Egg Donation and the Free Market
ROBERT SIEGEL, host:
This is ALL THINGS CONSIDERED from NPR News. I'm Robert Siegel.
And I'm Michele Norris.
For women unable to bear children on their own, advances in reproductive technologies have opened a world of new possibilities and a minefield of ethical dilemmas. For the next two days we're going to examine some ethical questions surrounding reproductive medicine. Today: egg donation.
If you pick up a college newspaper and look through the classifieds, along with sofas for sale and roommates wanted, you may well find an ad like this: `Loving, educated couple seeks egg donor; Caucasian, 5'3" to 5'9"; healthy lifestyle, cheerful disposition and high SATs.' Such ads are now fairly common. And while US laws prohibit the sale of body parts, such as a kidney or a heart valve, it's perfectly legal for women to make money donating their eggs. The US is one of the only industrialized nations that allows such transactions. We're going to talk to several people involved in the process. First, Lisah Horner, an artist living in Berkeley, California. She donated eggs four times.
Ms. LISAH HORNER (Artist): I had had an abortion when I was very young, and there was something about being able to do something that was this responsible and this well thought out from start to finish and be able to give something so incredible to somebody.
NORRIS: Lisah, you donated eggs four times. How much were you paid in each case?
Ms. HORNER: Twenty-five hundred dollars each time.
NORRIS: You know, egg donation in the US is largely unregulated. And because demand is so high, compensation can reach $50,000, sometimes much more than that. And what are your views on that? Does money in some way corrupt the system?
Ms. HORNER: I think it's possible. I think that I should have been paid actually a little more for it because it is rather extensive. But I'm thinking maybe, you know, $5,000 at the time. But $50,000, I--you know, it's--that's serious money, and I can't imagine that there wouldn't be a lot of people who would be motivated to respond to something like that for the wrong reasons.
NORRIS: That's egg donor Lisah Horner.
Julia Derek's experience couldn't have been more different. She was a college student from Sweden living in the US.
Ms. JULIA DEREK (Author, "Confessions of a Serial Egg Donor"): I didn't even have a green card at the time, so my options were very limited. This was, like, the best solution for me and lots of money for it and no tax on it. And it seemed like a fantastic idea.
NORRIS: Derek went through the process of donating eggs 12 times. Toward the end, she says, she experienced health complications and severe depression. Her main motivation, she says, was the money.
Ms. DEREK: When you're in your 20s, you kind of feel that you're invincible or nothing can hurt you. And since it was so easy, so much money, so why not do it?
NORRIS: Did your views about the process change over time?
Ms. DEREK: Yeah, I do think that you should be over a certain age before you start doing that. Like I know that they prefer women in their early 20s 'cause they're more fertile or, like, they're more in their prime age. But I don't feel that they're mature enough to make educated decisions about doing this. And the people I've spoken to who are now 30 who have done this, they have second thoughts about--maybe they shouldn't have done it. So maybe they should target older women, like women in--28 and up maybe.
NORRIS: But the ads that you see in newspapers are usually in college towns or in places where they're clearly targeting students...
Ms. DEREK: Yes.
NORRIS: ...the segment of the society that's financially strapped. And so in your view, are those ads in some way coercive? Do they...
Ms. DEREK: Oh...
NORRIS: Are they sort of an unfair inducement?
Ms. DEREK: ...of course. That's why you do it. The $8,000 you can make in New York nowadays, it's very clearly spelled out in the ad, so of course. It's very seductive because it's a lot easier to just go do that than to work as a waitress somewhere.
NORRIS: How much money did you make over time?
Ms. DEREK: Slightly over $50,000.
NORRIS: If the United States' system was more like the system in the UK or in Canada or Australia, where there are very strict limits on the compensation that women can receive, would women continue to donate eggs out of pure altruism? Would you?
Ms. DEREK: No. I know for a fact that that is not so. I mean, I would for a close friend or my sister. I would not expect them to pay me anything. I would do it because I can help somebody in that way. But actually in Sweden, where I'm from, there's a long line of couples waiting for donors because they don't offer any compensation, so they don't do it there. Nobody wants to donate. So they have actually a case which proves that people don't it if there is no money involved because there's not enough women who want to do it for free.
