By Amanda Friedman

Julia Derek's life as a serial egg donor began innocently. When she was 24, she left her native home of Sweden to study journalism at George Mason University in Washington, D.C. Three months after her arrival, she had managed to spend her entire life savings and knew that she would be forced to return home if she did not find some form of income. Yet, without a Green Card or legal working papers, getting a job was tough. In a last effort to solve her financial woes, Derek looked through the classified ads in a campus newspaper, hoping to find something. "I was going to see if I could get a waitress job at some restaurant in the more seedy parts of the city. Somewhere where they wouldn't really check or care if I had legal papers" (Derek Interview). As she was leafing through the paper, an ad of a different kind caught her eye: Egg Donor wanted. Infertile couple searching for tall (5'8" minimum), athletic, green eyes, brunette egg donor between the ages of 18-30. Preferably from Northern or Eastern Europe. Very Discreet. Compensation: $3,500. Call 567-XXXX (Derek 5). At first Derek thought the ad was too good to be true, as the desired physical traits matched her own and the money being offered was much more than she could make at any place she had a chance of finding work. She did not know exactly what being an egg donor meant, but the offer was intriguing. Derek called the number the next day, and just like that, her experience as an egg donor began. (Derek Interview).

"Over the course of four years, she would donate her eggs eleven more times"

The business of egg donation has been growing rapidly in the United States since the first baby was conceived through the process in 1984. In 2001, a total of 5,257 infants were born through this procedure used when a woman is unable to produce healthy eggs (Jeng 14). By using in vitro fertilization (IVF) techniques, the transferred eggs from another woman are fertilized by the recipient's partner, and the embryo is then implanted in the infertile woman's womb (American Society of Reproductive Medicine 4). In this way, the mother has the biological experience of having her baby while the father is genetically related. Except for rare cases when the eggs are truly "donated," the egg donor is rewarded through some sort of monetary payment. Today's standard amount of payment is $5-10 thousand. In one of the most extreme examples, a couple offered $500,000 for an egg donor that was an Ivy League student who was 5'10" or taller and scored at least 1400 on her SATs (Rothman 1).

Classified ads searching for donors are commonly placed in university newspapers because college students make extremely desirable candidates since younger women produce more eggs of a higher quality with less risk of genetic defects. Also, college students are often in debt and can be easily lured by the large sums of money being offered. In addition, couples usually look for traits in their donor that they hope will be passed on to their child, and education and intelligence are often high on the list. Julia, a broke, attractive and healthy young woman in pursuit of a higher education, was exactly the type of woman that these ads target.

The practice of offering such large amounts of money and searching for egg donors through college newspapers is ethically problematic in a number of ways. First, the classified ads target college women who do not always understand the procedure and are motivated by the monetary rewards. Women could be so overwhelmed by the large sums of money that they donate regardless of their own health issues or values. In addition, offering various amounts of money for specific traits raises the ethical dilemma of treating eggs like a commodity and life as something to be designed according to specification. The rising prices offered to egg donors has created a competitive market atmosphere where couples are searching for the "best" eggs that money can buy, with poor women essentially selling their body parts to the rich. The classified ads embody all of the problems presented by the issue of egg donation.

There are three methods in which a recipient can obtain donated eggs. One avenue is by using a known donor, usually a close relative or friend who is willing to give her the eggs for free. Another way is by using the donated eggs from a woman who underwent IVF treatment and produced more eggs than she needed to get pregnant. Although there are many couples who find a donor through these two modes, the most common egg donor is an anonymous woman who is connected with the recipient through median fertility clinics (American Society for Reproductive Medicine 5). At most clinics, prospective donors make appointments over the phone and then are screened by a fertility counselor. During the screening, a woman is first asked to read information about the procedure and potential risks, and then she must fill out a lengthy questionnaire asking for such information as family health history, physical features of herself and her family, activities and hobbies,her GPA and test scores. The information will be made available for potential recipients to help them choose a desirable donor. Although the woman's identity will remain anonymous to the searching couples, they will be able to learn nearly every other fact about her, from the regularity of her periods to the age at which she had her first alcoholic beverage (The Center for Egg Options). After going over everything, the woman returns home to wait, however long that may be, until she is matched with a couple.

