Introduction
Hello, and welcome to the Fertility Cafe podcast. I’m your host, Eloise Drane. Welcome to the first episode of Season 3. Today we’re talking about the current state of the third party reproduction field, particularly in regard to the supply and demand for egg donors and surrogates.
To a degree, there have always been ebbs and flows in the industry, times when we’ve received more surrogate applications than we expected, and also times when we’ve had historic lows. As with many aspects of life, the covid-19 pandemic has caused ripple effects that we’re still trying to trace. During this episode, I’m going to unpack how things are looking for third party reproduction now, in late 2021, both in terms of how the pandemic has affected our industry but also by examining non-covid related trends that are having a profound effect.
Let’s start with covid, a topic we just can’t seem to get away from.
As you know, the pandemic brought on many challenges for a variety of industries, especially healthcare. With an influx of COVID patients coming in all at once, healthcare facilities were in dire need of important resources like PPE, oxygen, blood…the list goes on. There was a collective push to free up resources so our hospitals wouldn’t be overwhelmed.
Because of this, mandates were put in place that required healthcare institutions to put all elective and non-emergent appointments and interventions on hold. Unfortunately for many hopeful parents, surrogates, and donors, most, if not all third party procedures were halted or canceled altogether.
Understandably, this caused feelings of worry and frustration among many intended parents. Many of these intended parents had already been waiting so long to grow their family and then to be forced to delay the process even further was not news most wanted to hear.
Women who intended to become surrogates were no longer able to get started. Sperm and egg donors couldn’t do so because the facilities were closed down. The entire industry was disrupted, as were a lot of things in life.
And all of that is of course 100% understandable.
Given the lack of data and information on the virus initially, some intended parents were more than willing to put things on hold. In the beginning, nobody knew the affects the virus was going to have on a fetus during pregnancy and thereafter. This wasn’t a risk some intended parents were willing to take anyways.
After a few months, once the mandate to shutter non-essential healthcare facilities was lifted, things certainly didn’t return to “normal” instantly. There were still many challenges and obstacles being faced.
For those intended parents who had already begun the surrogacy or egg donation process prior to the pandemic – they understandably dealt with added stress and worry during the pregnancy. Again, nobody knew the impact this virus would have on these babies in utero. There were travel restrictions in place. How were these intended parents going to be there for the birth of their child? They were scared and worried. If they weren’t there, who was going to care for their baby?
As travel bans were placed, the challenges increased for the intended parents who lived outside of the US but who had an American surrogate or egg donor. A presidential proclamation prohibited people from entering the United States from certain countries like China, Brazil, and the UK to name a few.
Intended parents doing surrogacy journeys, who lived in various countries were doing all they could to be there for the birth of their child. Some would, first, travel to another country where U.S. travel is not prohibited, shelter there for 14 days, then continue on to the U.S. They were willing to do whatever it took to be there.
We covered the effects of the COVID-19 shutdown on surrogacy in particular during episode 21 Give it a listen if you’re interested in more details.
Fast-forward to 2021 – facilities are, again, able to perform elective procedures, travel bans have been lifted for the most part, and things feel a bit more “normal” again. Intended parents who may have been hesitant before have become ready to start their surrogacy process and grow their family.
There’s a little problem though:
We have a shortage of surrogates and egg donors. Where’d they go? Why has the number of potential applicants not bounced back yet? Is this yet another unexpected outcome that can be pinned on the pandemic?
Look at the overall job market for instance. As we all know, many businesses are struggling to find workers right now. It’s very common to hear of businesses having to shorten their hours or, perhaps, limiting their services because they’re short-staffed. There has been a ton of speculation about why there are so many unfilled positions. Could it be the extended unemployment benefits? Did a lot of people find more fulfilling work by starting their own businesses? Will raising wages do the trick in attracting workers back?
Whatever the underlying reason, it’s left a lot of people scratching their heads.
Well, this staffing-shortage seems to be affecting the 3rd party world too, as agencies like my own are asking ourselves where are all the surrogates and donors.
During 2020, although many candidates were applying, unfortunately however, the majority did not qualify.
