Sex Cells: The Medical Market for Eggs and Sperm (30 page)

25
. Rosenwaks (1987). This article contains images of the technique being used in a cow and in a woman on opposing pages.

26
. Lutgen et al. (1984). As it became possible to freeze embryos in the late 1980s, the number of IVF patients willing to donate some of their eggs dwindled (Kennard et al. 1989). One of the physician–researchers I interviewed in 2006 explained that this is

still done in some centers, to have part of [a patient’s IVF] expenses covered in exchange for donating some of the eggs. Most [centers] don’t do that, partly because if she doesn’t get pregnant, then that’s difficult wondering if someone else got pregnant, and [she] was never able to have a child. The positive is that it can reduce the expenses for that patient. Most programs, because donors are so readily available, do egg donation with the donor.

There was also a third technique in use during the 1980s, one in which fertility programs relied on women undergoing tubal ligations to agree to take fertility medications. They would produce multiple eggs that could be retrieved at the same time as the sterilization surgery (Rosenwaks 1987).

27
. Sauer et al. (1989).

28
. Barad and Cohen (1996, 18).

29
. Lessor et al. (1993, 66).

30
. In one survey of fifty-two clinics providing egg donation in the early 1990s, nearly 80% required women to undergo psychological screening (Braverman 1993). Many of the physicians I interviewed were surprised to learn that sperm donors were not (and are not) psychologically screened.

31
. Kennard et al. (1989, 660).

32
. Nichols and Moore (2009). The article was picked up by several news outlets, including MSNBC and
Forbes
magazine.

33
. Sauer and Paulson (1994).

34
. Sauer and Paulson (1992). The survey included fifty-one clinics that offered egg donation in the early 1990s. Just about one-fifth of the clinics maintained a registry of donors, which listed between five and thirty-five women.

35
. Braverman and Corson (1995, 543).

36
. In the late 2000s, some programs and commercial firms began to offer egg-freezing services, but most of the physicians I interviewed in 2006 said that they did not believe that egg freezing was successful enough to warrant its use in clinical settings. See also Practice Committee of the ASRM (2008a).

37
. This same physician described how his program had a leg up on the scientific competition, because they had managed to recruit a cohort of donors before others did. Here, the women willing to donate eggs and women willing to be recipients are catalogued alongside technology as necessary to medical innovation.

There were, at that time, ten or so [academic] programs around the country that were interested in being at the forefront of the field and who moved along at approximately the same pace. We had a big advantage in that we had those donors, so we hit the ground running, and as soon as transvaginal egg retrieval became a reality, boom, we were ready to go. And we’d had patients that had already been recruited for that specifically, who had been lined up waiting to have it done. Most other programs were not quite like that. They had to go through, “How are we going to recruit donors? Are we going to get this through the IRB? Is the research committee going to be interested in this?” All of those things take time.

38
. In the early 1990s, Sauer and Paulson (1992) contacted sixty-three clinics where ASRM referred patients interested in egg donation. Of the fifty-one respondents, one-fifth had not performed a single cycle, and two-thirds had performed fewer than ten cycles in the previous two years. Ten percent of the programs had performed more than one hundred cycles.

39
. Data come from the CDC’s report
Assisted Reproductive Technology Success Rates
(2008). The CDC’s statistics, which are based on an annual survey of fertility clinics, do not include information about who the donors are, so this latter figure probably includes donations from other IVF patients, relatives, friends, and paid donors. A more restrictive figure is the number of transfers involving fresh donor eggs (not all cycles end in a transfer of the embryo to the recipient), which hovers around 6–7% of all IVF cycles during this ten-year period, beginning at 3,822 transfers in 1996 and rising to 10,049 by 2006.

40
. Sauer and Paulson’s (1992) study of fifty-one clinics reported donor fees ranging from $500 to $2,000. Around the same time, Braverman (1993) surveyed all SART members and found fifty-two programs that offered egg donation and paid donors between $750 and $3,500. Four programs used unpaid volunteers.

