BETA

Not by the dozen

Among the barrage of events, speakers, and opportunities plastered on the page, I almost missed it. On page eight of the Yale Daily News—the ad page—it was decidedly barebones, with no graphic accompaniment and written in a conservative serif font. It read:

EGG DONOR NEEDED

We are an Ivy League couple seeking the help of a special woman who is healthy, Caucasian, with highest percentile ACT/SAT scores, tall, slender, dark to light blonde hair, blue eyes, and under the age of 28. Please contact our representative at:

info @ aperfectmatch.com Or call 1-800-264-8828

$20,000+ compensation and all expenses paid

For the next four days, the same ad would appear next to articles, ads for speakers, and ads for hair salons. It was hard for me not to find some twisted humor in how banally this enormous request and reward were being presented. A week later, the advertisement was gone, but my curiosity still lingered.

At the forefront of this curiosity was the 20,000 dollars, a sum that seemed astoundingly high for a human egg. But beneath the staggering compensation was perhaps an even more disturbing thought: that human eggs could have a price tag at all, that they could be treated as a commercial product with a definite numerical value. Yet here they were, casually solicited for in the newspaper next to advertisements for Master’s Teas.

The phenomenon continued to get more unnerving, though, after considering all sides of this transaction. After all, every product has a producer and consumer. In this case, the consumers were an “Ivy League couple” willing to pay a premium for who was, in their eyes, “a perfect match.” And the pro- ducer? A “special woman” with a specific set of traits, a woman who would be willing to sell her cells, a woman to be found on our very own campus.

This sort of physical, bodily demand seemed to me to be peculiar at an institution like Yale, an institution that in its own admissions material claims a commitment to the mind. Students here are encouraged to value their intellects in the abstract sense of learning to think critically about themselves and the world. But upon second thought, the ways that we evaluate this abstraction—GPAs and salaries—are themselves a product of one our body’s most important organs. I don’t mean to conflate the two, but instead to suggest that the process at play in selling human eggs should perhaps not be so foreign.

***

As it turns our, Yale’s history with egg donation coincides with our nation’s as a whole. The first baby born from egg donation in the United States was announced on Feb. 3, 1984. Three years later, Yale-New Haven Hospital developed its own program at the Yale Fertility Center. In 1989, it was at this center that the first child to be born from egg donation in New England was conceived. The initial program offered only “directed” egg donation, which used unfertilized eggs from donors who were genetically related to the recipient. It was not until the early 1990s, however, that the program started implanting eggs from “anonymous,” non-genetically related donors. A 1994 YDN report on the expansion of the program estimated the cost of the procedure at 13,000 dollars, 2,000 dollars of which was given to the donor.

The next year, advertisements soliciting egg donors began to appear in the publica- tion. Nearly every day for a month starting on Jan. 11, 1995, the paper’s “Help Wanted” section featured an advertisement that read, “Give the gift of Life. Be an egg donor or maternal surrogate for a childless couple,” and offering an “excellent compensation” of 2,500 dollars and 17,000 dollars respectively for each service. Starting on Mar. 27, 1995, another advertisement appeared under the “Personals” section for the following month, stating: “Loving infertile couple (Yale ’80 grad and husband) wanting to start a family needs a healthy, light-haired, Caucasian woman (ages 21- 32) willing to be an egg donor. Reimbursed $2,000 plus expenses for time & effort.”

Twenty years later, these numbers have skyrocketed: the 20,000 dollars that is currently offered privately is a staggering amount in an absolute sense, and even the Yale Fertility Center’s own standard compensation has quadrupled to 8,000 dollars in the past 10 years.

The language of this solicitation, on the other hand, remains nearly unchanged. Ads often begin with an appeal to the “need” of the couple and of the “help” or “gift” that these women can provide, but they end with a large sum of monetary “compensation” or “reimbursement” for the donor’s “time and effort,” as it says in one ad, or for her “time and kindness,” as it says on the Yale Fertility Center’s website today.

***

“Time and kindness” might seem euphemistic for what is an invasive, intensive, and exhausting process. Donating eggs requires donors to first take contraceptive pills to keep hormones in a non-ovulatory state in order to prepare for suppression of the natural menstrual cycle. Donors are then instructed to self-inject the drug Lupron daily so that they can be better synced to the recipients’ own menstrual cycle and so that any ovarian stimulation that might occur is instead completely controlled by the next round of drugs.

The next step involves daily self-injections of follicle stimulating hormone, which over-stimulates the donor’s ovaries so that multiple eggs ripen at once instead of just one. During this process, women undergo regular blood tests and pelvic ultrasounds to measure their response to the treatment and also predict the appropriate time at to retrieve the eggs.

