BUY MY EGGS FOR $10,000
An editor with young ovaries dives into the murky waters of the test-tube baby industry's gene pool.
By Kerry Howley REASON MAGAZINE
Published September 24, 2006
Last December I flew to Chicago, underwent general anesthesia, endured a minor medical procedure, and sold 12 ova to a pair of strangers for $10,000.
Like thousands of other women that year, I joined in an assembly-line production of a human embryo.
The human egg market didn't emerge overnight. But within years of the 1978 birth of Louise Brown - the first "test-tube baby," born of her mother's egg and father's sperm, with doctors only helping the process along - babies were being born via donated eggs that were fertilized outside the womb and later implanted in women incapable of producing viable ova.
If you can imagine a scenario involving in vitro fertilization-related technologies, chances are it has already taken place. In 1999 Adam Nash was conceived in a laboratory as a perfect genetic match to his sister, Molly, who would have died without the bone marrow transplant he later provided. A few years later, an IVF mix-up led to a white couple with half-black twin sons. Today in Bombay, surrogate mothers are carrying the genetic children of European and American women.
The once-hypothetical fears of bioconservatives are now walking and talking human beings, but the debate over the ethical implications of such children is still oddly abstract.
College students sell their genetic material and low-income women rent out their wombs. There is considerable debate about whether they should be allowed to trade reproductive capacity for cash, how they should be compensated, and how far is too far.
But the more interesting questions are not regulatory. Reproductive technologies have spawned new markets in the business of babymaking while old fears about the commodification of human life persist; the social norms lag well behind the scientific capabilities. The result is a bizarre juxtaposition of
crass commerce and high rhetoric, of conceptions cooked up in a lab to fill a demand for natural childbirth and an industry selling illusion along with DNA.
Selling ova to another woman is at once impossibly intimate and wholly impersonal, a connected but highly distributed process of exchange. It is a transaction well suited to the Internet, which tends to provoke uninhibited sharing among strangers cloaked in anonymity. The Web sites I found, trolling through hundreds of Google hits for "egg donor," were similar, placing heavy emphasis on the motivation of donors. They spoke of fulfillment, of "making a difference," of "one of the most loving gifts one woman can give to another."
The application I chose invited me to "investigate the possibility of impacting a loving couple's life with the gift of egg donation." It promised that sharing genetic material is "one of the most powerful and rewarding decisions a woman can make." It demanded "a candid humanitarian desire to assist an infertile couple/individual in conceiving." It asked for all the basic facts: height, eye color, hair color, allergies, and ailments.
The application also asked, "What is the least amount of compensation you will consider accepting for an egg donation?" Elsewhere, the agency stated that it would not accept requests of more than $10,000. So I typed in: $10,000.
My picture was included in a donor database, a mail-order bride catalog with SAT scores. The Web-based list runs over 100 women long, listing our heights, weights, ages (all of us between 21 and 32), asking prices, standardized test scores, blood types, academic degrees, and whether we'd donated before. Later, I would find myself referred to as "Donor #15."
The first offer came almost immediately; another followed a day later. "We have one couple who definitely want to work with you, and they are bringing me a check to reserve you tomorrow," an e-mail message read. "The other couple ... are deciding if they want to match with you for your next cycle."
That I was selling something people actually wanted to buy did not become obvious until that message. I hadn't signed anything or talked to anyone; I'd simply answered a few questions and e-mailed a picture. And for what initially seemed a ridiculously inflated price, they were lining up.
It's easy to be flattered by women who want to have your children. Alas, the appeal likely wasn't that I stood out but that I blended in. I have brown eyes and brown hair; my height, at 5 feet, 4 inches, is exactly average. I am ambiguously ethnic, in turns thought to be Asian or Italian. Women look not for models but for mirrors; I was enough of a human Mad Lib that parents, scanning for pictures, could look at me and see themselves.
Two couples decided to look elsewhere after the agency revealed more details about my family's medical history, which is rife with drug and alcohol abuse, but a third looked past every skeleton in the closet and gamely agreed to move forward. "Match!" read a message in my inbox, agency-speak for "Sold!"
The parents wanted an anonymous donation, and so it would be, although I had indicated to the agency that I was open to a more intimate relationship with the recipients. E-mail messages from the agency referred to an "intended mother" and an "intended father," so I knew I was donating to a heterosexual couple.
I also knew that they were cheap. They asked that I lower my asking price after "reserving" me at the agency, not uncommon in a trade where the lines between commerce and altruism are left unclear. I refused.
"Match!" - that was how it started. The parents had chosen a Chicago-based fertility doctor, and the agency booked a September flight from D.C. to Illinois, where I would meet the man who would eventually perform the procedures on both of us. Before the parents signed a contract, he would make sure I was healthy, my ovaries normal, my egg-producing potential up to standard. When he gave the okay, they would ink the contract, a process not unlike buying a used car.
