Miracle or Madness? The Light and Dark Sides of Donating Eggs for Money
When Kirsten — whose name has been changed to protect her privacy — was in college in the early part of this decade, she began hearing discussion about and seeing advertisements offering $20,000 or more to young women who would donate their eggs to infertile couples. Though she passed on the opportunity at the time, she later found herself living in Southern California, with all the expense that entails. "I was job hunting and kept coming across egg donation ads — Craigslist, the paper, magazines," she says. She finally decided that the money — $5,500, plus all expenses paid — was too good to pass up.
"Selling" Life: A 21st-Century Ethical Dilemma
While the financial compensation helped tide Kirsten over until she found employment, some experts in ethics and medicine are worried that involving money in the practice of donating the basic ingredients of human life raises serious ethical issues. The money offered for an egg donation is much greater than for a sperm donation because the latter takes just a few minutes and involves no medical preparation and because there are no known significant risks associated with the production of sperm. By contrast, egg donation cycles must be spaced out by months as the patient's hormone levels are adjusted. In addition, there is a small risk of short-term side effects, primarily nausea and diarrhea, associated with a condition called ovarian hyperstimulation syndrome (OHSS), which can in rarer cases cause shortness of breath, abdominal bloating, and, rarest of all, death. The long-term risks of using fertility drugs, meanwhile, are thought by most doctors to be minimal because no trend of complications has emerged since their introduction 40 years ago. Still, some worry that donors may face an increased risk of contracting some forms of cancer as they age.
Agencies and clinics seeking egg donors must offer payments that are 100 to 200 times greater than what the typical sperm donor receives in order to compensate the women for these risks and hardships, and some people worry that this type of trade is exploitative. With the rewards so high, they argue, cash-strapped young women may fail to consider the downside as soberly as they should. Since the vast majority of donors are in their early or mid twenties, they may not have the life experiences or the appreciation for medical risks that are needed for rational evaluation. In fact, Kirsten reports that the issue of unforeseen long-term cancer risks, small though they may be, never came up in the otherwise diligent preparation process that her donor agency put her through. Other concerns of those observing the egg donation business include the specter of human life becoming commoditized as its basic building blocks are traded for money and the fact that egg donation, because of its high price, may become available only to the rich (in fact, under the status quo, recipients must be at least upper middle class to afford it). For these reasons, many developed countries, including Canada and the United Kingdom, and a few states have made payment for eggs illegal.
Live and Let Live: The Case for Egg Donation Freedom
Other experts, however, point out that, in the absence of financial compensation, egg donation is available to virtually no one at all. John L. Gililland, M.D. of Northern California Fertility Medical Center in Roseville, California observes that the UK, since banning payments for eggs, has seen a drastic reduction in the number and variety of donors. "In an ideal world, donors would not be paid for their services and thus would be motivated only by their desire to help someone have a baby," he says, before pointing out that this is not the case. Kirsten's experience helps explain why: "Initially, [the compensation] sounded like a lot of money, but by the end it seemed pretty equivalent to all of the inconvenience and discomfort. There are a lot of things you don't think about at first: no sex, tons of appointments, no heavy drinking, gaining weight, mood swings, et cetera." A more graphic description evokes greater unpleasantness as she adds, "You are injecting yourself, with a needle full of a medicine that you mix yourself, for three weeks straight. At some points, the injections are twice a day — once in your hip and once in your stomach. It pretty much goes without saying that a stomach injection is not enjoyable!" Enduring such hardships in return for nothing but thanks elevates egg donation from an act of kindness to one of charitable heroism, and it is not surprising that few people are willing to be so selfless.
In lieu of heavy-handed government intervention by non-experts that he fears may stifle egg donation, Dr. Gililland favors oversight by trade associations. One of those that he cites, the American Society of Reproductive Medicine (ASRM), has in fact already sponsored a serious debate of the issues for and against paid egg donation. This discussion has produced a set of formal guidelines that recommend, among other things, that standard donor compensation be set at $5,000 and that payments over $10,000 be considered "excessive." While these recommendations are not binding, they are respected; Dr. Gililland estimates that, like his, the vast majority of fertility clinics adhere to ASRM's guidelines. ASRM also publishes on its website a list of practices that have signed up to abide by them. Meanwhile, the Food and Drug Administration ensures basic medical safety through its strict testing requirements for those donating any type of tissue, including eggs. Dr. Gililland's practice employs rigorous screening to ensure compliance, rejecting two thirds to three quarters of applicants. He also will not accept donors who appear to be interested solely for the sake of the money.
Giving Life: A 21st-Century Medical Wonder
Amidst all the discussion of the risks and ethical questions attending egg donation, it is important to remember the profound benefits that it provides. Infertile women and their partners are able to have children, experience pregnancy and childbirth, and ensure that at least half of the couple is able to contribute to the genetic makeup of the child. Having a large pool of donors allows parents to select eggs from women who resemble the mother-to-be physically and intellectually. As reported by Helane S. Rosenberg, Ph.D. and Yakov M. Epstein, Ph.D., two researchers at Rutgers University who have worked with hundreds of egg-recipient couples and who conceived twins themselves through egg donation, the fact that the egg has come from another woman does not seem to impair a couple's bond with its child at all, even if one partner or the other is hesitant going in. "Nobody yet has told us that they are unable to love their baby. And nobody has regretted their decision to do this procedure. To the contrary, even the heretofore reluctant partner is thrilled with the baby when it is finally born," they write in an article published by the American Surrogacy Center on its website.
The primary benefits to donors seem obvious. Kirsten was able to use the money that she received to pay down college loan debt, give her sister some financial assistance, and enjoy a few extra trips to the mall. But there are less tangible rewards as well. Despite the discomfort, Kirsten donated eggs a second time and describes hers as "a very positive experience." Though she did not meet either recipient couple, she did receive a very personal and touching letter of gratitude from one of the mothers, along with small, thoughtful gifts and a comfortable hotel room for the night before the operation. And while she had already decided that she did not wish to have children of her own at any point, Kirsten felt happy that, through her efforts, a couple that truly wanted a family would have one.
All things considered... well, there is still much to consider about egg donation, and the issues may remain unresolved for some time more. Given the small amount of medical uncertainty regarding future cancer, it may be prudent to take steps, either through the legislature or the medical community, to ensure that donors are informed fully of the potential risks. Some of the ethical concerns, meanwhile, can be thought of in other ways. Should paying large sums of money for eggs be thought of as the commoditization of human life or as a touching sacrifice of material wealth in return for the more lasting rewards of bearing, rearing, and loving children? If money does corrupt the process, should a payment amount be centrally set or are individual doctors, donors, and recipients best equipped to decide what is appropriate in each case? Is it dangerous for people to select eggs based on the donor’s looks and intellect or is it the duty of prospective parents to give their children what they perceive as the best chance for success and happiness in life? We may not have definitive answers to these questions now or ever, but we do have, through egg donation, the power to do things that seem miraculous. If we can use this power responsibly, we may be able to bring joy and love to those whose lives would otherwise feel less complete.
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