The Racial and Ethnic Disparity and Homophobia in U.S. Sperm Banks
A recent article was published in the September 2024 issues of the American Society of Reproductive Medicine (ASRM)’s journal, Fertility and Sterility, that looked at the racial and ethnic disparity in donor sperm availability in the United States (1).
The study was designed to compare donors from 18 sperm banks with the U.S. male census data as well as those who had utilized donor sperm for in vitro fertilization (IVF).
The main results of the study are shown in this table:
Not surprisingly, the racial/ethnic breakdown of sperm donors were all significantly different from the composition of males in the general U.S. population, with White, Asian, and Multiracial donors exceeding the demographics in the U.S. census.
However, what I find most interesting is the mismatching of race/ethnicity between sperm donor and recipients.
In general, people who are utilizing donor gametes (egg or sperm) for their family building journey are looking for donor gametes that mirror and complement the intended parents (IPs). My husband and I reflected this sentiment, as race/ethnicity was a important to us during our own egg donor selection (https://www.babymoonfamily.com/original-articles/choosing-egg-donor).
With this in mind, it would make sense for sperm banks to offer the racial/ethnic background that matches the recipients. However, with the exception of White, Asian, and Multiracial, there was a shortage of all other racial/ethnic groups represented in the sperm banks for recipients to select.
This mismatch was most pronounced with Black sperm donors and recipients. Only 2.8% of sperm donors were Black, compared to 13% of recipients who identified as Black. Although less pronounced, there was still a disconnect between sperm donors and recipients for American Indian/Alaskan Native (0% of donors, 0.2% of recipients) and Hawaiian/Pacific Islander (0.1% of donors, 0.2% of recipients).
This showcases that some racial/ethnic minority recipients who are selecting sperm donors have a much smaller pool to select from, making it harder for them to build their families to match their own identities.
The authors then discuss possible explanations for this mismatch, particularly around the shortage of Black sperm donors:
Historically racist and unethical research with Black Americans (i.e. Tuskegee Syphilis Study (2)) still contributes to an understandable lack of trust in medical science.
Religious affiliations with Christian or Islamic faiths that discourage ART.
Family history and/or genetic carrier status of sickle cell anemia, which is more common in Black Americans and leads to automatic disqualification from sperm donation.
Included as another automatic disqualification for sperm donation in the U.S. by the authors was men who have sex with men (MSMs).
This was news to me.
I have been researching and writing about ART for queer people for over a year, and I’m a physician.
However, I had no idea that MSMs are ineligible to donate sperm in the United States.
This was shocking but also not entirely surprising. The U.S. has always been extremely conservative and homophobic when it comes to human bodily fluid donations and MSMs, blaming this on the increased risk around HIV transmission despite advances in screening that make this a scientifically unsound argument.
It was only last year that the FDA decided to lift its ban on MSMs donating blood and move to a more equitable system of risk assessment for all donors, similar to that used in countries like the United Kingdom and Canada (3).
The same move has obviously not been done for sperm donation. While allowing queer men to donate sperm could contribute to more diverse racial/ethnic representation of donor sperm in the U.S., more importantly to me and other queer IPs, it would allow us to openly and fully participate in ART and seek out donors who fit the profiles that we want for our growing families.
Many queer IPs want a queer donor, and just the other day, there was a Facebook post in a rainbow family group I am in where a queer female couple was looking for a queer man to be their sperm donor. Clinics will still conduct all the necessary HIV screening on these donors, and while MSMs are not forbidden to be donors at the request of a specific person or couple, they are not allowed to donate anonymously to a sperm bank.
Therefore, queer IPs who don’t have a friend or advertise for a donor on social media have to rely on a sperm bank and have no way of finding an out and proud sperm donor. Reflecting again on my husband and my experience with the egg donor database, we also had no information about sexual orientation or gender identity to leverage for our search. However, the risk for HIV with MSMs would not apply to a queer women donating ovaries, so as far as I know, there is no reason that egg donor databases could not have this information for IPs. So why don’t they?
This issue is also connected to the CDC’s National ART Surveillance and my review of that database (https://www.babymoonfamily.com/original-articles/cdc-database). This study leveraged the CDC database in order to get its demographic information for the sperm donor recipients. However, this database does not collect sexual orientation or gender identity information for IPs utilizing IVF or a gestational carrier through ART.
While I have written to the CDC and asked them to include this information on sexual minorities for the database, clearly more has to be done for queer people and ART.
In line with this article’s conclusion that there needs to be more Black American sperm donors, there needs to be more queer donors so rainbow families can have full visibility and be able to select donors that really resonate with them. With the current state of sperm donation, we cannot even have known queer men donating sperm, so we clearly have a long way to go before we have representation in sperm banks of queer men that reflects the U.S. demographics of about 5% (4).
More and more queer people are having children through ART, so the donor databases, clinics, and the CDC all need to be able to collect, describe, and share this vital information to help all people trying to build rainbow families.
As with all scientific publications that I review on BabyMoon Family, if you would like access to the full article described above, please email me at bryan@babymoonfamily.com.
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