CONFERENCE PROCEED
How COVID-19 Pandemic Affects Women’s
banks and CBRC in my doctoral dissertation [1]
and aim to promote women’s reproductive rights in Asia as well as to problematize and re-examine them in contemporary society. The research period was from 2016 to 2020.
The results indicated that both of them have had a wide impact in the past three decades on women’s fertility. However, the public holds different opinions on the issues, and related studies are not evenly distributed. My research believes that they are, on the one hand, an important staged solution to support women’s access to fertility, which has promoted the birth of new types of families and new types of motherhood, but at the same time they also bring about the issues of ethics and risk governance and other aspects of the debate, urging the general public to respond in a local context through discussion or policy modification.
They have become a common strategy for single women and lesbians to pursue reproductive autonomy and build families. For Taiwan or even Asia, our view of this phenomenon is still somewhat different from that of northern Europe and North America where sperm banks are popular. We don’t have many studies on it so far, our society is being deeply affected by it due to factors such as globalization, technological development and consumer society. As a symbol and a product of the modernity of artificially assisted reproduction, international commercial sperm banks and CBRC can be used as a representation of the changes in contemporary society and direct us on a path to reflect on changes in our cultural and social conditions.
Because I am concerned with the life situations of socially infertile women, I wanted to reflect on the current conditions of reproductive practices in Asia, so for this research I participated in the visiting program at Yale Interdisciplinary Center for Bioethics and The Hastings Center, about three years ago. I also went to Thailand, China, Europe, Japan, and other countries for field research and data collection with some government funding. One of my related studies has won the PhD. Thesis Award of the Population Association of Taiwan in 2021.
With the current trend of sub-replacement fertility
in many countries, this is an indication of the importance and the possible contribution of this topic. At the same time, however, it is necessary to conduct more comparative studies in different countries. In particular, this study believes that sperm banks and networks of international treatment not only provide reproductive materials and connections, but also influence people’s views on gender, family, and self, as well as the development of contemporary social relations and the process of family construction.
Here I would like to quickly provide some background information about the commercial sperm industry and CBRC. As we know, there are many different ways to obtain sperm resources, including government sperm banks, government-commissioned hospital sperm banks, commercial sperm banks, various forms of gray markets, and individual donors, each with different characteristics, advantages and limitations, and their own clients. For example, government sperm banks may have a shortage of sperm resources and users may have to wait longer, while commercial sperm banks may be profit-oriented and ignore ethical or governance issues.
However, due to the development of the consumer society, commercial sperm banks have become a major supplier of sperm resources. The sperm industry began to develop a long time ago and became visible around 1980 due to rapid changes in the global situation. Subsequently, through the establishment of a large number of sperm banks, the consolidation of large companies and the expansion of global businesses, the global sperm industry has reached a value of US$4-5 billion by 2020.
CBRC for the purpose of obtaining reproductive resources or treatments has been one of the main items in the development of medical tourism in many countries. Different biobanks target different populations, and the CBRC linked to them also has different routes. In addition to the regional travel within Europe, for example, sperm banks are most developed in North America and Northern Europe, so many people also travel to the United States and Denmark to get sperm resources. However, they have also established resource transportation networks with clinics or
small sperm banks around the world to allow users to plan for a more convenient trip. Anyway, CBRC appeals to socially infertile clients everywhere who are limited by the legal, cultural or social structures of their home countries.
Europe has a long-standing history of cross-border healthcare. The European Union lends itself well to cooperative healthcare through its culture, history, and geography. During the COVID-19 crisis, Europe’s cooperative approach has continued, while in North America isolationism has prevailed [2].
Broadly speaking, CBRC has become an important approach to accessing reproductive resources and treatment in the contemporary era, and a strategy to overcome the reproductive dilemma of socially infertile individuals. The occurrence of COVID-19 has affected global health care capacity and boundary control policies, and has changed the current status of CBRC, yet there is no research related to this issue. Therefore, this paper proposes a research question: What is the impact of COVID-19 on CBRC and women's reproductive practices?