" The practice of asking for specific traits when searching for an egg donor has potentially changed the procedure into a form of eugenics"

Egg donation, unlike sperm donation, is a complex procedure that involves a significant degree of inconvenience, time, and potential risk. This is why egg donors receive thousands of dollars while sperm donors are usually only paid around $60-75 (ASRM 219). For three weeks leading up to the egg retrieval, a donor must inject herself with fertility drugs that stimulate her ovaries to produce several egg follicles. This is done because pregnancy is more likely to occur if more than one egg is fertilized and transferred to the recipient. As the eggs mature, their development is monitored by ultrasound and blood hormone levels requiring the donor to make regular visits to the doctor.

The invasive procedure for harvesting the eggs usually takes about an hour. The donor will be administered with anesthesia and then, using an ultrasound machine for guidance, a needle is placed inside the woman and the ripe eggs will be removed from the ovaries. The eggs are then taken to a laboratory to be mixed with the recipient partner's sperm. The woman is allowed to leave the doctor's office about two hours later, but is recommended to "take it easy" for at least a week. During this time, she will usually experience some pain and bloating, but recovery is usually quick.

Although the large majority of egg donation procedures run smoothly, there are a number of potential risks to the donor. The hormones given to increase ovulation can cause some women to experience headaches, hot flashes, mood changes, fluid retention, discomfort and bruises at the site of injections, allergy, and ovarian hyperstimulation syndrome, which is when the ovaries produce too many eggs and become very large, painful, and may even rupture. Women with severe hyperstimulation also have an increased risk of blood clots that potentially lead to stroke or heart attack. However, the risk of such severe hyperstimulation is less than one percent, and the risk for blood clots and related problems is even less. Approximately three women per thousand are known to have had a serious medical complication during the actual egg removal procedure. The complications include, but are not limited to: internal bleeding, infection, and damage to the internal structure. After the procedure, the donor will usually experience some light bleeding, bloating, lower abdominal discomfort, or nausea for a few days. More severe symptoms are pain, lightheadedness, or vomiting (The Center for Egg Options 3-8). Although the risks involved with being an egg donor are slim, they are significant, especially in comparison to the few benefits to the donor. In fact, the only benefits from being an egg donor are the altruistic satisfaction of having helped another woman who might otherwise not be able to experience pregnancy and delivery. Of course, there is also the financial compensation.

Because of the intricacy and risks of being an egg donor, a monetary compensation seems necessary to keep the supply equal to the demand. This can be illustrated by the situation in the United Kingdom, where the government has capped the amount of payment for egg providers at the United States' equivalent of about $24. This amount is inadequate to recruit a sufficient amount of egg providers, and as a result, the waiting period to receive eggs is about five years (Shanley 10). Since prohibiting payment completely seems to be too extreme of a measure, the issue now is the amount a woman should be paid for her eggs. Many supporters of payment for egg donors argue that it is essentially a compensation based on the time, inconvenience, and discomfort associated with the egg retrieval process. However, the amount women are currently being offered and receiving is much too high to be considered solely compensation for their involvement. Five to ten thousand may be the normal price range, but a person could potentially offer any amount to buy a woman's eggs. Financial incentive creates the possibility of the exploitation of donors, who may agree to provide their eggs in sole response to their financial need without fully considering their feelings about giving their reproductive material to a stranger. In addition, the lure of money could also cause some potential donors to conceal medical information that endangers their own health, as well as the health of the recipient and offspring.

Another problem with offering large sums of money is that donors can put themselves at risk by repeating the process multiple times. Julia Derek donated her eggs for the first time through the fertility clinic in Los Angeles, where she was introduced to Rosa, a woman who became Derek's "egg broker." Rosa informed her about the procedure and potential risks, and after being screened and selected by a couple, Derek was excited to begin the process and make money. For three weeks, she gave herself shots of the fertility hormones, which caused some bruising and a minimal amount of pain, and paid regular visits to the doctor's office where the egg retrieval would take place. The retrieval itself was fairly easy, but the weeks following were not. Derek was extremely sensitive to the hormones and produced nearly 30 eggs, which caused her to become hyperstimulated. "My stomach was so swollen that I looked like I was six-months pregnant, it hurt to sit up, and my emotions were a mess. I was miserable," she says. "And I vowed at that point that I would never, ever donate my eggs again." Derek was given a check for $3,500 and really thought that her egg donor experience was in the past. Rosa called her constantly, begging her to repeat the process since she had proven to be so fertile, but Derek declined. However, after living the high-life for a few months, Derek's bank account dwindled and she became desperate once again. The next time Rosa called to tell her that a couple would love to use her eggs, Derek agreed. Over the course of four years, she would donate her eggs eleven more times (Derek Interview).

