“Sex Cells,” a new book by Rene Almeling, an assistant professor of sociology at Yale University, pulls back the curtain on the egg and sperm market. She looks at the ways our cultural assumptions about gender roles influence not only the egg and sperm donation industry but also the people within it. As it turns out, egg and sperm donors have remarkably different experiences of the process. “Sex Cells” explains how this unique industry shapes the way we think about gender and parenthood.

Salon spoke to Rene Almeling over the phone about the strange rhetoric of the sex cell industry, which donors are most valued and what this says about the American family.

Egg and sperm donors are essentially providing the same thing, so why are they treated differently by sperm banks and egg agencies?

Egg agencies and sperm banks are both in the business of recruiting sellable donors who will attract recipient clients. But the details of how they go about doing this reveal the importance of gendered stereotypes in their day-to-day operations. For example, drawing on the stereotype of women as nurturing caregivers, egg agencies emphasize the plight of infertile couples so that women will want to “help” people by giving the “gift of life.” In contrast, sperm banks rarely mention recipients, and they encourage men to think of donation like a job.

One cheeky ad calls on them to “Get paid for what you’re already doing!” So the market for sex cells is structured both by traditional economic forces, such as supply and demand, and also by cultural expectations of women and men that are associated with reproduction and the family.

Are there biological explanations for the differences?

For most people, the first thing that comes to mind when I talk about comparing egg and sperm donation are biological sex differences. Women who provide eggs must self-inject fertility medications for several weeks before undergoing outpatient surgery. Sperm donors do not face any such physical risks, to say the least. But many people do not realize that sperm banks require men to donate on a regular basis, usually once a week, for at least a year. It costs a lot of money to screen donors, so sperm banks have to make sure that the tiny fraction of men who are accepted as donors will produce enough samples to make the investment worth it.

All that is to say that there are biological differences between women and men and there are technological differences between egg and sperm donation, but neither biology nor technology explains why producing eggs for money is a “gift” and producing sperm for money is a “job.”

How does the screening process differ between men and women?

Egg agencies and sperm banks require extensive medical evaluations of all donors, including a family health history that goes back three generations, but that is where the similarity ends. Many of the screening standards are driven by social concerns. Sperm banks usually require that men be at least 5 feet 8 inches tall. Egg agencies don’t set height minimums. Most sperm banks require that men be enrolled in college or have a college degree. Egg agencies do not. Most egg agencies require psychological evaluations to assess how women feel about having children out in the world. Sperm banks don’t require that men discuss this possibility with a mental health professional.

But that carries an illogical assumption that the sex of the child will be the same as the sex of the donor. So why might a donor be rejected?

The largest egg agencies in the country receive hundreds of applications every month, so they can afford to be picky. Some differences are driven by medical guidelines to optimize fertility. For example, egg donors must conform to rigorous height and weight ratios, but sperm donors do not. And women over 30 are unlikely to be accepted as donors while sperm donors can donate until they are 40.

Even though most of the egg and sperm donors I interviewed reported that they were motivated by the money they could make, being honest about that would result in a woman’s application being thrown in the trash. Egg agencies prefer women who are motivated by altruism, or at least say they are motivated by altruism, because otherwise they violate the cultural framing of egg donation as a gift from one woman to another. Sperm banks are just the opposite: They expect men to be motivated by the money.

Who are the most valuable donors for agencies?

There were really interesting differences by gender and race. Egg agencies and sperm banks post “donor catalogs” on their websites, and they strive for diversity of various kinds — racial, ethnic, religious, and even donors’ hobbies — to appeal to a diverse recipient population. In all of the donation programs where I did research, staffers complained about the difficulty they had recruiting African-Americans and Asian-Americans, so these donors were considered particularly “valuable.” In a given sperm bank, all men are paid the same rate, usually around $75 or $100 per deposit. In contrast, some egg agencies will adjust a donor’s compensation based on her personal characteristics, including race. As a result, sometimes African-American and Asian-American egg donors are paid a few thousand dollars more than white donors.

It seems silly that this is referred to as a “donation” when people are getting paid.

Fertility is a multi-billion dollar industry in the United States. However, the idea of selling body parts makes people very uncomfortable, so the euphemistic language of donation suffuses the market for eggs and sperm. Staffers at egg agencies and sperm banks consistently use this rhetoric, even as they make profits on the sale of sex cells. Egg and sperm donors use it, even as they earn thousands of dollars for their genetic material. And recipients of sex cells use it, even as they purchase eggs and sperm in the hopes of conceiving children.

Do male and female donors react differently to their experience?

