Sex Cells: The Medical Market for Eggs and Sperm (13 page)

Rene: Are you serious?

Donor Manager: Oh yeah. That was a gift to her. They said, “What do we do?” Well, you bought me and [the donor] a pair of $3,000 earrings. They’re a very wealthy couple. I love them. She had [the earrings] made by somebody in Italy. Mine had rubies at the end of them, the donor’s had emeralds, and the couple’s, hers had sapphires. So when her girls were born, she says “Maybe I’ll get her some more earrings.” I said “The likelihood of her wearing those earrings is very slim [because] she’s really low key.” I said “Give her a financial compensation.” She’s like, “Okay, I’ll give her $15,000, 7,500 [dollars] per girl.” She had twins.

Here, the monetary value of the recipient’s gift to the donor is explicitly tied to the number of children she had as a result of the donor’s eggs, making the line between gift and sale indistinguishable.

In egg donation, the earlier stage of fee negotiation gives way to an understanding that donors are providing a gift to which recipients are expected to respond with a thank-you note, and many choose to give the donor a gift of their own. In sperm donation, men are far more likely to be treated like employees, clocking in at the sperm bank at least once a week to produce a “high-quality” sample. Indeed, this framing of donation as a job leads some men to be so removed from what they are donating that when a new employee at Western Sperm Bank excitedly told a donor that a recipient had become pregnant with his samples, she said it was like “somebody hit him with this huge ball in the middle of his head. He just went blank, and he was shocked.” During his next visit, the sperm donor explained, “I hadn’t really thought about the fact there were gonna be pregnancies.” The donor manager described this state of mind as “not uncommon.”

Anthropologist Rayna Rapp observes that “Contemporary biomedical rationality . . . [is] operating to reproduce older forms of gender, ethnoracial, class, and national stratification even (or perhaps especially) on its
technologically ‘revolutionary’ edges.”
¹⁹
Indeed, these portrayals of altruistic femininity and emotionally distant masculinity fit a very traditional pattern, and the sperm donor’s reaction exposes the reflexive application of gendered norms in this medical market. Although most egg donors will never meet their genetic children, they are still expected to be “naturally” caring, guiltily hiding any interest they might have in the promise of thousands of dollars. This is a form of emotional work not required of men donating sperm, even though they are more likely to be contacted by their biological offspring through the banks’ identity-release programs.

ONE PROGRAM, TWO KINDS OF DONATION

Donor insemination and
in vitro
fertilization developed at different times in distinct spheres of scientific research. Many early commercial programs were started by people with links to these worlds, so they generally offered egg donation or sperm donation but not both. This division of the market into sex-specific firms continues to the present, with most programs specializing in one or the other. To assess whether the gendered protocols that exist at CryoCorp, Western Sperm Bank, Creative Beginnings, and OvaCorp persist even in organizations that sell both eggs and sperm, I turn briefly to daily business practices at Gametes Inc. and University Fertility Services.

Gametes Inc. was one of the first commercial sperm banks to open in the United States, but it was nearly thirty years before it decided to get into the egg donation business. The founder of Gametes Inc. derided other egg agencies as simply offering “picture galleries” of attractive young women, and he decided his company would medically and psychologically screen prospective donors
before
posting their profiles to its website. He hired new staff members, and within just three years, Gametes Inc. had compiled a roster of 75 women who were willing to donate their eggs, a surprising figure given that the sperm bank offered samples from just 112 men after so many years of being open.

In starting the egg agency, though, Gametes Inc. did not follow the model it had established at its sperm bank. The new staffers hired to run
the egg agency worked in a different wing of the building, and they were sometimes surprised when I pointed out the differences in protocols that each program had developed. For example, the sperm bank had an elaborate identity-release program, one in which it paid men 50% more per sample if they consented to release identifying information to offspring. In contrast, the egg agency, like most egg agencies, had no such program and even refused to give egg donors basic information about whether their recipients had become pregnant or not, a direct contrast to the more open egg agencies on the West Coast. Examples such as this underscore the extent to which there is gendered bifurcation in program protocols. However, the fact that the content of those protocols can be so variable provides further evidence that there is nothing inherent in biology or technology that determines particular policies.

