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In the booming business of treating infertility, individuals’ and couples’ desire to carry a baby to term or to produce biologically related offspring has created a market in which third-party women can earn thousands of dollars for providing their wombs for surrogacy, or for donating their eggs for in-vitro fertilization. Although standard compensation for women who provide eggs hovers around $5,000, women with highly desired or less-common genetic characteristics can earn up to five-digit sums for their tiny gametic material. Those are small prices to pay when the ultimate result can fulfill the dream of having a baby, some say. In this emerging industry, babies are premium products—both the result of a scientific process and a commodity by marketplace definition.

Debora Spar, a professor at Harvard Business School, researched the IVF industry for her 2006 book, The Baby Business: How Markets Are Changing the Future of Birth. She estimates that the IVF industry is a $4.5 billion business in the United States alone. “It is not huge, but it’s substantial, and it’s growing pretty quickly.”

Current undergraduates at Harvard, who often are attractive to individuals or couples seeking an egg donor because of their demonstrated academic prowess, can earn up to $50,000, “no questions asked,” Spar says.

In the Capital Region, compensation amounts are far lower, typically between $3,000 and $5,000. CNY Fertility Center, which has locations in Latham and Syracuse, provides $4,000.

Despite the high sticker price, Chris Gray, egg-donor coordinator at CNY Fertility in Latham, says potential donors rarely cite money as their motivation for contacting the clinic. “Many of them have had a friend or relative who has gone through infertility and watched them suffer,” she says. Others “have their own family and know what the joy is to be a parent, and want to be able to pass that on to somebody else.”

Pick up a handful of student news papers from America’s largest colleges and universities, and chances are you’ll find advertisements seeking women willing to donate their eggs. College newspapers, because they often land in the hands of young, educated women, have become a significant mechanism for reaching potential donors with characteristics that match those sought by the individuals or couples who participate in donor-egg fertility treatment programs.

This notoriously successful advertising strategy often is viewed skeptically by those with concerns about the business of donor-egg IVF. Some argue it’s a means for IVF clinics to lure in women whose cash-strapped lifestyle makes them vulnerable because the dollar signs in their eyes overwhelm their ability to evaluate the risks.

Bonnie Steinbock, professor of philosophy at the University at Albany, says keeping the compensation amount “reasonable” is necessary to ensure that women make truly voluntary decisions about whether to participate. Steinbock is one of several professionals who serve on committees of the New York State Task Force on Life and the Law, which was created in 1985 to develop public policy on various issues, including assisted reproduction. As part of the task force’s advisory group on assisted reproductive technologies, Steinbock helped prepare an informational guidebook for potential egg donors.

“The whole issue about whether egg donors should be compensated is really not the important ethical issue,” Steinbock says. “The real issue is do [potential donors] know what they’re getting into? And, I think, the answer to that is very clear—in most cases, no, they do not. I think that’s a much more important ethical issue: that [donors] are not really giving informed consent and they have a lot of misconceptions.”

The process of informing women about the procedures and risks associated with egg donation varies from facility to facility. CNY Fertility, which advertises primarily on local radio stations, begins educating a potential donor when she first contacts the clinic to request more information, says Gray, who fields these inquiries at the Latham office. After an initial screening process to determine if a woman satisfies the age and body-weight requirements (CNY Fertility requires women be between the ages of 21 and 32 and less than 200 pounds), Gray sends each potential donor a package of materials that includes detailed family medical history forms and information about the egg- donation process and its risks.

Once potential donors complete and sign the medical-history packet, women have “very lengthy conversations with me on multiple occasions,” Gray says. “By the time they get to the part where they sign the consent, I feel pretty comfortable that they understand what’s happening because I’ve talked to them so much and given them so much information ahead of time.”

Even after a woman signs the five-page consent form, Gray says she again reviews the form with the potential donor. As an additional level of consent, if the woman is married, CNY Fertility requests that the partner also read and sign the consent form.

“Unfortunately, too often, [informed consent] is just a matter of signing forms,” Steinbock says. “Consent has become a transitive verb: ‘Did you consent that patient?’ Ideally, what it’s really supposed to be is a discussion with either the researcher or the physician to make sure the patient really does understand what is going on. Of course, in the case of egg donation, it’s a conflict of interest. They [the IVF clinic] want the eggs, so they don’t want to spend an awful lot of time saying, ‘Are you sure this is what you want to do?’ because [the potential donor] might say ‘no.’ ”

While many clinics screen and educate potential donors internally, an alternative process that utilizes professionals who work independent from the facility may alleviate concerns about any conflict of interest. For example, some clinics in Chicago request that potential egg donors undergo a psychological screening with an outside evaluator.