I was the only patient in the place the Sunday morning I arrived at the Chicago clinic for the first time, but there was, as always, a wait. The doctor swept in later, a middle-aged Indian obstetrician who brushed past a nurse to shake my hand. He was friendly and talkative, but most of all paternal, a second father to the many, many kids he'd help conceive. We headed straight to the examination room for a quick ultrasound, where he chattered excitedly at the sight of young ovaries.
He led me into another small room - this one crowded with books and diagrams - where two nurses would lay out the specifics of the donor drug regimen. "Stimulation" of my egg production would require four different injected pharmaceuticals over four weeks. From across a wooden desk, a woman composed a long list of dates to be kept and dosages to inject. Every instruction looped back to the importance of scrupulously following each step of the process, the danger of putting off a dose for an hour and imperiling the entire undertaking. A nurse beside her appeared to serve no purpose other than to nod in agreement with everything the first nurse said.
All of this sounded little more harrowing than taking vitamins until the first nurse pulled out a single, tiny syringe as she continued to provide monotone commentary on the importance of timing. She dipped the needle in water, pulled back to draw in the fluid, flicked it twice, and plunged it into a pink piece of rubber. I leaned forward as if to ask a question but said nothing. She pushed a DVD on self-injection across the desk.
The last paragraph on Page 13 of the 21-page contract I signed in November asserts, bolded and underlined: "It is expressly understood that this Agreement in no way constitutes payment for any genetic material, a child or children, or payment for relinquishment of parental rights to any child or children."
The United States is one of many countries in which legislation and social norms proscribe the selling of body parts. It is also the world capital of the genetic material market: No other nation trades in DNA so widely and freely.
The birth of Louise Brown in 1978 was considerably less complicated, both logistically and ethically, than many in vitro births today. The researchers who oversaw Brown's conception simply circumvented her mother's damaged fallopian tubes - the most frequent cause of infertility - by combining her mother's ova with her father's sperm outside of the body, and implanting the resulting embryos in the womb. Had Mother Brown's eggs been inadequate, due to age or abnormality, her daughter would not have been born. A live birth from a donor egg was first reported in Australia, a pioneer in fertility treatments, in 1984. It took time for doctors to use ova from other women, and more time for the offer to extend to strangers rather than sisters and best friends. American couples began advertising for healthy young eggs by the early 1990s.
The American Society for Reproductive Medicine estimates that each year 10,000 babies are born from donated ova in the United States. For the near future at least, it seems likely that demand for donor eggs will continue to grow alongside the fertility industry. In 1985 there were 30 fertility clinics in the United States, and that number has grown to more than 400 since.
While egg prices range from a few thousand dollars to $30,000 or more, ASRM guidelines recommend donors receive a maximum of $10,000, above which compensation is deemed "inappropriate." Paradoxically, such guidelines are sold as being in the interest of the donor, usually portrayed as cash-strapped and naive.
Even longtime supporters of IVF sometimes draw the line at egg donation, suddenly voicing objections as the technology barrels forward to its logical extension. When a British talk show host asked Louise Brown how she would feel if she found out she were the product of a donor egg, she replied, "I would be disgusted."
The fertility drugs arrived in a small brown box, packaged crisply with clear tape and bearing the name of the pharmacy that had sent them. Above my apartment address, the box read "Donor #15." I cut it open carefully, dipped my hand into the styrofoam, and pulled out vial after vial, ice cold from the freezer pack that lay at the bottom of the box.
There was more, buried under packing peanuts: dozens of translucent syringes with orange plungers and a thick, stapled wad of receipts indicating the $1,622 all of this had cost someone else. The nurse's assistant had said to keep most of the pharmaceuticals chilled. Not knowing what else to do, I placed each vial in the fridge, next to a half-empty bottle of diet Sprite.
The drugs would manipulate the menstrual cycle into an obedient and predictable pattern. Over the course of 14 days before ovulation, ova start as invisible cells and bubble into highly complex systems barely visible to the naked eye. Two weeks after it has begun to mature, a single ovum will burst out of its skin, float through a spaghetti-sized tube, plant itself in the uterus, and wait. But once the egg is released, it is useless to another woman. A fertility doctor hoping to transfer it must capture the egg when it is fully mature but just before the follicle erupts.
It's no easy thing to predict when an egg will escape, and there are no guarantees that an egg will respond to sperm outside the body. Subcutaneous injections induce the donor to "superovulate," producing not just one mature ova but as many as 20. They also help the donor and doctor gain control over the process. I would have to fly to Chicago a week before the extraction so the doctors could watch the follicles multiply and expand before removing an egg from each one.
