Sex Cells: The Medical Market for Eggs and Sperm (9 page)

TWO
Selling Genes, Selling Gender

Contemporary egg agencies and sperm banks operate within the context of a thriving medical marketplace. In many cases, the programs are founded or staffed by physicians, nurses, and psychologists. They cultivate networks with referring physicians, belong to professional medical associations, set goals for expanding their businesses, charge a variety of fees for different services, and develop official protocols for dealing with donors and recipients. Even when the donation program staff members are not actually clinicians, they are part of the broader medical market for sex cells and, as such, are able to draw on the cultural power of medical authority in shaping the structure and meaning of egg and sperm donation.
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To stay in business, donation programs must recruit “sellable” donors who provide “high-quality” gametes to recipients who “shop around.”
In the words of OvaCorp’s psychologist, “Medically, the invention of IVF really broke it down to [fallopian] tubes, eggs, uterus, sperm. To this day, that’s how we solve the problem. Do you need sperm or eggs, or do you need both? Or do you need a uterus? What do you got, what do you need, and what can you give up psychologically? Then sort of broker what you need.” But even as egg agencies and sperm banks engage in similar practices—advertising to recruit donors, screening applicants, monitoring the production of bodily goods, and setting fees—a detailed comparison of their organizational processes reveals that what makes an egg donor sellable is not what makes a sperm donor sellable and that the definition of “high quality” is not the same for women and men.

This chapter details the daily business practices of two egg agencies, OvaCorp and Creative Beginnings, and two sperm banks, CryoCorp and Western Sperm Bank. Economic rhetoric permeates all four programs, but staff members are very aware of being in a unique business. They discuss “people-management” strategies and point out that they are not “manufacturing toothpaste” or “selling pens.” They also consistently refer to the women and men who produce eggs and sperm as “donors” who “help” recipients, and they refer to the donor-recipient exchange as a “win-win situation.” But as will become clear, cultural beliefs about sex and gender shape this confluence of economic logic and altruistic rhetoric so that in egg agencies donation means giving a gift while in sperm banks it means performing a job. To assess whether these differences persist even in programs that sell both eggs and sperm, where one might expect such distinctions to be more apparent, I conclude the chapter with a brief discussion of Gametes Inc. and University Fertility Services.

RECRUITING “SELLABLE” DONORS

To find donors, egg agencies and sperm banks advertise in a variety of forums (college newspapers, free weekly magazines, radio, and websites), hold donor information sessions, and encourage previous donors to refer siblings, friends, and roommates. CryoCorp and Western Sperm Bank are located within blocks of prestigious four-year universities, and their
advertising is directed at cash-strapped college students. The marketing director of CryoCorp, which requires that donors be enrolled in or have a degree from a four-year university, explained that the location was a deliberate choice because “the owners of the sperm bank thought that that was a good job match, and it really works out well for the students. They’re young and therefore healthy. They don’t have to make a huge time commitment. They can visit the sperm bank anytime.” Nevertheless, the staff members at sperm banks lament difficulties in recruiting men and offer hefty “finder’s fees” to current donors who refer successful applicants.

In contrast, OvaCorp and Creative Beginnings receive several hundred applications from women each month. Creative Beginnings’ founder explained the impetus behind her marketing strategy. “We appeal to the idea that there’s an emotional reward, that they’re going to feel good about what they’ve done, that it’s a win-win situation, that they’re going to help someone with something that person needs, and they’re going to get something they need in return.” Both agencies report that “young moms are the best donors. They pay the best attention and show up for appointments” because they understand the importance of a child to recipient clients.

When a potential donor calls or e-mails a program for the first time, the staff initiates an extensive screening process by asking about family health history (including physical, mental, and genetic disease) and social characteristics. Some screening standards are based on biomedical guidelines for genetic material most likely to result in pregnancy. For example, ASRM issues guidelines for age and height/weight ratios, which are followed closely by egg agencies to select donors who will respond well to fertility medications. But some of the guidelines reflect recipient requests for socially desirable characteristics, such as the height minimums set by sperm banks at around 5 feet 8 inches.