This paper has two objectives, which also demonstrate its importance. The first is to complement the existing studies by adding an Asian perspective to strengthen the cross-regional perspective of this issue, so that future studies can better analyze this global situation. Second, although there are many studies on how COVID-19 affects health and public health governance, there is still a lack of research on the effects of COVID-19 on women’s fertility [3] and the fertility dilemmas that women experience during COVID-19. Therefore, based on this basis, this paper is intended to serve as a reference for exploring the current state of women’s reproductive practices and to contribute to the formulation of current public health, health care, and border policies.
2. Methods
This paper is a qualitative study, the purpose of this short experience-based paper is to compare and discuss the state of CBRC before and after the outbreak, and to point out the possible impact of the COVID-19 pandemic on
women who rely on cross-border treatment.
The analysis begins with an introduction that briefly presents some of the findings from my doctoral dissertation. It then critically reflects on the overall phenomenon during the COVID-19 pandemic, based on research and interviews from 2020 to 2022. The main methods and materials of this study are as follows. First, a text analysis method was used to analyze the social meanings of official border policy texts and artificial reproduction recommendations of various countries, with particular attention to the United States and Northern Europe, where sperm banking and CBRC are highly popular.
The materials were collected by searching for key words such as COVID-19, fertility, reproductive medicine, guidelines, and border policy. Among them, the fertility-related unofficial guidelines announced by the American Society for Reproductive Medicine (ASRM) and the European Society of Human Reproduction and Embryology (ESHRE) have a strong influence on CBRC. Information was mainly obtained from the official websites of the Ministry of Health and other agencies.
Second, from Facebook communities related to sperm banking and CBRC, I picked five of them with more than 3,000 members representing diverse backgrounds and posted on the Facebook site to publicly ask members about their experiences with the COVID-19 and to announce the call for random respondents. I interviewed 20 voluntary donors, users, and administrators of various nationalities, 30 to 45 years of age.
All information was anonymous, and each conversation lasted about an hour, mostly in English via Facebook messages. The discussions were open-ended and focused on their experiences with CBRC, their fertility dilemmas after encountering COVID-19 pandemic, and adjustments to their original fertility plans and practices. At the same time, I have also observed the variability of medical mobility due to the COVID-19 pandemic as a complete observer in the Facebook communities, the websites of sperm banks and hospitals providing reproductive treatments, and everyday life.
3. Results
3.1. Images of reproductive practices during COVID-19
With regard to the impact of borderline policies under the COVID-19 pandemic, we are not just talking about the inability of people to travel abroad for CBRC or the inaccessibility of reproductive resources, but about the nature of the change: It is a change in the overall reproductive practice program, a change in the strategies and relationships between different actors in response to international conditions and reproductive markets, a change in ethics and value choices, and an opportunity to see that there is still room for progress in social policy.
An important element of CBRC is navigating the border and finding available resources and treatment between the gaps in the law across countries. Therefore, changes in border policy will have a significant impact on CBRC. The trends resulting from the border closures and transportation bans of the COVID-19 pandemic suggest that such travel is only a palliative solution, not a permanent one. In the packaging of free markets and the commercialization of fertility, we ignore the fact that the issue of reproductive rights has never been resolved.
Border restrictions limit people’s interactions, which means they are less likely to seek reproductive resources outwardly[4]. On the one hand, ASRM and ESHRE recommend that people limit their movements and minimize non-essential and non-urgent medical behaviors during the COVID-19 pandemic to avoid the risk of transmission and maintain medical capacity control [5].Many women’s reproductive programs are delayed because there are insufficient cases and studies demonstrating the impact of COVID-19 pandemic on fertility, and reproductive resources are more difficult to obtain. Some of them postponed their fertility plan because of the fear of future financial hardship, potential pregnancy risks, psychological stress and anxiety [3, 6, 7]. However, in Europe, for example, the proportion of abandoners is much higher in Italy than in other European countries. Different economic, demographic, and policy pre-crisis
background and post-crisis prospects may have had some impact on this result [8].