Susan Klock, clinical associate professor at Northwestern University, is a Ph.D. psychologist who has worked in the field of reproductive endocrinology and infertility since 1988. In addition to providing counseling for infertile individuals and couples, she provides numerous independent consultations and psychological evaluations for women considering egg donation. After an interview session with the woman and the psychological evaluation, Klock makes a decision about whether or not to recommend the woman as a donor.

“I think there’s a wide range in how clinics practice,” she says. “My bias is that it’s nice to be separate because the person doing the screening doesn’t have any other kind of vested interest in the process. It’s not to say that when it happens within a program [at a clinic] it’s not a good idea, I just think the way we’ve done it here has worked well.”

Once potential donors at CNY Fertility Center complete the health-history forms and are approved, their “donor profile” is posted on the clinic’s Web site. At any given time, about 50 to 65 potential donors are listed on the site, which contains profiles for donors in both Syracuse and Latham.

When a couple or individual decides to use the donor-egg procedure, they may view the donor profiles in order to identify a donor who matches the characteristics they seek. Potential donors and infertility patients who choose not to work through a clinic may also connect with one another by alternative means, including using independent Web sites designed to be utilized as a classified service for donors and recipients.

Some opponents of donor-egg IFV question this process of shopping for desired genetics and the ethics of seeking a “designer baby.” Proponents, however, say few patients are looking for a “perfect child,” but instead often simply want to find a potential donor whose genetics most match their own, as well as be assured their donor does not have any preexisting medical conditions.

“I think parents always want the best of, and the best for, their children,” says Michael Grossman, physician at the CNY clinic in Latham, “but fundamentally that’s no different than choosing a spouse, choosing the style of car that you drive or the model of house that you live in.”

Once a potential donor has been matched with a recipient, egg retrieval involves a three-step process. First, she is prescribed a medication that she self-injects to temporarily prevent the ovaries from functioning normally. The woman is then given a second medication, also to be self-injected, that stimulates the ovaries to produce many eggs at once. The third and final medication, which causes ovulation, is injected shortly before the actual retrieval.

After the final medication has been injected, but before the ovaries actually release the eggs, the eggs are retrieved by a surgical procedure that involves placing the woman under anesthesia and inserting a needle through the vagina and into the ovaries. Typically about 10 to 20 eggs are extracted.

Throughout the process, the donor is monitored to evaluate how she responds to the hormonal medications and when to begin the next step.

At each point, there are several potential, but relatively mild, side effects, including hot flashes, fatigue and body aches.

The most likely serious risk associated with the process is caused by the hormonal medications. Ovarian Hyperstimulation Syndrome causes fluid retention and swelling of the ovaries. In mild cases, the woman will have abdominal pain, pressure and swelling, but severe cases can cause serious medical problems, including blood clots and kidney failure, and can be life-threatening.

“That only requires medical attention and intervention about three percent of the time,” Grossman says. “It is unlikely to happen, and it’s still the most likely thing that’s going to happen from this. Bad cases, yes, they could require hospitalization. It can be disaster, but that is very, very rare.”

There’s also a surgical risk associated with the use of anesthesia and the needle, including the possibility of bleeding and causing damage to or puncturing the bowel, bladder or nearby blood vessels. Since the procedure is still relatively new, whether there are any long-term effects is still unknown.

“While ultimately that is true,” Grossman says, “the best epidemiologic studies with all in-vitro fertilization fail to show any increase in health risks. You are not increasing your risk of cancer by going through these procedures. You are not decreasing your own eggs by going through this. You are not speeding up menopause by going through it. The short answer is there are no known long-term health risks from going through this. Yes, these are powerful medications, but they’re given for such a short time that there are no long-term problems.”

After extraction, the donor’s eggs are injected with the recipient’s chosen sperm. On average, if 10 eggs are injected with sperm, seven or eight will form embryos, according to Grossman. About five or six will survive five days in culture outside the human body, and normally two will be placed in the recipient’s uterus. Approximately 40 to 45 percent of cycles result in a pregnancy at CNY Fertility in Latham.

The disposition of any additional, unused embryos is up to the recipients: They may choose to freeze the embryos to implant in a few years, donate them to another infertility patient or to research, or thaw them so that they naturally stop developing.

Once a woman’s eggs have been extracted, her participation in the process is complete. According to Grey, however, the most common feedback she receives from recent donors is: “ ‘When can I do this again?’ ”

CNY requires a woman to have one normal menstrual cycle before undergoing the extraction procedure again; so realistically, a donor could be ready for another donation in a couple of months. Currently, about half of the donor profiles listed on the CNY Web site are for donors who have participated in a cycle at least once before.