Let’s fast forward a bit to summer 2021. The ratio of surrogates to intended parents I feel is at an all time high. As you can tell from the episode title, we are facing a pretty unprecedented shortage of surrogates and donors in third party reproduction.
Let’s talk about why this might be the case.
Today, intended parents are feeling more comfortable and ready to proceed. As life started to feel safer and more normal, those IPs who had been holding off felt okay to proceed. Unfortunately, the number of women applying to be surrogates and egg donors has significantly changed in quantity and in quality.
Those of us in the industry are left trying to figure out why, as we work hard to help our intended parents match with their ideal candidate.
One thought is that because people now have the time and ability to travel – vacations, visiting family they haven’t seen for months and months, they are less willing to commit to becoming a surrogate or donor. For surrogacy for instance, the time commitment is serious, requiring a surrogate to have a solid year to 2 years of availability in most cases. It’s not too surprising that women are hesitant to stay home after 18 months or more of being stuck at home.
On top of that, a lot of Americans are dealing with hectic changes to their schedules and routines – home-schooling, a return to the office, the looming threat of delta and other variants, and what that means for any future shutdowns or restrictions.
It’s possible that some have removed their applications for health reasons, to care for sick family members, or because the Delta variant is threatening our return to “normal.” There are still a lot of uncertainties out there regarding covid despite the availability of vaccines.
Covid Vaccinations
Can’t discuss the shortage of applicants, without unfortunately discussing covid vaccinations. Vaccination is turning into quite a hurdle in the third party reproduction field. As of August 20, 2021, ASRM (the industry’s governing group), sent out a new recommendation for clinics, agencies and intended parents, to strongly consider requiring vaccination for surrogates and donors.
This as you can imagine will affect many as there are many women considering become surrogates or donors who are not willing to get vaccinated. This will definitely reduce the already small pool of candidates.
We now must consider people’s vaccination status as part of the matching process. Some intended parents are adamant that their surrogate or donor be vaccinated although there are others who prefer she not be. But they are no longer the norm.
Just like I’m sure you’re seeing all over media, we’re seeing all ends of the spectrum when it comes to people’s views on the covid vaccine.
I’ve also wondered if extra financial help from the government such as the child tax credit, stimulus payments, and extended unemployment have made some would-be applicants less compelled to apply.
It’s hard to say exactly what the reason is for such a drop in applications, but it appears that it’s due to a combination of the still lingering effects of the pandemic and a lack of the same level of spare time many had during the first year of covid.
Because of all this, as you can imagine, intended parents are now experiencing historically long wait times. Many places are quoting wait times that are triple the length of what it was prior to the pandemic.
There are other factors at play, though, in this back-and-forth dance of supply and demand in the 3rd party reproduction world. While we’re at an all-time low with applications, we’re seeing an all-time high as far as hopeful parents that are interested in starting their journeys.
I’m sure you don’t need me to confirm this, but yes, the last 18 months or so have been a wild ride.
Let’s talk a bit about why there’s been an increase in the number of intended parents seeking surrogacy.
In general, I would say that it seems like surrogacy is becoming more commonly accepted. After nearly three decades of advocacy and education, it’s finally legal in almost all 50 states except for Michigan and Louisiana. This fact, plus the increase in rights and equality for LGBTQ individuals, are factors that play into the increased demand.
Just earlier this year, New York, which has long been a holdout in the legalization of commercial surrogacy, finally legalized the practice. During his announcement, Governor Cuomo was quoted stating, “With this law now in effect, no longer will anyone be blocked from the joys of starting a family and raising children simply because of who they are.”
New York Senator Brad Hoylman, who personally experienced the process of surrogacy, was the lead sponsor of the bill. He and his husband made about 10 trips to California, where their two daughters were born through surrogacy. He shared with ABC news that they chose to go to California because they had the best laws, although I personally disagree with that. There are plenty of states that have favorable laws for surrogacy. He now believes that New York has the best protections for all parties involved in a surrogacy arrangement.
New York’s law is yet another step to legitimizing and normalizing the practice of surrogacy, and it lays the groundwork for doing so safely and ethically. Surrogacy has gotten a bad rap in the past due to a few cases that made headlines. New York’s law is very strict in that it doesn’t leave much, if any, gray area when it comes to surrogacy agreements.
