When Jennifer Nardini was in her final semester at the University of
Washington in the spring of 1996, she was, like many college seniors,
idealistic, adventurous -- and broke. So when she heard about women who
were making easy money by donating their eggs to the University of
Washington Fertility and Endocrine Center, she was intrigued. Though she
hadn't yet given much thought to having children herself, she'd always
assumed she'd have them some day. But in the meantime, if she wasn't ready
yet, why not help someone who was?
"You get 1,700 bucks, some shots, and then they take the stuff out," she
remembers thinking. "People strip for money, I figured, why not donate your
eggs? It didn't seem like such a big deal."
Having watched her own roommate go through the two-month cycle of birth
control pills and hormone injections without suffering any side effects,
Jennifer eagerly signed on with the clinic's growing stable of donors. She
filled out a 15-page questionnaire about her medical history, answered
myriad questions about her current hobbies and interests, and signed the
legal consent forms; when the clinic called weeks later to tell her that a
couple had chosen her as their preferred donor, she was thrilled. "I didn't
really know how I felt about the possibility that 18 years from now someone
could contact me and say, 'You're my mother,'" she admits. "But I thought
the happiness I'd get from helping out a couple would balance out any
weirdness."
But the actual process of donating eggs proved to be a much bigger deal
than Jennifer bargained for. For the first month after the clinic called,
Jennifer took hormones in order to synchronize her menstrual
cycle with the recipient's. (Although recent breakthroughs may soon make it
possible to fertilize frozen eggs in vitro, currently donor eggs must be
fertilized fresh and then immediately implanted into the recipient's
uterus.) Every day for the following month, she went to the clinic for
hormone injections that stimulated the development of more eggs. Instead of
experiencing PMS symptoms, as she was warned she might, the injections made
her feel sick.
When the time finally came to "harvest" her eggs, Jennifer was in
considerable pain. The doctor, using a tiny needle to puncture her ovaries
and suction out the eggs, discovered that her ovaries had been
hyperstimulated, a potentially fatal condition that occurs in about 4 to
5 percent of women taking fertility drugs (much milder forms of
hyperstimulation occurs in about 20 percent of cases); normally
walnut-sized, they had swollen to the size of grapefruits and had developed
more than 50 eggs -- almost twice as many as during a typical harvest.
Immediately after the extraction, her ovaries leaked excess fluids into
her abdominal cavity, causing her to gain about 30 pounds. "It looked like
I was pregnant," she says with disgust. "They took 44 eggs from me,
and there were still some left." She was hospitalized for five days, and it
took another two months before her body returned to normal. Later, she was
told that the procedure had been a success; the recipient was pregnant with
an embryo formed from one of her eggs.
Although the clinic did pay for Jennifer's hospital bills, they offered
her no further compensation for her trouble -- or for the extra eggs they
harvested. "They were legally entitled to use the other eggs," she
acknowledges. "But I just felt it was rude to take advantage of that --
they never talked to me about that possibility until after I got really
sick."
What Jennifer refers to as merely "rude" is what a growing number of medical professionals and
bioethicists call outright exploitation -- placing one group of women
at risk for the benefit of another. Fertility clinics, they charge, are
part of a market-driven, underresearched, dangerously unregulated industry
that is growing too quickly and that may pose long-term medical and
psychological risks to its participants. Some argue that only women who
don't want any more children of their own should be allowed to donate their
eggs and that there should be standard age limits for both donors and
participants. Others, citing long-standing strictures against people selling
parts of their body, object to the fact that people are paid -- and paid
increasingly well -- for their eggs. And there are still broader
philosophical and ethical questions: By encouraging women to sell their
eggs, are we mechanizing motherhood, turning life itself into a commodity?
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Defenders of the new reproductive technologies, for their part,
point out that techniques like egg donorship give hope to thousands of
childless couples -- and give women unprecedented
control over every aspect of the reproductive process. They argue that some
form of payment is reasonable -- after all, the donors must undergo hormone
treatments and surgery. And they dismiss fears of the degradation of the
maternal instinct, pointing out that no one seemed so worried when it was
only men who were seeding the earth.
