Is Participating in the Fertility Industry Ethical?

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​In discussions about modern infertility treatments, many articles concerning in vitro fertilization (IVF) and surrogacy, and even the ethics of using a third-party gamete donor, have been written. For information on the ethics of the procedures themselves, Scott B. Rae¹ and Heather Zeiger² have published thorough treatments in the Christian Research Journal.

As an extension of the ethical conversation surrounding fertility treatments, the fertility industry itself must be examined. From lack of reasonable regulations, to targeting young gamete donors, to the problem of anonymous donors and non-transparent medical information, the fertility industry itself does not at present align with Christian moral values.

Christians have a long-standing history of non-participation in industries with which we disagree. We remove financial support from all kinds of businesses that we perceive to be advancing immoral agendas, promoting immoral products, or funding immoral practices. We must consider the current corruption and non-regulation in the fertility industry alongside any ethical and moral concerns about the treatments themselves in order to make an informed Christian decision.

LACK OF REASONABLE REGULATIONS LEADS TO ABUSES

With the release of the popular documentary entitled Our Father, which premiered on Netflix nearly a year ago,³ the discussions surrounding the fertility industry in America came to the forefront of national dialogue. This documentary details the story of a fertility doctor based in Indianapolis, Dr. Donald Cline, who used his own sperm — instead of chosen donor sperm — to impregnate women who used him as their fertility doctor.⁴ Lisa Kennedy of the New York Times called this shocking documentary a “horror movie.”⁵ According to Our Father, there is now a sibling pod of at least ninety-four known children from Dr. Cline’s deceptive actions.⁶ Director Lucie Jourdan, in describing the opening scene of the documentary in which the doctor is shown collecting his own sperm sample and subsequently entering the room to use it on his patient, explains what question she wants viewers to ask: “How is that not, in some way, some form of sexual assault?”⁷

In the United States, however, there is currently no federal law prohibiting doctors from swapping chosen donor sperm with their own, or any other sperm for that matter.⁸ Dr. Cline of Our Father infamy is not the only doctor alleged to have done this. The New York Times reports that since the popularization of commercial DNA testing in recent years, over fifty doctors have been accused of doing the same thing.⁹ This is the case even though only approximately twenty-one percent of Americans have taken a commercial DNA test.¹⁰ The number of offending doctors may be much higher.

This kind of deception has plagued the practice of donor insemination since it began. In 1884, one of the first documented cases of donor insemination was done in this manner. The woman, whose husband suffered from infertility, was anesthetized and inseminated with her doctor’s sperm under the guise of the donor being an attractive medical student. The husband eventually was informed, but the wife — whose subsequent pregnancy resulted in a live birth — was never informed about who the biological father was.¹¹

To date, only eleven U.S. states have statutes prohibiting such actions.¹² Even so, some of the laws concerning this practice have incredibly short statutes of limitations, making it virtually impossible to bring charges against offending doctors. For example, in California, the statute of limitations is only three years after conception.¹³ Currently, fertility fraud legislation has been proposed on a federal level. The bill, entitled H.R. 451, would “codify fertility fraud as a federal sexual abuse crime with a maximum imprisonment of 10 years,” along with amending the statute of limitations window and allowing “judges to order restitution for victims.”¹⁴ However, this bill is new and is not yet law.

Consider the case of a married couple seeking fertility assistance using the husband’s own sperm. In such a case, the couple could, from a Christian perspective, assume no moral ill in the procedure since it would be medically assisting conception that could otherwise be accomplished through faithful married sex.¹⁵ In this situation, however, because the couple would need to consult a fertility doctor and participate in this highly unregulated industry, they may open the door for a third-party donor that neither husband nor wife considered a possibility. This would undoubtedly violate their conscience and cause extreme emotional damage in the event that, years later, they find out that their child was conceived using another man’s sperm.

Christians should champion truth, rather than falsehood. Jesus calls Himself “the way, and the truth, and the life” (John 14:6 ESV, emphasis added), underscoring how integral truth is to His own character. Jesus Himself is the truth. If we are called to be like Christ, as we are, we must weigh what it means to fund, participate in, and subject our bodies to such an industry that is known for falsehood.

ANONYMITY AND THE POTENTIAL FOR INCEST

The fertility industry in America is largely anonymous. Anonymity leaves the door open for serial donors to run rampant, for sibling pods to grow to excessive numbers, and for significant mental distress to occur in donor-conceived individuals and recipient families.

