Urgency of Risk in Reproductive Health – A Blockchain Solution

In an article published in The Washington Post in November 2018, the author shared the horrific experiences of women being inseminated with their own doctor’s sperm instead of the sperm donor that the doctor had promised to procure. For at least one victim and her now adult child in Indiana, this reproductive scam felt like rape. The article observes that reproductive fraud is not an isolated event in one or two regions. No, it has occurred across the globe; women struggling with fertility and their children-to-be are exposed to unidentified illness, medical criminality and scandalous abuses of trust, identification, security and safety.

Sadly, state laws vary in how effectively they address fraud and criminality in the context of reproductive fertilization methods.  The public response is varied too, with self-interest business rationalizations and the absence of victim sympathy since a healthy child was born, regardless of the source of the sperm. With the absence of legal recourse, the money motives of fertility treatments go unchecked in more instances than we likely have imagined.

For example, donor children in Ottawa are calling attention to 11 women who were impregnated by a fertility doctor who used his own sperm; they are proposing a ban on anonymous sales of reproductive material. A report In Rotterdam in 2017 alleged that 12 men and women were conceived with sperm from a fertility center’s director. In that case, the doctor allegedly falsified his clinic's data, analyses and donor descriptions and exceeded the permitted number of children per donor.

These frauds are accruing as the business of artificial insemination is on the rise. Existing markets are challenged to grow at a fast enough pace because demand for reproductive services has risen. The global artificial insemination market is expected to reach $2.62 billion by 2025. And WHO reports that about 10% of women in the world are struggling to get pregnant. Presently, the United Nations report 46% of the global population lives in countries with low levels of fertility. In developing countries, medical consultation services regarding infertility falter due to lack awareness regarding available assistance, let alone practices that go to the root of knowledge, trust, identity and enabling personal responsibility for a person’s most personal health decisions. It is expected that fertility treatments will rise in the Asian Pacific arena, among single women globally and among gay or other sexually diverse individuals.

For me, the question is whether blockchain software in electronic health record supply chain functions can help solve the problem of un-tracked, misidentified or unidentified sperm donor sources and fraudulent insemination of unsuspecting women? My answer, stated simply is yes. Here’s why.

Blockchain has real power to advance trust in times of weak integrity in healthcare delivery. Blockchain holds capabilities such as immutable auditability, transparency of data and information, trust of root source of data and positive identification of information held within the blockchain ledger.

The level of interest in blockchain as part of a search for feasible use cases to improve a myriad of systems (of which healthcare is but one) is especially high in enterprise applications. The recently formed Ethereum Enterprise Alliance (Enterprise Ethereum Alliance, 2016) and the open-source Hyperledger project (Hyperledger, 2017) now have hundreds of members across a broad spectrum of Fortune 500 companies. Virtually every major software vendor is offering services and consulting on blockchain technology. (MITRE Corporation, Blockchain Technology for Government, December 2017.)

In the context that is the focus of this article, namely the integrity of sperm donation to improve fertility, the following definition of blockchain signals its potential.  “A blockchain can be compared to a bank ledger containing transactions. It provides information about the date, time, and amount of money or other property of interest changing ownership. Once transactions are written to the ledger, they are permanent; they can’t be changed or deleted. Transactions are bundled into blocks and these blocks are linked to form the ledger, which is called blockchain. A blockchain is distributed over multiple nodes using an underlying peer-to-peer (P2P) network protocol for node discovery and communication.”

(MITRE Corporation, Blockchain Technology for Government, December 2017.)

No doubt, in reproductive medicine, there is an urgency to pilot blockchain where there is real potential for fraud or distrust in the sperm bank donor arena where trust, identity and safety can impact the health, illness, mental and social well-being of mothers, children, families and ethics of the field.  Consider, for example, what is to become of the son or daughter of a mother with who discovers she was impregnated with the sperm of a man whose DNA presents serious genetic risks in the offspring? 