Framing paid donation as a gift or a job has profound implications for egg and sperm donors. Egg agencies are constantly thanking women for the wonderful difference they are making in the lives of recipients, so egg donors spoke with a great deal of pride about helping people have children. Some egg donors even described the money they received as a “gift” for the gift they had given. Sperm banks treat men more like employees who are expected to clock in on a regular basis, and sperm donors respond by calling the money “income” or “wages.” More importantly, several of the sperm donors said they felt like “assets” or “resources” for the sperm bank, which reveals a sense of self-objectification. I didn’t hear that kind of language from the egg donors, even though they are making much more money than sperm donors. These kinds of differences demonstrate the power that fertility agencies have in shaping donors’ views. Framing donation as a gift or a job is not just a matter of rhetorical flourish. There are actual effects on how women and men experience the exchange of sex cells for money.

How is sex cell donation changing our ideas about family?

Donors are often asked, “How does it feel to have children running around out there?” The truth is that women and men will answer this question in different ways, but not because biology is dictating their responses. Not only are donors responding to how fertility agencies organize the process of selling sex cells, they are also drawing on a longstanding cultural assumption that the male contribution to reproduction is primary. Sperm donors think of their seed as essential to the child, downplaying the role of the recipients in conceiving, gestating, and rearing the baby. Egg donors do just the opposite, de-emphasizing the egg and pointing to the recipient’s nurturance in pregnancy and beyond. So along with all those who rely on reproductive technologies to have children, egg and sperm donors are building on old stereotypes to craft new definitions of motherhood, fatherhood and, ultimately, what it means to be a member of a family.

One of the most interesting aspects of your research is that egg donors do not see themselves as mothers while sperm donors do identify as fathers.

It is interesting because egg and sperm donors each provide half the genetic material needed to create an embryo, so they have the same biological connection to the children who result. Yet sperm donors have a straightforward view of themselves as fathers, while egg donors insist they are not mothers. This is the opposite of what many people would expect, given the greater physical commitment of egg donation and our beliefs about maternal instinct. But it begins to make sense when you take into account the emphasis that egg agencies place on recipients.

Egg donors consider the recipient to be the “real mother,” because she is the one who will carry the pregnancy, give birth and raise the child. Women can make this distinction because, thanks to technology, maternity is more easily separated into different parts than paternity. One woman can provide the egg, another can carry the pregnancy and a third (or more) can raise the child. All of these women can lay claim (or not) to the label of “mother.” Fatherhood is more often reduced to a cultural equation in which sperm equals dad. Sperm donors rely on just this definition of fatherhood, particularly because they are not asked to think much about the people who use their donations to become parents.

We are ready. I am 30, she is 31. This condo we bought last year is a two-bedroom, McCarren Park is down the block, and the schools in Greenpoint are good. We just spent a decade graduating and clerking and teaching and secretarying and marrying and back-to-schooling and climbing and moving and traveling and fighting and growing and still liking our lives (mostly), and this is the right time for a family.

But still: Holy crap.

This could take a year of trying, we heard. You can only get pregnant a few days a month anyway, we heard. But there they are, two pink lines.

The whole testing idea is a whim; there is no waiting through days of lateness, no tense and excited buildup. It’s a rare night off for me. She arrives home at 7 and mentions she’s one day late. I say, “Let’s get a test, then.”

She’s tired from work and doesn’t feel pregnant (a woman knows, you know), so she’s sorry she even mentioned it. At this point, though, I’m too wound up by the idea, so we head down to the Rite Aid with the disco ball in the ceiling, and pick up a three-pack of First Response. The whole way home she’s telling me it’s nothing.

Then, the pink lines. Plopping back into the chair, I clasp her hand between both of mine. “How do you feel right now? You feel good?”

“Yeah, absolutely, I feel good,” she says, smiling and smacking my arm.

After passing the next 30 seconds or so like Beavis and Butt-Head — huh huh, huh huh — we finally hug, tightly, after realizing that we have received the news in the same exact way. Both shocked and thrilled and without words: perfectly connected.

“Lemme get you some water so we can take another one,” I say.

While waiting for her bladder to refill, we order Indian food. By the time she has to go again, we’re staring at samosa, our bellies fluttering. Just as fast: two lines. She makes me read the directions aloud again. A hormone called gonad-something. Elevated. Two lines. Pregnant. All righty, time to start googling “First Response accuracy rate.” Hm. 90-some percent.

Now the verbal explosion happens. We are blabbing about due dates, and how cool is it that my job writing about baseball means I’d be home all offseason for the third trimester and do you think the doctor would see you tomorrow and oh my god that was fast. OK, let’s take the third test in the morning.

