Sex Cells: The Medical Market for Eggs and Sperm (3 page)

The challenge lies in incorporating biological factors into sociological analyses without reverting to an essentialist tautology, in which sex differences are the beginning and end of explanations for gender inequality. As a way out of this conundrum, Judith Butler suggests a social constructionist approach that acknowledges bodily differences but contends that bodies are anything but empty, “natural” vessels waiting to be filled with cultural meaning. Instead, she argues that bodies themselves (their differences and similarities) cannot be understood outside of social processes, which means that sex differences are just as socially constructed as gender differences.
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This perspective, with its analytical openness to variation in how sex is constructed—or more specifically for the purposes of this study, in how biology is valued—sits well within a theoretical framework that allows for variation in how biological factors come together with cultural factors, structural factors, and economic factors to shape markets.

If the valuation of biology is inseparable from these other factors, then bodies do not contain inherent and unchanging value, and it becomes important to think through the various ways in which the worth of sex cells might be established. The first possibility is that eggs and sperm will be equally valued. This may be due to
biological
symmetry, in that eggs and sperm each contain twenty-three chromosomes and creating an embryo requires one egg from one woman and one sperm from one man. Or it may result from
structural
symmetry, in that both egg and sperm donors are recruited by donation programs to produce genetic material for sale to recipient clients, who will conceive children to whom the donors have no responsibility.

The second possibility is that eggs and sperm will be differently valued. After all, these cells are produced by differently sexed bodies. Female bodies have a limited supply of eggs while men’s supply of sperm is continually replenished, and extracting eggs entails risk and pain that extracting sperm does not. These
biological
differences may result in an understanding of eggs as a scarce resource, and
economic
mechanisms associated with the pressures of supply and demand may result in women’s donation being more highly valued than men’s.

Shifting the emphasis to
cultural
and
structural
factors suggests the opposite outcome: broader patterns of gender inequality will result in men’s donation being more highly valued than women’s. In her research on descriptions of eggs and sperm in medical textbooks, Emily Martin finds that “cultural ideas about passive females and heroic males [are imported] into the ‘personalities’ of gametes.”
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If a similar pattern holds in the market for sex cells, sperm will be more valued than eggs. Another possibility is that egg agencies and sperm banks consider donors to be reproductive service workers. Given that there is persistent income inequality by sex, trends that are exacerbated in service work and care work,
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it is possible that sperm donors will be more valued than egg donors.

However, it may be
cultural
norms associated with the family, not the workplace, that influence processes of valuation in this market, as these bodily goods are intended to help people have children. Traditionally, ideals of femininity and motherhood have portrayed women as denizens of the private sphere who are selfless, caring, and devoted to others, while ideals of masculinity and fatherhood situate men as hardworking, emotionally distant breadwinners who inhabit the public sphere. These distinctions are nicely summed up by Julie Nelson and Paula England, who write that “women, love, altruism and the family are, as a group, [viewed as] radically separate and opposite from men, self-interested rationality, work and market exchange.”
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Thus, it is possible that women donating eggs will be perceived as altruistic helpers who want nothing more than for recipients to have families, while men donating sperm will be construed as employees performing a job with little care for the bank’s customers.

In the first part of the book, I demonstrate how these factors—biological bodies, economic mechanisms, and gendered cultural norms—interact
within the structural context of donation programs to produce variation in the organization of the market, both in terms of how sex cells are valued and in the expectations placed on egg and sperm donors. The end result is that eggs are more highly valued than sperm, and egg donation is understood as a gift while sperm donation is considered a job. The next question is whether such variation influences women’s and men’s experiences of bodily commodification.

EXPERIENCING THE MARKET: GIFT RHETORIC,
EMOTIONAL LABOR, AND BEING A PAID DONOR

The market for sex cells incorporates both financial compensation and the language of donation, a combination that appears oxymoronic at first glance. The reason that paid donation sounds so incongruous is the longstanding assumption that gifts and commodities are not only completely distinct from one another, but are also very different kinds of things. Arjun Appadurai traced this assumption among social scientists to the different legacies of Marcel Mauss and Karl Marx, providing the following summary.

Gifts, and the spirit of reciprocity, sociability, and spontaneity in which they are typically exchanged, usually are starkly opposed to the profit-oriented, self-centered, and calculated spirit that fires the circulation of commodities. Further, where gifts link things to persons and embed the flow of things in the flow of social relations, commodities are held to represent the drive—largely free of moral or cultural constraints—of goods for one another, a drive mediated by money and not by sociality.
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In an echo of Zelizer’s argument, Appadurai considers this dichotomy to be an oversimplified depiction of economic life, and he has encouraged scholars to trace the social life of things. In particular, he underscores the possibility that the same thing can sometimes be both a gift and a commodity, albeit at different points in its trajectory. Lesley Sharp pushes this point further, drawing on research in organ donation to contend that multiple understandings of the same bodily good might be operating at the
same
time, especially in medical settings. For the deceased’s
kin, a donated organ is a part of the family that lives on; for the recipient, it is a lifesaving gift; for the doctors, it is a valuable commodity that should not be “wasted” on an undeserving recipient. Sharp concludes, “The language of gift exchange may obscure capitalist forms of commodification. In other words, two models of commodification might be at work simultaneously, one more akin to Mauss’s understanding of the symbolically charged gift and reciprocity, the other to Marx’s notion of commodities as goods produced under the alienating conditions of capitalism.”
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The question is whether these various understandings
matter
for the people whose bodies are being commodified. What happens when paid donation is considered to be more of a gift or more of a job? Shifting the focus from determining which things are actually gifts or actually commodities to comparing the use of gift rhetoric and commodity rhetoric makes possible an analysis of whether commodified exchange can be experienced in different ways.
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The first possibility is that framing donation as a gift or a job makes no difference whatsoever. It is merely language that “obscures,” to use Sharp’s word, what is really going on. This is a common theoretical vision of bodily commodification, one that also appears in Nancy Scheper-Hughes’ definition of it as “encompassing all capitalized economic relations between humans in which human bodies are the token of economic exchanges that are often
masked
by something else – love, altruism, pleasure, kindness.”
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These scholars echo the view of Titmuss and others that the monetary exchange is fundamental, that commodification is inherently objectifying and alienating, and calling it something else does nothing to change the experience of being paid for bodily goods.

