Sex Cells: The Medical Market for Eggs and Sperm (6 page)

Rene: When did this start to change?

Founder: In the early days, the physicians we relied on for insight into the marketplace pretty much said any donor will do. My patient
simply wants to get pregnant. It just doesn’t matter who the donor is, so long as you give a Caucasian donor to a Caucasian woman and a Black donor to a Black woman. So if physicians really don’t care about matching recipient and donor, ten is probably more than you really need.

Rene: So it wasn’t even like they were picking the brown-haired donor or the blond donor?

Founder: I think most of the physicians we were working with were that cavalier. Some of them might look down on a catalog of ten and say you’re blond and here’s a blond donor. But as time went along, women probably said, “Can I see that donor catalog?” [
laughs
] And physicians said, “Yeah, sure, fifteen less seconds I have to spend with you. Take it home, and spend all the time you want.”

Gametes Inc. redesigned its catalog to be “patient-friendly” in 1989, adding personal essays written by donors in 1993 and photographs of donors in 1994.

The changing demographic profile of sperm bank clientele also contributed to the demand for more information about donors. For most of the twentieth century, physicians generally limited donor insemination to heterosexual married couples. In a 1987 survey, about 50% of the physicians refused this service to unmarried heterosexual couples, and 60% refused it to single women or lesbians.
²³
But in the early 1990s, a new technology called intracytoplasmic sperm injection (ICSI), in which a single sperm is injected directly into an egg cell, allowed men previously considered infertile because of low sperm count or impaired motility to forego the use of a donor. ICSI is expensive because it must be used in conjunction with IVF, but it reduced the number of heterosexual couples turning to sperm banks.

As a result, commercial banks became much more reliant on single women and lesbians, groups they had long refused to serve, and these new customers were interested in obtaining as much information about the donor as possible. Referencing his experiences with recipients over nearly four decades, CryoCorp’s founder explained,

Now the recipients can’t get enough information. But at that time, we weren’t talking about single women, lesbian couples. We were talking about married couples, and we just tried to match the donor to the physical characteristics of the husband and left it mostly at that. But now it’s mostly the single women and lesbian couples that are interested in information. When we sent the audio tapes [of donors] to a married couple, the guy would walk out of the room, because it was difficult for him to deal with the fact that his wife is being inseminated with another man’s sperm.

It makes sense, then, that Western Sperm Bank was the first in the United States to offer “identity-release” donors, who agree to future contact with offspring. A nonprofit bank with roots in the feminist women’s health movement, it opened in 1982 intent on serving the single women and lesbians who were barred from many university and commercial banks. With no husband to match and less investment in keeping donor insemination a secret, some of Western Sperm Bank’s first customers expressed an interest in making arrangements for their children to meet the donor. To avoid legal liability for both the bank and the donor, the bank’s founder decided that children could not be given identifying information about the donor until they were eighteen. Although slow to do so, many commercial banks have since followed suit.
²⁴
Gametes Inc. began a similar program in 2001 and CryoCorp in 2004.

A physician who served as president of ASRM and chair of the obstetrics and gynecology department at a major research university is dismissive of all the additional information. “The bells and whistles are for the patient, not for me. What do I care if the guy is a violinist or not? It’s a marketing tool. It’s got nothing to do with the medicine. It has nothing to do with the quality of the sperm.” He began referring patients to CryoCorp in 1991 after closing the small sperm bank at his university, because “it was an administrative problem and a legal problem, so let somebody else handle the processing of the sperm.” In response to my question about whether he had provided much information about donors in his university’s program, he said no, explaining “but that’s the difference between a university program and a commercial program. The university asks very simple questions: eye color, height and weight, perhaps something about ethnicity. So it’s going to a socialized store and a capitalist store. CryoCorp has much more information, but it’s
commercial, so they’re selling a product. We were providing a medical service.”

EGGS: THE GIFT OF LIFE

Sperm donation had been around for nearly a century by the time the first egg donation was performed, but the physicians responsible for organizing this new kind of gamete donation did not follow their own pre-existing model. They recruited donors from a different population, used different rubrics for characterizing the material, and relaxed their own requirements for anonymity between donor and recipient.

Throughout the 1970s, research teams around the world raced to be the first to claim success with
in vitro
fertilization, and the birth of Louise Brown, the first child conceived using this technique, made headlines in 1978. Although IVF with a patient’s own eggs addressed some causes of infertility, such as blocked fallopian tubes, it did nothing for those without viable eggs. However, as one physician–researcher who conducted experiments with egg donation in the 1980s noted, “it doesn’t take a huge leap of the imagination, if you’ve got dishes in the laboratory, you can get the egg from one person and put it into somebody else.”

Researchers tried different techniques for doing just that, with the first pregnancies from donated eggs occurring in the mid-1980s. In one program, physicians inseminated the egg donor with sperm, waited a few days for an embryo to develop, and then flushed it out of the donor’s uterus so as to implant it in the recipient. This technique is called “uterine lavage” and was first developed with cattle. But it put the egg donor at risk of sexually transmitted diseases, tubal pregnancies, and even retained pregnancies if all the embryos were not removed.
²⁵
In another program, researchers used a different method, asking patients undergoing IVF for their own infertility to donate one of several eggs they produced to another patient. The egg was fertilized in the laboratory and then implanted in the recipient’s uterus.
²⁶
By the late 1980s, a new technique for retrieving eggs reduced the level of risk associated with this outpatient procedure and made it acceptable to ask women
who were not already undergoing fertility treatments to serve as egg donors.
²⁷

To find egg donors, physicians looked not to students in need of extra cash but to women in the surrounding community. Describing how the “initial cohort of donors” was recruited for the uterine flushing experiments, a physician–researcher recalled,

They put an advertisement in the paper saying: “Help an infertile woman have a baby. We are looking for women who have completed childbearing who previously were extremely fertile.” So they recruited a cohort, and I want to say that they screened a hundred women and got twenty of them. And they were paid very little, I want to say $500, and imagine what they had to go through. The idea was that they would have all of these women, all similar looking, and they had a set of recipients that would simply say, “Well, I’ll take any one of these.” In talking to the investigators at the time, they called them Earth Mothers. These women were really into the whole motherhood experience.

