Sex Cells: The Medical Market for Eggs and Sperm (8 page)

Throughout the 2000s, ASRM persisted in drawing a line at $5,000, but egg donor fees continued to rise. Several physician–researchers blamed commercial agencies, as in this 2006 interview with a past president of SART.

With the involvement of agencies, the payment of the donors has crept up to a level that makes physicians a little bit uncomfortable. The whole question is whether at some point it becomes coercive. A person decides to do egg donation partly because of the money, and that kind of coerces them into accepting the risks of egg donation. We would have liked to see it stay down in the 3, 4, 5,000 [dollar] range where it’s more just compensating them for their time, their effort, to some extent the risks that they go under, discomforts. Everyone could have a different opinion on that, but I think that when it gets up to levels like 7,000 [dollars], it’s more than just compensating the patient for those other things.

In an attempt to rein in fees, SART’s executive committee sent a letter to egg agencies in 2006 informing them of the expectation that they abide by the ASRM guidelines. Egg donation programs that agreed in writing were then included on a list of “approved agencies,” which was posted on SART’s and ASRM’s websites. However, as professional societies, these organizations do not have any regulatory power to enforce limits on compensation, and they do not independently verify the actual fees paid to donors.
⁴⁶
The debate over compensating women for eggs continues to the present day, with articles appearing on the front page of
USA Today
and in the
New York Times
.
⁴⁷

As in sperm donation, physicians resisted the shift to commercial egg agencies, because they would have preferred to continue recruiting their own donors. One physician–researcher, who was among the first to offer egg donation in the United States, described the state of affairs in the mid-2000s, echoing Titmuss and Guttmacher in assuming that pecuniary motives are incompatible with ethical practices.

We have now a situation that I think is not very good, where the egg donor agencies sort of out-hustle and out-advertise the IVF programs. We no longer have our own donors [in my university program], except maybe three or four that came in by word of mouth, but we no longer advertise. The agencies really jacked up the price, and they have an entirely different mindset. We were trying to get recipients pregnant. We wanted to make sure we had the best kind of donor that we possibly could have, and of course we wanted to make sure we protected the donors. The agency is motivated to sell the donor, so they want the donor to be attractive and appear as good as possible, not so much to screen them out. We get recipients who are already very much invested in a particular donor. We then find out the donor lives in [another state], is not available, wants to come down and do as little as possible. The agency is putting pressure on us saying “This donor is very reliable, blah, blah, blah, everything should be good.” And so we’re [hormonally] stimulating somebody that we’re not watching. There’s clearly been a shift in the way that these things are being done. Yes, another doctor can see her there, but is somebody holding her hand? Is somebody actually asking her whether she’s having issues with injections? You get a lot more information from a patient-doctor interaction than just looking at a piece of paper that has ultrasound. And the donors go from program to program, and the doctor doesn’t have experience as to how they responded [to the medications] last time. Previously the donor was with us; by the third or fourth time, it was autopilot.

When asked how he would organize egg donation if he had the only program in the country, he harkened back to an earlier era of physician control, saying “I would go back to the way we used to really have personal hands-on control over all of the egg donors.”

It is striking that OvaCorp’s psychologist expresses similar concerns about the “business people” running egg agencies. Here, she described OvaCorp’s initial pitch to physicians at fertility practices in the early 1990s.

We used to say to the doctors that they’re really trained in medicine, but once they became brokers, they were really working out of their expertise and having staff do things they weren’t trained for. Why not say to the patients, “Listen, I’m the doctor; I have certain requirements. Here’s ten agencies: Get your donor, get her screened, let them hold your hand, do your legal, and then come back when you’re ready.” So much cleaner, really. The upside is the doctors stopped making their offices so labor heavy with all the hysterics of egg donation, and it gave couples a lot more choice and freedom and access. On the downside, it turned egg donation out of the hands of professional, licensed people who are accountable to a higher level, meaning AMA [the American Medical Association], and turned it over to people who don’t have any professional liability, any code of ethics. They’re just business people, not accountable to anybody. If you want to change an egg donor application to make it look better, if you want to erase the word alcoholism or whatever, there’s nothing stopping you.

For just these reasons, several physicians underscored the importance of vigilance when it comes to referring patients to egg agencies, especially given the lack of regulation in this market. One said, “The most important thing is to recognize they’re not all equal, and so individual practices should be sure that an agency is doing a good, thorough job.” Another noted that his practice only refers to agencies where “we know the people that run them personally, know them to be responsible, and we have not had bad experiences with the donors.”

ONE OF THE HOLDOUTS

While most physicians turned to commercial providers for sex cells, some continue to maintain their own small sperm and egg donation programs. University Fertility Services falls into this category, and in 2006, the medical director there referenced the importance of physician control in describing his rationale for running a small bank, which included samples from just ten sperm donors.
⁴⁸

We knew our donors, so not only on paper do they pass everything, but we had a relationship with them and believe in their honesty when they said, ‘No, I haven’t had any more sexual partners in the last six months.’ Rather than I’ve got something from [CryoCorp] that lists those things, and, well, I hope that’s all true. That was the big difference from our standpoint. We just had a better feeling that we knew these donors and had control over it.

However, given the small size of their donor pool, University Fertility Services also finds it necessary to refer patients to CryoCorp and Gametes Inc.