In nine years together, there have been periods of distance and misunderstanding — and periods of finding each other again. The coming together happens when something is ours and no one else’s, when we have a secret. When life isn’t defined by our jobs.

There is hugging and kissing, and blurted thoughts like, “I’ve never loved you more than I do right now” — corny things that we will miss saying when the intensity passes — and later, in a dark cozy bedroom, falling asleep after suggesting stupid baby names like Birdie and Herman. It is fun to be silly and light.

She uses the third test in the morning; two lines yet again. We leave the trio of pee-soaked plastics on the counter in our living room for more than a week, unable to remove those symbols of a night as pure and elevated as anything we’ve shared.

This feeling does not stop. We do nothing but grin for two weeks. I am at work; she texts me, “The baby is the size of a poppy seed. We can hear the heartbeat in a few weeks.”

The next afternoon, an email, and staggering disorientation. The news arrives electronically because she has forgotten her phone at home, and it is too urgent to wait. I’m typing away in the Wrigley Field press box, bright and bouncy with impending dadhood.

My BlackBerry pings. The message is from “Expectacus,” who used to be “Wife” in my contacts. The subject is “bad news.”

“My hormone levels are now too high. Doctor says most likely not going to work long-term as a pregnancy. This blows. I wish we hadn’t told anyone.”

Blink. Blink. Read again. Why had we rushed into those giddy speakerphone calls with our parents, and the proud gathering of our close friends? We know early miscarriages are common, but cannot imagine an interruption to our extended sublime moment. We are surely immune.

We wait nine days for the death. Enough time for, hmm, maybe it will be OK. Then, early on a Saturday morning, she returns from the bathroom and says she is bleeding. Waking, I extend my arms; she sinks into a weepy hug on the bed. She calls herself a failure, which feels like a punch in the stomach to hear.

We aren’t crying for long. The rest is dry, boring gloom — except when it is fear.

The next morning, Ruby is standing in the kitchen. She screams and hunches over; I leap up from the couch. We call the doctor, who says don’t go to emergency unless it recurs. It does not. The whole thing finishes with a slow fizzle.

There are nice elements in here with the muck. We were connected first by joy, and now by piercing disappointment, and will probably even miss the uniting depression a bit. Although we will miss the pregnancy more.

Those First Response sticks remain in the house. I have by now moved them into a drawer, but still can’t throw them away. 

1. Justin Bieber and Tiffani Thiessen have a creepy crush on each other: As evidenced by the shirts the two wore to Canada’s MuchMusic Video Awards, bearing each other’s faces. Bieber was born one year after “Saved by the Bell” went off the air.

2. James Blunt’s blunder: Put a photo of himself on Facebook in front of a historical building near Auschwitz, then claimed it was his “hotel in Poland.“

3. Bikini killer: Kathleen Hanna went off on a rant against Lady Gaga and Katy Perry during a CNN interview this week: “It’s exactly every male fantasy of fake lesbian porn. It’s pathetic.” Also she hates Jason Mraz and called the new James Blunt song “the worst thing that has ever been created on the face of the Earth.” Wait till she checks out his Facebook page!

4. Megan Fox loses support: We’ve already covered why the actress was fired from “Transformers,” but now her biggest supporter, Shia LaBeouf, has even admitted that it was the Hitler comment, not her “woman empowerment stuff,” that caused director Michael Bay to can her.

5. Pixar’s first poster for its latest film, “Brave”:

The description makes the movie sound like a Scottish fairytale told by your fairly drunk uncle. You know what, I don’t care. Sign me up for two tickets, please.

6. “Jackass” star escaped Ryan Dunn’s fate: You could have put money on the reckless Steve Glover (aka Steve-O) being the first one of the “Jackass” kids to die tragically. But he is now sober, thanks to the support of Johnny Knoxville and the rest of the cast, and is talking openly about his drug use for the first time in interviews.

7. “The Muppets” get official trailer: I would say there are officially too many trailers for this movie, but when it comes to the Muppets, there is no such thing as too many anything.

8. Summer journalism, at its finest: Maura Kelly’s piece for Slate “Why Are Air Conditioners So Heavy?” is neck and neck with the New York Time’s style profile last week on Far Rockaway’s hip “Rocapulco” scene. (Please don’t call it that.)

9. The real cost of the royal wedding: The demand for the morning after pill tripled in Northamptonshire the weekend after Kate married William. America’s rates of emergency contraceptive stayed approximately the same.

10. Most surprising rehab celeb story: “Glee’s” Cory Monteith, opens up to Parade magazine this week about hitting rock bottom at age 19.  “I stole a significant amount of money from a family member,” said the actor who plays Finn on the Fox show, “I’m lucky on so many counts — I’m lucky to be alive.”

