Sex Cells: The Medical Market for Eggs and Sperm (29 page)

41
. In most cases, I simply cold-called the program, identifying myself as a graduate student interested in learning about egg and sperm donation. The exceptions include Creative Beginnings, which is run by the mother of a fellow graduate student, and University Fertility Services, where my parents’ neighbor used to run the egg donation program. After interviewing the first person I contacted in each program, I requested to speak with other staff, and eventually I asked to interview donors.

At OvaCorp in 2002, I interviewed the donor manager, several of her assistants, and two psychologists who screen donors. I spent one day observing at the program’s offices, which included attending a weekly staff meeting with the agency director, a psychologist, a lawyer, the donor manager, and an assistant. I re-interviewed one of the OvaCorp psychologists in 2006, because she was instrumental in starting its egg donation program after working for several years on the surrogacy side. At Creative Beginnings in 2002, I interviewed every member of the staff, including the founder/executive director, assistant director, financial manager, office manager, and several office assistants. I also observed for six days in the program’s offices and attended two of their informational meetings for women interested in egg donation.

In sharp contrast to the egg agencies, it was more difficult to gain access to the sperm banks. (Schmidt and Moore [1998] also point to this kind of “organizational gatekeeping,” which is probably related to the emphasis on anonymity in sperm donation, which I discuss in Chapter 1). In 2002, I interviewed CryoCorp’s marketing director, who also gave me a tour of the bank, but I was denied access to other staff. After a 2005 interview with a prominent physician–researcher who said I could use his name, I contacted the founder/medical director of CryoCorp. At the conclusion of my interview with him, I requested interviews with other members of his staff. He introduced me to the CEO, who granted final permission. In 2006, I interviewed the CEO, two recipient managers, two donor managers, a donor recruiter, a genetic counselor, and the human resources manager.

I encountered similar hesitancy at Western Sperm Bank when I first made contact in 2002. The staff asked for a detailed research plan, my résumé, and a writing sample. Interestingly, it was my work at a pro-choice organization before entering graduate school that eased their minds about my intentions as a researcher, and I was allowed to interview the donor manager, the research director, and a donor/recipient staff person. In 2004, I returned for a brief visit to interview the executive director and tour the sperm bank.

On my first research trip to University Fertility Services in 2005, I interviewed one of the physicians, the nurse responsible for egg donation, and the nurse responsible for sperm donation (among their many other duties). After completing Health Insurance Portability and Accountability Act (HIPAA) training and IRB review at that university (in addition to IRB review at my home institution), I returned for a longer trip in 2006 and talked again with the same physician and both nurses. I also interviewed the medical director, the psychologist, the embryologist, one of the lab technicians, and a third physician who worked in the practice but was part-time.

My two trips to Gametes Inc. in 2006 were organized in a similar way, with the first trip involving a three-hour interview with the founder/executive director and brief conversations with the egg and sperm donor managers. On the second, longer visit, I re-interviewed the donor managers and also spoke to the directors of clinical operations, finance, marketing, and shipping as well as several assistants and lab technicians. Gametes Inc. has two locations; “headquarters” is in a small city, and the satellite office is in a larger city a few hours away. I interviewed staff and observed at both locations.

Although it was sometimes difficult to get in, once I was granted access, staff members at all of the programs were unbelievably helpful and patient in responding to my many, many questions.

42
. I interviewed six sperm donors from Western Sperm Bank and fourteen sperm donors from Gametes Inc., half of whom donated at “headquarters” and half at the satellite office (see previous note). After extensive negotiations, CryoCorp agreed to put a sign-up sheet for interviews near the entrance the donors used, but after a week, there were no names on it. One staff member said she even personally asked her most gregarious donor, and he declined. She speculated that my affiliation with a university where many of the donors attended school might have contributed to their lack of interest. At University Fertility Services, the staff had not actively recruited sperm donors for several years, and they were not willing to contact past donors on my behalf. They thought the men would not be cooperative (previous attempts to contact former sperm donors about updating disease testing had not always been successful) and did not want to invade their privacy.

43
. Previous studies suggest that sperm donors who release identifying information about themselves differ from those who wish to remain anonymous, both in terms of their initial motivations for donation as well as in their attitudes about offspring (Foster-Fraser 1990 and Daniels and Haimes 1998). So it is important for the reader to note that the findings reported here may reflect this selected population. It is also possible that their willingness to be known to offspring makes them more willing to be known to a researcher.

44
. In general, the interviews I did in 2002 were much longer, averaging a little more than two hours for egg and sperm donors alike. By the time I began interviewing donors again in 2006, the interviews had become considerably more focused. This, combined with the fact that Gametes Inc. required me to interview donors in the program’s offices, often when they had just dropped by to donate or take care of other paperwork, made the interviews shorter. Most of the remaining interviews were in restaurants or coffee shops. Three of the interviews with egg donors took place in the women’s homes.

45
. Codes for the donor interviews included:

•
Donor’s Response to
: Ads/Recruitment; First Contact with Program; Screening/Profiles; Legal Contract; Confidentiality/Anonymity/Identity Release; Matching with Recipients; Abstinence; Bank Visits/Masturbation; Hormones/Shots/Egg Retrieval; Being a Number; Repeated/Continued Donation; Gifts; Other.

•
Donor’s Relationship to
: Staff; Money; Gametes/Offspring/Recipients; Own Reproductive History/Future; Other Donors; Other.