Serial donors are men who donate excessively to multiple cryobanks and clinics, and sometimes even donate privately, leading to many pregnancies and live births. An example from the news: Jonathan Jacob Meijer, a Dutch man, was recently alleged to have fathered approximately 550 children all over the world through cryobanks and private donations.¹⁶ This far exceeds Dutch guidelines, and he was blacklisted from donating in the Netherlands. Having been sued for his actions by the Dutch Donor Child Foundation,¹⁷ he is now banned from donating sperm, and he faces a $110,000 fine if he does so again.¹⁸

In America, there is currently no national donor registry, making it difficult to track serial donors across multiple clinics. Because American donors can remain anonymous, and each bank maintains its own records without necessarily communicating with other banks, this can lead to enormous sibling pods — some reaching over one hundred.¹⁹ Though there are suggested guidelines, there is currently no federal cap on sibling pod size in America.²⁰ We also have only an approximate understanding of how many live births happen from these serial donations since live births must be self-reported by recipient families.

Many donor-conceived individuals are not provided with information about who their biological parents are, and many are not given information about being donor-conceived to begin with. They are therefore left in a position in which they may unknowingly enter into a relationship, even marriage, with a half-sibling. With massive sibling pods, especially in less-populated areas, there can be cases of accidental incest. And though it should go without saying, incest is illegal and immoral. The Bible is clear: “You shall not uncover the nakedness of your sister, your father’s daughter…whether brought up in the family or in another home” (Lev. 18:9 ESV).²¹

Anonymity, likewise, can lead to complications in transferring accurate medical histories. When people become parents, there is an awareness of possible medical concerns that may run in each parent’s family. This allows parents and physicians to accurately screen for possible conditions from a young age. If, for example, a critical heart defect could be inherited, the child would be screened immediately and frequently throughout their life. Currently, there is no federal requirement that clinics verify donor-submitted medical history before they receive sperm donations; all medical information is self-reported by the donor.²² As such, cryobanks and clinics might well absolve themselves of the duty of reporting accurate medical histories of their donors to recipient parents, leading to possible chronic illness, mental stress of enduring excessive medical testing, and sometimes even death.

TARGETING COLLEGE-AGED DONORS

According to a report published on March 16, 2023, the market size of the fertility industry in the U.S., measured by revenue, is $7.6 billion.²³ A lucrative business in many respects, the industry thrives on a consistent donor base and the promise of monetary compensation for donations. Cryobanks and fertility clinics specifically target college-aged donors with paid advertisements hung around campuses, social media ads, and even with promotions on TikTok. Some of these advertisements clearly demonstrate the age group that they want to reach, with ads like “Jerks Wanted,” depicting a clenched hand, with a voiceover saying, “You’re already doing it, why not get paid for it?”²⁴

Cryobanks are known to purchase real estate near college campuses, especially close to Ivy League institutions or otherwise well-known schools.²⁵ After all, well-educated sperm donors are especially profitable; donors with “demonstrated intellect” are prioritized and are much more likely to have their genetic material selected.²⁶ Despite the American Society of Reproductive Medicine stating that “compensation should not vary according to…the number or outcome of prior donation cycles, or the donor’s ethnic or other personal characteristics,”¹²⁷ there have still been reports of donors with a GPA of over 3.7 receiving more compensation.²⁸ With promises of the potential to earn a thousand dollars or more each month for consistent sperm donations, and significantly more for women who are willing to donate their eggs,²⁹ the draw for young people is strong. The problem is that many college-aged students may not fully grasp the life-altering decision that they are making in becoming donors.

It is especially difficult for young women who are targeted with online marketing to fully understand the impact that these procedures may have on their bodies. Women must undergo medically invasive procedures to procure eggs, including regular hormone shots, ultrasounds, blood draws, and surgery. Many of the long-term effects of these hormone procedures are yet to be determined, meaning many young women may experience negative side-effects — without having been sufficiently warned.³⁰ Related to this, many young women have noted that they have been over-stimulated, producing far beyond the number of eggs needed for the procedure, causing Ovarian Hyperstimulation (OHH), and leaving them ill.³¹

It may not be explicitly unethical to target donors who are technically adults, but it certainly raises the question about why the industry in general wants such young donors. There is no difference in live birth outcomes with respect to the age of the sperm donor ranging up to 45 years old.³² So the question remains: why target young men, rather than older men, who may be able to make a more well-informed decision?

