followed the saga of a West Hollywood lesbian couple, B.A. and Nikki Williams, both Black, who wanted to become parents using a sperm donor and IVF. As Nikki recounted, the couple researched numerous sperm banks, searching for organizations that were both LGBTQ-friendly and offered racially diverse donors, before finally settling on the one that had the largest number of Black donors—23 out of 450 total listed.
Then they ran up against another hurdle: Nikki, whose egg would be used in conceiving their baby, tested negative for both sickle cell anemia and CMV, a viral infection that can result in birth defects. To avoid the chance of passing along those diseases to their child, they needed to find a donor who also tested negative. Their choices dropped instantly from 23 to four.
The shortage of Black egg and sperm donors is echoed in other countries: In 2017, of some 1,900 egg donors in the UK, 15 were identified as “Black Caribbean,” 20 as “Black African,” and 1,608 were identified as white, according to a BBC report.
Racial disparities in healthcare access and outcomes, including in reproductive healthcare, are nothing new. According to infertility advocacy website The Broken Brown Egg, Black women experience infertility at much higher rates than white women, yet are much less likely to seek treatment. And when they do access treatment, outcomes for Black women and other women of color are less successful than for non-Hispanic white women: According to a long-term study by the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SARTCORS), in 2014 and 2105, ART cycles in Black women “were 64 and 67%, respectively, as likely as white women to result in a live birth following primary transfer.”
Why Aren’t There More Black Egg Donors, Black Sperm Donors?
Many of the same cultural and socio-economic factors that historically have discouraged Black intended parents from seeking, or impeded access to, ART treatment also have contributed to the shortage of Black egg donors and sperm donors. In a November 2020 statement, the ASRM Diversity, Equity and Inclusion Task Force “concluded that the lack of people of color in key positions in our profession, high price of treatment, inaccessibility of medical care, differences in success rates, lack of accessible patient education, and implicit biases and discrimination by some offices pose immense burdens to infertile individuals of diverse backgrounds, in same sex relationships or who are without a partner.”
Stigma of Infertility
Fertility often is a taboo subject in the Black community, the Rev. Dr. Stacey Edwards-Dunn, founder of non-profit advocacy group Fertility for Colored Girls, told WZZM13. Older African-Caribbean women, reluctant to seek fertility treatment, will say, “You don’t talk your business to people,” UK counselling psychotherapist Helen George told the BBC.
Other ART professionals believe cultural or religious taboos discourage some would-be donors. “There are some challenges culturally when it comes to recruiting non-Caucasian donors, whether it be religious or secular cultural reasons where people are not necessarily supportive of sperm or egg donation,” Michelle Ottey, director of operations at the Virginia-based Fairfax Cryobank told Rewire.
Distrust of Medical Profession
Both egg and sperm donation require extensive medical screening and multiple visits to the lab or clinic; egg donation also involves the administration of medications on a strict schedule and one or more invasive medical procedures. Black people in America and in some other parts of the world have experienced generations of discrimination, systemic racism and denial of access within the medical profession. “There is fear of the medical system,”…fear of “going into the doctor’s and not being cared for rightly.” Edwards-Dunn told WZZM13.
“You can never exclude [the knowledge of that history] as a possibility,” said Scott Brown, vice president of communications for California Cryobank, in the Rewire report. “I don’t know how aware most 23-year-old men are about their ethnic history, but the potential for [decreased] interaction with the medical community in general [is there]. Probably some of the same challenges we face in every career or walk of life.”
For some potential donors, such historical mistreatment creates an understandable foundation of distrust that translates to a reluctance to become an egg or sperm donor.
Lack of Information for Black Egg Donors, Sperm Donors
Edwards-Dunn, who struggled with infertility before founding Fertility for Colored Girls, attributes the shortage of black egg donors, in part, to lack of education. “A lot of young black women don’t even realize it’s an option,” she told WMMZ13.
Natasha, a UK woman of Afro-Caribbean heritage, said she doesn’t believe women realize there is a shortage of egg donors. “There’s no awareness; no one’s printed any leaflets,” she said. “It’s not sitting in the waiting rooms of any hospitals.”
UK counseling psychotherapist George told the BBC she faults the country’s Human Fertilisation and Embryology Authority, which, while aware of the shortage of racially diverse egg donors, claims that informing the public, and publicizing the one-time £750 donor payment, is not its job.
