By Devin Shuman, MS, CGC and Jenny Rietzler, MS, CGC
Have any of y’all read the most recent American Society for Reproductive Medicine (ASRM) recommendations for gamete and embryo donation lately? Probably not if you don’t work in ART (assisted reproductive technology). It’s a bit painful, particularly if you comb through it with a JEDI (justice, equity, diversity, and inclusion) lens (which let’s be real, we should *always* be doing). While the guidelines tout using donors to “provide individuals and couples who otherwise may not be able to conceive with an opportunity to build a family,” the recommendations impose their own value system of “prenatal optimization” onto patients regarding who is “qualified” to contribute to their future family.
Let’s start off with sperm donor screening as our first focus in this series. People at “high risk” of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) are specifically excluded. That statement might make you pause at first–who are they targeting here?–but the Food and Drug Administration (FDA) kindly circles back with specifics in the guideline so you’re not left wondering. As of January 2020, the wording goes, “males with a history of sex with another man” should be deemed ineligible to be a sperm donor (TL;DR if you’re gay, we don’t want your sperm). In fact, every six months while remaining an active donor, the FDA requests that donors undergo a complete physical examination and be denied participation if there is ANY evidence of anal intercourse. Even if you’re HIV negative (with plenty of time after your last sexual encounter for a negative HIV result to not be a false-negative), if you are a male and having sex with other males, you cannot be a sperm donor. End of story.
In a Washington Post article published last October, Seattle Sperm Bank shared that they turned away a “really great [sperm donor] candidate” because he disclosed he was gay. Their clinic relations manager went on to say, “It feels like we’re stuck in this duality where we wholeheartedly support and welcome the LGBTQ community, but then we have to fall under these ancient regulations.” The ASRM had the opportunity with their latest recommendations to advocate for leaving these outdated regulations in the past, like the relic of antiquated medical guidelines that they are. Instead, homophobia was perpetuated.
If we’re really trying to reduce the chance of HIV transmission, then let’s stick with the facts. Whether or not HIV can even be transmitted by sperm itself, after sperm washing to remove seminal fluid and non sperm cells prior to insemination, remains up for debate. HIV tests used to screen sperm are highly sensitive. There is no way to accurately detect anal intercourse through a physical exam. Self-report of sexual history is not a more sensitive detection method than HIV biochemical tests are. If we’re worried about undetected HIV positive cases, we would be preventing males under the age of 24 from donating as they are most likely to have HIV and not be aware of it – and yet, this is often the main targeted group as sperm banks purposefully recruit near college campuses.
This level of hypervigilance of screening for HIV/STI is stunning when compared with ASRM’s recommendations for medical and family history. There are zero checks and balances for donors reporting most other details in their life. Medical records are not obtained and proof of work/education are not always required. Why then do we test samples for HIV, test the donors for HIV multiple times, do physical anal exams, and still rule out anyone who is gay – all in the name of medical risks? Applying statistics regarding a group or identity to deny an individual access is discrimination – plain and simple.
As medical providers, we need to acknowledge the deeply personal decisions that go into building a family. These are not our bodies and these are not our babies. When we disqualify LGBTQIA+ donors with these guidelines, we are hiding the discriminatory history behind our guidelines under the cloak of medical recommendations.
Genetic Support Foundation stands with other medical providers and organizations in the fight for inclusive healthcare. If you’d like to talk with a genetic counselor about your family planning goals and options for preconception screening, contact us today to meet with one of our reproductive genetic counselors via telehealth.