There is also evidence of the gendered framing of egg and sperm donation at Gametes Inc. Gametes Inc.’s egg agency created its own distinct website, which differed in both design and organization from the sperm bank’s website, and each program asked prospective donors to fill out gender-specific applications with different questions for women and men. Staffers joked around with sperm donors, offering them free T-shirts and key chains with funny slogans, but egg agency staffers thanked women for their gift with Fabergé-esque eggs or small hearts at the end of a cycle. One similarity between the egg and sperm branches of Gametes Inc. is that both offer adult photos of donors; its sperm bank is one of the few in the country to do so. However, just 27% of men’s profiles included adult photos, compared to 92% of women’s profiles.

At University Fertility Services, there had been an active sperm donation program for years when nurse–coordinators began recruiting egg donors. In organizing both kinds of donation, staff members offered recipients very little information about donors, and they maintained strict anonymity, as at other university programs on the East Coast. The similarity ends there, though. As at Gametes Inc., there were different screening protocols for and expectations of women and men. For example, during a period in the 1990s, the same person was responsible for screening both egg and sperm donors, and she used the same preliminary questionnaire. However, many of the egg donors’ forms included a
scribbled note about why the woman was interested in being a donor (e.g., “why—wants to help” or “why—loves kids”). Not a single one of the sperm donors’ forms includes these handwritten notations about motivations.
²⁰
By the time I conducted research there in 2006, the sperm donor program was no longer active, but this question about women’s motivations had been formally incorporated into the intake questionnaire for egg donor applicants.

The different expectations of egg and sperm donors are made especially clear in this discussion with a prominent physician–researcher who had served as medical director of University Fertility Services for two decades. When asked how he would define a great egg donor, in addition to discussing her medical and reproductive history, he explained,

Physician: I like to see some altruism of the [egg] donors. Yes, we pay them $2,000, and that’s probably the low end of what donors are getting paid around the nation, but in [this small college town], it’s not an insignificant amount of money. When we ask them, “Why do you want to be a donor?” most say, “Well, I saw this [news] program on TV, or I’ve got a cousin that’s going through infertility, or I want to help people.” Most of them, it’s about some reason other than I saw an ad in the newspaper, and I want to make some money, because it’s a hard way of making money.

Rene: What is it about altruism that’s important?

Physician: It just tells me that they’re less likely to have regrets down the road, that they’ve really approached this as “I want to help somebody,” not “I’m doing this to make money.”

Rene: And then a similar question for sperm donors. What would make you think this is a great donor?

Physician: The sperm donors were different. They weren’t paid very much per specimen. I think it was 50 bucks. Sperm donors, in general, weren’t as altruistic. They honestly were guys that wanted to make money, and guys have less attachment of their sperm than women do of their eggs. Very few sperm donors actually ever have regrets about, you know, “What did I do?” So, men were a little different than the women.

In summarizing attitudes toward the men and women who provide sex cells for infertility patients, a lab technician who had worked at University Fertility Services since the late 1980s said, “I think a lot of people felt that sperm donors were a dime a dozen and your egg donors are gold.”

CONCLUSION

Casual observers of the medical market for sex cells point to biological differences between women and men and consider them explanation enough for the greater economic and cultural valuation of egg donors. Indeed, individual women have fewer eggs than individual men have sperm, and egg retrieval requires surgery, while sperm retrieval requires masturbation. However, shifting the lens from individual bodies to the broader market reveals an oversupply of women willing to be egg donors. Both the yearlong commitment and stringent requirements make men difficult to recruit, yet hundreds of women’s profiles languish on agency websites, far outstripping recipient demand. Despite this abundance, egg donor fees hold steady and are often calibrated by staff perceptions of a woman’s characteristics and a recipient’s wealth. Moreover, these high levels of compensation coexist seamlessly with altruistic rhetoric, because agency staff members draw on cultural norms of maternal femininity to frame egg donation as a gift exchange.

