All it took was an advertisement in the San Francisco Metro to make Duke senior Deirdre Hess think about her ovaries.
The ad was straightforward: ‘Are you between the ages of 18 and 32? You can help a woman have a baby and earn $7000!’
Even before she saw the advertisement—one of many soliciting women to donate eggs to other women—Deirdre found herself intermittently discussing egg donation “as a general theoretical principle” with her friends.
“I had already guessed from those previous conversations that I was more okay with egg donorship than some other people,” she says.
Egg donation, one method under the umbrella of alternative reproductive technologies that help infertile couples conceive, is as it seems: a young, healthy woman gives some of her ova to a woman who can no longer produce viable eggs. The process is invasive, hormone-destabilizing, body-altering and uncomfortable. Yet for some women, donating eggs can be the single most altruistic act of their lives.
So Deirdre picked up the paperwork from Duke University Medical Center in the spring of 2004, submitted the package last fall and began the process of becoming a donor.
Egg donation deals with infertility—not something most students dwell upon when contemplating the future. But somewhere in a dream home in the United States, an educated, wealthy couple has it all—except a baby. And they’re willing to pay.
According to Resolve, the National Infertility Association, infertility affects 10 percent of the U.S. population. Although risk factors are equally distributed between men and women, egg donation becomes an option when the woman’s eggs are the issue. Sometimes, a woman has a genetic or hereditary disease she does not want to pass onto her own children. In other cases, she simply waited until she was too old to have a baby with her own eggs. Couples can then turn to egg donors to accomplish their goals.
There are three avenues to an egg: recipient couples can find donors through medical center infertility clinics, through egg brokers or by placing private ads.
But the eggs are never free—every donor is monetarily compensated for the difficulty of the donation process. And the prices vary. If Deirdre wanted to ‘donate’ her eggs at Dartmouth’s medical center, for example, she would be handsomely compensated for her time and discomfort to the tune of $4,000. But if she chose to donate at Columbia, she would receive a check for $8,000. At Duke, donors receive $2,700.
Differential prices (or compensation amounts… it’s 6 eggs to one, half dozen another) can be explained by economic factors such as cost of living and competition. The three university medical centers that offer the highest egg compensation rates in the country—Columbia, Cornell and New York University—all operate out of facilities in New York City. So while the caliber of Dartmouth students may be no different than that of their peers at New York institutions, the competition for their eggs seems significantly lower. And just eight miles down the road, UNC offers $2,000 to egg donors, a full $700 less than Duke.
What is the difference?
If there is a discrepancy between high-premium eggs and their cheaper counterparts, it won’t be found in the donation process.
A woman’s first step to egg donation at a medical center involves extensive pre-screening questionnaires that can request information ranging from detailed family medical histories to lists of hobbies and interests. She then goes through comprehensive medical and psychological screenings: There are physical and pelvic exams, sexually transmitted disease and blood tests and at least one psychological screening to determine whether the woman is a fit candidate.
Dr. David Walmer, founder and chief of the Reproductive Endocrinology and Infertility division of Duke University Medical Center, said that the screenings let the infertility team know whether a woman is “tough enough” to go through the entire donor cycle.
“We almost try to talk them out of it,” he says. “This is not an easy process.”
Once accepted, the donor and egg recipient must synchronize their menstrual cycles, typically accomplished with a combination of birth control and a medication that suppresses normal ovarian function. While only one egg matures during most normal cycles, the goal during a donor cycle is to produce as many eggs as possible. To this end, the donor begins self-administered injections of fertility hormones that induce her ovaries to mature a surplus of eggs. A series of ultrasounds from inside show the numbers of follicles, or egg-containing sacs, in which eggs are being prepared for ovulation. Exactly 37 hours before egg retrieval, the donor takes human chorionic gonadotropin (hCG) to trigger ovulation.
Deirdre is going in for her egg retrieval after spring break. She will be under general anesthesia during the process. A doctor, using ultrasound imaging as his guide, will insert a thin needle through the back wall of her vagina and use suction to harvest as many eggs as possible from the follicles. The eggs, once harvested, are no longer her own. She will never know how many were harvested or whether any eggs were successfully retrieved at all.
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An egg is a cell; it had no monetary value as raw material until humans possessed the technology to harvest and appropriate its genetic potential. Now that technology is available, the procedure is fairly standardized regardless of donation site. So how is it that one institution’s monetary value for an egg can be double that of another? Are some eggs simply more valuable?
“If you rule out diseases, the answer is no,” says Angela Roddey Holder, acting director of Duke’s Center for the Study of Medical Ethics and Humanities.
If eggs cannot be more or less valuable, they can certainly be more sought-after.
Online egg broker services typically offer more money to Asian and Jewish donors because the egg supply does not match the demand. Walmer notes that DUMC occasionally encourages black women to donate eggs, but that targeting certain demographics does not result in higher compensation rates at Duke.
Without the recipient couple requesting any specific traits, Duke REI looks for the best fit in terms of height, weight, hair and eye color. “We’re basically looking for bright young women who look as much like the recipient as possible,” Walmer says. “At some point in time we may find ourselves with more African-American recipients in our pool.”
For some couples, it just isn’t enough for a woman to be healthy and within the proper age range. Donor traits such as physical attractiveness, quantifiable intelligence and musical and athletic abilities seem to make eggs more desirable to recipient couples. Think of it as dating: ‘childless couple seeks compatible genetic material with sparkling green eyes, and love of intelligent conversation and football.’