In the egg donor market, repeat donors are considered to be more valuable than newcomers because their fertility and dependability have been proven. The pressure from infertility clinics to donate again combined with the increase of payment with multiple donations can be hard for a young woman to resist. As a result, many women who donate once will often repeat the procedure. Although there are no scientifically proven risks associated with multiple donations, many medical professionals, such as those at the American Society for Reproductive Medicine, recommend that a limit be set on the amount of times one person can donate. They feel that a limit should be created as a measure to keep the money motivator from being a damaging factor for the women and the egg donation practice in general. A survey of 52 anonymous donors by Northwestern University in Chicago and Fertility Centers of Illinois found that all of them felt that compensation was important and that only eleven percent would donate if they were not paid. Thirty percent answered that financial gain was the most important motivation for donation.

At twelve donations, Julia Derek exceeded the ASRM's recommended limit by double the amount, and the repeated process did indeed affect her psychologically. After Derek's ninth donation, she began to notice that she felt a bit depressed. As her depression escalated, Derek told Rosa about what was going on, but Rosa responded by telling her that those feelings were completely separate from being an egg donor. Although Derek was not entirely convinced this was true, she needed the money and decided to donate three more times. "It was so obvious that my depression was being caused by the hormones I was given, but Rosa always tried to blame it on me instead. She would tell me that I was the problem, which wasn't true," Derek says (Derek Interview).

After the twelfth donation, Derek's depression became so bad that she could barely get out of bed and had recurring severe headaches. Rosa refused to help her and would not even return her phone calls, possibly out of fear of being sued. Derek eventually decided to seek professional help, and a doctor was quick to verify that the fertility hormones she had been taking had caused a psychological imbalance that had made her very depressed. She was given a prescription order of Serafem, a type of antidepressant meant to treat women with severe Premenstrual Syndrome (PMS). After two weeks on the medicine, her depression began to go away, and four months later, she was off the antidepressants and feeling like herself again. Today, four years later, the only long-term physical effect she has from being an egg donor is severe monthly PMS.

During the time Derek was donating her eggs, she says that she was never bothered by the thought of being genetically related to as many as twelve children, and she still feels this way today. "I don't feel bad about passing on my genetic material, and I don't ever think that I have children," she says. "This is just like giving a hair or a nail to someone and then having that person create a child. It is not mine." Derek says that if she felt differently about the issue, she would never have donated her eggs in the first place. She seems willfully blind to her genetic relationship with the children she helped create, but does say that she would be alright if one of these offspring came to find her in the future. "I know that if I was one of those children, I would at least want the option to find my biological mother," Derek says (Derek Interview). Derek's own comments about being an egg donor are contradictory, with her initially completely rejecting her relationship to these children and then basically admitting that she is indeed their biological mother later in the conversation. Her obvious confusion with the issue of egg donation and her individual part in the procedure shows that some women who donate their eggs may not fully understand the implications of their decision.

Aside from taking advantage of young women and putting them at potential risk by offering lofty financial rewards, the actual content of the classified ads that ask for specific traits is a huge issue in itself. In an essay written for Amherst University, Professor Mary Lyndon Shanley points out that: The differential pricing of gametes based on characteristics like the provider's height, skin and hair color, athletic or academic achievement, and musical ability seems to validate the assumption that persons with such attributes — both providers and as-yet unborn children — are "worth more" than others (Shanley 7). By placing different prices on different traits, women's eggs are being treated as commodities, completely devaluing human life. The practice of asking for specific traits when searching for an egg donor has potentially changed the procedure into a form of eugenics, which the Encyclopedia Britannica defines as "the organic betterment of the race through wise application of the laws of humanity." If a woman is desperate to have a baby and using an egg donor is her only option, she should be happy with any egg she can get. The fact that recipients pick donors based on their physical and mental traits means that they are partially attempting to design their own offspring.