Border closures or strict controls have had a number of immediate effects that can be broken down into a holistic and individual analysis perspective or explored through the roles of user and donor. Briefly, the most common physical effects are a decrease in the number and stock of sperm donations, a lack of reproductive resources, and the inability of sperm to enter customs or for people to take CBRC or receive sperm across borders as they did in the past.
Because of the delicate time planning and management involved in fertility planning, there are many uncontrollable factors or increased costs when people are unable to move or miss important time points due to COVID-19 pandemic [7].Also, COVID-19 pandemic makes it challenging to confirm the quality of donor sperm and the health status of the donor.
In addition to personal responses, the entire donor-conceived community network responded in many ways, such as providing emotional support and encouragement, and sharing relevant information (medical knowledge, healthcare experiences and first-hand information, customs shipments, biobank processes, changes in medical procedures, funding updates, differences in donor selection and evaluation, etc.). They also guided community members to adopt different strategies during the COVID-19 pandemic, such as doing egg retrieval and shipping the eggs to another country for later IVF. But at the same time, the original problems of these communities have become more apparent. The user groups in a community determine the culture and status of the community, but many communities lack information about the culture of people from specific regions or backgrounds, such as Asia. In the process of interaction, users sometimes try to interpret the possible situations of other users through their own cultural perspectives, and this cultural gap from economic, cultural, and geographical factors is extremely large.
Commercial Sperm banks have their own marketing strategies in response to COVID-19 pandemic due to the need for continuing business operations. For example, they provide more
personalized assistance and interviews, increase marketing of additional genetic testing services, offer discounted donor sperm, extend the period of free sperm storage to encourage user motivation and customer retention. They also promote the leading role of sperm banking as a confidential, professional, scientific and secure service.
3.2. Boundary restrictions and time allocation Although CBRC has emerged as a social and political strategy for single women and lesbians to overcome their reproductive dilemmas and build families, this route of solving problems has changed since the COVID-19 pandemic. After I completed my PhD in 2021, the COVID-19 pandemic started to get worse. In the context of global travel restrictions and border closures, even countries in the Schengen area delayed their border-free policies, and global mobility has been forced to slow down or even stop. This has compelled us to re-examine the various social and economic conditions we take for granted. What we have to face is that this situation and its timing have brought us into a new world that is different from the past, affecting the global trade in reproductive resources, and access to reproductive travel to overcome legal and resource constraints.
We must now return to our original perspective and face fundamental outstanding issues.
In this globalized generation, if you want to use third-party donor sperm to facilitate pregnancy, you can obtain sperm through private donations, national sperm banks, and commercial sperm banks [9, 10]. Because commercially donated sperm can be ordered via the Internet and delivered over a short timescale, and because there is a wide range of donation templates to choose from, it has quickly become an important method for receiving donor sperm. However, it should be emphasized that many countries may not allow the importing of reproductive resources such as sperm and eggs. This is based on different cultural backgrounds, religious beliefs, and legal provisions. Some countries may face a scarcity of local reproductive resources. Most commonly, the government does not allow people who do not belong to a heterosexual marriage to use assisted
reproductive technology and donor sperm.
Therefore, people in need must travel to other countries to obtain commercially donated sperm and the required reproductive treatment [11].
On the one hand, CBRC appears to address some of the problems in a market-orientated manner. On the other hand, many countries consider reproductive rights to be a difficult issue that can easily arouse social opposition. So, these countries may choose to ignore the issues or rely on cross-border treatments too much in order to deal with their own legal amendments and social conditions. However, the trends resulting from the border closures and transportation bans of the COVID-19 pandemic suggest that such travel is only a palliative solution, not a permanent one.
In the packaging of free markets and the commercialization of fertility, we ignore the fact that the issue of reproductive rights has never been resolved. Border restrictions limit people’s interactions, which means they are less likely to seek reproductive resources outwardly. As can be seen, the law has a far greater impact on the use of donor sperm and CBRC than capital and wealth. This suggests that countries that do not yet broadly allow access to donor sperm and assisted reproductive technologies for diverse subjects need to address the most basic issues of legal revision to protect the fundamental rights of diverse subjects and demand reproductive justice.