Sometimes, anxious couples even take matters into their own hands.
In March 1999, a couple placed an advertisement in student newspapers at Stanford, MIT, Cal Tech and throughout the Ivy League seeking an “intelligent, athletic egg donor” for a loving family. More specifically, the donor should be at least 5’10”, blonde and have a minimum SAT score of 1400. The asking price? $50,000.
The next year, a half-page ad in Stanford’s paper offered $100,000 for a donor of similar qualifications.
Ethicists and geneticists immediately raised an outcry over the appropriate limitations of reproductive technology. Some scholars voiced concerns that such choosiness could lead to a culture of designer babies. Others cautioned that offering so much money could backfire by attracting unfit donor candidates interested solely in the money. Despite the uproar, the advertisements redefined the value scale for eggs.
Recipients who offer such high dollar amounts say they are merely attempting to have children as similar to themselves as possible, as if the egg were their own. While the donor’s hair color may have no effect on a child’s cognitive ability, it could make the parents feel they’re getting a more natural fit, they say. And no one said they couldn’t ask. This isn’t a job application; it’s choosing baby’s DNA.
But critics lampoon couples that offer small fortunes for eggs as opportunists waiting to ride to social achievement on the backs of their highly attractive and intelligent children. And what if all of the money and hard work does not result in a tall, blonde, accelerated reader? Eggs from a smart mother do not guarantee like offspring.
Holder, also professor of the practice of medical ethics with a joint appointment at Duke Law School, believes the “valuable egg” paradigm is built on a shaky genetic foundation.
“The genetic assumption under all of this is crap to start with. But people think that if a woman at Duke or Yale or Harvard or Stanford is the mother of their child, at least it rules out downright stupidity,” Holder says. “Look at the families you know who have what’s called ‘regression to the mean’: very smart parents can have not very smart children, and very smart children can come from very un-smart parents,” she says.
The root of judgments on egg value is that some couples seem to equate a lucky convergence of certain donor traits—height, eye color, IQ, religion and hobbies, to name a few—with life success. In seeking a donor with desirable traits, they may hope these traits translate to their future children.
The genetic fallacy that a smart, beautiful, accomplished donor will result in similar children has led to a profusion of websites claiming to sell ‘supermodel’ eggs. Now a supermodel who went to Harvard—that would be something.
Deirdre sits in her West Campus dorm room, back in the realm of $2,700 eggs. Her room feels like it must be on a different, kinder planet than other dorms. She has a sheepskin throw on a welcoming wicker-frame chair, small art pieces on the wall by her desk and a window with iron latticework overlooking the bus circle. White reindeer gallop across warm, peach-colored walls that she painted herself.
She plays with Cookie, her hamster, on the floor as she describes how she came to the decision to donate her eggs.
“I spent probably two or three months wrestling with all the questions. I talked with all of my friends, telling them to think of anything that they could think about before I did it,” she says.
One of the most immediate responses from friends was dismay at the thought of giving away one’s own children. After all, an egg does contain half of the genetic material required to build a fetus—a donor’s eggs are used to make children with sperm from a man she has never met. Deirdre found that was never much of an issue.
“I see people being individuals in and of their own right, not owned by other people,” she says. “My children are going to be the children that I raise, or the children that I give birth to, but not just the ones I have in my genetic material.”
But what if the recipients are bad parents?
“I struggled with that for a bit because even if the child is his or her own person, every child deserves good parents. And these are total strangers—I will never know who they are.” She emphasizes the last part of her statement with hand gestures that seem to startle Cookie. Her hands then become scales.
“On the one hand, we have 16 year-olds getting pregnant. Are they really good parents? And somehow, people survive,” she says. “On the other hand, recipient couples have been trying so hard to have a kid, they want a child so much they’re wiling to pay thousands of dollars, they obviously have the financial means to care for a child, and chances are they’ve put a lot of personal investment in as well.”
She said she considered the future implications of having genetic offspring who are not her children, and the changing laws of anonymity.
“If you go back 40 years ago, adoption was completely anonymous, the way this is currently completely anonymous. Then kids grew up and wanted to know who their birth parents had been. If any children do result from this process, it’s possible that they would come find me later on,” she says. “In the end, I figured that if I decided I could do it, I should be able to answer that child’s questions too. And frankly, is it better that they would have not been born? I doubt that they would think that.”
The reasons women choose to donate their eggs become obscured amid the rows of dollar signs and zeroes. Religion also factored into Deirdre’s decision; she wondered whether it was significant that her egg might go to a non-Christian family. She thought about the risks, the fate of the extra eggs, money and faith.
Walmer says at least one woman who donated at Duke was motivated by her own regret. She had an “elective pregnancy termination” when she was young, and while she knew she could not alter the past, she wanted to help another couple have a child that she did not.
Behind the bluster and shine of supermodel egg websites and newspaper advertisements offering tens of thousands of dollars for eggs are couples willing to devote their lives and livelihoods to the chance of a child.
Women continue to donate eggs with lower-compensating medical centers when every day, ads purport to offer so much more money. In the end, the reason medical centers and ads can put such different price tags on eggs comes down to the donors themselves. Although Deirdre’s initial interest was piqued by the idea of money for eggs, her eventual decision to donate was based in personal conviction. She was attracted to the idea of helping people who were unable to have children—a gift without price for the couple that receives her eggs.
But the money’s not bad either.