Even some of the nominally biomedical factors are better understood as social characteristics, as evident in this donor manager’s discussion of Western Sperm Bank’s standards.

We have to not take people that are very overweight because of a sellable issue. It becomes a marketing thing; some of the people we don’t accept. Also height becomes a marketing thing. When I’m interviewing somebody to be a donor, of course personality is really important. Are they gonna be responsible? But immediately I’m also clicking in my mind: Are they blond? Are they blue-eyed? Are they tall? Are they Jewish? So [I’m] not just looking at the [sperm] counts and the [health] history but also can we sell this donor? And anyone that’s [willing to release identifying information to offspring at age eighteen], obviously we will ignore a lot; even if they’re not quite as tall as we’d like, we’ll take them. Or maybe if they’re a little chunky, we’ll still take them, because we know that [their willingness to release identifying information] will supersede the other stuff.

Likewise, in explaining the screening process for women applying to be donors, Creative Beginnings’ office manager said, “this is a business, and we’re trying to provide a service.” Later that day, her assistant noted that recipients “basically go shopping and they want this and they want that.”

OvaCorp’s donor manager also emphasized social characteristics, including education level and attractiveness, in describing what makes an egg donor “sellable.”

You will find that a donor’s selling tool is her brains and her beauty. That’s a donor’s selling point, as opposed to she’s a wonderful person. That’s nice. But bottom line, everyone wants someone that’s either very attractive, someone very healthy, and someone very bright. That’s her selling point/tool. That’s why I also work with women who don’t have children, because I get a higher level of academia with a lot of our single donors because they’re not distracted by kids.

Research on how recipients select donors suggests that staff members are responding to their clients’ interest in attractive and intelligent donors whose phenotypes are similar to their own.
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Egg agencies and sperm banks use education as a signifier of genetic-based intelligence, but as the donor manager quoted above suggests, women without children have more time to pursue additional schooling.
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During this early phase of recruitment, egg agency staff members are also assessing an applicant’s level of responsibility, which is often glossed as “personality” or “helpfulness,” as in this interview with the assistant director of Creative Beginnings.

Assistant Director: Personality is a big thing. We always want this to be a positive experience, if it is going to bring them to a different point in their life instead of just doing it to do it. A lot of them don’t care about the money; they just want to help somebody, and that’s all the more reason to continue with them.

Rene: So if donors don’t ever meet the recipient, though, why would their personality matter technically?

Assistant Director: Well, we don’t really look at the personality for them to meet the recipient. If they have a good personality, then we can trust them. They really want to go forward with this. They’re more likely to continue with the process by getting their profile finished in a timely manner, getting their pictures into us and all the release forms that they need. Then it just shows responsibility.

At the same time, according to Creative Beginnings’ founder, the staff is responding to recipients who “want to know that the person donating is a good person. They want to know that person wasn’t doing it for the money, that person’s family history is good, that person was reasonably smart, that they weren’t fly-by-nights, drug abusers, or prostitutes.” Intersecting with gendered expectations about egg donors having, or at least expressing, altruistic motivations are class-based concerns around defining “appropriate” donors.

Sperm banks, in stark contrast,
expect
men to be financially motivated, and the staff speaks directly about responsibility rather than couching it in terms of altruistic motivations. Western Sperm Bank’s donor manager explained,

Aside from personality, the other thing that makes me fall in love with a donor is someone that’s responsible. It is so rare to get someone that’s truly responsible, that comes in when he’s supposed to come in or at least has the courtesy to call us and say, “I can’t make it this week, but I’ll come in next week twice.” Then of course the second thing that makes him ideal is that he has consistently very high [sperm] counts, so I rarely have to toss anything on him [i.e., reject his sperm sample]. And then, I guess the third thing would be someone that has a great personality, that’s just adorable, caring, and sweet. There are donors, that their personalities, I think, ugh. They have great [sperm] counts, they come in when they’re supposed to, but I just don’t like them. That’s a personal thing, and I think, huh, I don’t want more of those babies out in the world.