It is not that altruistic rhetoric is completely absent in sperm banks or that men cannot make a couple of thousand dollars a year providing weekly samples, but the dynamic interplay between biological, economic, cultural, and structural factors differentiates the market for eggs from that for sperm in each stage of the donation process. In recruiting marketable donors, both egg agencies and sperm banks place advertisements listing biological requirements (e.g., age), but egg agencies emphasize the opportunity to help and sperm banks portray donation as a job, a distinction shaped by gendered stereotypes that appear in countless organizational processes. The greater cultural acceptance of egg donation probably results in more women applicants than men, and staffers screen women based on biological factors such as medical history. But
also under review are a woman’s physical appearance and stated motivations. Men’s health history is similarly scrutinized, and those willing to release identifying information to offspring are preferred, but responsibility, height, and sperm count ultimately define the ideal sperm donor.

Once accepted into a donation program, a woman’s profile will be used to match her with a specific recipient client, as eggs cannot yet be frozen like sperm.
²¹
Men must build enough “inventory” for their profiles to be posted to the program’s website, and their vials are available on a first-come, first-serve basis. Stored by the hundreds in large tanks, men’s donations resemble a standardized product more so than the eggs that are removed from an individual woman and placed into “her” recipient a few days later. This is probably partly responsible for the different approaches to compensation, in which men are paid a set rate only for those samples deemed acceptable. Although most egg donors receive the market rate, it is common for a woman’s characteristics (such as prior donations, education level, and race) to increase her fee. The personal, one-to-one relationship between altruistic egg donor and grateful egg recipient is codified into an actual gift exchange when staff members encourage recipients to write a thank-you letter or provide a small token of appreciation. Bank staffers do not request similar displays of gratitude for sperm donors.

Neither biological differences between women and men nor economic laws of supply and demand fully explain the medical market for sex cells. Reproductive cells and reproductive bodies are filtered through economic and cultural lenses in a particular organizational context—that of medicalized egg agencies and sperm banks. It is not just that individual women have fewer eggs than individual men have sperm, or that eggs are more difficult to extract, that produces both high prices and constant gift-talk in egg donation, but the close connection between women’s reproductive bodies and cultural norms of caring motherhood. In contrast, men are much more difficult to recruit, yet they are paid low, standardized prices, and sperm donation is seen as more job than gift. As a result, both eggs and egg donors are more highly valued than sperm and sperm donors in this medical marketplace, where it is not just reproductive material but visions of maternal femininity and paternal masculinity that are marketed and purchased.

PART TWO
Experiencing the Market

THREE
Producing Eggs and Sperm

In the medical market for eggs and sperm, women and men are paid money to produce sex cells, a practice referred to as “donation” by egg agencies and sperm banks alike. However, egg donation is organized as a gift exchange, while sperm donation is likened to paid employment. In the second part of the book, I turn from the staff to the donors and ask whether these gendered framings of donation affect women’s and men’s experiences of bodily commodification. In each of the next three chapters, I approach this question from a different angle. First, I examine how egg and sperm donors experience the physical processes of donation; then, I compare how they think about the money they receive; and finally, I analyze how they respond to the possibility of children being born from their donations.

In this chapter, I focus on egg and sperm donors’ embodied experiences, paying particular attention to how those experiences are shaped
by the social context of paid donation. Most of what we know about the physical experience of
in vitro
fertilization is based on studies of infertile women, who turn to the technology in hopes of conceiving a child. In going through the first part of an IVF cycle, egg donors encounter the same regimen as infertile women: they inject the same medications, attend the same monitoring appointments, and endure the same egg retrieval surgery.
¹
Because they are subject to the same technological processes, one might expect that infertile women and egg donors would have very similar physical reactions to the shots and surgery. However, the social context in which these two groups of women experience IVF is very different. Infertile women usually spend tens of thousands of dollars and months, if not years, of their lives trying to become pregnant. Egg donors are young, healthy women who receive thousands of dollars to give the gift of life. This raises the question of whether being paid to undergo IVF affects women’s physical experiences of the technology.