The pace of the world has slowed as a result of COVID-19 pandemic and the best time for women to have children is being lost [6].The American Society of Reproductive Medicine issued the first version of “Patient Management and Clinical Recommendations” [12] on 17 March 2020. This recommended that any unnecessary fertility treatment should be suspended for the following reasons: the inadequacy of existing COVID-19 research; any drugs developed may not be suitable for patients undergoing fertility treatment; optimizing medical human resources allocation; and avoiding close contact with people. Given the importance of timing for fertility, the current COVID-19 pandemic makes it necessary to suspend fertility planning, which is not fully and effectively controlled [4]. Therefore, information will be
updated every two weeks to help people grasp the timing of treatment. In the most recent information, it was mentioned that the “COVID19 vaccination does not induce antibodies against the placenta”.
For females, timing is the key to reproductive success. When people have to stop their way of life, change their work and social patterns, or stay at home to manage their health, a woman’s physiology never stops ageing. One of the risks women face in such emergencies is that the timing of childbearing may be missed and is irreversible. At the same time, the current situation places greater emphasis on the status of the family as a basic social unit. It also forces us to look squarely at whether the definition and structure of the family have changed, as well as looking at assisted reproductive technology and third-party donor sperm, which are different ways from how families were established in the past.
Indeed, sperm banks have not stopped their global operations and people can still order donor sperm via the Internet. However, in addition to the national restrictions I mentioned earlier, due to the lack of a complete study of the COVID-19 pandemic, doubts about safety and donor sperm quality still exist and have become a test of risk management ability in the sperm market.
Due to strict regulations and cultural openness, Denmark is well known in the commercial sperm market. Denmark has amended the legislation around 2020 to improve the ethical concerns of donor-conceived families and to establish a ceiling on the number of conceptions. The new regulations state that all donor sperm must be sent to a medical institution or an address where medical staff are located, and the mode of receiving sperm from a private address is no longer accepted. Despite good intentions, the provision now highlights the restraints of the problem and the possible effects of moving again from home insemination to medicalization in a situation of restricted movement.
Medical institutions are now high-risk places to which people no longer have the mobility to cross borders or travel. Many donation arrangements have also been temporarily postponed or stopped, leaving a lack of sperm sources. Donors’ new
disease histories and varying degrees of self-management in the face of COVID-19 pandemic may also present different risk management and sperm quality issues. This approach to pregnancy, especially for single women and lesbians, which was initially used as a model solution, is now reversing and facing the same dilemma as it was decades ago.
I believe that the commercial donor sperm market and CBRC are temporary alternatives, but are still incomplete. They support multiple forms of family development, but at this time when COVID-19 pandemic is rampant, their impact has declined significantly, and multiple reproductive choices associated with capital no longer exist. As can be seen from this, the effect of the law on the use of donor sperm is far greater than that of capital and wealth. According to the establishment of the law, people and institutions that store donor sperm are further shaped by each other under the legal framework and form a complete network.
Finally, capital and wealth play different roles.
4. Discussion
The COVID-19 pandemic poses a risk management challenge for female fertility, a time allocation and practice challenge, and an increased economic challenge, and has stimulated renewed public reflection on Taiwan’s reproductive and cellular regulation and social infertility, leading to a debate on the accessibility of reproductive resources and technology.
I started to think about the main theme of this paper based on Taiwan. Although there is still room for improvement in the governance and ethics of the sperm industry and CBRC, I also believe that CBRC is still a temporary solution to social infertility until the law in Taiwan allows single women and lesbians to have legal access to ART and reproductive resources. The outbreak of COVID-19 pandemic and its impact on CBRC has led me to reflect on why people do not have access to reproductive resources and technologies in Taiwan and some other countries? Can we provide more structured support for the reproductive practices of others who are not in heterosexual marriages?
One of the key tasks that the gender