The debate is complicated by the fact that doctors don't really know
what long-term risks are associated with egg donorship. What little
research has been done suggests that repeated exposure to fertility drugs
may increase the incidence of ovarian cancer, as well as encourage the
early onset of menopause.
Since assisted reproductive technologies (ARTs) became available in
1981, about 15 percent of American women have received some type of
infertility treatment; today, couples are spending more than $2.5 billion a
year on ARTs. While sperm banks have been around for more than 40 years,
egg donation -- or the process by which a mature egg is extracted from a
donor, fertilized in vitro and implanted into a recipient's uterus -- is,
by contrast, a relatively recent development, responsible for less than 10
percent of the 11,000 births made possible by ARTs in 1995 (the most recent
year for which statistics are available).
But as the boomer generation grows older and more and more couples are
trying to have children at a later age, egg donation -- which, unlike most
other ARTs, boasts a 30 percent "take-home baby rate" that stays constant
across all age groups -- has become an increasingly available and
sought-after option.
Recipient couples, who can choose donors based on what they deem to be
desirable genetic traits, pay anywhere from $10,000 to $30,000 for the
procedure, which is currently offered by more than 280 clinics in the
United States. (That's more than twice the number of clinics performing the
procedure in 1993, compared to 26 in 1988, when the practice was in its
infancy.) Fertility clinics and egg brokers looking to recruit "Ivy League
eggs," as one bioethicist disparagingly referred to them, place ads where
young women are most likely to see them -- on the back pages of free
weeklies and in college newspaper classifieds: "Help infertile couples. If
you're 21-29, educated, healthy, average weight, $3,000 plus costs. Bonus
for Asians," reads one typical ad. And here, as in most cases, it's the
altruistic gesture of "donation" that is emphasized.
"If a woman says to me that she thought this would be a good way to make
money, I'll tell her to go get a job," says Gretchen Sewall, R.N., M.S.W,
manager of the UW Fertility and Endocrine Center donor egg program since
1990. "I don't think women should be selling body parts -- I feel quite
strongly about that. If it's reduced to a commodity, what does that say
about how a woman feels about herself as a person?" Sewall says that she
interviews patients at length to weed out those who might be in it for the
wrong reasons. "We talk about their motivations several times over a period
of two months -- why they want to do this, what they're spending the money
on," she says. "The bottom line is that I want to make it harder for them
to continue in the screening process."
That's not enough, says Dr. Arthur Caplan, director of the University of
Pennsylvania Center for Bioethics and author of "Am I My Brother's Keeper:
The Ethical Frontiers of Biomedicine" (Indiana University Press). "When
donors get paid, they need to get information from people who aren't in the
business of selling their eggs," he says. Currently, most fertility clinics
adopt the American Society for Reproductive Medicine's guidelines for donor
recruitment, which mandate that potential donors be educated in all aspects
of medical treatment, including "health risks and complications." But
because many of those risks are unknown, such guidelines are difficult to
enforce. "There's no standardization on what women who might be egg donors
are told" about medical risks, Caplan says. "It's all over the map."
Indeed, when this reporter posed as a potential donor and called to
request information from five services seeking egg donors in the Bay Area,
only one -- a third-party broker, not a medical practitioner -- mentioned
any medical risks. But when the broker was pressed for details about such risks,
she quickly added that they are "so minimal to be almost non-existent."
More tellingly, one of the actual clinics, in an informational brochure
sent to potential donors, explained the potential side effects this way:
"The best testimony about the ease and comfort of egg harvest comes from
the two patients we've had in recent years who served as Maids of Honor in
a wedding the night that their eggs were taken out. Both were able to enjoy
the wedding, perform all their duties, and dance the whole night."
