Sex Cells: The Medical Market for Eggs and Sperm (11 page)

Matches are the primary source of income for agencies and banks, and the staff works hard to confirm them. Recipients are urged to browse donor profiles, but staff members will also take the time to discuss various donors’ attributes, thereby shaping recipients’ perceptions. This intermediary role is made clear in the following excerpt, which is one side of a telephone conversation between Creative Beginnings’ founder and a recipient who is in the process of choosing a donor.

Both the donor and her embryos are labeled “beautiful,” and she is “bright” and “a really good student,” which provides an innocuous explanation for why she needs money from egg donation. Positive descriptions such as these help agencies create a sense of urgency about the donor being “grabbed” by some other recipient if the caller does not act quickly. These sorts of pressure tactics are helpful in confirming a match because as OvaCorp’s donor manager explained, “99.9% of the time [recipients] will go with a donor], especially if they know someone else is waiting.”

Although recipients learn details about donors from the profiles and staff, this flow of information does not go both ways. Sperm donors at CryoCorp and Western Sperm Bank are not given any information about who purchases their sperm. Creative Beginnings’ egg donors are often given vague, nonidentifying information (e.g., the recipients are “school-teachers in their forties who have been trying for a long time to have children”). OvaCorp’s egg donors are given a short letter written by the recipients explaining why they are using egg donation. Program mangers
see this information as quite motivating for egg donors. OvaCorp’s psychologist called it an “obvious rule of thumb about human nature,” encouraging recipients to “Please call [the donor], stay in touch. She’ll do a better job for you if she knows you care.” The founder of the second major egg agency on the West Coast agreed, stating,

I believe that a donor has a right to [an] important, honest, nonidentifiable evaluation of the recipient. That’s how they let go. To say “You’re going to give an egg and you’ll never know anything about it and we’re going to give you $5,000,” it’s a business transaction. Versus “We’re going to give you $5,000, thank you for what you’re going through, you’re answering someone’s prayer, and you’re changing their lives. They have two Dalmatians. He’s a fireman. She’s always dreamed of being a mother. She’s had two miscarriages. Their lives have stopped. You’re changing them. They’re going to raise this child with so much love.” There’s a real big difference for the donor.

Egg agencies find some donors easier to match than others. The most sought-after are “repeat donors,” who have proven their reliability by completing at least one donation cycle, or “proven donors,” whose eggs have resulted in pregnancy for a previous recipient, thus providing evidence of fertility. All sperm donors are screened for exceptionally high sperm counts, so banks do not label their donors as “proven.” In fact, neither sperm bank had ever considered dropping a donor whose sperm had not resulted in any pregnancies. Some donors are also labeled “popular” because their profiles generate almost daily calls from potential recipients visiting the website. OvaCorp’s donor manager, leafing through a profile she had just received, said, “I can tell when I can match a girl quick.”

Well number one, she’s attractive. Number two, she has a child, which is a huge plus. I mean look [
shows Rene her picture and profile
]. And the kindest woman. She has a really good background. See, definitely it’s not for the money. She makes 65 grand a year. Great height and weight. Obviously Hispanic, and I start reading a little bit about her, and she has phenomenal answers about why she wants to do this. She’s given the couple total leadership, and that’s wonderful. She can travel because she’s in Texas. So she’d be an easy match. Young, twenty-six, young child. There’s definitely proven fertility. 5 feet 7 inches, 110 [pounds]. She’s Caucasian enough. She’s white enough to pass, but she has a nice good hue to her if you have a Hispanic couple. Educated, good family health history. Very outgoing. Easy match. Easy match.

This stream-of-consciousness perusal of a donor profile reveals the intersection of sex and gender with race and class in defining popular donors. The donor’s own child attests to her body’s ability to create pregnancy-producing eggs. Her relatively high salary and eloquence on the page demonstrate her altruism. And her “hue” makes her phenotypically flexible to match either Caucasian or Hispanic recipients.

FEES

One of the most striking comparisons in this market is how egg agencies and sperm banks pay women and men for sex cells. The most obvious difference is the level of compensation; per donation, egg donors are generally paid around $5,000, and sperm donors are paid around $75. Of course, there are enormous differences in what is required of women to produce eggs and men to produce sperm (discussed in more detail in
Chapter 3
), particularly in terms of physical risk, a rationale for the difference in fees that is referenced both by the ASRM’s Ethics Committee and program staff.
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In the succinct words of one physician–researcher: “The egg donor goes through a lot more, and they’re paid more.”

However, when one compares the rate per contract, the difference is not so extreme; it takes women a month or two to complete a cycle, and men agree to donate at least once a week for a year. By the end of the year, men’s total earnings may begin to approach women’s, but women can complete several donations in that time as long as they continue to attract recipient interest. Moreover, women’s fees generally increase with each cycle, especially if a previous donation resulted in pregnancy, so an egg donor’s annual earnings can quickly outpace a sperm donor’s.