The second possibility is that these gendered frames do have consequences. Given that gift exchange is traditionally associated with affective ties and reciprocity while commodified exchange is marked by contractual relations that conclude when payment is rendered, it is possible that even just the use of gift language evokes a sense of sociability, a sense of connection between donor and recipient that is more durable and lasting than would be expected given the monetary exchange. This is especially plausible in a market for genetic material, as eggs and sperm
are purchased in the hopes of conceiving children. Our culture’s emphasis on biogenetic ties in defining kinship may mean that donors are considered more as family than as strangers.

However, forging such connections may result in the expectation that donors and recipients demonstrate care and concern for one another, a form of emotional work. Arlie Hochschild originally formulated the concept of “emotional labor” in her study comparing female flight attendants, who had to exhibit empathy for the customer’s every concern, with male debt collectors, who had to manufacture anger with debtors over the phone. Subsequent studies have revealed that these sorts of gendered expectations for emotional work appear in many kinds of employment, and they are based in large part on the cultural norms of nurturing femininity and distant masculinity discussed in the previous section.
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More recent research on emotional labor suggests that it may be experienced as more than just coercive and alienating. In a study of nursing home workers, Steven Lopez finds that meaningful interactions can result from “organizational attempts to create hospitable conditions for the development of caring relationships between service providers and recipients.”
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This raises the possibility that instilling an emotional connection between gamete donor and recipient may forestall feelings of alienation, in that both parties are offered an alternative narrative to the stigmatized story of handing over cash for body parts.

Since the dominant assumption has been that bodily commodification is inherently and uniformly degrading, there has been relatively little empirical research on the experiences of those who participate in such markets, including the market for sex cells.
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There is a rich tradition of sociological and anthropological research on reproduction, some of which includes discussions of commodification, but most of it centers on pregnancy, abortion, and birth, so there is little known about men’s experiences in this realm.
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In general, there has been less concern about the commodification of men’s bodies.
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Thus, I devote the second part of the book to analyzing how egg and sperm donors experience bodily commodification. First, I examine how they describe the physical aspects of donation, assessing whether being paid to undergo IVF or engage in routine masturbation alters the
experience of these embodied processes. Second, I compare how egg and sperm donors define the money they receive with special attention to whether they consider it a gift for the gift they have given or wages for a job well done. Third, I look at how women and men respond to the possibility that biological offspring may result from their donations and analyze whether they identify their genetic connection as familial. Through close empirical attention to what happens when commodified exchange is mixed with gift rhetoric and when it is not, I find that the simple fact of payment does not solely determine the experience of commodification. Instead, I argue that organizing paid donation as a gift or a job has real consequences; it affects egg and sperm donors’ physical experiences, as well as how they conceptualize what it is they are being paid to do.

DATA AND METHODS

To study how the medical market for sex cells is organized and experienced, I collected data on egg and sperm donation in the United States. Most of the data come from six donation programs, where I interviewed a total of forty-five staff members, nineteen egg donors, and twenty sperm donors between 2002 and 2006. These six programs vary in terms of which gametes they provide (eggs or sperm or both), tax status, size, geographic location, and longevity (see
Table 1
).

CryoCorp is one of the oldest and largest commercial sperm banks. It was started by a physician in the 1970s to serve infertile couples. OvaCorp is one of the oldest and largest commercial egg agencies. It expanded on a successful surrogacy business in the late 1980s to offer egg donation. Both programs run several offices in different parts of the country, but my research was limited to their West Coast locations. (All programs and people have been assigned pseudonyms. CryoCorp and OvaCorp have similar names not because of any relationship between the two programs but to indicate the symmetry in their organizational characteristics and their status as industry leaders.)

Western Sperm Bank is the only nonprofit sperm bank in the United States. With roots in the feminist women’s health movement, it opened in the early 1980s and maintains a small program on the West Coast. Creative Beginnings is a commercial egg agency on the West Coast that had been open for just a few years, but the founder/executive director had worked in infertility clinics for several decades. Gametes Inc., located in the Southeast, opened in the 1970s as a sperm bank and is similar to CryoCorp in age and size. However, it differs from CryoCorp in that it offers both sperm and eggs; it expanded on its established sperm bank business by opening an egg agency in the early 2000s. University Fertility Services is also located in the Southeast, and it is part of a major research university’s department of obstetrics and gynecology. In an off-site women’s health clinic designed for those with private insurance, the physicians and nurses run a small sperm and egg donation program to serve their infertility patients.
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