"Yeah, they kind of skimmed over that stuff," Jennifer recalls. But she
mostly blames herself for not knowing about the complications she
encountered. "Once you're in the clinic, it's like a PR firm," she says.
"You have to investigate it on your own."
Not so, counters Sewall, who says that her policy is to inform patients
of potential risks at least three times. "I'm almost compulsive about that," she says, emphasizing that Jennifer's case was highly unusual. "In fact, my general stance is to recommend against donation [if the motivation is monetary]."
Dr. Benjamin Younger, president of the ASRM, insists that ART is no
different than any other rapidly evolving field of medicine. "Sure, every
now and then, you hear of someone who didn't get all the proper
information," he concedes. "But it's hard to figure that out, because
people do have selective hearing."
Opponents of commercial surrogacy, however, maintain that it's the
increasing financial incentive that encourages potential donors to overlook
the fine print. While the amount paid to sperm donors has remained
constant, the average amount paid to egg donors has risen from $250 to
$2,500 in the last 10 years, with at least one clinic, the St. Barnabas
Medical Center in Livingston, N.J., recently offering $5,000.
"The poor people are going to start selling their fertility to the
rich," says George Annas, head of the Health Law Department at Boston
University's School of Public Health. "That's just too directly
exploitative. I'd be willing to bet that the U.S. is the only country in
the world willing to pay $3,000 for donated eggs." That may be so, but
Americans certainly aren't the only ones willing to buy them. Encouraged by
the perceived ease and availability of fertility treatments, more and more
people from other countries are coming to clinics in the U.S., ensuring an
ever greater demand for donors -- one that, as defenders of the fertility
industry are quick to point out, almost certainly wouldn't be met if donors
were recruited on a volunteer-only basis.
"I find it hypocritical that the opponents of commercial surrogacy are
sitting in judgment, when for the most part they have children of their
own," says Andrew W. Vorzimer, a Beverly Hills lawyer who specializes in
surrogacy cases. "To sit there in their smug manner, and determine that
infertile couples should not have access to these techniques is the
ultimate display of arrogance."
It's true that for many infertile couples, egg donation is often the
last shot in a long line of attempts at "having" a child of their own.
While some would just as eagerly adopt a child, adoption can be a much more
difficult and expensive option -- one that affords the couple far fewer
choices. And, in contrast to the process of adoption, it's the potential
donor -- not the potential parent -- who is more stringently screened.
"I was really surprised that I had to take the MMPI [Minnesota
Multiphasic Personality Inventory] test," says Kara Daillak, a lawyer who,
during her first year in law school, went through three harvests for
the same recipient and was paid $2,500 for each. Like Jennifer, Kara was
initially attracted by what seemed like a lot of money and signed on as a
donor, figuring she could back out at any time. But once she found out she
had been chosen by a couple who had reviewed her photo and portfolio at the
clinic, her motivations changed.
"I figured that with brown hair and brown eyes, I wasn't in very high
demand, so I figured whoever chose me was doing so on the basis of
something else," she says, tucking her hair behind a triple-pierced ear. "I
was starting to think I didn't want to have kids, and I figured that was
all the more reason to do this. It was a real antidote to having had two
abortions -- like some reversal of that clinical process."
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Seeking a more meaningful, less clinical experience than the typical
anonymous donation situation normally affords, Kara demanded to meet the
recipient couple. Once she had, she devoted herself completely to their
plight. "It felt constant -- I quit drinking, I hardly smoked, sex was
uncomfortable -- it was a total interruption of my life," she says. "But
it's not like I had a choice at that point anyway. I wanted to do it for
these people."
Such a deep sense of commitment points to the complex psychological
factors that come into play when a young women is evaluating her
reproductive potential for the first time, particularly when it's for the
benefit of someone else. For Kara, it seems, it was a chance to be as close
to having a child herself as possible without actually taking
responsibility for it.
