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Naomi Cahn, University of Virginia and Sonia Suter, George Washington University
(THE CONVERSATION) The fertility industry generates approximately $8 billion in revenue annually and plays a role in the birth of tens of thousands of children each year. Regulations are currently limited even though technology is changing and demand is increasing. But a new Colorado bill introduced in late April 2022 could help the industry better meet the needs of those who use it.
Fertility treatments take many forms. They may include fertility drugs, intrauterine insemination, in vitro fertilization, or the use of donor sperm, eggs, or embryos. Expenses for each type of treatment vary widely, ranging from around $15,000 to $30,000 for a single cycle of IVF to around $1,000 for a vial of semen. Often several attempts are needed to achieve pregnancy, and the costs can add up.
Despite these costs, the number of people using reproductive technologies continues to grow. In the United States, births assisted by fertility treatments more than tripled between 1996 and 2015.
We are law professors who study the techniques of reproduction. One of us has used these treatments himself. The new Colorado bill we testified for would be the first in the United States to require the identity of egg and sperm donors to be released upon request of their donor-conceived offspring when they reach the 18 years old. In the current version of the bill, it would also limit the number of families per individual donor.
To understand the significance of Colorado’s proposed legislation, it is worth considering the extent of problems with fertility treatment in the United States and how the industry operates.
Access to fertility services
Twelve percent of women in the United States have received some form of medical care for infertility, a condition that affects approximately 10 to 20 percent of heterosexual people. Same-sex couples and single people who wish to procreate face social infertility, where their relationships and social situation prevent them from conceiving a child.
A small but growing number of states require insurance companies to provide fertility coverage, although the extent and nature of coverage varies by policy and state.
More and more employers are also offering fertility benefits. However, the services they cover vary, with the most common being an assessment by an infertility specialist. A growing percentage of companies are covering egg freezing and in vitro fertilization.
While some Medicaid programs cover fertility testing, only one state covers a few types of treatment. Most states still do not require health insurance policies to cover fertility benefits, and some of those states limit benefits to heterosexual married people.
The lack of fertility specialists in some areas of the United States also limits access to fertility care. For example, as of 2019, Alaska and Wyoming do not have fertility clinics offering assisted reproductive technologies such as IVF. Similarly, black and Hispanic women are less likely than white women to access fertility care and have successful IVF cycles, in part due to socioeconomic barriers.
Follow-up of fertility treatment and confidentiality
The federal government collects information on the success rates of fertility clinics. But little is known about a growing segment of this market: egg, sperm and embryo donation.
A 2019 report from the Centers for Disease Control and Prevention indicates that there have been nearly 78,000 live births resulting from fertility treatments. These births resulted from a total of 330,773 assisted reproductive technology cycles, of which 27,131 were from eggs and embryos. Since the federal government does not keep track of the number of children born through sperm donation, it is unclear how many births are the result of egg, embryo, or sperm donation.
The secrecy surrounding reproductive cell donation has long been entrenched in the culture of the fertility industry, often leading doctors to urge parents not to tell their children they were donor-conceived. Such secrecy was considered the best for everyone by creating the illusion of a biological connection. She was also influenced by shame about infertility and a desire to prevent any interference in the parent-child relationship.
While genetic testing, personal information on the Internet and changing family structures challenge this culture of secrecy, donor anonymity remains a common practice. A 2022 study by the US Donor Conceived Council, a non-profit organization advocating on behalf of donor-conceived people, found that despite a growing number of sperm banks allowing donor-conceived people to access information about their donor , 70% still allow anonymous donation.
Protect donors, parents and their children
States are beginning to introduce means to protect the interests of parties involved in the fertility industry. Many states already have laws in place that follow a version of the Uniform Parentage Act, which provides special rules for parentage when a child is donor-conceived. A growing number of states have enacted fertility fraud legislation that criminalizes or provides civil remedies for donor misrepresentation, such as when a fertility doctor uses his own sperm without inform parents.
Another area of growing interest is providing donor-conceived individuals and recipient parents with important medical or personally identifying information about their donor.
In 2011, Washington became the first state to allow donor identification and medical history to be released to children when they turn 18. Since then, a few other states have passed the Uniform Parentage Act, which requires banks and fertility clinics to collect and publish identifying donor information to donor-conceived persons if the donors had agreed to release it.
Proposed legislation in New York would require sperm and egg banks to collect, verify and share important information about a donor’s health, education and criminal history with intended parents and donor-conceived persons. Some countries have gone further by banning donor anonymity, including Sweden in 1985, the UK in 2004 and the state of Victoria in Australia in 2016.
Other protections may come down the line.
One measure is to limit the number of families using the same donor. This can prevent donor-conceived people from feeling commodified and dehumanized if they discover they were conceived in a large group as part of a lucrative industry.
In the UK, no more than 10 families can use the same donor (excluding the donor’s own family), although there is no limit to the number of children conceived per family. And in Denmark, donor sperm can only be used for 12 inseminations.
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No US state currently sets such limits. Although some sperm banks have attempted to impose limits, they are not required to track the number of children born to an individual donor. In addition, donors can donate their sperm to another bank. Any limits would be difficult to monitor, let alone enforce.
Finally, regulations could ensure that donors and parents are fully informed of the social and legal implications of donor conception, including that other people can be conceived with gametes from the same donor. Some states may also reduce the risk of harmful health effects from repeated egg donation by limiting the number of times a person can donate.
The Colorado Bill
Colorado has taken a revolutionary step by considering a bill that introduces sweeping regulations that bridge industry trends. The law would ensure that donor-conceived people can know the donor’s identity when they reach adulthood and sets limits on the number of families a particular donor can provide their gametes to. It would also ensure access to educational materials that guide families and donors through the process, including resources on how to discuss donor conception with children.
Although there is concern that eliminating donor anonymity will compromise donor confidentiality and affect donor availability, we believe there is substantial evidence to the contrary.
A 2016 study of 161 sperm donors found that while some might be deterred by such laws, more than two-thirds would be willing to donate for an additional price of $60 per donation. In Australia, where payment for sperm donation is prohibited beyond fee reimbursement, the number of sperm donors actually increased after anonymity was removed. Similarly, a 2020 survey of 148 egg donors in South Africa, where donor anonymity is allowed, found that 79% would still have donated their eggs even if their identity had been revealed.
We believe Colorado’s bill could set a precedent for how other states regulate fertility treatment and protect the interests of everyone involved.
This article is republished from The Conversation under a Creative Commons license. Read the original article here: https://theconversation.com/fertility-treatment-use-is-on-the-rise-new-legislation-could-increase-protections-for-donors-and-families-in-an – industry-shrouded-in-secret-181664.