Furthermore, it may not be fully understood by donors that one sperm donation can be divided and used in multiple sellable vials.³³ So, in the case that a college student donates one time — on the off-chance that everything goes perfectly, and they are a highly desirable donor — they may help bring three or more children into the world. And many of the donors who go in on a regular basis to donate sperm go to the clinic two or three times a week for months at a time.³⁴ This can lead to many more live births than they may consider possible.

In targeting such young donors with promises of monetary reimbursement when they may be in a place in their lives where this kind of compensation is significant, the fertility industry as a whole currently acts contrary to Christian morality. Whereas the Bible says, “the love of money is a root of all kinds of evils” (1 Tim. 6:10 ESV), the fertility industry says: you can receive $5,000 to $10,000 by becoming an egg donor. Additional incentives include medical insurance, payment of medical expenses, attorney fees, travel expenses, and more.³⁵ Treating the act of bringing children into the world as a monetary transaction is ethically problematic, but when you realize that the industry preys on people being young and uninformed, it is even more suspect.

Moreover, the monetary exchange for viable third-party sperm or eggs to produce children is wrong in that it abstracts conception from the sex act between two married individuals. It also places an emphasis on choosing a donor based on physical characteristics, rather than the person themselves, as would be the case in marriage.

CONCLUSION

With more couples than ever before opting to use fertility treatments to conceive, it is imperative for Christians to weigh the ethical issues of the fertility industry alongside the procedures themselves. From regulation issues to problematic practices, the industry at present poses many concerns that must be thoroughly considered, prayed about, and weighed by Christians who are struggling to conceive. There may be situations in which Christians believe they can ethically make the choice to use various types of fertility treatments, but this industry should not be opted into without significant care and concern, with full awareness about the procedures and the industry’s current practices.

We must, as Christians, open our eyes to the emotional and mental ramifications of the practices of this industry on individuals. Consider the mental distress of a donor-conceived child when they find out that they have over one hundred half-siblings. Consider the anguish of these individuals who never get to know their biological parent, and the longing for that relationship. The agreement of protecting anonymity made between parents and a clinic before conception is a decision the child had no part in making. The experiences of donor-conceived individuals and recipient families should be taken into account when weighing the ethics of participating in this industry. For firsthand accounts of how anonymity and fertility fraud impact individuals and families, The Anonymous Us Project features hundreds of such stories.³⁶

Ultimately, no industry will function perfectly, but where human lives are so intensely and readily impacted, Christians must employ wisdom in choosing a moral path, and that may include refusing to participate.

Lisa Cooper is a senior copywriter at RevelationMedia and a freelance writer with Barna. She has a master’s degree in religion from The American Lutheran Theological Seminary.