The MTV show has generated a lot of controversy because of the way the mothers and mothers-to-be on the program behaved after they’d decided to have a child. But, for a pediatrician like me, the show raises a different question: Did these young women have the chance to talk privately with their doctors before MTV started shooting their second trimester?

In every state, including California where I practice, adolescents are legally entitled to some level of confidentiality when it comes to issues related to sexual activity. And it’s because of these privacy laws that I’ve been able to talk to patients of mine about practicing safe sex, learn that girls I’m treating are pregnant and want an abortion, and prescribe antibiotics for sexually transmitted diseases (STDs).

This confidentiality plays a vital role in keeping teens healthy. Research shows that a significant number of adolescents would stop using birth control pills and skip out on STD-testing if their parents had to be informed, though only 1 percent would stop having sexual intercourse. A study of Texas policies that require parental consent for state-funded family planning and increased reporting of adolescent sexual activity estimated that the resulting increase in teen pregnancies and STDs could be costing the public as much as $44 million annually. When an economist in Illinois examined the effects of one county’s decision to implement a parental consent requirement for contraception, she found an increase in the relative proportion of births to females under age 19 in the area as compared to nearby counties with similar racial and economic profiles but no restrictions on minors’ access to contraception.

The legal protections and health benefits should make treating teens straightforward. But in practice it’s complicated, challenging and often messy. Parents are usually the first obstacle when it comes to confidential consultations; many are determined to stick to their child’s side throughout the visit. For example, my 15-year-old patient’s mother did leave the room but I later discovered she had her ear pressed up against the door the entire time her daughter and I were having our “private” conversation.

Studies show that many parents don’t know about teen privacy rights. And they’re often not thrilled when they find out. One mother cut an appointment short when I told her why she needed to leave the exam room (“It’s not so I can learn all of his dirty secrets — it just allows me to take the best care of him that I can,” I tried to explain). After directing a few choice expletives at me and my staff, she dragged her son out of the office.

The culture wars also complicate our ability to treat teenage patients, especially when it comes to abortion. Some states have general statutes that allow minors of a certain age to consent to medical or surgical care on their own, but they usually make an exception for abortion. In order to get that particular procedure without parental consent, a minor often has to get judicial permission. (While judges in some states, like Massachusetts, routinely grant permission, there are some judges in other states, like Alabama, particularly Alabama, who have never OK’d the procedure for any girl, no matter how close she is to her 18th birthday.)

The HPV vaccine is another instance where I often see ideology impinging on adolescent health. The vaccine, which is designed to prevent an STD infection that can cause cervical cancer, is offered to girls starting at age 11. Yet, echoing a talking point from the hard right, I’ve had some parents who won’t let their daughters get the vaccine because they view it as a “permission slip” for their children to have sex.

But parents and politics aren’t the only obstacles. Doctors sometimes contribute to the problem. Even for those of us who see teens regularly (I used to, up until one year ago, work parttime in a clinic for adolescents), it can be tough to keep up with the latest medical practices, legal requirements and political debates. As a result, some of us get nervous when confronted by an adolescent who needs more than a sports form signed to play high school volleyball. The situation brings up questions like “How do I prescribe birth control?” or “How do I do a pelvic exam?” that don’t arise when treating other patient age groups.

The laws present their own complications. The statutes, written in the worst legalese, are difficult to understand and interpret. Even though I keep a copy of the laws on a corkboard above my desk, I still find myself regularly asking one of my colleagues whose focus is adolescent medicine to explain certain technicalities.

Confidentiality does not cover all services a teen may receive, only sensitive ones. And mandatory notification laws trump privacy. If a teen admits to being suicidal, for example, I’m legally (and ethically) obligated to inform the parents and the psychiatrist. Yet, out of ignorance or a desire to earn a patient’s trust, many doctors falsely promise “total confidentiality.” (And, of course, in situations where a parent does have to be notified, you can imagine how likely it is for that patient to trust us — or any other doctor — with private information again.)

So how do doctors walk the tightrope of teen care? Certainly, we can do our best to keep up with developments in adolescent health public policy. We can also encourage parental education on these issues. One study showed that many more parents approved of private doctor-child consultations after they were given further information about the subject in the form of a handout or a face-to-face meeting. We should fight to keep the barriers to access low as well — allowing teens to walk in for pregnancy and STD testing, eliminating any out-of-pocket fees associated with confidential care, and giving out our email address so that teens can connect with us if they need to.