Difficulty of Donating
Neither egg donation nor sperm donation are quick and easy. Reputable agencies require extensive donor screening for genetic or contagious disease and mental health. Brown of California Cryobank says for every hundred applicants, only one makes it through the process to become a sperm donor; Ottey at Fairfax Cryobank estimates only one in every 200 applicants becomes a donor. Once accepted, a sperm donor must return once or twice a month for six months, making geography and proximity potential obstacles as well.
“You can’t just walk in off the street, donate, and get $50,” Ottey said. “[Donating] is a real commitment, and you’re contributing to a family. We do lose applicants who come in and don’t take it very seriously.”
In addition to extensive screening, which can take three months or more, egg donors must self-inject hormones and medications on a strict schedule over a period of weeks, in addition to the egg harvesting procedures. For some women, the time, inconvenience and discomfort make it difficult or impossible to meet work or study responsibilities while undergoing the donation process.
Lack of Diverse Representation in ART Profession
Contributing to the fear and distrust some Black people feel about egg or sperm donation is their underrepresentation among donor agency and sperm bank staff and professionals.
LGBTQ activist Jaime Grant, who has two children with her Black ex-partner conceived using donor sperm, told Rewire her experience was “white doctors serving white people.”
Brown of California Cryobank says a lack of diverse leadership in the profession contributes to the shortage of diverse donors. “They say to themselves, ‘I wonder why?’ when they don’t have a doctor of color among them.”
Marketing to White Customer Base
Because there is little regulation of sperm banks and donor agencies in the U.S., facilities are guided by market factors, and the shortage of racially diverse donors at sperm banks and donor agencies reflects the perceived economics of the industry. “Sperm banks are private companies so they don’t have to provide data,” Yale sociologist Rene Almeling, author of Sex Cells: The Medical Market for Eggs and Sperm told Rewire. “Is it [that] sperm banks don’t have donors of color, or customers of color because they don’t have donors?”
Solutions to Black Egg Donor, Black Sperm Donor Shortage
The COVID-19 crisis has shone a spotlight on healthcare disparities that disproportionately impact Black and other communities of color; Black Lives Matter and other current social justice movements have raised awareness of the need for equal access to all forms of medical services. This increased awareness has informed and inspired all sectors of the assisted reproductive technology profession to make needed changes.
Advocacy organizations such as ASRM, which has for years studied racial inequalities both in access to ART and outcomes, have begun to formulate solutions. “Understanding the racial disparities in outcomes of different IVF treatments is a critical first step in assuring access to care for all patients,” said Michael Thomas, MD, ASRM Secretary and Chair of the ASRM Diversity, Equity and Inclusion task force. “Due to lower implementation rates and higher clinical loss rates, Black women are experiencing disproportionate barriers in pregnancy through IVF.” Among the ASRM recommendations are increasing the representation of Black people and other people of color “in the profession and leadership of reproductive medicine” through enhanced recruitment and educational efforts.
We must take a serious look at these issues in the ART legal community as well. As a growing number of states require insurers to offer coverage for infertility treatment, the financial burden of ART, which has historically disproportionately impacted people of color, is slowly lessening for many intended parents. We have a duty to increase the number of states with fertility insurance mandates and to promote the removal of all insurance barriers to family formation through assisted reproduction.
We also must strongly consider racial balancing within the leadership ranks of assisted reproductive lawyers. In my role with the American Bar Association’s Family Law Section and ART committee, I am working with colleagues to develop a continuing education course on diversity, inclusion and cultural competency for fertility lawyers. This just a small but important start; there is so much more we could be and should be doing.
All of these efforts, taken together, will make a difference. In its 2015 report in Fertility and Sterility, the ASRM Ethics Committee concludes:
Reproduction is a fundamental interest and human right, and the access, treatment, and outcome disparities that are associated with ART are a form of stratified reproduction that warrants correction. Moreover, supporting increased access to ART appropriately recognizes infertility as a disease, in keeping with pronouncements by the WHO and worldwide trends…. The status of fertility treatment as available mainly to non-Hispanic whites and the “economic elite” perpetuates the dismissal of fertility treatment as a “lifestyle choice” or as a luxury comparable to elective cosmetic surgery.
As the report states, “It is the responsibility of all assisted reproductive technology (ART) stakeholders, including physicians, policy makers, and insurance providers, to address and lessen existing barriers to infertility care.” We at IFLG proudly accept the responsibility.