NOTES

1. Scott B. Rae, “Brave New Families? The Ethics of Reproductive Technologies,” Christian Research Journal, Spring 1993, https://www.equip.org/articles/reproductive-technologies/.
2. Heather Zeiger, “When Baby-Making Takes Three: You, Me, and She,” Christian Research Journal, vol. 39, no. 01, 2016, https://www.equip.org/articles/baby-making-takes-three/.
3. Our Father, directed by Lucie Jourdan, released May 11, 2022, Netflix, https://www.netflix.com/title/81227735.
4. See also Adam Wren, “Donald Cline: The Fertility Doctor Accused of Fraud,” Indianapolis Monthly, May 15, 2019, https://www.indianapolismonthly.com/longform/the-immaculate-deception.
5. Lisa Kennedy, “’Our Father’ Review: A Doctor’s God Complex Revealed,” New York Times, May 12, 2022, https://www.nytimes.com/2022/05/12/movies/our-father-review.html.
6. See also Molli Mitchell, “‘Our Father’: How Many Children Does Dr. Cline Have and Where Are They Now?,” Newsweek, May 12, 2022, https://www.newsweek.com/our-father-donald-cline-how-many-children-where-now-jacoba-ballard-1705955.
7. Ben Rawson-Jones, “‘Our Father’ Shows What Happens When a Fertility Doctor Has a ‘God Complex,’” Director’s Cut, Netflix Tudum, May 11, 2022, https://www.netflix.com/tudum/articles/our-father-director-interview-lucie-jourdan. 
8. “Fertility Fraud: Federal Criminal Law Issues,” Congressional Research Service, July 19, 2022, https://sgp.fas.org/crs/misc/IF12168.pdf; Candice Nguyen and Jeremy Carroll, “Federal Fertility Fraud Bill Introduced After ‘Widespread’ Doctor Sperm Donor Cases,” NBC Bay Area: Investigative Unit, February 23, 2023, https://www.nbcbayarea.com/investigations/fertility-fraud-bill-doctor-sperm-donor-cases/3163419/.
9. Jacqueline Mroz, “When an Ancestry Search Reveals Fertility Fraud,” New York Times, February 28, 2022, https://www.nytimes.com/2022/02/28/health/fertility-doctors-fraud-rochester.html; Alyssa Lukpat, “Fertility Doctor Accused of Using His Own Sperm Is Ordered to Pay Millions,” New York Times, April 28, 2022, https://www.nytimes.com/2022/04/28/us/paul-jones-fertility-settlement-colorado.html.
10. Taylor Orth, “DNA Tests: Many Americans Report Surprises and New Connections,” YouGovAmerica, February 25, 2022, https://today.yougov.com/topics/society/articles-reports/2022/02/24/dna-tests-many-americans-report-surprises-and-new-.
11. Lisa Luetkemeyer and Kimela West, “Paternity Law: Sperm Donors, Surrogate Mothers and Child Custody,” Missouri Medicine: The Journal of the Missouri State Medical Association, May–June 2015, 162–65, National Library of Medicine, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6170122/.
12. Nguyen and Carroll, “Federal Fertility Fraud Bill Introduced.”
13. Nguyen and Carroll, “Federal Fertility Fraud Bill Introduced.”
14. Nguyen and Carroll, “Federal Fertility Fraud Bill Introduced.” See “Press Release: Bice, Sherrill Introduce Bill in Response to “Our Father” Documentary,” Stephanie Bice, August 16, 2022, https://bice.house.gov/media/press-releases/bice-sherrill-introduce-bill-response-our-father-documentary; “H.R. 451 — Protecting Families from Fertility Fraud Act of 2023,” 118th Congress (2023–2024), https://www.congress.gov/bill/118th-congress/house-bill/451/text.
15. For clarification on Christian moral parameters, see Rae, “Brave New Families? The Ethics of Reproductive Technologies,” and Zeiger, “When Baby-Making Takes Three: You, Me, and She.”
16. Olivia Land, “Serial Sperm Donor Banned from Continuing to Donate,” New York Post, April 28, 2023, https://nypost.com/2023/04/28/serial-sperm-donor-jonathan-jacob-meijer-banned-from-continuing-to-donate/; cf. Jacqueline Mroz, “The Case of the Serial Sperm Donor,” New York Times, February 1, 2021, https://www.nytimes.com/2021/02/01/health/sperm-donor-fertility-meijer.html.
17. Claire Moses, “Man Who Has Fathered Hundreds Is Barred from Donating Sperm,” New York Times, April 28, 2023, https://www.nytimes.com/2023/04/28/world/europe/dutch-sperm-donor-ban.html.
18. Peter Aitken, “Prolific Sperm Donor with over 500 Children Must Pay $110K If He Donates Again, Court Rules,” Fox News, April 29, 2023, https://www.foxnews.com/world/prolific-sperm-donor-500-children-pay-110k-donates-court-rules.
19. “Large Donor Conceived Sibling Groups,” Donor Deceived, 2023, https://donordeceived.org/large-sibling-groups.
20. “Guidance Regarding Gamete and Embryo Donation,” ASRM Pages, vol. 115, no. 6 (2021): 1395–1410, American Society for Reproductive Medicine, https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/practice-guidelines/for-non-members/recs_for_gamete_and_embryo_donation.pdf; “Large Donor Conceived Sibling Groups.”