Consider these hurdles in the context of sperm donation and how blockchain can provide remarkable improvement:

• Lack of Transparency: Like the overall healthcare systems, the field of reproductive health has many actors, divergent motivations and weaknesses with accountability.  Globally, suppliers of sperm and reproductive medical supplies may be ill-informed. Without an immutable, auditable and transparent ledger of the movement, timing and identification of donor sperm, a vulnerable patient population can be the target of increasing bad practices.

• Meddlesome Middlepersons: Adding to the matrix is intermediaries, donors, clinicians, sperm banks and finance of procedures with little or no guidance or oversight. Some of these actors will see profit over the people’s health and trust.  And, blockchain can cut down on system protective deficiencies.

• Lack of Data Integrity: Despite the nationwide and global initiatives for interconnected community care and electronic health records, there is no single source of truth that is owned and authorized by the prospective mothers or other actors in the reproductive health supply chain process.  When it comes to data about the mother’s pregnancy health, genetic impacts and healthy outcomes of offspring and parent(s), data collection and interoperable availability present a gap, leaving patients (and offspring) vulnerable to fraud and abuse.

• Misaligned Incentives: Although American and global systems are making efforts to put the value of the individual’s health and wellness for life first, governments and businesses processes may not adequately incentivize reproductive health practices to establish self-regulating behaviors or protocols that can be appropriately verified for trust and identity. A basic flaw globally: knowing accurately the source and nature of sperm donations.

Blockchain can help in different ways. The shared blockchain ledger brings transparency and traceability to the data showing the origins and conditions of transactions of donor sperm ranging from DNA to the individual donor’s health, history and ancestry. Blockchain architects and programmers can use a mix of electronic health records, economics and cryptography to align incentives. 

To tackle the emerging problem with artificial insemination through blockchain, I propose

tracking sperm donations and their attributes sent from donor, to processing, to storage, to fertility clinics, doctors, patients and supply vendors. This is similar to the use of blockchain to

track the prescriptions sent from providers to the pharmacy and the quantity being prescribed. Building a prescription drug platform on the blockchain allows each party to have a set of shared facts. This removes information discrepancies between plan sponsors and drug companies, while reducing the power and involvement of the PBMs in price negotiations—and holding them accountable for cost management for the patients.

Instead of fragmented or non-existent paper records, an electronic record platform in the cloud on the blockchain can securely store and ensure trust in a modernized systematic way with a layer of monitoring for misuse or fraud.  The blockchain design can be algorithmically built into a network that ensures the consistency and integrity of data, which prevents attempts to tamper with information or reproductive health samples involving doctors and patients.

I am not alone in considering the power of blockchain to ameliorate fraud and other criminality in the context of reproductive health.  One company partnership worthy of attention, Donor Concierge and ALTR, anticipate using blockchain technology to secure health data and patient privacy for the FRTYL fertility exchange, a service that links fertility agencies and clinics with parents seeking infertility treatments.

The just referenced technology appears to be the first commercial software package that applies blockchain to data security in the reproductive health, fertility arena. The technology provides an interoperable network infrastructure that ensures control over how patient data is seen or used and by whom.

Readers, imagine how better access to vital data and information affecting women, their offspring, and families with trust and identity, would benefit our health system and those within it. It is high time to call for blockchain pilots that will address solutions involving a dangerous side of artificial insemination, perhaps even using open source opportunities. As we launch these pilots, ask these questions:

• How can data be more timely enabling on-the-spot verification of reproductive materials, intervention, and responsiveness, e.g., medical, personal choice or legal?
• Can we achieve transparent, distributed, and disseminated proof of identity, trust, and accountability, across the supply chain in the fertility health arena?
• How can we enable auditing with transparency post-event when an error or possible bad actors are involved in reproductive health schemes?
• Can we improve reproductive tracking and planning with accountability for valuable health and human resources built in to reproductive health information systems?

Take a moment to answer the posed questions and then please share your ideas about how the introduction and utilization of blockchain can help make artificial insemination trustful and accountable for patients and their children. The time for that thinking is now.