As a result of impending FDA regulations, the university decided to stop recruiting sperm donors in 2001. The embryologist there explained,

To maintain a [sperm] donor program is time- and employee-intensive, and since there are other agencies that can provide that type of thing, it is probably becoming less available within a particular program. A university program is not just doing IVF and donor; they’re doing all sorts of other things as well. The medical director [here] has wanted to provide full-service everything, and I think we’ve done a pretty good job of that until the FDA came through [
laughs
]. It just burdened us down personnel- wise and added time and expense that, as a smaller program, we couldn’t see our way through to extending that cost and personnel time for a condition that we could make use of elsewhere. And the patient’s gonna pay for it one way or another [
laughs
].

At the same time, University Fertility Services continues to recruit egg donors, even though the medical director described it as a “hassle.” He said, “With egg donors, there is no bank that you order from and it comes in the mail. Essentially, you either have your own donors, or you send your patients away to another program. So we go through all the hassle of recruiting and screening.” A review of the university’s charts reveals that a total of 149 women signed up to donate eggs between 1993 and 2005. However, it appears that only about half completed a cycle: 30% of the women donated once, 13% donated twice, 8% donated three times, and 2% donated between four and six times.

The founder of Gametes Inc. also pointed to the importance of monetary motivations in explaining why some physicians continue to recruit their own egg donors.

Surgeons consume blood, but they aren’t responsible for finding blood donors. Somebody else does that for the surgeons. So the physicians practicing reproductive medicine probably didn’t need to be out looking for gamete donors. The fact of the matter is that some of them think that that’s an important part of their practice, and I suspect that some of their personnel encouraged their doctors to think that way, because that’s how their salary is justified, that they evaluate egg donors. I don’t think any of these people, or very few of these people any more, bother to seek out sperm donors. But there is still a substantial number that recruit and evaluate egg donors for their patients. And it’s remunerative for them. They not only recover their cost, there’s value added on top of that. We think as time goes along physicians in reproductive medicine will pass on that responsibility to others. We think they’ll be encouraged to do that in part by regulation.

Like other physicians, the medical director at University Fertility Services expressed skepticism about commercial egg agencies, saying it was they who “need to be regulated.” In particular, he raised questions about the expertise of their personnel and the high prices paid to donors. Like other academic programs, University Fertility Services offers less compensation than commercial agencies; egg donors received just $2,000 per cycle in 2006. As a holdout in a world where the going rate is $5,000, the nurses and physicians in the practice lament the difficulty they have in recruiting enough women to provide eggs for their patients.
⁴⁹

Ironically, one effect of drawing the line at too much commodification is that University Fertility Services sometimes had to be less choosy than commercial agencies. For example, in one session I observed there, the psychologist was screening a prospective egg donor, whom she later described to me as completely unacceptable. The applicant’s financial situation seemed precarious, she did not like the idea of taking hormones, and she did not seem to understand that she would need to take hormones for several weeks to stimulate egg production. However, the nurse–coordinator wanted the applicant to continue with the screening process, because there was a list of recipients who had been waiting months for a donor. This episode suggests that there are not always obvious lines to be drawn in the market for sex cells and that the drive to generate revenue leads to complicated calculations by commercial and university donation programs alike.
⁵⁰

CONCLUSION

As scientific experiments in assisted reproduction became standard clinical practice, both sperm and egg donation traveled the path from medical service to commercial good. In outsourcing the procurement of sperm and eggs, physicians reflected broader trends in medicine during the last third of the twentieth century, including challenges to their professional authority, which came in part from newly constituted patientand consumer-rights groups, several of which were part of the broader women’s health movement. The medical profession was also contending with explosive growth in the health care sector of the U.S. economy.
⁵¹
In 1980, Arnold Relman, then editor of the
New England Journal of Medicine
, dubbed it a “medical–industrial complex,” describing a “large and growing network of private corporations engaged in the business of supplying health-care services to patients for a profit—services heretofore provided by nonprofit institutions or individual practitioners.”
⁵²
This description certainly encompasses the commercial sperm banks and egg agencies that came into existence around this time.

To procure sperm, commercial banks that first opened in the 1970s largely mimicked the physicians they sought to supplant, recruiting students, prioritizing high sperm count, and offering a range of physiognomies to match recipients’ husbands. It was not until the demographics of their clientele began to change to include more single women and lesbian couples that commercial banks began expanding their efforts to provide more information about sperm donors. At the same time, banks were responding to a more general trend of patients demanding more control over their medical care. But the egg donation programs that emerged in the 1980s and 1990s did not adopt the already-established model of gamete donation provided by sperm donation. Emphasizing altruistic motivations, programs recruited caring women from the broader community who wanted to help infertile couples have a child, and they allowed, and in some cases even encouraged, donors and recipients to meet.

In characterizing the reproductive material on offer, donation programs used a similar strategy to personify sperm and eggs: the provision of ever-more extensive information about the donors. However, the
kinds of information deemed important depend on whether the person donating is a man or a woman. Program staff emphasize different aspects of who egg and sperm donors are, their personalities and characteristics, and they share different types of information with sperm recipients and egg recipients. The next chapter offers a detailed look inside contemporary sperm banks and egg agencies, and it reveals how these initial patterns, driven by beliefs about biological sex differences and gendered expectations of donors, calcified into countless organizational processes, suffusing the medical market for sex cells.