Innovations in reproductive health are advancing at an exponential rate. Unfortunately, the latest technology is inaccessible to many, putting underprivileged parents at a reproductive disadvantage because they cannot select for the “ideal” child among potential offspring. As the use of these technologies is becoming more mainstream, its potential to exacerbate current racial and socioeconomic inequalities is abundantly evident.
Consider an example. Some couples seek egg donations in order to conceive, a simple intervention that can break the bank: A fresh donor egg at the Center for Human Reproduction, one fertility clinic in New York, can cost around $5,600, with a discounted cryopreserved egg costing around $3,370 [1]. For these couples, insurance does not typically cover donor egg costs or the fertilization procedure and shipping. Additional fees for the mother or surrogate may or may not be covered and include blood work, doctor visits, and prenatal care [2]. Then, because such attempts at fertilization are only successful 50% of the time, it is often necessary to purchase several eggs. Another common technology, in-vitro fertilization (IVF), can cost anywhere from $10,000 to $15,000, with additional costs of medication ranging from $1,500 to $3,000. The average couple at a fertility clinic usually spends about $19,00 per cycle, with an additional $7,000 tacked on for every additional cycle needed [3].
Systemic barriers such as poverty, educational inequality, and racism may prevent couples from seeking these services. Thus, those who use an egg donor or receive these IVF treatments have often themselves benefited from various privileges, such as higher education or wealth. As a result, good health, athletic capability, and high intelligence may all be prioritized in potential children,4 further perpetuating this existing inequality.
When it comes to egg donors, their lifestyle, race, educational background, and physical features can make the difference between a $20,000 egg harvest and a rejection by the egg bank. Currently, there is demand for eggs from Jewish, Indian, and Asian donors, which are in low supply at egg donation centers. In addition, college-educated and pre-existing donors are highly sought after and tend to be paid much more for their eggs [1]. White and Asian donors can earn between $10,000 to $20,000 for their eggs, but donors of black or Latinx descent are often rejected due to high supply and low demand, earning a maximum of about $6,000 even if they are chosen [4].
Dr. Richard Sherbahn, the founder of the Advanced Fertility Center of Chicago, initially launched his egg donation program with three white female donors. The eggs were quickly chosen. Over time, he met couples with more specific requests — one couple requested “a thin, white women with green eyes and wavy blond hair who stands between 5-feet-7 and 5-feet-8, has Swedish ancestry, played college-level athletics, holds a master’s degree — at the very least — and registers a minimum 120 on an IQ test.” [5] This level of genetic, educational, and social specificity is, in some ways, as frightening and complicated as the concept of designer babies: a baby genetically engineered in vitro for specific traits, ranging from reduced disease risk to gender to specific physical features [6].
As reproductive technology advances, it will become increasingly important to incentivize diverse populations to donate their eggs, and to regulate these technologies. “Shopping around” for the most desirable egg donor may not be equivalent to engineering a designer baby, but its ethical implications and popularity are too large to ignore. The pre-existing reproductive disadvantages of minority and poor parents, such as lack of access to birth control and greater financial insecurity, are exacerbated by the fact that many reproductive technologies are only accessible to the wealthy and privileged. While there is nothing wrong with wanting a better life for one’s child, we have to ask ourselves: Is it fair that some people get to build their baby and that others cannot?
References
1. Egg Donor America. (2017, September 8). How Much Will It Cost to Use an Egg Donor?: Egg Donation Center: Egg Donor America Donor Egg Database & Frozen Egg Bank. Retrieved from https://www.eggdonoramerica.com/blog/how-much-will-it-cost-to-use-an-
egg-donor. 2. Mazel, S. 2019. Using a Donor Egg to Get Pregnant. Retrieved from
egg/. 3. Pagán, C. N. (n.d.). Surprise Pregnancy: Why Unplanned Pregnancies Happen. Retrieved from www.webmd.com/sex/birth-control/features/surprise-unplanned-pregnancy. 4. Li, S. (2012, May 4). Asian Women Command Premium Prices for Egg Donation in U.S. Los Angeles Times. Retrieved from https://www.latimes.com/health/la-xpm-2012-may-04-la-fi-
egg-donation-20120504-story.html 5. Hess, A. (2014, November 13). Couples Want Their Egg Donors to Be Smart, Athletic,
Good-Looking, and Swedish. Retrieved from https://slate.com/technology/2014/11/egg-
donation-study-couples-want-donors-to-be-smart-athetic-good-looking.html. 6. Boudreau, A. (2015, November 5). ‘Premier’ Donor Eggs Command High Prices for Desirable Genes. ABC News. Retrieved from https://abcnews.go.com/Health/big-
business-egg-donation-sparks-controversy-pricing/story?id=34967399 7. Egg Donor Cost: Understanding Costs Associated with Fresh vs. Frozen Egg Donation. (n.d.). Retrieved from https://www.centerforhumanreprod.com/services/discountprograms/eco-egg-donor/cost-
of-egg-bank/. 8. Ly, Sarah. (2011, March 31). Ethics of Designer Babies. The Embryo Project Encyclopedia. Retrieved from https://embryo.asu.edu/pages/ethics-designer-babies. 9. Gurevich, R. 2019. How Much Does One Cycle of In Vitro Fertilization Really Cost? 10. Pérez, M. Z. (2018, November 28). Where Are All the Sperm Donors of Color? Rewire.News. Retrieved from https://rewire.news/article/2018/11/28/where-are-all-the-