Although egg agencies and sperm banks are interested in responsible women and men who fulfill their obligations, donors are also expected to embody notions of American femininity or masculinity. Staff members expect egg donors to conform to one of two gendered stereotypes: highly educated and physically attractive or caring and motherly with children of their own. Sperm donors, on the other hand, are generally expected to be tall and college educated with consistently high sperm counts.

In terms of other characteristics, egg agencies and sperm banks work to recruit donors from a variety of racial, ethnic, and religious backgrounds to satisfy a diverse recipient population. In fact, race/ethnicity is genetically reified to the degree that it serves as the basis for program filing systems. In Creative Beginnings’ office, there is a cabinet for “active donor” files. The top two drawers are labeled “Caucasian,” and the bottom drawer is labeled “Black, Asian, Hispanic.” During a tour of CryoCorp, the founder lifted sperm samples out of the storage tank filled with liquid nitrogen and explained that the vials are capped with white tops for Caucasian donors, black tops for African American donors, yellow tops for Asian donors, and red tops for donors with “mixed ancestry.” All four programs complain about the difficulty of recruiting African American, Hispanic, and Asian donors, and Jewish donors are in demand for Jewish clients. In one case, even though a director thought a particular egg donor applicant was too interested in the financial compensation, she was accepted into the program because she was Catholic, reflecting the director’s interest in diversifying the donor catalog.

The final phase of recruitment involves reproductive endocrinologists, psychologists, and geneticists or genetic counselors, who serve as professional stamps of approval in producing sex cells for sale.
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Applicants are examined by a physician and tested for blood type, Rh factor, drugs, and sexually transmitted infections. Both egg agencies require a psychological evaluation and the Minnesota Multiphasic Personality Inventory,
but neither sperm bank requires that donors be psychologically screened. All four programs require that donors prepare a detailed family health history for three generations (and thus do not generally accept adoptees). In some programs, this history is evaluated by genetic counselors or geneticists, who might request specific genetic tests. In at least one case, though, test results revealing the mutation that causes cystic fibrosis were not enough to disqualify an “extraordinary” egg donor. The founder of Creative Beginnings explained,

All the time there are calls coming in about problems or questions. Like today, there is a donor who’s mixed. She’s got Black and Caucasian, and her cystic fibrosis screening turned out that she’s a carrier.
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She’s a really pretty girl, and the recipient really wants her badly because she’s fair skinned, she’s very pretty, and the recipient knows that this donor is extraordinary. But then [the recipient is] torn because her husband’s saying, “Well, do we want to introduce something into our gene pool?” They could go ahead and use her, but the husband just has to be tested to see if he’s a carrier.

As part of describing why she is the “right person” to open a commercial egg agency (discussed in
Chapter 1
), the founder of Creative Beginnings criticized other programs for just this scenario, which underscores the difficulty of refusing paying clients who become attached to a particular donor.

Staff members at each of the four programs view donor screening as a staged process that requires more of a monetary investment at every step. According to one of OvaCorp’s psychologists, the psychological screening in egg donation is often performed before the medical tests because it is cheaper. Similarly, in sperm donation, banks confirm that a donor passes one set of tests before advancing him because, according to a Western Sperm Bank donor screener, “at each step of the game, we’re spending more money on them.” CryoCorp’s marketing director takes this rationale a step further: “Once someone goes through our screening process, it’s in our best interest to continue him in the program, because we’ve invested a huge amount of money, thousands and thousands of dollars. So the more vials we can collect before he drops
out of the program, the better, especially if that donor’s a popular donor.”