Welcome to Fertility Cafe, the home for every conversation exploring alternative family building through IVF, surrogacy, egg, sperm, and embryo donation. Our host Eloise Drane, alternates episodes between educational shows, covering specific topics and guest narratives for further insight. For a mastery understanding and confidence in all things, alternative family, subscribe to Fertility Cafe.
00:28
Hey there, Welcome to Episode 96 of Fertility Cafe. I’m your host, Eloise Drane.
Today, we’re going to delve into a topic that’s often overlooked but incredibly important — the lack of regulation and oversight in the fertility industry.
Assisted reproductive technology is becoming more common in today’s world. Yet, there’s a pressing need for more regulation and transparency in the fertility industry. It’s time we lift the veil and have an open conversation about it.
In this episode, we’ll explore the current state of the fertility industry, the need for more oversight and the importance of patient care, and the accessibility of fertility care.
01:13
So, let’s get into it.
01:18
Picture this: you’re embarking on a journey to start or grow your family, and you’re navigating a landscape that’s not only emotionally charged, but also complex and often confusing. You’re dealing with surrogacy agencies, egg donors, fertility clinics, surrogates, and a whole lot of medical jargon. And in the midst of all of this, you discover that the industry helping you bring life into the world is, in many ways, a bit like the Wild West — there’s a startling lack of regulation.
Now, what does this mean? Well, without proper oversight, there’s a risk of some pretty unethical practices. We’re talking about potential exploitation of surrogates and egg donors, and inadequate care for patients. And just to be clear, surrogates and egg donors are not just service providers; they’re individuals whose health and well-being should always be a top priority.
And then there’s the issue of misinformation. Without clear, standardized guidelines, it’s all too easy for confusion and misunderstanding to creep in. This can lead to uninformed decisions, unrealistic expectations, and a whole lot of unnecessary stress.
To set the stage, let’s look at some compelling statistics. Reproductive problems in both men and women are rising at an alarming rate. The whole spectrum of reproductive problems in males is increasing by about 1% per year in Western countries. This includes declining sperm counts, decreasing testosterone levels, increasing rates of testicular cancer, and a rise in the prevalence of erectile dysfunction. I mean maybe “1% per year isn’t really a big deal.” But it is! It adds up to more than 10% per decade, and more than 50% over 50 years. When you consider that sperm counts declined by 50% in just 40 years, it’s difficult to deny or discount how alarming this is.
Female infertility is a widespread concern, affecting approximately 12% of women aged 15 to 44 in the U.S., according to the CDC, and 10% of the reproductive-age population, as reported by the American Society for Reproductive Medicine. Globally between 48 million couples and 186 individuals suffer from infertility, according to the World Health Organization. Common causes of female infertility include polycystic ovary syndrome (PCOS), affecting 6-12% of women in reproductive age in the U.S., and endometriosis, impacting around 1 in 10 women during their reproductive years or approximately 176 million women worldwide, as reported by The World Endometriosis Research Foundation. Miscarriage rates are also increasing by about 1% per year in the U.S., and so is the rate of gestational surrogacy.
04:23
The World Health Organization recently released an article that stated a large number of people are affected by infertility in their lifetime. Around 17.5% of the adult population — roughly 1 in 6 worldwide — experience infertility, showing the urgent need to increase access to affordable high quality fertility care for those in need.
The fertility industry is a booming business, but it’s also a field that lacks regulation and transparency. This is particularly true when it comes to third-party reproduction. When we talk about the fertility industry, we’re talking about a vast network of services, technologies, and professionals. It’s an industry that’s been growing rapidly thanks to advancements and medical technology and changing societal attitudes towards family building. But with this rapid growth, there has been a struggle to keep up in terms of regulation, and oversight.
Let’s consider the professionals involved in this industry. We have fertility doctors, nurses, embryologists, agencies, mental health professionals, and legal experts, to name a few. Each of these roles is critical in the fertility journey, and each requires a high level of expertise and ethical conduct. Yet, without proper regulation, there’s a risk that some individuals or organizations might fall short of the standards leading to subpar care or even harm to patients.
And then there’s the technology. Assisted reproductive technologies (ART), ART have revolutionized fertility care, offering hope to many who might otherwise be unable to conceive. But these technologies also raised complex ethical and legal questions. For instance, what happens to unused embryos? Who has the right to use stored genetic material after a divorce or death? Without clear regulations, these questions can lead to legal battles and emotional turmoil for those involved.
06:30
The fertility industry also intersects with other industries, such as insurance and pharmaceuticals. The cost of fertility treatments can be prohibitive, and insurance coverage is often inadequate. This can lead to disparities in access to care, with only those who can afford out-of-pocket expenses able to pursue certain treatments. And then there’s the role of pharmaceutical companies, which produce the hormones and other medications used in fertility treatments. Without regulation, there’s a risk of price gouging, leading to even higher costs for patients.
07:07
Another critical issue is the lack of insurance benefits for fertility treatments. While some insurance plans do cover certain treatments, many do not. This leaves many patients paying out of pocket for treatments that can cost 10s of 1,000s of dollars. This financial burden can add significant stress to an already emotionally challenging process.
The fertility industry is also a global dimension. Fertility tourism is a growing trend, with individuals and couples traveling to other countries for treatments that are cheaper or simply available when they are not in their home country. This raises additional concerns about regulation and oversight, as standards and laws may vary widely from one country to another.