When the eggs are ready, the donor must perform one last injection of human chorionic gonadotropin, which will cause her oocytes to detach from the ovarian follicles and be retrievable within 36 hours of the injection. As invasive as this may seem al- ready, it is only at this point that the eggs are ready to be harvested. A donor is then sedated under a light general anesthesia to have her oocytes aspirated from her uterus through a special needle and suction device. This procedure takes up to an hour; the entire process three to six weeks.

***

After understanding the full medical process, it may seem reductive to advertise to women that they would be paid

for their “time and effort.” However, “time and effort” is certainly more accurate than “time and kindness,” as the Yale Fertility Center puts it on their website, and both euphemisms turn out to be more accurate than simply saying that women are being paid just for their eggs. Dr. Rene Almeling, a professor of sociology at Yale who spent four years researching the market for human gametes for her book Sex Cells: The Medical Market for Eggs and Sperm, told me, “[Sperm donors] are only paid if their sperm count is high enough. In contrast, egg donors are paid regardless of how many eggs are produced or if the recipient gets pregnant.” Yale Fertility Center Director of Psychological Services, Dorothy Greenfeld, says that compensation as high as 8,000 dollars is justifiable given the demands put on donors: “They spend a great deal of time and effort,” she say. “They can’t be needle- phobic. They need to be responsible and compliant and able to follow a tricky protocol. They have to come into our program and be monitored with a pelvic ultrasound and have their blood drawn.”

Yale Fertility Center’s 8,000 dollars standard rate fits comfortably within the American Society for Reproductive Medicine’s (ASRM) ethical guidelines, which set a ceiling of 10,000 dollars for ethically acceptable compensation. “You do get the potential there for coercion,” Greenfeld says of ads that offer 20,000 dollars to college students. However, the United States has yet to enforce any limit on compensation. Professor Stephen Latham, the director of Yale’s Interdisciplinary Center for Bioethics, describes the two historical sides of this de- bate regarding money and exploitation: “One school of thought says once you’ve decided it’s permissible to recruit women, altruistically or whatever, and put them through the risk of donating eggs in order to get the benefit of fertility for some other couple, then paying people to do it is fine. People should be able to make their own judgments about whether they’re willing to go through that risk for that amount of money.

The other school of thought, he said, worries that for at least some people—likely people who have lacked education or who have low income—such a monetary offer will lead them to make decisions that they will come to regret. “They will underestimate risk and have their head turned by large values of money with the result that they’ll be exploited,” he said. “This school of thought wants to paternalistically protect these people from making bad choices—from taking risks they will regret later for the sake of a head turning amount of cash.”

Nonetheless, he feels that Yale women are not at a very high risk of being exploited. Even though 20,000 dollars is a substantial sum, it isn’t a life-changing amount of money for a current Yale undergraduate stu- dent who has the prospect of income much higher than that in the not-so-distant fu- ture. “I’m not worried that there are women at Yale whose heads turn so much by that dollar amount that they will make irrational choices that they wouldn’t otherwise make,” he stated, “They’ll either view it as an economic opportunity or they won’t.”

***

Money, Almeling explained, generally provides the initial motivation for women, but through her research she has found that the language of the staff at donor agencies reframes the act from a transaction to something akin to an exchange of gifts: “[The donors I interviewed] were not women who were extremely poor. They were college students or young mothers, and the money was the thing that got them in the door. As the process goes on,” she continued, “the staff would tell them about what an amazing thing they were doing, how important it was. They are told by program staff that they are giving the gift of life. Some even met the recipients. Eventually, the idea of what they were doing changed because they were exposed to this notion of helping someone have a family.”

These practices, she argued, build on the deeply-rooted cultural norms surrounding gender. Concerning the male side of the gamete market, she said, “The staff in sperm banks are not waxing poetic about the wonderful gift that is sperm. But egg donors and sperm donors are giving half the genetic material you need to make a child. They are parallel bodily goods.” She acknowledges that gender is not the only difference between the act of donating sperm and eggs, but that these norms do interact with the biological and technical differences to create an “organizational framing” around women that makes a real difference in their experience as paid donors.

On top of this gendered framing, Dr. Almeling pointed out, “Egg donation has been happening since the 80s and the fact that there have been no long-term studies is a real ethical problem in this market. When young women come in to become donors, they are told only the short-term risks of the treatments and the surgery. No long-term studies have been done to follow young women over time.”