41
. Kennard et al. (1989) and Schover, Rothman, and Collins (1992).

42
. There do not appear to be any statistics available on the number of egg agencies over time. As of 2008, the ASRM listed ninety agencies in the United States that had agreed to abide by their guidelines governing egg donor compensation.

43
. Seibel and Kiessling (1993), Eastlund and Stroncek (1993), Sauer (1999) and Bergh (1999).

44
. Kolata (1998). In keeping with concerns about rising fees for egg donors, German et al. (2001) compared applicants to donation programs before and after the increase from $2,500 to $5,000. They found that women in the second group were more likely to finish their questionnaires, but there were not any significant differences in their social or epidemiological characteristics.

45
. Ethics Committee of the American Society for Reproductive Medicine (2000).

46
. Covington and Gibbons (2007). The list of approved egg agencies at
www.sart.org
is prefaced by the following statement: “These Egg Donor Agencies have all signed an agreement with the Society for Assisted Reproductive Technology (SART) that states that they will abide by the American Society for Reproductive Medicine (ASRM) Ethics Committee Guidelines governing the payment of egg donors. This information is self-reported and has not been verified by either ASRM or SART.”

47
. Hopkins (2006) and Rabin (2007). These debates have also spread into the realm of egg donation for stem cell research (Thompson 2007).

48
. In total, fifty-seven men had been accepted as donors at University Fertility Services between 1986 and 2001.

49
. The psychologist at OvaCorp described a similar situation at another university donation program. “We have a couple who wants to save money, so they’re going to have the [university] IVF clinic find them a donor. Great, save a ton of money. It took four months to get a choice of one. Generic, nice, Caucasian girl, and they’re fine with it, because that’s who they are. It’s cheaper, it’s almost always anonymous, and it’s totally doctor-controlled.”

50
. One extraordinary example of a university program gone awry comes from the University of California at Irvine. In 1995, the
Orange County Register
received the Pulitzer Prize for reporting on physicians there who were “donating” their patients’ excess eggs without permission. There have also been scattered reports, as well as a few prosecutions, of fertility doctors surreptitiously using their own sperm to inseminate patients.

51
. On the professional authority of physicians, see Freidson (1970) and Starr (1982). On the health care sector of the U.S. economy, see McKinley and Stoekle (1988) and Light (1993). On the women’s health movement, see Bell (2009) and
Our Bodies, Ourselves
, first published in 1971, by the Boston Women’s Health Book Collective. Physicians themselves also began to modify the definition of their role, shifting from the image provided in Guttmacher’s 1955 statement, in which the doctor is responsible for evaluating both donor and recipient, to one in which the patients’ reproductive choices are paramount. Thompson (2005) traces this historical process in the realm of IVF.

52
. Relman (1980, 963).

2. SELLING GENES, SELLING GENDER

1
. On the ways in which medicine is influenced by market forces, see Conrad and Leiter (2004), Light (2004), and McKinley and Stoekle (1988). On the cultural power of medical authority, see Parsons (1951), Freidson (1970), and Starr (1982).

2
. Becker (2000) and Becker, Butler, and Nachtigall (2005). These studies are limited to heterosexual couples and do not include systematic comparisons of how recipients select egg donors versus sperm donors.

3
. Rindfuss, Morgan, and Offutt (1996).

4
. There is less screening of recipients. Creative Beginnings asks for recipients’ health histories and doctors’ names to confirm that they actually do “need” egg donation. OvaCorp and both sperm banks require certification that recipients are working with a doctor.

5
. Being a “carrier” means that an individual has one copy of a defective gene that causes a disease but that person will not develop the disease. To develop the disease, a person must have two copies of the defective gene, one copy inherited from each biological parent. If both parents are carriers, there is a 25% chance the child will have cystic fibrosis and a 50% chance the child will be a carrier.

