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THE PRICE OF EGGS IN AMERICA | PAGE 2 OF 3 - - - - - - - - - - - - - - - - - - - - - Defenders of the new reproductive technologies, for their part, point out that techniques like egg donorship give hope to thousands of childless couples -- and give women unprecedented control over every aspect of the reproductive process. They argue that some form of payment is reasonable -- after all, the donors must undergo hormone treatments and surgery. And they dismiss fears of the degradation of the maternal instinct, pointing out that no one seemed so worried when it was only men who were seeding the earth. The debate is complicated by the fact that doctors don't really know what long-term risks are associated with egg donorship. What little research has been done suggests that repeated exposure to fertility drugs may increase the incidence of ovarian cancer, as well as encourage the early onset of menopause. Since assisted reproductive technologies (ARTs) became available in 1981, about 15 percent of American women have received some type of infertility treatment; today, couples are spending more than $2.5 billion a year on ARTs. While sperm banks have been around for more than 40 years, egg donation -- or the process by which a mature egg is extracted from a donor, fertilized in vitro and implanted into a recipient's uterus -- is, by contrast, a relatively recent development, responsible for less than 10 percent of the 11,000 births made possible by ARTs in 1995 (the most recent year for which statistics are available). But as the boomer generation grows older and more and more couples are trying to have children at a later age, egg donation -- which, unlike most other ARTs, boasts a 30 percent "take-home baby rate" that stays constant across all age groups -- has become an increasingly available and sought-after option. Recipient couples, who can choose donors based on what they deem to be desirable genetic traits, pay anywhere from $10,000 to $30,000 for the procedure, which is currently offered by more than 280 clinics in the United States. (That's more than twice the number of clinics performing the procedure in 1993, compared to 26 in 1988, when the practice was in its infancy.) Fertility clinics and egg brokers looking to recruit "Ivy League eggs," as one bioethicist disparagingly referred to them, place ads where young women are most likely to see them -- on the back pages of free weeklies and in college newspaper classifieds: "Help infertile couples. If you're 21-29, educated, healthy, average weight, $3,000 plus costs. Bonus for Asians," reads one typical ad. And here, as in most cases, it's the altruistic gesture of "donation" that is emphasized. "If a woman says to me that she thought this would be a good way to make money, I'll tell her to go get a job," says Gretchen Sewall, R.N., M.S.W, manager of the UW Fertility and Endocrine Center donor egg program since 1990. "I don't think women should be selling body parts -- I feel quite strongly about that. If it's reduced to a commodity, what does that say about how a woman feels about herself as a person?" Sewall says that she interviews patients at length to weed out those who might be in it for the wrong reasons. "We talk about their motivations several times over a period of two months -- why they want to do this, what they're spending the money on," she says. "The bottom line is that I want to make it harder for them to continue in the screening process." That's not enough, says Dr. Arthur Caplan, director of the University of Pennsylvania Center for Bioethics and author of "Am I My Brother's Keeper: The Ethical Frontiers of Biomedicine" (Indiana University Press). "When donors get paid, they need to get information from people who aren't in the business of selling their eggs," he says. Currently, most fertility clinics adopt the American Society for Reproductive Medicine's guidelines for donor recruitment, which mandate that potential donors be educated in all aspects of medical treatment, including "health risks and complications." But because many of those risks are unknown, such guidelines are difficult to enforce. "There's no standardization on what women who might be egg donors are told" about medical risks, Caplan says. "It's all over the map." Indeed, when this reporter posed as a potential donor and called to request information from five services seeking egg donors in the Bay Area, only one -- a third-party broker, not a medical practitioner -- mentioned any medical risks. But when the broker was pressed for details about such risks, she quickly added that they are "so minimal to be almost non-existent." More tellingly, one of the actual clinics, in an informational brochure sent to potential donors, explained the potential side effects this way: "The best testimony about the ease and comfort of egg harvest comes from the two patients we've had in recent years who served as Maids of Honor in a wedding the night that their eggs were taken out. Both were able to enjoy the wedding, perform all their duties, and dance the whole night." "Yeah, they kind of skimmed over that stuff," Jennifer recalls. But she mostly blames herself for not knowing about the complications she encountered. "Once you're in the clinic, it's like a PR firm," she says. "You have to investigate it on your own." Not so, counters Sewall, who says that her policy is to inform patients of potential risks at least three times. "I'm almost compulsive about that," she says, emphasizing that Jennifer's case was highly unusual. "In fact, my general stance is to recommend against donation [if the motivation is monetary]." Dr. Benjamin Younger, president of the ASRM, insists that ART is no different than any other rapidly evolving field of medicine. "Sure, every now and then, you hear of someone who didn't get all the proper information," he concedes. "But it's hard to figure that out, because people do have selective hearing." Opponents of commercial surrogacy, however, maintain that it's the increasing financial incentive that encourages potential donors to overlook the fine print. While the amount paid to sperm donors has remained constant, the average amount paid to egg donors has risen from $250 to $2,500 in the last 10 years, with at least one clinic, the St. Barnabas Medical Center in Livingston, N.J., recently offering $5,000. "The poor people are going to start selling their fertility to the rich," says George Annas, head of the Health Law Department at Boston University's School of Public Health. "That's just too directly exploitative. I'd be willing to bet that the U.S. is the only country in the world willing to pay $3,000 for donated eggs." That may be so, but Americans certainly aren't the only ones willing to buy them. Encouraged by the perceived ease and availability of fertility treatments, more and more people from other countries are coming to clinics in the U.S., ensuring an ever greater demand for donors -- one that, as defenders of the fertility industry are quick to point out, almost certainly wouldn't be met if donors were recruited on a volunteer-only basis. "I find it hypocritical that the opponents of commercial surrogacy are sitting in judgment, when for the most part they have children of their own," says Andrew W. Vorzimer, a Beverly Hills lawyer who specializes in surrogacy cases. "To sit there in their smug manner, and determine that infertile couples should not have access to these techniques is the ultimate display of arrogance." It's true that for many infertile couples, egg donation is often the last shot in a long line of attempts at "having" a child of their own. While some would just as eagerly adopt a child, adoption can be a much more difficult and expensive option -- one that affords the couple far fewer choices. And, in contrast to the process of adoption, it's the potential donor -- not the potential parent -- who is more stringently screened. "I was really surprised that I had to take the MMPI [Minnesota Multiphasic Personality Inventory] test," says Kara Daillak, a lawyer who, during her first year in law school, went through three harvests for the same recipient and was paid $2,500 for each. Like Jennifer, Kara was initially attracted by what seemed like a lot of money and signed on as a donor, figuring she could back out at any time. But once she found out she had been chosen by a couple who had reviewed her photo and portfolio at the clinic, her motivations changed. "I figured that with brown hair and brown eyes, I wasn't in very high demand, so I figured whoever chose me was doing so on the basis of something else," she says, tucking her hair behind a triple-pierced ear. "I was starting to think I didn't want to have kids, and I figured that was all the more reason to do this. It was a real antidote to having had two abortions -- like some reversal of that clinical process." N E X T+P A G E: The politics of choice |
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