How much is your egg worth?
Lisa Stern, APRN
Welcome to the largely unregulated world of oocyte (egg) donation. While numerous groups have already commented on the scant oversight of the fertility world in general, a new and stinging report from the Hastings Center lays out the tactics used to recruit and incentivize egg donors through college newspapers. As author Aaron Levine writes, the "nearly half of the advertisements offered compensation exceeding recommended levels. In addition, analysis indicated that average SAT scores at the college or university where an advertisement was published were a strong predictor of the compensation offered—a violation of the guidelines. These findings call into question the notion that the current self-regulatory framework provides appropriate ethical protections for oocyte donors."
Egg donation, used to provide oocytes for in vitro fertilization when a patient's own supply is diminished, involves a young, healthy woman using hormonal fertility medication(s) to stimulate the ovaries to produce multiple follicles. The oocytes contained in those follicles are then harvested and fertilized in the lab to produce embryos for transfer, usually to the intended parent (often termed the “recipient”) or sometimes to a gestational carrier. The technology is used most commonly by older patients. The main risk incurred by egg donors is ovarian hyperstimulation syndrome (OHSS), and while many experience mild symptoms, few require intervention if monitored closely.
According to a 2007 statement from the American Society for Reproductive Medicine, the professional body loosely governing the fertility industry, compensation for egg donors should be capped at $5,000. And any fee over $10,000 is "not appropriate." The ASRM's suggestions, however, have not stopped some private recruiters from paying $10,000 and even more to donors. One quarter of the college newspaper ads that Levine surveyed offered compensation over $10,000. One infamous ad from the Brown Daily Herald offered $50,000 for an "extraordinary donor."
I've interacted with this issue on a variety of levels. Recruitment for egg donors is most active -- and donation most lucrative -- on those campuses where students have the highest SAT scores. I spent seven years of my life as a student at two of those universities, Harvard and Yale. The small classifieds sections of the student newspapers consisted almost entirely of ads from agencies, individuals, and couples seeking oocytes -- usually from women with specific characteristics. One anonymous advertiser was looking for a young, athletic Jewish woman, 5'4"or taller with SATs of 1500 or higher. That's me! I responded to the ad via e-mail but was so horrified by the response ("I am looking to produce more Jews," I believe, was how it went) that the correspondence stopped there.
Later, an NP in a fertility practice, I screened and worked with egg donors, doing histories and physicals, teaching them how to administer injectible fertility medications, monitoring cycles, and managing complications. Couples or singles seeking an egg donor underwent mandatory interviews with a wonderful social worker named Jeanne. The same went for the prospective donors. Because the actual match was shrouded in anonymity (donors and recipients never met), each party relied on the practice to screen their counterpart. The same way I screened donors for infectious diseases and conditions like PCOS, which can predispose to OHSS, Jeanne looked for any symptoms that could compromise the health of the donor, recipient, or offspring.
Prospective donors were queried mainly about personal and family history of mental illness and asked about their motivation for donating their oocytes. Contrary to my expectation, "I want to help a couple have a baby," wasn't Jeanne's ideal response. According to her, these "do-gooder" young women were too likely to become attached and too likely to suffer emotional sequelae from the donation process. Donors who instead cited the $8,000 compensation their primary motivation garnered Jeanne's highest approval. These young women had greater emotional distance from the process and had come in the door primarily to make a fair buck.
In contrast to what we believed, the ASRM does not regard payment as incentive for young women to donate but simply as fair compensation. As far as the ASRM is concerned, paying donors is intended "to acknowledge the time, inconvenience, and discomfort associated with screening, ovarian stimulation, and oocyte retrieval." The lived experience of those in the fertility field, as well as the growing influence of brokers and other intermediaries, casts doubt on this statement.
Reform does not seem forthcoming. The oocyte marketplace, increasingly useful to infertility patients has become an evermore Byzantine assemblage of providers, patients, donors, recruiters, brokers, and advertisers. The myriad participants in the marketplace have little incentive to lobby for change. Rather, is up to each care provider, each couple or single person, each donor, to erect safeguards against coercion or abuse.
Are egg donor payments OK? If the ASRM's contention that donors merit financial acknowledgement is true, this raises a larger question for the medical community. Namely, why don't we pay people who donate other organs and tissues? Certainly kidney, marrow, and blood donors sacrifice "time, inconvenience, and discomfort," not to mention assuming a fair amount of physical risk. Shouldn't they be paid too?
Is something shady is taking place in the oocyte market? If payments are too high, should they be capped at, say, $5,000? Eliminated entirely? And, if so, who should enforce the regulations? Voluntary professional organizations lack the muscle and clout to police their thousands of members and others in the field.
I'd love to hear your comments and experiences on all sides of this issue.