6
. A study of attrition at Oregon Health Sciences University (OHSU) reports a similar rate (Gorrill et al. 2001). Researchers tracked all inquiries from potential egg donors for ten months in 1999. Of these, 315 women responded to the program’s advertisements; 124 returned profiles; 82 were invited to an orientation session (the others were rejected based on age, weight, smoking, and/or family health history); 64 attended the orientation; and 56 began screening. Of those screened, 13 were rejected for medical or psychological reasons; 5 completed the screening but were lost despite follow-up efforts; and 38, or 12% of the women who initially inquired, entered the donor pool. OHSU estimated the cost of bringing one donor into the pool at $1,869.

7
. Throughout its long history, donor insemination has been marked by extensive secrecy (see Chapter 1). CryoCorp and Western Sperm Bank do not share adult photos of sperm donors with recipients, but there are a few banks that do, including Gametes Inc.

8
. The founder of another major egg agency on the West Coast had a similar response to online profiles. “The biggest change came with the Internet, because that made donors immediately available. It became a catalog for choosing people. It had the bonus that a lady from Australia can get online and see donors immediately [but] the detracting element of depersonalizing it and making the donors seem like a commodity or an object, rather than a person. So that was really hard.”

9
. It is not uncommon for egg agency staffers to refer to the donors as “girls.”

10
. See Almeling (2006) for an extended analysis of the donor profiles. To code altruistic and financial motivations, I categorized each donor’s answer to the profile question “Why do you want to be a donor?” as reflecting an interest in “helping” and/or “money.” In most cases, “helping” referred to the donor’s interest in assisting recipients in having a child, but I also included donor responses as vague as “I get a good feeling knowing that I am helping others in some way.” Most of the responses coded for “money” included explicit references to financial compensation, but I also included more vague references to donation as “mutually beneficial” for the donor and the recipient. Each donor’s response was coded separately for “helping” and for “money.”

11
. Many of the physicians I interviewed for this study were surprised by the lengthy time commitment required of sperm donors, probably because the older sperm donation programs that were operating at the time they were in medical school were not run in the same way (see Chapter 1). For example, in one mid-century study, the Farris Institute for Parenthood in Philadelphia reported that 60% of the men in the program had donated less than ten times. Just about a tenth had donated more than forty times (Murphy 1964).

12
. Ethics Committee of the American Society for Reproductive Medicine (2000).

13
. At some egg agencies, women are paid in two installments, the first (usually $1,000) when the donor begins injecting fertility medications and the remainder after the egg retrieval. Egg agencies do this so that the donor will receive some money even if the cycle is cancelled, usually as a result of the recipient not responding to the medication.

14
. Some commercial agencies do not allow negotiations. In a 2006 interview, the founder of the second major egg agency on the West Coast explained how she had recently revised her fee structure by drawing on her experience with sliding scales as a therapist.

We wanted to be able to stay in business, but the costs were so high that we couldn’t do that without raising our fees. We didn’t want to raise our fees all over. We knew that donors were getting higher and higher and higher fees. It was like three or four years ago when the donor fees were going way up. A couple of people just defected: “I’m gonna get 25,000 [dollars], why should I do it for 10 [thousand dollars]?” I understood that. So if we keep this model of people who want to help, let’s really hit the nail on the head with that, but let’s also take certain people and spoil them. Let’s tell them how wonderful they are, treat them like really nicely, give them gifts and massages and chocolates and stuff like that. We can raise the fee a certain amount, but I think we’ll engender loyalty if we do these nice things for them and give them the human experience. I don’t think they’re all going to leave, [because] “well I can get five extra there.” So that’s what we did, and it helped us to keep certain clients that couldn’t afford to pay. We even have a new thing called a fast track, which is an incredibly low fee for both donor and agency for people who really can’t afford to do egg donation. We’re working absolutely at cost, and the donor’s taking a lower fee. And we did keep donors’ fees down. I’m not saying they’re not high, but we haven’t gone past a certain fee, and I feel really proud of that, because I know a lot of places, they’ll bid, or they’ll say “Let the donor make her fee.” We really set the donors’ fees.