•
Donation as Compared to
: Job; Donating Other Body Parts; Surrogacy; Parenthood; Adoption; Other.

•
Donor’s Rhetoric
: Helping/Gift/Service; Genetics; Science/Technology; Pro-choice; Religious/Spiritual; Emotions; Programs as Businesses; Other.

•
Miscellaneous
: Donation as Part of Identity; Changing Views; Recommended Program Changes; Resistance to Program Policies; Summing up Experience; Other Programs; Telling Others about Donation.

I did not limit the number of codes that could be applied to a particular interview excerpt. In the end, each code contained anywhere from a few pages to 150 pages of interview excerpts, with the exception of Gametes/Offspring/Recipients, which was more than 300 pages long. I printed out each code as needed and did more detailed coding on paper. At the same time, I was also creating a spreadsheet that grew to include more than 300 variables about each donor’s interview, including everything from their ages to whether they used specific words or phrases in discussing donation.

1. CHARACTERIZING THE MATERIAL

1
. See Hard (1909), mentioned in Daniels (2006). In the article, Dr. Hard reports meeting the young man and shaking his hand, which has fueled speculation that he was in fact the donor.

2
. Daniels (2006, 76).

3
. Tompkins (1950).

4
. Guttmacher et al. (1950, 266–268).

5
. This is a reference to the eugenic logic of a previous generation that still held sway over the field (Daniels 2006).

6
. Davis (1956).

7
. Duka and DeCherney (1994, 65).

8
. On medicalization, see Conrad (2007). On the history of the medical profession, see Freidson (1970) and Starr (1982). On the power of the medical profession in matters of reproduction, see Luker (1984) and Roberts (1997).

9
. Several of the physicians I interviewed for this study were in their forties and fifties and remember being asked to donate sperm in medical school.

10
. A 1938 article in
Time
magazine profiled the Georgetown University School of Medicine, where medical students and residents were paid $25 per sample (Daniels 2006, 79). By the mid-1980s, Novaes (1985, 576) notes that most sperm donors were still being paid between $20 and $35.

11
. Guttmacher et al. (1950, 268).

12
. See, for example, Murphy (1964), which details a study of 511 men who had applied to donate sperm at the Farris Institute for Parenthood in Philadelphia in the previous two decades. All of the applicants were students, with most enrolled in medical school. About a fifth were rejected for low sperm count and about half for other reasons with the remainder going on to donate, but the majority provided fewer than ten samples.

13
. Titmuss (1971).

14
. Guttmacher (1958, 370).

15
. See Ansbacher (1978, 378). Scientists working on animal breeding in the 1860s were the first to propose “banks” to store frozen sperm, a project that eventually took hold, particularly in cattle breeding. Cryopreservation experiments with human sperm began in the 1930s, but it proved more fragile than bull sperm. It took several decades to render the technology successful in humans (Sherman 1964). The first children conceived with frozen and thawed sperm were born in 1953. Shortly thereafter, the first banks dedicated to storing human sperm opened in the United States, including the Tyler Clinic in Los Angeles. These banks were initially intended for men who wanted to freeze their own sperm as “insurance” against some future calamity or illness (Daniels 2006, 81–90). Reproductive medicine, including artificial insemination and IVF, has a long history of exchanging ideas and techniques with veterinary medicine (Clarke 1998 and Friese 2009).

16
. Novaes (1985).

17
. Peterson (1986, 569).

18
. United States Office of Technology Assessment (1988, 10).

19
. Daniels (2006, 91).

20
. Daniels (2006, 90–91).

21
. However, if a physician requests that the sperm be shipped directly to a patient’s home, then the sperm banks will do so.

22
. In a 2006 interview, the embryologist at University Fertility Services described current practices for assessing sperm.

You normally expect at least a 50% recovery of sperm [after it is frozen and thawed], and therefore what you’re looking for in a sperm donor is somebody that has high sperm counts, good motility, vigorous moving sperm, and you would like to have a known fertility status on the donor. You don’t always know that. Certainly with the younger donors, that’s not always assured. There used to be some testing that went along with the screening to at least try to get some indication of the fertility factor of the sperm, usually just based on sperm numbers and sperm count. Now we’re adding sperm morphology, because morphology and function are very tightly connected with sperm. Everything is put together for one purpose, and that’s transporting chromosomes, DNA. The sperm head is very dense and compact. It has some structure to it that you can see under certain conditions, which have to do with its ability to bind and transfer through that outer membrane of the egg zona. So that’s something that can be assessed as well. Of course, the mid piece [of the sperm] is primarily concerned with the generation of the energy production, ATP [adenosine triphosphate], which drives the tail to drive the motility. So we can take account of all those things to give a morphological index, which then we presume will carry through to some kind of a functional ability. That’s what we look for in a donor, and so they’re highly selected.

23
. United States Office of Technology Assessment (1988, 9). Several interviewees at University Fertility Services mentioned a vote that the physicians and nurses in the practice had taken on this issue. The majority voted not to provide fertility services unless they were “medically necessary,” which excluded single women and lesbians on the grounds that they did not have a medical diagnosis of infertility. In 2008, the California Supreme Court ruled that fertility practices could not discriminate on the basis of sexual orientation in
Benitez v. North Coast Women’s Care Medical Group
.

24
. Scheib and Cushing (2007).