To her, this is a more pressing issue than the controversy surrounding compensation: “Starting in the 1990s, there have been a lot of controversies about paying young women for their eggs,” she shared. “My primary concern with this market is the lack of information that we have to give young women so that they can make an informed decision about the risks that they are undertaking.” After all, money cannot impede on women’s ability to evaluate information about risk that is simply not available. Ironically, it seems that critics of the monetary component might themselves be guilty of what they are afraid impressionable young women would do: namely, be too distracted by the large figures to consider the other issues at hand.

***

Personally, it was hard to read an advertisement offering so much money to a white woman with blonde hair and blue eyes and not immediately associate it with a form of racial selection or even eugenics. These concerns were diminished when considering the fact that the couple is probably looking for someone that matches the description of the mother, but the worry that women of color were devalued in this market persisted.

Almeling’s findings, however, countered my expectations: “I found in my research that women of color, specifically African American and Asian American donors, were often compensated a few thousand dollars more than White donors. Egg agencies had trouble recruiting them so their eggs were seen as biologically ‘scarce’ in this market. This is in stark contrast to what happens in the realm of adoption.”

Of course, the fact that black women’s eggs may be worth more money does not mean that racism is not a factor in the market for egg donors. In her book Killing The Black Body, racial scholar and social justice advocate Dorothy Roberts, BK ’77, identified IVF and egg donation as sites of systematic inequality: “The profile of people most likely to use IVF is precisely the opposite of those most likely to be infertile. The people in the United States most likely to be infertile are poor, Black, and poorly educated. Most couples who use IVF and other high-tech procedures are affluent, white, and highly educated…Using donor eggs makes the procedure even more expensive—10,000 dollars to 20,000 dollars for each attempt. (Ironically, eggs from Black donors may be the most costly because they are so scarce.)” Roberts argues that IVF and egg donation are technologies of privilege; while they can be tools of empowerment for infertile couples, it is important to note the discrepancy between which couples need them most and which couples actually get access to them.

While there do exist state mandates that require insurance companies to cover infertility diagnosis and treatment, there is still no national policy that guarantees equal access to such reproductive healthcare. On top of this, egg donation is rarely covered by such mandates. For example, Yale Health, as a Connecticut state health insurance policy, does cover 4 cycles of IVF for university employees but excludes coverage of any purchase of donor eggs and the associated cost of retrieving and transferring them. According to Greenfeld, the total cost of using an egg donor to conceive at the Yale Fertility Center, including all the medications, retrieval, IVF, and donor compensation, is 35,000 dollars. Roberts’s charge that empowering technologies unequally enable people still very much rings true in 2014.

***

After teasing out these social realities surrounding egg donation on a national scale, it was not immediately clear if and how they relate to Yale’s campus. In a survey sent out to the college to which 721 stu- dents responded, I asked students to rank numerically how accurate the following descriptions of egg donation were: “A medical procedure,” “A business transaction,” and “An opportunity to help an infertile couple.”

Sixty percent of the respondents put “An opportunity to help an infertile couple” first, and the same sixty percent of respondents put “A business transaction” last. When the answers are filtered for female respondents only, this distribution remains the same. It is fair to say that the respondents prioritize the generosity aspect of egg donation over the financial one. Nonetheless, more than two-thirds of the women who responded as to whether they would consider donating their eggs without monetary compensation replied “No.” The difference between considering something good and doing it, it turns out, has much to do with money.

Of the seven students who expressed to me their consideration of donating their eggs, all seven agreed that they considered money to be a primary motivator in cases besides those involving close personal ties to the recipient. None expressed any current pressing financial need, with four of them attracted to the abstract notion of having the money while three appreciated it as an optional source of income for potential costs such as graduate school.

Those who were born of donor sperm or eggs themselves expressed a much stronger motivation towards donating their own eggs and more willingness to donate their eggs to a family member or close friend in need. Regardless of their willingness to donate, how- ever, most were content to entertain their curiosity for a couple of hours or so on the Internet and then leave it in the back of their minds. A majority of the seven I interviewed were also turned off by idea that they could get more money than other donors because of specific characteristics such as race and Ivy League education. One exception was an African American student who felt that she would have no problem donating her eggs for a higher compensation due to her race since she saw it as a “product” she was offering. The other was a student who emailed the agency from the YDN advertisement who intended to use her Ivy League status as a negotiating point because she was aware that she did not match the other criteria asked for in the ad.

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However, there is a time limit to the value that the name adds to any Yale student’s eggs. Past a certain point, eggs are biologically destined to lose their value as donations, Yale eggs or not.

The hope is that the same does not apply to a Yale education. Part of its value comes from the general perception that we are intelligent, that we are leaders, that we are generally capable. It hopefully grants us the ability to not only live up to those expectations, but to define those expectations, and therefore our own value, for ourselves.

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