"I went through a whole phase -- almost an entire decade, from 15 to at
least 24 or 25 -- where I desperately wanted to have kids," she says. "But
only in that sense of wanting to see what it was like. I felt the potential
in me -- I had the drive to do it -- and I wanted to see me pregnant. But
now I feel pretty sure I never will. I'm just too self-centered."
But Kara soon found that sharing in the couple's plight also meant she
would share in their disappointment as well. After two attempts to
fertilize and implant Kara's eggs into the recipient's uterus failed, the
couple decided to give it one last try. A week before first-semester law
school exams, the doctors discovered that the eggs hadn't been growing
properly. Kara, who kept a picture of the couple in her wallet, was
crushed. "I was in tears," she says. "They had chosen me, and I felt like I
had failed them."
The words "chosen" and "choice" -- so often associated with the politics
of abortion -- come up frequently in conversations about fertility: Couples
seeking fertility treatments have more "choice" with regard to their
reproduction; donors are not simply paired with recipient couples, they are
"chosen." But it's no accident of semantics, says women's health activist
Dr. Judith Turiel, author of the forthcoming book "Beyond Second Opinions:
Rethinking Questions About Fertility" (University of California Press) --
it's part of an often overlooked dimension of the complicated politics
behind the growth of the fertility industry.
"Ever since the Reagan-Bush administration, the government has refused
to fund any research on anything where embryos might be destroyed, because
of anti-abortion pressures," Turiel says. In her book, she argues that such
policies have deterred the development of alternative fertility treatments
that could eliminate the need for surrogacy. "In a strange ideological
alignment," she writes, "'pro-life' forces were pitted against -- and were
triumphant over -- women and men seeking to have babies. Stranger yet,
these anti-abortion conservatives found themselves allied with those
feminists who see the new technologies as robbing women of control over
their reproductive lives rather than creating greater control and choice."
Like many women working in the field of reproductive technology, Turiel
is careful not to suggest that college-age women are incapable of making a
responsible decisions regarding their own bodies. She does, however,
support regulations that would permit only woman who have had children, or
those who know for certain they don't eventually want them, to donate their
eggs.
"Of course everyone has to make decisions at the time you're faced with
them," she says. "But you're not the same person when you're 21 or 22 and
in college that you will be when you're 35."
Both Jennifer and Kara say they have no regrets about donating their
eggs -- but both also say they would think twice about doing it all over
again. "I felt more like a salmon than a woman," Jennifer says of the
actual harvesting procedure; but once she fully recovered, she says, she
felt "like God. I feel so creative -- there's a person who wouldn't have
existed if it weren't for me."
Although she says she doesn't feel any sense of attachment to the child
she helped create, Jennifer does harbor hopes that one day that child, now
a little more than a year old, might want to meet her.
"I think about it sometimes, in an outside observer kind of way," she
admits. "And sometimes, if I pass a child that has dark hair or something,
I'll kind of get this twinge, like that kid could have my genes. It should
be more of a big deal to me than it is, I think -- it's part of me, but
science has made it so that we can overlook the human factor. It's become
more of a scientific curiosity than a real child to me. But if someday,
they got my name through the fertility clinic and found me, I'd be open to
that. I'd be overjoyed. It would be so neat to see that."
Dr. Caplan warns that such a possibility is highly likely -- even for
the majority of anonymous donors who don't necessarily feel the same way.
"It's as clear as day to me that 20 years from now, people who donated
sperm or eggs are going to be contacted by the children who were made this
way," Caplan says, pointing to the legal precedent that adoption has set.
"Women who donate their eggs need to understand that."
Such a possibility seems like a pleasant one to Jennifer, who wants to
have children of her own someday. But because she won't know until then
whether or not donating her eggs has reduced her own chances of doing so,
to meet her genetic offspring, she says, would be "the ultimate
affirmation."
"You never really know if you're worth something to someone else until
they choose you to model their child after. I mean, how flattering is
that?" she says, adding half-jokingly: "Who knows, I might end up at the
same clinic myself some day -- wouldn't that be ironic?"
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