Egg donations build dream families, but systemic racism in the industry has hints of eugenics

When a person with a uterus decides to freeze their eggs, any number of things can go wrong. Ice crystal can form, killing an otherwise viable ovum. A fertilized egg may fail to properly implant, or the egg may not even get fertilized in the first place. When potential parents decide that one partner should freeze their eggs, they are urged not to make that decision lightly.

"Eggonomics: The Global Market in Human Eggs and the Donors Who Supply Them," a new book by University of Alabama anthropology associate professor Diane Tober, raises even more questions about egg donations — not just in terms of accidents here and there, but about systemic abuses like deceiving consumers and engaging in racial discrimination.

"This is the first comprehensive, mixed methods research done with egg donors in the U.S. and around the globe," Tober told Salon. Conducting research with over 300 interviewees spread across the United States, Spain and other countries, Tober ultimately collected over 1,000 egg donor surveys "which included questions on their decisions and experiences donating eggs, the immediate and longer term health conditions donors experienced as either a direct result of donating eggs or conditions they felt were connected, and also information on how their feelings about donation changed over time — including how they came to view the children born from their eggs."

The conclusions from her study were alarming. Donors "reported significantly higher rates of immediate complications, like ovarian hyperstimulation syndrome (OHSS), than exists in most of the literature." Even though egg donors are typically told during the process of informed consent that the risks of complications are "less than 1%," Tober's quantitative data "demonstrates that in this survey population, donors experienced immediate complications like severe OHSS about 12% of the time and about 1% experience critical OHSS and suffered life-threatening conditions like kidney failure as a result."

In order to learn more about the experience of being an egg donor, researchers needed to follow patients through as much of the medical process as possible. Patients are expected to have a roughly 5% chance of successful impregnation with each effort, so few only undergo it only once.

"I was able to follow many of the donors over time, over several donation cycles, and saw that while some had no complications for their first few donation cycles, things went awry for them on cycle 5 or 6," Tober said. "And donors who experience even moderate OHSS on any cycle are more likely to experience on a subsequent cycle, but more severe."

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As with all matters involving health, the best way to serve patients is for doctors to be transparent. When it comes to reproductive health, it is equally critical that patients consent to every aspect of the treatment — especially the risks. Patients should have standardized informed consent forms so that donors are aware of all the risks, according to Tober, and egg donor registries can protect the health of both the parents and the children. Similarly, Tober argues that patients should know about the possible legal ramifications of their decision. In addition to the potential medical problems, egg donors also risk one day losing their anonymity due to ancestry testing.

"Currently, many donor-conceived people are advocating for their rights to know where they come from and have access to their medical information," Tober said. "Ancestry testing makes donor anonymity unsustainable. And many donors want to have contact with the children born from their eggs, or their parents. But there are obstacles that restrict the possibility for more open donation arrangements, even though many intended parents, donor conceived people, and donors want more open contact."

That open contact may be hard to come by, at least if the egg donor industry continues to be unmoored from traditional ethical considerations. For example, Tober discovered patterns of racism over and over again throughout her research. The top rate for white egg donors in the United States was around $100,000, compared to the top rate for black egg donors being only $12,000. One donor sold eggs for $250,000 for being "perfect" because she was a Chinese American with a master's degree from the Massachusetts Institute of Technology.

“Donor profiles are the marketing tools used to attract intended parents, and those women who possess desired social and physical traits will sell faster to a wide range of intended parents than others," Tober writes, describing the mindset as being disturbingly similar to eugenics.

"Another issue, beyond the medical issues, pertain to some of the social and ethical consequences that arise in a system, like we have in the U.S., where donors are differentially selected, ranked and compensated based on traits like skin color, eye color, education and race," Tober said. "There are clearly eugenic forces underlying how the supply and demand aspect of egg donation operates in the U.S. and globally — but is more pronounced in the U.S. because donors are the products and intended parents are consumers who peruse profiles and pay top dollar for 'perfect donors.'"

Tober added, "We don't see these kinds of dynamics around donor selection in many other countries. Spain, where medical professionals choose donors based solely on the degree to which they look like the intended parents, all donors are paid the same. I'm not saying there aren't also challenges to that system, but I find the tiered market in human eggs that exists in the U.S. to be hugely problematic.​"

Ultimately, Tober believes the issue of egg donation must be rigorously viewed through the prism of consent. Donors should recognize that donors are primary patients who deserve to be treated in accordance with best medical practices and who should have their "no" respected when offered in answer to their questions. Donors should not have their compensation taxed, Tober argues, and all donors should be treated equally regardless of race, gender identity, sexual orientation, and patient status. Finally, to avoid systemic issues, there should be a "three-pronged donor registry" that protects all of the patients in the long-term as well as short-term.

Early in her book, Tober quotes a patient who nearly died because a doctor accidentally nicked one of her arteries while retrieving her eggs. Despite being told to go home, the patient, Dr. Sindy Wei, insisted that the industry be held accountable. Her plea for justice perhaps best sums up the book's overall thesis:

"I fear that cases like mine are buried deep by fertility centers concerned about their image," Wei said. "An industry thriving on profits and reputation has little incentive to report adverse events, or protect the health and medical rights of donors ... Please don’t expand the market in human eggs unless minimal protections for egg donors are ensured."