The High Price of Donation

By Jennifer Liss, October 7, 2005

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Young college women are increasingly being targeted by egg donation agencies for their good looks and their good grades.

What she did have going for her is that she is the grandchild of Holocaust survivors. Jewish, Asian and Indian egg donors -- she would learn -- are in great demand.

So at 21 she decided to ditch the agency route and try to sell her eggs on her own. She said she loved the idea of helping infertile couples fulfill their desire to become parents. And the money she made would help her pay off credit card debt.

The first time she made $4,000 and had "the easiest donation of all time." But after the fourth donation she ended up in the emergency room with dehydration. It was her own fault, she says, and giggles over irresponsibly planning a road trip after the donation procedure. By the time she graduated, Jessica had earned $23,000 through egg donation.

Do her parents know she donated eggs for cash? No. Does she plan on donating again? Yes, this winter.

Jessica’s story may be more common than we think, because little is known about college students who donate their eggs. The Centers for Disease Control (CDC) report that they do not collect information on donors’ age, race, income, or education levels.

But we do know that one in six American couples struggle with infertility, and the demand for viable eggs is increasing. Assisted Reproduction Technology (ART) procedures performed in the U.S. increased 78 percent from 1996 to 2002, according to the CDC.

Outdoing Nature

"Caroline,"* who used to model, earned a high G.P.A. at a reputable liberal arts college. A three-time egg donor, she pocketed over $20,000 for her efforts. Now 25 and living in New Jersey with her husband and young child, she doesn’t regret a thing.

In many ways, students like Caroline fit the description of a perfect egg donor. The American Society for Reproductive Medicine (ASRM) says that younger women respond more favorably to the hormone medication used during the donor procedure, and their eggs result in higher pregnancy rates. Caroline’s good grades, hot looks, and spotless health history, combined with her young age made her a highly sought-after donor.

Darlene Pinkerton of the egg donation agency A Perfect Match says that 80 percent of her donors are college students. And Dawn Hunt, owner of Fertility Alternatives, says that 90 percent of her donors are college students.

Hunt used to advertise for egg donors in family and parenting publications. But dissatisfied with the lack of response, now she sticks almost exclusively with college publications.

A typical classified ad in a college publication will call for a donor under 29, physically attractive, with an impressive S.A.T. score. It will list a high dollar figure, but usually won't mention the procedure or the legal, medical or ethical risks. (One ad awkwardly and inaccurately encourages students to "donate to infertile couples some of the many eggs your body disposes monthly.")

For about five years the Stanford Daily has run a special classified section reserved for egg and sperm donation ads. Several years ago, a Stanford student suffered a stroke due to a rare reaction to one of the synthetic hormones used in egg donation. The current editor-in-chief does not know if the newspaper received any complaints about the classified section.

How It Works

How does egg donation work? First, a donor is screened for genetic diseases and H.I.V. She then undergoes a psychological evaluation. Once "approved," she is given synthetic hormones to self-administer over a series of weeks.

During a normal ovulation, a woman releases one egg. But the hormonal medication stimulates the donor’s ovaries to produce many eggs -- sometimes a few dozen. This is called "controlled super-ovulation."

Once the eggs are mature the donor receives an injection that triggers ovulation. Thirty-six hours later, the eggs are retrieved through the vagina with an ultrasound-guided needle. The menstrual cycle of both the donor and the recipient have been synchronized. After the eggs are fertilized, the embryos are placed in the recipient’s uterus. Hopefully, a pregnancy will stick.

The sale of body parts in the United States is illegal, explains Lynn Westphal, director of the Oocyte Donation Program at the Stanford Medical Center and a professor. However, it is perfectly legal for people to donate body parts -- like blood, sperm, eggs or organs -- and be compensated for their time, effort and discomfort.

Amy Turner also learned about egg donation through a school publication. Turner, who lives in Waxahachie, Texas, is a 22 year-old married mom putting herself through massage therapy school. She’s donated once, and her $2,000 compensation is going toward college tuition.

Compensation is a controversial issue. In some parts of the world, compensation for eggs is illegal. Typical compensation in California used to be $2,500, says Mary Cedarblade, an attorney who specializes in fertility issues. But as more people turned to egg donors to get pregnant it became harder to find donors, she explains. Cedarblade says that just last year the going rate in California was $5,000 per cycle. And now, she says, the average is about $5,500.

"Because of how invasive the egg donation process is, it would be unreasonable for someone to go through the process and not be compensated," says Westphal. "But how to determine what is the right compensation is a difficult thing."

"You have to look at it like you are helping someone who has tried thousands of times to get pregnant. I’m giving them the joy I had when I had my child," says Turner about her experience.

As professionals and donors point out, altruistic intentions can run as strong as the financial motivations.

"Infertile women do not choose to be infertile," Pinkerton writes in an email about her agency’s work. "When they find a donor they relate to and who resembles them they are transformed into women of hope."

Donor Risks

The first egg donation took place in 1984, but egg donation was relatively rare until about 10 years ago. In the early years of egg donation, there were a handful of studies indicating a possible connection between the hormonal treatments given to egg donors and certain cancers.