21. For an excellent sermon on Leviticus 18 and its application to Christian living, including commentary on why God forbids incest, see Kevin DeYoung, “Sexual Integrity for a People Set Apart,” Christ Covenant Church, April 23, 2023, https://christcovenant.org/sermons/sexual-integrity-for-a-people-set-apart/.
22. See Ellen Trachman, “Federal Legislation Introduced to Require Egg and Sperm Donor Background Verifications,” Above the Law, July 27, 2022, https://abovethelaw.com/2022/07/federal-legislation-introduced-to-require-egg-and-sperm-donor-background-verifications/; Naomi Cahn and Sonia Suter, “Sperm Donation Is Largely Unregulated, but That Could Soon Change as Lawsuits Multiply,” The Conversation, January 18, 2022, https://theconversation.com/sperm-donation-is-largely-unregulated-but-that-could-soon-change-as-lawsuits-multiply-174389#; Grace Browne, “Egg and Sperm Donors Could Be Required to Share Their Medical Records,” Wired, August 23, 2022, https://www.wired.com/story/sharing-egg-sperm-donor-medical-history/; Wendy Kramer, “Sperm and Egg Donation: 10 Things Your Doctor, Clinic, or Sperm Bank Won’t Tell You,” The Donor Sibling Registry, https://donorsiblingregistry.com/dsr-booklet-brochures.
23. “Fertility Clinics in the US – Market Size 2005–2029,” IBIS World, March 16, 2023, https://www.ibisworld.com/industry-statistics/market-size/fertility-clinics-united-states/.
24. “Xytex Sperm Donor Program,” Donate Sperm.com, April 20, 2023, https://donatesperm.com.
25. Julie Borg, “Sperm Banks Find Fertile Recruiting Grounds on College Campuses,” World, April 10, 2015, World News Group, https://wng.org/sift/sperm-banks-find-fertile-recruiting-grounds-on-college-campuses-1617428349.
26. Sonia F. Epstein and Polina N. Whitehouse, “Inheriting the Ivy League: The Market for Educated Egg and Sperm Donors,” The Harvard Crimson, April 30, 2020, https://www.thecrimson.com/article/2020/4/30/inheriting-the-ivy-league/.
27. “Financial Compensation of Oocyte Donors: An Ethics Committee Opinion,” Ethics Committee of the American Society for Reproductive Medicine, Fertility and Sterility, ASRM, October 27, 2016, https://www.fertstert.org/article/S0015-0282(16)62871-6/fulltext.
28. Epstein and Whitehouse, “Inheriting the Ivy League.”
29. Epstein and Whitehouse, “Inheriting the Ivy League.”
30.  Tasha McAbee, “Egg Donation Risk and Reward,” Public Health Post, October 9, 2020, https://www.publichealthpost.org/viewpoints/egg-donation-risk-and-reward/; Pinar Tulay and Okan Atilan, “Oocyte Donors’ Awareness on Donation Procedure and Risks: A Call for Developing Guidelines for Health Tourism in Oocyte Donation Programmes,” Journal of the Turkish-German Gynecological Association, vol. 20, no. 4 (2019): 236–242, National Library of Medicine, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883756/; Naomi Cahn and Jennifer Collins, “Fully Informed Consent for Prospective Egg Donors,” Virtual Mentor, vol. 6, no. 1 (2014): 49–56, AMA Journal of Ethics, https://journalofethics.ama-assn.org/article/fully-informed-consent-prospective-egg-donors/2014-01.
31. Gwyneth Rees, “How Young Women are Being Persuaded to Sell Their Eggs by Social Media,” I News, March 20, 2023, https://inews.co.uk/inews-lifestyle/fertility-clinics-using-social-media-persuade-young-women-sell-eggs-2217424.
32. N. K. Ghuman, E. Mair, K. Pearce, and M. Choudhary, “Does Age of the Sperm Donor Influence Live Birth Outcome in Assisted Reproduction?,” Human Reproduction, vol. 31, iss. 3, March 2016, 582–590, Oxford Academic, https://academic.oup.com/humrep/article/31/3/582/2384700.
33. Wendy Kramer, “Egg and Sperm Donors: It’s Complicated,” Psychology Today, April 24, 2023, https://www.psychologytoday.com/gb/blog/donor-family-matters/202303/egg-and-sperm-donors-its-complicated; “How Many Vials of Donor Sperm Will I Need?,” Fairfax Cryobank Blog, November 22, 2020, https://fairfaxcryobank.com/blog/how-many-vials-of-donor-sperm-will-i-need; “Sperm Donor Myths and Misconceptions,” Cryogenic Laboratories, September 12, 2012, https://www.cryolab.com/blog/?p=586.
34. See Epstein and Whitehouse, “Inheriting the Ivy League.”
35. “Egg Donor Compensation,” Egg Bank America: Egg Donor America, April 27, 2023, https://www.eggdonoramerica.com/become-egg-donor/egg-donor-compensation.
36. “AnonymousUs.Org,” April 20, 2023, https://anonymousus.org