As more universities around the country began offering IVF and recruiting egg donors, their advertisements also incorporated maternal imagery and called on women to “help” others. Montefiore Medical Center placed the following radio ad in 1992, “A Westchester fertility center is seeking altruistic and compassionate women under thirty-six years of age who are willing to donate their eggs to women who are unable to have children because of lack of eggs. Financial compensation is available.”
²⁸
Clinicians at the University of California–Irvine published a study in 1993 that pointed out “volunteers are women from the community surrounding the medical center . . . A periodic advertisement has been placed in a major metropolitan newspaper on a prominent page. It pictures a mother and a baby and asks if the reader is a woman under thirty-five who would like to help an infertile woman to have a child through egg donation.”
²⁹

In appealing to women’s sense of altruism, physicians placed much more emphasis on egg donors’ motivations than they ever had with sperm donors. In fact, the earliest egg donation programs incorporated psychological evaluations, in part to assess women’s motivations, a form of screening that had rarely, if ever, been required of men donating sperm.
³⁰
But, as Cleveland Clinic researchers reasoned in a 1989 article, they needed to make sure that women were motivated by something more than money because “financial gain as a primary motive seems to be a negative prognostic indicator for compliance with the program.”
³¹
Twenty years later, Eric Surrey, past president of the Society for Assisted Reproductive Technology (SART), expressed identical sentiments in an interview with Reuters reporters. “We understand that financial compensation is certainly one motivation, but should never be the sole motivation. These women are providing a great gift to others that should not be taken lightly.”
³²

Indeed, in talking with a physician–researcher about the early days of egg donation, he underscored the importance of women’s motivations before mentioning their medical history in describing the screening he does.

Physician: Screening for people who are motivated properly, motivated because they want to help somebody, not just because they need money. That’s a real issue. Screen them psychologically, make sure they’re healthy, infectious diseases, family history to make sure they have no genetic diseases.

Rene: You’re transferring biological tissue, so I can certainly understand why you would want to do all the medical screening, but why did it matter what their motivations were?

Physician: Well, because if their motivation isn’t correct, then they may not be telling you the truth. Their motivation, it may cloud their honesty in terms of saying whether they have had an infectious disease in the past or whether there’s a genetic disease in the family. That’s always concerned recipients: how much can you rely on what the donor says? Because there’s no independent verification of what the donor gives you in terms of the history. So that’s one of the main reasons you’d like them to be properly motivated. Also they have to do things exactly right. So if they’re really well motivated and have the best interests of the recipient in mind, they’re altruistic, they’re less likely to screw up on medications or something that they should be doing.

In providing a rationale for the expectation that women have altruistic motivations, this physician uses altruism as a proxy for honesty about medical information, which, as he notes, there is no way of verifying.
This is also true of sperm donors’ medical history, but there is no such expectation that men be altruistically motivated. In fact, the 2006 edition of the ASRM patient guide
Third Party Reproduction
recommends that egg donors be evaluated for their motivations but contains no analogous recommendation for sperm donors.

Physicians also deviated from the sperm donor model in that they were less insistent on strict anonymity between donor and recipient. At the University of Southern California, one of the first programs to offer egg donation, a full quarter of the first 325 cycles, which took place between 1987 and 1993, involved donors whom recipients had brought into the program.
³³
A survey of other early egg donation programs revealed that more than half required recipients to bring in their own donors.
³⁴
As a study published in
Fertility and Sterility
in 1995 noted, “Ovum donation evolved differently from sperm donation. The first case of ovum donation used an anonymous donor, but, in subsequent clinical practice, known donors, such as a sister or friend, became common. It was the advent of ovum donation that began to raise questions about the assumptions that had traditionally accompanied donor insemination.”
³⁵

Another contrast with sperm donation is that, to this day, egg donation usually involves fresh eggs. It is possible to freeze sperm and to freeze embryos, but freezing eggs is still in the experimental stages, primarily because of the high water content in these large cells.
³⁶
Although the exact levels of risk of transmitting particular diseases via eggs are not clear, egg donors are fully screened for a range of sexually transmitted diseases.

The trajectory of egg donation did mimic that of sperm donation in one crucial way: the medical profession eventually had to cede control of egg donor recruitment to commercial agencies, a process driven by rapidly increasing recipient demand. As one physician–researcher explained, in the early days, it was not clear how many people would need donated eggs.

In 1984, egg donation was a speck on the horizon, a gee-whiz, but really how applicable is this going to be? Sperm donation seemed much more obvious. Lots of men didn’t have sperm, but women, as near as we could tell, all had eggs, except for the rare few who had premature ovarian failure, meaning menopause under the age of 35. We thought they would be the only potential recipients, and that was indeed the first group. We thought older women were not going to get pregnant no matter what you did to them. It was serendipity that some of the women with premature ovarian failure had turned 40 by the time we got our program going. When we did egg donation to them, lo and behold, they got pregnant at very high rates, at the same rates as the young women. And it was like, “Oh, oh, it’s in the egg. The older uterus is not a problem.” This is obvious now, but this was the big a-ha moment.
³⁷