That aligns with the national trend, says Klock. “When we have looked at donors, we find that about one-third of donors donate one time, another kind of third or so will donate twice, and then it’s a very small number who donate more than two times,” she says.

Although there are no firm rules about how many times a woman can provide her eggs, CNY limits donors to six cycles due to regional genetic concerns.

“The more cycles you do, the more likely it is that you’ll have genetically related offspring,” Grossman says. “It’s still very rare that you would actually get genetically related people in the next generation pairing up and encountering unforeseen difficulties, but it could happen. It’s also to avoid another effect where if the donor happened to have a rare genetic disease you don’t promulgate it among the region. It’s just so we don’t end up on a Lifetime movie.”

The earliest successful IVF procedure dates back to July 1978, when the first baby conceived through the technology was born in England. Since then, IVF technology—which refers to any procedure that involves fertilizing egg cells outside of a woman’s body—has been used to create thousands of children around the globe, both by fertilizing a woman’s own egg with her partner’s sperm and by using donor gametes.

Initially, egg donation most commonly occurred between two women who knew each other. For example, an infertile woman might ask her sister or friend to supply the genetic material for the IVF process. As donor-egg IVF became more regularly used to treat infertility, the practice of anonymous egg donation expanded to its current level of practice.

Despite the fact that the practices of egg donation and IVF continue to grow, both exist with nearly nonexistent governmental oversight.

“As far as a women’s-health issue, I find it remarkable that there is so little regulation and so much exploitation, I think, of young women in this country,” says Elizabeth Marquardt, director of the Center for Marriage and Families at the Institute for American Values. “College women think that $5,000 is a lot of money, and it’s not for the risk that they undertake to donate eggs.”

Both federal and New York law is relatively silent about egg donation and IVF, aside from requiring clinics to test potential donors for certain infectious diseases and preexisting conditions. State law requires reproductive tissue banks be licensed with the state and specifies that each must develop specific internal policies about how the facility will operate, but the law allows clinics to create those rules without much guidance.

“I think the baby business is, from my particular lens, at sort of the second stage of a very, very predictable evolution,” Spar says. “The technology works. The technology has created a market. People are now aware of that market. The folks in the market, for understandable reasons, don’t want any regulation—just like early movers in any market never want regulation. But, I think what we’re starting to see, really in just the past 12 months, is increased interest in and demand for regulation. . . . I think they’re going to occur slowly because all this is complicated by the politics of abortion, but I think they will happen.”

It’s the same progression other technologies have followed, from the telegraph and radio to the modern Internet, says Spar, who predicts one of the first governmental actions will be for some state legislatures to forbid compensating egg donors.

‘What most interested me about this market was that nobody in the market was willing to acknowledge that they were in a market,” Spar says. “That’s very unusual.”

Within the industry, clinics have opted for softer rhetoric so as to avoid the cold language associated with market-speak, she says. “That’s why they use the word ‘donation’ rather than ‘sale,’ and if you look at any of the ads, it’s all about ‘creating hope’ and ‘giving the gift of life.’ ”

Even people outside the baby business are often hesitant to talk about the industry in market terms, and many are concerned by what they view as technological procedures that invite the commodification of human life.

“People are very uncomfortable using the market terms,” Spar says. “I use the market terms because I think if we are concerned in any way with this process, we have to just call a spade a spade and describe what’s going on and then figure out if we are uncomfortable with certain aspects of it.”

Although some organizations, generally conservative and anti-abortion groups, oppose all assisted-reproductive technologies as a matter of principle, donor-egg IVF garners additional criticism—even among those who might otherwise support assisted reproduction—because of the invasiveness of the egg-extraction procedure as well as questions that emerge with regard to biological relation and parenthood.

Marquardt spent many hours interviewing adults who represent some of the first donor-sperm-conceived children while researching for a recent report titled, The Revolution in Parenthood: The Emerging Global Clash Between Adult Rights and Children’s Needs.

While she has not interviewed individuals conceived from a donor egg, primarily because she says many of these children have yet to reach adulthood, Marquardt says the identity concerns expressed by those conceived by donor sperm are the same.

“They’re saying that biology matters,” Marquardt says of her interviewees, “and I’m interested in listening to them. Particularly, I’m interested in listening to them because a lot of people don’t want to listen to them. A lot of people want to say, ‘[Donor-sperm and donor-egg IVF] is all about adult rights to form families as they choose,’ and, ‘Adult needs and desires to reproduce are of imminent importance. Adult feelings are vulnerable and fragile, and we need to take care of the adults and the children will be fine.’ That’s really where I take issue with it.”