New York’s law outlines a set of very strong protections to ensure no woman is ever taken advantage of in a surrogacy arrangement. It guarantees things like the right to independent legal representation, guaranteed medical coverage, and the explicit right to make her own health care decisions, including whether to terminate or continue a pregnancy. All of these things help prevent bad actors from entering into sticky situations and then hitting the tabloids with a crazy headline that makes the whole industry look shady. You can hear a whole episode’s worth of shady surrogacy stories in episode 23, Sensational Surrogacy.
Now you might be wondering, okay, what does the New York surrogacy law have to do with this episode topic? I bring it up to illustrate the point that as laws like this get passed and as more people start talking about surrogacy as a viable option, it’s going to become more accessible and accepted. More and more potential parents are looking at surrogacy as a reasonable option, many of whom would have dismissed the idea just a few years ago.
And while there are certainly still loud and vocal opponents to surrogacy, the more times it hits the news in a positive light rather than negative, the better.
One of the most positive developments I see, is the practice of surrogacy as one more step to equality for LGBTQ individuals.
Surrogacy is really gaining steam in the LGBTQ community. Gay men in particular are turning to surrogacy as a way to have biological children of their own. In the past, adoption was pretty much the main option for gay men to become parents. Advocacy, awareness, and increasing support for LGBTQ parents have all led to a greater demand for surrogates. What was once thought of as an option only for the ultra-wealthy or celebrities is now seen as possible for anyone.
Egg & Sperm Donation
Alright, so surrogacy is one major part of the third party reproduction world that’s been having serious supply and demand issues. Unfortunately, we’re also seeing the same thing with sperm and egg donations.
Even if intended parents get matched with their perfect surrogate, it’s kind of hard to move forward should they require donor material to form their embryos. Gay or single men have to find donor eggs somewhere. Women who are unable to use their own eggs are in the same boat. Lesbian couples, single women or those couples who need sperm have to find donor sperm to use.
Some intended parents are fortunate to have a personal contact who is willing and able to donate for them, but not everyone has that option. Without a known donor, most turn to either cryobanks for frozen eggs or sperm, or they arrange for a fresh donation.
The problem today is that there just aren’t enough donors. Again, let’s talk about why this might be the case.
Back to covid. Yes, I know, I’m tired of hearing about it too. But it is what it is, so let’s dive in.
During the early stages of the pandemic, donor facilities and clinics shut down and paused their donation services. Since then, the industry has had a hard time catching back up to meet the rising demand. And this issue is happening worldwide, by the way, not just here in the states.
In England, for example, some people are being told there’s a wait of nearly two years before donated eggs may be available. In Australia, women who have frozen eggs in storage are being asked to donate them. Here in the States, there’s an alarming shortage of egg and sperm donors, particularly among minorities.
Not all of this can be chalked up as pandemic-related, but we have definitely seen negative effects due to covid. Travel restrictions, shuttered facilities, hesitance to enter medical facilities…all of these things play a factor, for sure. But demand was on the rise even before covid threw a wrench in all of our plans.
So what’s going on here? Are more people using donor material? Are fewer people donating? Or is it a perfect storm of both?
We know there was a significant increase in demand for donor sperm pre-pandemic, and it has only gotten worse. This is thought to be partly due to the fact that more single women along with same-sex lesbian partners are using fertility clinics to start their families.
The pandemic made this matter worse by some health institutions closing or limiting visits for a period of time. When clinics were open for donors, some potential donors just did not feel comfortable going for fear of contracting or contributing to the spread of the virus.
Likewise, egg donors with various ethnicities were in short supply prior to the pandemic. Likely, this was due to more couples and individuals being comfortable with using donor eggs.
Add to all of this the fact that infertility rates are increasing at an alarming rate, and well, any disruption to the pace of egg or sperm donation is going to cause big problems for the industry. Research has shown that infertility cases are increasing at a rate of 5-10% each year. With more and more couples seeking assisted reproductive treatments and many entering into donor agreements, we’re facing a chronic shortage of egg and sperm donations.
So who is donating their eggs and sperm, and how can we as an industry encourage more people to contribute?