Another problem with recipients offering whatever price they desire in the search for a woman with certain traits is that this creates a situation where only the rich can afford to get the "very best" eggs. There is essentially an egg donor market, where eggs, containers of a woman's genetic material, can be bought and sold as if they were commercial property. Shanley points out that "control over eggs or sperm can be transferred from provider to doctor to fertility clinic, and from those to the recipient. They can be treated as a generalized 'resource' that can be traded in the market" (Shanley 7). In addition, because the market is competitive, fertility clinics are constantly forced to raise the donor's payment to keep up with the other clinic's offers. And because the prices continue to increase, using an egg donor for reproduction has become an option that only the well-off can really afford. The process alone costs the recipient between $15-25,000, excluding the price of eggs, and less than one-third of health insurance plans cover infertility treatments (Bader 2). So the egg donor business has become one in which the poorer donors are essentially selling their bodily material to the richer recipients. Ironically, Federal law prohibits direct payment to people who donate their organs and tissues for transplantation in order to avoid this very situation, although they do allow for the donors to receive reimbursement for expenses and other costs associated with the donation procedure (American Society of Reproductive Medicine). Should a person's eggs be treated any differently? The payment egg donors receive far exceeds an amount that could be considered solely reimbursement for their involvement, and yet the government has done nothing to regulate this constantly increasing market.

On the surface, government regulation of the egg donation procedure and market seems like a necessary solution to the various problems that the business presents. However, there are many reasons the government will probably not get involved any time soon. As Ken Baum, MD, a Yale lecturer in bioethics and lawyer specializing in medical litigation explains:

Ultimately, it comes down to vested interests, money, and political capital…The providers are in a race to get women pregnant, so they have higher success rates, thus a more marketable facility. The patients are another vested group; they want access to as much technologies as possible. There is a social ambivalence, so politicians, particularly the present administration, just leave the issue alone: they're bound to alienate half the electorate (Binham 2).

If there is a limit set on the amount a donor can receive, women will probably not be as willing to donate their eggs, and this will cause fertility clinics to lose business and money. In addition, since the monetary reward comes from the recipients and not the clinics themselves, the increasing market does not affect them. If anything, it brings in more potential donors. Another reason the clinics may not want regulation is because they may lose donors if there are strict guidelines created about who can donate and how many times. Infertility professionals are also mostly against government regulation because they do not want to lose control over the scientific aspects of the procedure, which may happen if the government creates legislation. Lastly, although the egg donor issue is extremely controversial, it is not a priority of the government because it is not a life-saving treatment and only affects approximately ten percent of all couples nationwide (Binham 3). For all of these reasons, the chance for government involvement seems slim.

The issues involved with the business of egg donation are controversial and complex, and it does not seem like a solution will be found any time soon. By looking at the classified ads searching for donors in college newspapers, the various problems can be addressed and defined. First, by offering large sums of money, the ads, as well as the business in general, take advantage of college women's common financial need by using the money as a motivational tool that can convince a woman to donate without considering the potential risks or the ethical issues involved. The payment also creates a situation where a woman may lie about the amount of times she has donated or genetic conditions that she could be passing on to the offspring because she is in need of money and wants to be accepted by the clinic. Finally, by putting a price on both the eggs and the specific traits of the donor, women's eggs are being treated like a commodity in an open market without regulations. And because usually only wealthy people can afford to be a recipient, the market has become one in which the poor are essentially selling their body parts to the rich, and the rich are essentially designing their own children. After all, if Julia Derek did not need the money and was short, overweight, and a minority, do you think she would have become the serial egg donor that she once was?

About the Author:

Amanda Friedman was born in New York City. She is currently a junior at USC, majoring in Public Relations and minoring in English with an emphasis on creative writing. She first became interested in the issue of egg donation after considering donating eggs herself. After writing this paper, she decided otherwise.

Works Cited

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