Although some egg donors and recipients agree to a relationship with each other—they may know each other’s names, meet face-to-face, or even have continued contact after a child is born—the majority of donations, especially those that take place through fertility clinics, occur under a veil of anonymity. Under these conditions, the recipients have ultimate discretion about whether to tell the child about how they were conceived.

According to Marquardt, parents who use donor eggs are less likely to tell a child the truth about their conception than recipients who use donor sperm.

The potential for donor-egg IVF to create a growing population of nonbiological families also concerns Theresa Schweigert, administrative director of Citizens Concerned for Human Life, which is based in Albany.

“A lot of the members in our group have suffered from infertility, so it’s not that we’re being callous or insensitive to the desire of families to have children,” she says. “But, we need to be sensitive to society as well, and we are going to be creating children with the potential for having all these different but nonbiological people in their lives. You can have a woman who’s raising somebody else’s donated eggs that was fertilized by someone who’s not her husband. You get all of these very strange combinations of family, which really goes against the grain of what family is, and what respect for human life is.”

CCHL opposes assisted-reproductive technologies for two reasons, explains Schweigert. First, members believe that the creation of life outside the womb takes away from human dignity by making babies into a commodity. Additionally, the organization opposes the practice because, inevitably, not all embryos created in the process will survive or be implanted in a woman’s uterus, thus denying the right of a person to be born.

“I would say, too, that donating eggs removes dignity from the woman who donates them,” Schweigert says. “She may have good intentions, she may want to help her sister, she may want to help people she doesn’t even know, but nevertheless that love between a man and a woman, the procreative love is removed.”

For individuals and couples who cannot conceive naturally, however, assisted-reproductive technologies serve an important function by providing the opportunity to fulfill a lifelong dream to bear children, supporters say.

“This isn’t their first choice,” Steinbock notes. “If they could do it with candles and in front of the fireplace, that is what they would prefer to do, but they can’t.”

In the donor-egg IVF process, donors choose to participate in the process and often for reasons beyond the money. The majority of the donors Gray sees genuinely want to help an individual or couple, she says.

“They are doing something fundamentally altruistic, for someone else’s good without any chance of repayment in-kind,” Grossman says. “I guess there’s monetary compensation for their time and inconvenience, but still, how do you put a price on human life in that sense?”

Similar to the politics of abortion, there also is a difference between choosing not to participate in the practice and refusing to allow others a choice, says Steinbock.

“I myself am past my sell-by date, but I have a daughter,” she says. “I would very much discourage her from doing this sort of thing, but it’s one thing to say I don’t think it’s worth it and another to say that I don’t think other people should be able to make that decision.”

As the use of assisted-reproductive technologies, and specifically donor-egg IVF, continues to grow, the practice is certain to provide new legal, ethical and social questions and debate about such issues as the definition of parenthood, genetic selection, government regulation, the appropriateness of paying a woman for her genetic material, and the ethics of creation—and, sometimes, destruction—of life in petri dishes.

“I think the most interesting piece of this moving forward is going to be around genetic selection,” Spar says. “That’s something that really—no pun intended—is in its infancy. I think there’s going to be a real demand, even among fertile couples, to think about doing genetic screening of their embryos, and that’s going to raise public-policy issues because we’re going to have to think about what kinds of screening we, as a society, are comfortable permitting.”

Already, some see signs that organizations and individuals are beginning to speak up about the issues associated with IVF technology as well as the need for regulation.

“I think there’s a huge women’s-health issue here that some women’s organizations are beginning to speak up about,” Marquardt says. “But there has been a real conflict within the women’s movement, I think, over this—between the desire to satisfy the needs of professional women who delay childbearing and who are struggling with infertility and their right to reproduce, and balance that with the vulnerability of young women who I don’t think have full-informed consent to donate these eggs.”

Before Spar’s book about the baby business was published, little had been written analyzing the industry as a market. Today, most of the literature about the infertility business tends to be firsthand accounts from women struggling with infertility. And while there are numerous support groups and Web sites devoted to assisting infertile individuals and couples, there are less supports for children conceived by donor gametes, and still less for donors themselves—particularly egg donors.

“I’m not aware of a lot of organizations that are available for donors, unfortunately,” Klock says. “I think that’s an area where it might be a good idea to begin giving women an opportunity to kind of keep track after the donation process is over or speak with other donors to share her experience.”

Such groups might also become more necessary as the number of egg donors increases. According to Spar’s predictions, in the near future the supply of potential egg donors will continue to grow and, consequently, so will the supply of donor eggs. The upward trend of compensation amounts also will continue, she says, at least until state governments begin to regulate the industry.

nklaas@metroland.net

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