Let’s start with egg donors. The typical American egg donor is a woman in her 20’s who is enrolled in or who has completed college. Historically, egg donation agencies and clinics have focused their recruitment efforts on college campuses and social media.
That’s because, in the United States, one of the reasons young women in their 20’s choose to donate their eggs is to alleviate student loan debt. With some student loan amounts reaching $100,000 or more, these young women see egg donation as not only a way to help others achieve pregnancy, but also to take away some of the financial stress that comes with college.
What happens if that debt goes away, though? Since early on in the pandemic, the United States government has offered student loan relief to everyone. As of now, student loan payments are not required until January 2022. Those loans haven’t been accruing interest, either, and there is talk of more permanent student loan forgiveness possibly in the future.
Given that many young women choose to donate their eggs in order to assist with their student loan debt – one can’t help but wonder if this, too, is impacting the current shortage of egg donors. Of course, there are other reasons someone chooses to donate her eggs of true sense of altruism. I do believe there will always be women who feel called to help in this way, but it’s possible that we will see fewer who do so to help with college loans.
There’s yet another issue that has honestly been a problem all along, but it shows no signs of improving. That issue is the lack of diverse donors. The vast majority of egg donors are Caucasian which can impose challenges for individuals of other ethnicities. After all, a lot of intended parents are seeking third party reproduction, at least in part, because they want to have a child who looks like them. That’s really hard to achieve if there aren’t any donors who look like you.
For example, one article I read recently told the story of an African-American woman who needed to seek an egg donor. She was hopeful to find a donor of the same race so that her child would look similar to her. However, when completing her form online, the donor results went from nearly 50 down to 2 when she selected African American as the preferred race. The extremely limited options were disheartening to her, as you can imagine.
This story is not unique. There is an unfortunate lack of representation and diversity throughout the fertility industry in general, causing people of color to make difficult choices based on limited options. Do they continue to wait until they find a match, or do they choose to work with a donor who belongs to a different race or ethnicity.
The issue isn’t just about who looks like whom, though. For some, there can be important religious implications. For example, some Jewish intended parents feel very strongly that they want their child to be genetically Jewish. The search for a donor who meets a religious or ethnic requirement in addition to all the other requirements can take quite some time.
The lack of diverse donors applies to sperm donation as well. In the same article, the author describes one sperm bank search that resulted in a total of 433 donors: 260 of those being Caucasian and only 15 African American.
This is not a new issue, so I don’t think we can really pin this one on covid. The lack of diversity in our field has been an issue for decades.
So why is there a lack of diverse donors?
It could be partly due to fertility issues – it’s been proven that African-Americans have a higher probability of dealing with infertility, despite most people believing the opposite is true.
I can tell you that there is a long-documented history of medical mistrust in the Black community that I am sure plays into this disparity. Just look up details on the Tuskegee Experiment, Henrietta Lacks, or the forced sterilization policies of the 20th century (yes, that last one is really a thing, and it’s horrifying). I could go on about this but suffice it to say that Black people have very valid reasons for being skeptical of medical professionals.
The reasoning isn’t completely known, however, it really puts intended parents of color in a difficult position when choosing their donor.
On a personal note, the first time I inquired about becoming an egg donor, I was told that Black women don’t struggle with infertility so I’d probably have to wait a very long time to get matched with someone, if anyone reached out at all.
They were wrong. It is a complete myth that Black women don’t deal with infertility. I’ve done many interviews and episodes about this – check out my conversation with Regina from the Broken Brown Egg for a deep dive into this issue. By the way, I went on to donate five more times. So yes, there is absolutely a demand for donors of color.
So what is the solution to this shortage, particularly the problem with finding diverse donors? For the most part, the industry is doing what it can to recruit. The article I read on Insider highlighted the efforts of various clinics and egg banks to target their ads to diverse communities. There are also attempts to contact minority student organizations at universities, but the results are often mixed. And in the case of outreach to the Black community, it very rarely works. Again, likely due to the well established mistrust of the medical field.
What myself and others in the field have noticed, particularly among people of color, is that it often comes down to word of mouth and personal referrals.
What about egg banks as an option?
Keep in mind that the lack of egg donors is going to affect an egg bank just as it will an agency. Again, diversity is also an issue with the supply of frozen eggs.