Because of biological sex differences, it is difficult to justify a direct comparison of the
amount
paid to women and men, but it is possible to compare other aspects of how programs manage the financial compensation.
First, women who complete a cycle are paid regardless of how many eggs they produce, yet men are paid only if the sample meets bank standards for sperm count. Otherwise, men receive nothing for that day’s donation, a form of piecework compensation in which payment is based on production. Second, egg agencies pay women in one lump sum, usually after the retrieval surgery.
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Men are paid every two weeks, mimicking the schedule and format of a paycheck that one would receive as an employee in a workplace. Third, sperm banks pay the same flat rate to each of their donors, but egg agencies often adjust a donor’s compensation based on her personal characteristics.

Indeed, the final stage of confirming an egg donor match is negotiating the donor’s fee, which can be affected by her performance in previous cycles, her education level, and even her race/ethnicity. During an interview in 2002, an OvaCorp staffer explained how “the donors range.”

They start at $3,500, but if you’re Asian, you command a higher fee. If you’re highly educated, there’s no set number. If you have a degree, you’ll get more than if you’re a high school graduate. If you’re a successful repeater, [that is,] couples have had a child by you, then you’re a better bet than to go through the cycle with a newcomer and nothing happens, or she produces two eggs. A successful repeater could get $12,000 for her eggs. We have a few that are just exceptional, where everyone’s gotten pregnant, they’re brilliant, they’re beautiful, they’re educated.

Due to the difficulty of maintaining a diverse pool of donors, both egg agencies often increase the fee for donors of color, especially Asian Americans and African Americans. This results in a situation where they are often more highly valued than white women, which is unexpected, given that the reverse is often true in other contexts, including the labor market and in adoption agencies. But in this market, race is seen as a biologically based characteristic, and sex cells from women of color are perceived as scarce, which contributes to their increased value.

In determining appropriate fees for particular donors, egg agency staffers often consult with one another. In this excerpt from a weekly staff meeting at OvaCorp, the donor manager and her assistant discuss with the agency director a match between a wealthy recipient and a donor
they call “an ace in the hole” and a “sure bet,” because her eggs consistently result in recipient pregnancies.

In addition to reflecting the widespread use of gift rhetoric in egg agencies, this discussion also highlights the continuing intermediary role played by staffers, as they determine what recipients can afford while also securing the highest possible fee for women, in part to cultivate donor loyalty in a metropolitan area with several other egg agencies. If recipients are perceived as wealthy, the staff members will often ask for a higher donor fee, as when a program assistant at one egg agency mentioned that “gay men, single men have a lot of money, and they think nothing of 7, 8 thousand dollars.” However, staffers do not appreciate it when requests for higher fees come from the donors. Creative Beginnings’ founder expressed “disappointment” in “girls that really ask you to negotiate,” saying, “I really don’t like that. It’s really uncomfortable, and couples don’t like it.”
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There are literally hundreds of other donors available, either within a given program or at nearby programs, so it appears that these fees are not as responsive to supply and demand as one would expect. Unfortunately, there are no aggregate statistics available to measure “supply” (number of donors or number of gametes produced) or “demand” (number of recipients or quantity of gametes consumed), which makes it difficult to test this claim rigorously. However, it has been noted by other observers of this market.
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There is also a dearth of data about the financial situations of egg and sperm recipients, which leaves open questions about the extent to which they are able to afford assisted reproduction. Such calculations would be further complicated by a patchwork of state mandates and insurance policies, some of which provide coverage for donor insemination or IVF.

In an attempt to capture the supply of sex cells available at the egg agencies and sperm banks in this study,
Figure 3
illustrates the number of donors with profiles posted in each program.
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At the egg agencies, the white part of the bar reflects the number of egg donors who are currently matched to recipients, which renders them unavailable to other recipients and thus provides some evidence of demand. OvaCorp, one of the largest and oldest egg agencies in the country, cataloged 465 donors and had 100 active donor/recipient matches in the summer of 2002. That same summer, Creative Beginnings, a new egg agency that had been open for just three years, already had 123 egg donors listed online, with 23 women in active matches. In 2006, Gametes Inc., a sperm bank that had been open for thirty years, posted just 113 sperm donors, and its egg agency, which had opened just a few years before, already had profiles for 75 women, 25 of whom were matched. In 2002, CryoCorp, one of the largest and oldest sperm banks in the country, listed 125 donors, and Western Sperm Bank, the small, nonprofit program, had vials from just 30 donors. In terms of recipient demand for men’s gametes, CryoCorp reports distributing about 2,500 vials every month, and Western Sperm Bank estimates that it serves around 400 recipients each year.
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