Despite how much I understand all this intellectually as a doctor, I wonder how I’ll react when my two little girls, both still under 4, reach that trying age. I hope I’ll be able to let go, but I know it’ll be difficult. When it happens, I’ll try to keep in mind the story of one of my first adolescent patients. She came in with her mother to ask for birth control. She was 16 at the time, but years before they had made a commitment to discuss sex openly and frankly. I smiled and complimented them for their ability to broach such a difficult subject. At that moment they both started to cry, thankful for each other and their relationship. I counseled her about birth control and wrote her a prescription.

That experience reminds me that, despite all the statutes and science, fostering trust and communication between parents and children is the most important factor in keeping teens safe and healthy.

Do these people really harbor a burning desire to know whether we are careful planners or total screw-ups? Because that’s what it boils down to. You were either trying — under the sheets or, perhaps, the steely gaze of fertility specialists — or you weren’t, and are shocked, delighted, confused or feeling litigious toward your birth control manufacturer.

The funny thing is, we’ve been on both sides of the coital coin. My first pregnancy, although utterly welcome, was not entirely intentional. More recently, we were pretty careful about not being careful. So I should have two simple answers: last time no, this time yes.

Instead, I struggle to come up with a reply. “Well, we were trying to have a good time,” I said the first time around, trying to shock the questioners as much as they’d shocked me. This time, I’ve placated the curious with the slightly more direct, “We were, but it happened more quickly than we expected.” Trying, but still surprised! So stick that in your pacifier and suck it!

I know I’m not the only one who finds this question unsettling. Not long ago, someone wrote to Slate’s advice column, Dear Prudence, to ask how to handle it. Her response — “More than one person has asked that?” — suggests the question has become more socially acceptable in the years since she had her own child. The horrified reactions of my older sister and sister-in-law when I told them about this essay seem to support that theory. Both said they were never asked the question during their turn-of-the-millennium pregnancies.

So what changed? Are people simply more bold now? Is it the impact of bare-all reality TV? The rise of the navel-gazing parent? Or something else entirely?

Whatever the explanation, it’s rubbing people the wrong way. At BabyCenter.com, the popular Web community for mothers and mothers-to-be, a senior manager told me that 80 percent of those discussing this question find it “offensive, rude, and nosy.” She also told me certain people get the question more than others. If you’re unmarried, conceived too quickly or too slowly after getting married, are having more than the picket-fence norm of two children, having them close together, or having them late in life, prepare to be probed. And prepare your best comeback.

That’s exactly what frustrated mothers-to-be are doing all over the Web. These fertile minds suggest responses including, “Yep, every night”; “No, I have no idea how this happened”; “Are you kidding? I don’t even know whose it is”; and “Why do you ask?”

That last one might be the best approach. Because no one out there is weighing in to explain why the question really comes up. Curious, I reached out to a few of the people who’ve lobbed this question my way. Mary, a former supervisor in her 50s, said she’d never asked anyone before blurting it to me. Sarah, a friend and co-worker in her late 20s, said she only broaches the topic with close friends, and suspects others who ask are trying to figure out how to respond to the news. Matt, a friend and doctor in his 30s with three kids of his own, confirmed her theory: “I ask that question because the response dictates the next several minutes of conversation, and the next several months of your lives.” As a clinician and as a friend, he said, he keeps an ear out for the rare but occasional, “No, we weren’t, and we don’t know what to do,” so he can offer any necessary support.

Matt’s answer gave me pause, because I had been fully prepared to unleash this admonition: The appropriate response to pregnancy news is to express excitement and joy — and then shut up.

Which is funny, because in all other matters parental, I try to be blunt and honest, probably to excess. I am particularly committed to countering fairy-tale notions of glowing expectant and new mothers (what, not a stretch mark or hemorrhoid in sight?). So I should appreciate someone like Matt, who’s sincerely interested in offering help if things are less than picture-perfect.

Still, I’m pretty sure people like that are few and far between. Instead, the question has become part of a curious series of invasions all pregnant women face, from hands on the belly to comments on skin tone and size. When I was 8 months pregnant with our first child, the female caterer at a work function looked me up and down before rasping, “How much weight did you put on?” This time around, multiple people — men and women — told me I looked “ready to pop,” a particularly alarming visual. And it takes about 10 seconds after you have your first child, as Tina Fey so eloquently chronicled in her New Yorker essay earlier this year, for people to start asking when the second is coming.

Ultimately, all women have to decide how to respond to these intrusions, drawing boundaries between what we take in and what we ignore. But marking out that territory can start to feel … well, pretty trying. So here’s a tip for those who find themselves eager for details in the face of baby news: Imagine how you’d feel if someone asked you how often you have sex, or how your own family planning is working out. Instead, take a deep breath and offer a simple, “That’s great. How are you feeling?”