While it now appears that the risks are low, medical professionals are still uncertain if there will be long-term consequences for donors. Simply put, there is a lot we don’t know. And compared to its male counterpart -- sperm donation -- that involves a cup and a willing hand, egg donation is much more invasive and risky.

Westphal explains that the most common health risks she sees are bruising at the injection site and some bloating. Some women who "over respond" -- meaning they produce too many eggs -- may develop Ovarian Hyperstimulation Syndrome (OHS).

If untreated, a donor with OHS will experience significant swelling, a sense of discomfort, dehydration, moodiness, or possibly difficulty breathing. In a worse case scenario, her ovaries, under great stress, could be damaged.

"In general it should not affect the future fertility [of the donor]," she says. (There have been no documented cases.)

Julia Derek lived an egg donation nightmare, documented in her self-published book "Confessions of a Serial Egg Donor." In four years, Derek donated 12 times -- six times over the limit recommended by the ASRM. She made between $40,000-$50,000. However, as a result of the hormones and lack of care, Derek sunk into a severe, almost suicidal, depression.

A Swedish student in Los Angeles, Derek couldn’t legally work because she didn’t have a green card. She felt her only two choices to make a living as a student were egg donation or being a server under the table. She chose egg donation.

At first, the compensation got her out of a jam, but soon egg donation was funding her "L.A. lifestyle." She describes in her book speeding on the 405 freeway on her way to a comedy open mic while shooting Lupron (hormone used to stimulate ovulation) into her bruised inner thigh.

Derek found herself in a dependent relationship with her egg broker who encouraged her to continue donating despite the health risks. Her broker lied and misled her. "I’m lucky more things didn’t happen to me," she says.

How was Derek able to put herself at such a great medical risk? Weren’t there precautions in place to protect her?

Relying on "Good-faith" Regulation

The ASRM advises that "a good-faith effort should be made to avoid accepting women who have already made a high number of donations elsewhere." But if a donor chooses to travel to another clinic, her donation history does not travel with her. It is up to her to disclose that information. There is a concern that the higher the payment, the more likely prospective donors -- like Derek -- will be tempted to conceal crucial medical information.

And agencies, often referred to as brokers, play a controversial role in the play of egg donation. There is a concern that there is a conflict of interest if the broker is serving both the donor and the couple and collecting "finder’s fees."

An agency or a broker does not have to disclose all of the potential risks to a donor. And an inexperienced donor, who has not been properly advised or done her own research, could find herself in a vulnerable position.

After Turner’s egg extraction, she received a letter from her agency stating that she would not be able to continue donating. After the time she had committed to the first donation, she was shocked because she had counted on donating again. She also had learned that her agency’s compensation was significantly less than other agencies in Texas. She called to inquire about the letter and voice her complaints.

"They said it was basically none of my business. Thanks for your eggs. Screw you, bye," she says. (Her agency didn’t respond to this writer’s request for an interview.)

But like the donors, many brokers are also driven by both the financial reward and the desire to help a couple desperate for a child.

"I help facilitate everything. I’m there to remind the donor of her appointment and be her support system as well. I try to help out if she has questions," says Hunt, who was an egg donor before she started the agency.

She typically charges a fee between $3,000-$5,000 on top of what the donor receives. Hunt says she makes a good faith effort to follow the majority of the egg donation guidelines set by the ASRM. But some of the guidelines, she says, are not up to date.

Long-Term Consequences

The donors interviewed for this article don’t have ethical regrets. They all share a healthy curiosity about what their DNA will produce, but they are not preoccupied or haunted by the idea that there are young people growing up right now who share their DNA -- young people they will never meet.

Jessica’s seen pictures of "her" children, and she’s "totally curious" how they will turn out. But she doesn’t stay up at night thinking about it.

Nevertheless, ethical concerns are still an issue in the world of egg donation. Westphal says, "You don’t want people just doing this over and over, and you want to limit the number of children from any one donor."

There are legal considerations too. "The most important consideration is that a donor is not going to be held responsible for the child," says Cedarblade. (She does not know of this ever happening.)

It is also important, she says, that the donor not be held financially responsible for associated medical treatments or any complications that may arise.

A 21-year-old woman is able to vote, drink and be drafted, but many people wonder if a young college student with pressing financial needs (or wants) is in a position to make a responsible decision about whether or not to donate her eggs.

The considerations -- medical, ethical and legal -- are daunting, and the compensation is nothing short of seductive. But would a 30-year-old woman be prepared to make the same decision? In some ways, so little is known about the long-term consequences, that even the most cautious donor is still taking a risk.

Egg donation is a more complicated decision than choosing second semester classes, securing an internship, or making Friday night plans. College women need to be their own advocates, do their homework and invest time and thought before they proceed with egg donation.

Or as Jessica says, "I think my advice to college women is to not allow people to bully you through the process ... A lot of people get pressured into things they aren’t comfortable with. The language of altruism ... resembles blood donation. It can lead vulnerable women into a bad place. It is your life. You have to live with it for the rest of your life. You don’t want to be treated like equipment."

* The names of two donors have been changed at their request.

Jennifer Liss is a writer living in San Francisco.