Alright, so I have mostly focused on egg donors here, for a couple of reasons. First, it’s who I work with most often. And secondly, it’s a much more difficult “ask” for donors. What I mean by that is that an egg donor must go through a round of fertility medications that can cause side effects, and then undergo an invasive retrieval procedure. To donate sperm, a man simply walks into a clinic and, well, you know. Now, of course there’s a little more to it than that, like blood work, but for the most part, sperm donation is pretty simple. At least as compared to egg donation.
But still, let’s talk about the sperm donation process for a minute. Men who wish to donate need to meet standard health requirements and submit to blood and semen testing. Industry best practices state that men should be under the age of 40, however, there are some places that allow older men to donate. There are guidelines about the number of times a man can donate, but it’s not regulated by law in the United States, so you can find reports of a single donor resulting in dozens of offspring. Other countries do a better job of regulating this, placing a limit on the amount of possible children that could result from one donor.
Despite the relative ease of donating sperm, we’re still facing a shortage of donor sperm, particularly in terms of having a diverse selection. And many of the same reasons still apply: cultural mistrust of medical institutions, lack of awareness about the need, and so on. I think it’s worth noting that in the many minority communities, infertility just isn’t talked about in the open like it is with other communities. The reasons for this are deep and complicated. Suffice it to say that we still have a long way to go in terms of opening up the conversation about infertility, and until that becomes less taboo, we’re going to keep seeing a shortage of diverse donors.
And then there’s the question of DNA testing…boy, has that changed the conversation about egg donation.
The truth is, egg and sperm donation looks very different today than it did even a decade ago. In the past, donors could have relative confidence that they could donate anonymously if that was what they chose.
Today? Not so much. Anonymous donation is pretty much impossible. Given the popularity of at-home DNA test kits, which over 30 million people have taken worldwide, it’s safe to say that if a donor-conceived child wants to find their donor, it won’t be too difficult.
The appeal to many egg and sperm donors often comes down to the anonymity piece, at least it used to. The fact that it’s more likely than not that a curious teenager or young adult might come knocking at their door sometime in the future is turning out to be a big deterrent for a lot of potential donors.
There has also been a lot of conversation out there led by donor-conceived voices. There’s a large community on TikTok in particular that has become vocal about the realities of life as someone who was conceived using donor material. Check out Episode 30 wher eI speak to Erin Jackson who founded We Are Donor Conceived.
A quick scroll through TikTok of the hashtag #donorconceived turns up the story of a young woman who has found 65 half-siblings…and counting. In the US and a handful of other places around the world, there aren’t any limits to the number of times a person can donate sperm, so in theory one donor could have hundreds of biological children out in the world.
These donor-conceived stories add an emotional and ethical layer to the question of egg and sperm donation, making some would-be donors think twice.
So what does the future of the industry look like?
It’s hard to say. Having been in the field for nearly two decades, I can say that it definitely ebbs and flows. But many of these changes seem quite permanent, like the question of anonymity. And they are sure to change the way we approach third party reproduction for the foreseeable future.
One possible outcome is that compensation for donors and surrogates will continue to rise. We’re in a period of economic inflation across the board. According to Forbes, prices rose over 5% over the summer. Housing prices have absolutely soared as demand rises. So far, they’re up 16.6% from last year.
Everything is costing more, so I suppose it stands to reason that as demand for surrogates and donors rises, so does the compensation. That will make third party reproduction less accessible for some intended parents, for sure.
Conclusion
To wrap up this episode, My sense is that things will begin to even out eventually. One thing about life is its always evolving and changing and so to will this pandemic and I am sure the shortage of women willing to become egg donor or surrogates.
We just need to keep moving ahead with hope. Let’s normalize talking about these issues. Let’s normalize talking about infertility and third party reproduction. Share your stories. Share your experiences with your community, with your families and people you know. One day it may be your own children listening to these same stories.
I hope you’ve found this discussion helpful as you weigh your next steps. We would love for you to rate us. So if haven’t yet, go to your listening platform of choice and subscribe, rate and review this podcast. 5 star reviews are our favorite.
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Thank you so much for joining me today. Remember: “love has no limits – neither should parenthood.”