Patient care in the fertility industry is a multifaceted concept that goes beyond the medical procedures involved. It’s about treating patients with respect, understanding, and empathy. It’s about providing emotional support and clear accurate information. It’s about being there for patients every step of the way, from the initial consultation to the final outcome.
Unfortunately, their reality often falls short of this ideal. Many patients report long waits to schedule appointments, which can be particularly stressful given the time-sensitive nature of many fertility treatments. This is partially due to a shortage of reproductive endocrinologists. As the demand for fertility treatments has grown, the number of specialists has not kept pace. This can lead to overworked doctors and rushed appointments, neither of which is conducive to high-quality patient care.
08:48
Despite the increasing rate of gestational surrogacy, there’s a shortage of surrogates, especially since the pandemic. Potential surrogates face more potential health risks and limitations because of the pandemic. For example, being pregnant puts someone more at risk of getting severely ill or dying from COVID-19.
09:09
The reality is, it can be tough to find a surrogate who matches the Intended Parents’ requirements and passes all medical screenings. This process can be even more intense for LGBTQ+ individuals. Surrogacy is a complex process, and it’s not entered into lightly. It’s financially prohibitive for many people, and it also comes with its own set of emotional challenges. For heterosexual couples considering surrogacy, they’ve likely already experienced heartache and loss in their fertility journey. For LGBTQ individuals, surrogacy may be the only path toward building a biological family.
09:48
The shortage of ethnic egg and sperm donors is a significant and complex issue within the fertility industry. Factors like cultural and societal stigma, misconceptions about donor responsibilities, and a general lack of awareness about the donation process have contributed to a lower number of donors from various ethnic backgrounds. This shortage impacts individuals and couples who desire to have children that share similar characteristics or racial heritage, leading to extended waiting times, higher costs, and additional emotional stress during an already challenging fertility process. To address this, comprehensive efforts are needed to raise awareness, revise possible restrictive regulations, and increase understanding and openness about the donation process within diverse ethnic communities.
The overturning of Roe v. Wade, the landmark Supreme Court decision that legalized abortion in the United States could also have significant implications for fertility care. While the primary focus of the debate around Roe v. Wade is on abortion rights. The decision also underpins the legal framework for many fertility treatments.
Roe v. Wade, the 1973 Supreme Court decision that recognized the constitutional right to privacy, extended to a woman’s right to make her own personal medical decisions, including the decision to have an abortion. The ruling has been a significant landmark for women’s rights and reproductive health. While often associated primarily with abortion rights, Roe v. Wade has a broader impact on reproductive health and fertility treatments.
For example, treatments like In Vitro Fertilization (IVF) involve the creation and manipulation of embryos outside of the body. This is a process that can challenge traditional beliefs about conception and pregnancy and might be regulated more heavily or possibly even prohibited if the legal principles underlying Roe v. Wade were overturned or significantly altered.
Another important aspect is that if the scope of Roe v. Wade is narrowed, it could provide states more leeway to enact laws limiting access to specific fertility treatments or to regulate them more heavily. Some of these laws could limit certain types of research or impose additional requirements on fertility clinics, potentially making treatments more expensive or less accessible for many people.
Furthermore, legal principles affirming reproductive autonomy also protect the rights of individuals and couples to access fertility preservation treatments, such as egg freezing or sperm banking. These methods are particularly important for individuals facing treatments like chemotherapy, that could impact their future fertility, or for those who wish to delay childbearing for personal or professional reasons.
Next, there’s an urgent need to address misinformation in the fertility industry. Many patients report feeling overwhelmed by the sheer volume of information available online, much of which is conflicting or misleading. That’s why patient education is so critical. Patients need access to reliable, evidence-based information to make informed decisions about their care. They also need support in interpreting this information and applying it to their unique situation.
But education should not be the responsibility of patients alone. Professionals in the fertility industry also have a role to play. They need to be well-informed about the latest advances in fertility care, and they need to be able to communicate this information effectively to patients. This requires ongoing training and professional development, which should be a standard part of any fertility care practice.
In terms of accessibility, there are a few key issues to consider. First, fertility treatments need to be affordable. This can be achieved through insurance coverage, government funding, or innovative pricing models. Second, fertility care needs to be available to all regardless of sexual orientation, gender identity, marital status, or socioeconomic status. This means removing barriers to care and in creating inclusive, welcoming environments. Patients need access to the full range of fertility treatments, from basic testing to advanced procedures like IVF and egg freezing.
The need for regulation in the fertility industry is not just about preventing unethical practices. It’s about ensuring that everyone involved in this process — from the professionals providing care, to the patients receiving it, to the donors contributing genetic material, to the surrogates and how their pregnancies are covered, is protected, and treated with the respect and dignity they deserve. It’s about making sure that the incredible advances in fertility care are accessible to all, not just a privileged few. And it’s about navigating the complex ethical and legal terrain of assisted reproduction with care and oversight.
Going forward, we need to advocate for transparency, patient education, and standardization in the fertility industry. We need laws that protect all parties involved and that provide clear guidelines for ethical conduct. We need regulations that ensure fertility treatments are safe, effective, and accessible. And we need insurance policies that cover fertility treatments, to ensure that cost is not a barrier to those who wish to start a family.
Thank you so much for listening. If you found this episode helpful, please rate Fertility Cafe on your favorite listening platform and share this episode with anyone you think could benefit from hearing it.
Tune in next week for another amazing episode on Fertility Cafe.
Until then, remember, “love has no limits — neither should parenthood.”