Three days later, the intended mother would take my place on the operating table and the doctor would implant a number of fertilized embryos. There would be a 50 percent likelihood that none would "take." IVF is always a risky investment. Because doctors usually implant a large number of embryos, the opposite danger applies as well: The risks were laid out right there in photos on the doctor's wall of thanks. More than half of IVF babies are multiples, and are therefore more likely to be born prematurely and abnormally small. Parents worried about the risks inherent in carrying a litter of children sometimes opt for selective termination, usually between 9 and 12 weeks. The weaker ones are selected out in hopes of keeping a stronger one or two healthy.
Because the mother's womb must be prepared to accept the fertilized embryo shortly after the ova are extracted, her menstrual cycle is timed in tandem with the donor's, a strangely intimate harmony of bodies between strangers.
Beyond cycle synchronization, the anonymity in such relationships is oddly asymmetrical; the donor is a prisoner in front of a one-way mirror. The mother knew what Donor #15 looked like, her exact age, the addictions that plague her family. She knew that her blood type was O and that her undergraduate major was philosophy. About the future mother of my genetic children, I knew just one thing: She was on Day 3 of her cycle.
Miss Manners has naught to say on social niceties between women who have contracted for a surgical procedure; the etiquette of egg donation is protean. Some agency Web sites suggest mothers send donors an "appreciation gift" of flowers after the retrieval.
I began packing for Chicago in December; scarves, thick socks, snow boots. In my purse I carried a handwritten note from the doctor to the airline, explaining why my carry-on was stuffed with syringes.
Once I arrived in the Windy City, I spent five mornings being poked, prodded, monitored, and ordered to inject. The retrieval would take place at precisely 10 a.m., just before the follicles would burst. My last visit to the clinic was my first visit to its operating wing, which is physically shut off from the warm waiting and examination rooms. Walking through the door felt like walking from a home into a hospital, the carpet replaced by spartan white flooring, pictures of pink babies replaced by a bare wall and a ticking clock. A nurse's aide led me to a wheelchair, touching me as I sat down, an oddly delicate gesture.
I caught a glimpse of the probe before I fell asleep from anesthesia, the plastic sheath hiding a needle that would pierce the vaginal wall, plunge into each follicle, and suck in each egg. The doctor would take only the big and promising ova, leaving those that were unlikely to survive their test tube futures. The whole procedure, from start to finish, took 20 minutes.
When I woke up outside the operating room, I asked the doctor how many of the 12 he'd taken. Pleading confidentiality issues, he said only, "I can't tell you."
The most remarkable thing about the egg trade is that it exists. The market takes place within what is arguably the most heavily regulated economic sector in modern America - health care - in a society that regularly chooses prohibition over individual autonomy. The impulse to ban extends from soda in schools to card games in cyberspace; it hovers over abortion and stem cell research. For whatever reason, infertile women have not been held hostage to this impulse: Thousands buy eggs every year, and no one expects that to change.
Yet this extraordinary permissiveness operates within a constrained and misleading language of altruism, barriers erected to hide the reality of commerce behind narratives of womanly generosity. The immediate concern of egg donors - most probably, money - is downplayed in order to emphasize an improbably abstract, universal desire to help other women conceive.
My experiences bear no resemblance to the nightmarish scenarios thrown out by those who portray egg donation as a clumsy eugenics scheme. Strip away the nexus of fertility doctor, donor agency, and donor, and two would-be parents were hoping for a kid who would look something like them. They weren't looking for a "designer baby," so much as a close approximation of the homegrown variety.
Before we ask IVF opponents to accept the implications of new reproductive technologies, though, we might ask the same of IVF supporters. From the recipient's side, the egg donor process can be an extended effort to pretend that the donation never occurred. Straddling the natural and the artificial, egg donation embodies a contradiction. It glorifies the experience of natural pregnancy and the gift of biological children, while it in fact produces neither: Egg donor babies are the product of foreign genetic codes, and the "natural" pregnancy is manufactured in the lab. The approximation of natural pregnancy also entails a studied psychological distance from the donor who made the pregnancy possible.
Perhaps unblinking honesty is too much to ask of IVF's early adopters, who are breaking sacred taboos even while conforming to norms of the nuclear family. And given that donor agencies are in the business of selling illusions, the blurring of economic exchange and altruistic venture is unlikely to disappear any time soon.
That's not reason to object to technologies consumers increasingly want, but it's enough for me to want my eggs off the auction block. I never objected to being grist for the pregnancy mill or considered it dehumanizing to sell body parts for profit. But there is something strangely degrading about being lauded as a humanitarian and paid handsomely on the side.
Shortly after the procedure, I e-mailed the agency to ask that they remove my picture from their gallery of donors and asked in passing whether my genetic children were developing somewhere on the other end of our e-mail chain. "I'm sorry to say that your donation did not result in a pregnancy," read the reply. It reassured, "Your gift was very precious."
"Donor #15" is Kerry Howley, an associate editor of Reason magazine. This column is excerpted from her October 2006 Reason cover story.
[Last modified September 24, 2006, 09:36:59]
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