NORRIS: Julia Derek wrote about her experience in the book "Confessions of a Serial Egg Donor." With a dozen procedures, Derek far exceeded the limit of six egg donations recommended by the American Society of Reproductive Medicine. The ASRM also suggests capping fees at $5,000, but it's a professional organization, not a government agency, so its guidelines are not enforceable. Given the current system, some say it's debatable whether women who provide the eggs are really donors.
Ms. CYNTHIA COHEN (Kennedy Institute of Ethics, Georgetown University): Some women do donate eggs because they are just doing it altruistically for perhaps a family member or a friend. Others, though, are doing it for the money, and probably they're more appropriately called vendors. I wish they knew what they were getting into.
NORRIS: Cynthia Cohen is with the Kennedy Institute of Ethics at Georgetown University. She's also the former executive director of the National Advisory Board on Ethics and Reproduction.
Ms. COHEN: The theory is that when you provide compensation to egg donors, what you're providing them with is money for their time, their inconvenience. They do undergo a procedure that carries some risk with it. And so it's very different from what sperm donors undergo when they donate.
NORRIS: The compensation, the fees that are paid to the women who donate their eggs, have increased greatly over time from about $250 in the mid-'80s to an average range of 5 to $7,000 now, and those fees can go much, much higher than that. Is this a case where a free-market system should prevail?
Ms. COHEN: It's my sense that it's inappropriate to have a totally free-market system. I think we need some regulations to protect the donors. I think we need some regulations to protect the resulting children. There ought to be regulations indicating just what sort of testing should go on for donors. There ought to be regulations indicating just how much information about donors should be put into circulation. So there are many aspects of this whole procedure that I think need to be regulated for the protection of both the donor and the child.
NORRIS: Beyond compensation, there's not a good deal of federal regulation right now that would cover a disclosure of risk, for instance.
Ms. COHEN: No, there's...
NORRIS: Why the lack of federal regulation in that area?
Ms. COHEN: This is a medical practice involving medical procedures, and historically legislatures on the federal level have stayed out of the regulation of medical practice. People in reproductive medicine have said, `We can regulate ourselves. We have the best interests of our patients in mind. We don't want the federal government stepping in because it would be unfair to do so in our case when they don't do so, for instance, in the case of a surgeon, for instance, who invents a new surgical procedure.' And they feel that they, too, are entitled to provide medical care in the way that they deem most appropriate without the intrusion of the government.
NORRIS: So to listen to you, it sounds like you'd come down on the side that more regulation is needed. But many fertility specialists say that the current system is actually a model of self-regulation. And they say that these high compensation fees may make some people uncomfortable, but it's also encouraged many more women to enter the system.
Ms. COHEN: Oh, I'm sure that more women have entered the system, but do these women really know what they're getting into? Are they really informed of the risks? You know, and these are rare that any sort of calamities occur after this procedure, but they do occur. Are they informed how uncomfortable it is, or can be, to provide eggs to others? It seems to me that there's no uniformity among various infertility centers in the country, and there's no way of patrolling that and governing that.
NORRIS: You're with the Kennedy Institute of Ethics at Georgetown University. When you pick up the paper there, I imagine you sometimes see these ads in the back pages.
Ms. COHEN: Oh, yes.
NORRIS: And they appear also in The Washington Post, the local paper here. When you come across one of those ads, as a bioethicist, what goes through your mind?
Ms. COHEN: It really depends on the ad. Some of the ads are appropriate in that they say that they're looking for donors; that this is meant to help couples who are infertile and who need assistance. If they give information about the amount of money available, they also provide information about `Come and find out about what the risks are of this.' So some ads are appropriate. Others are totally inappropriate. The advertising is scandalous in some cases, and there's a need for better regulation of that.
NORRIS: Bioethicist Cynthia Cohen of Georgetown University.
So who actually places the ads that solicit egg donors? Kathy Stern of Houston, Texas, is one example. She runs an agency called Southwest Surrogacy Arrangements and Parenting Options. Stern says part of her job is to weed out potential donors who are motivated only by money.
Ms. KATHY STERN (Southwest Surrogacy Arrangements and Parenting Options): I think that is done through the clinical interview that I and the other counselors provide to the donors that we are screening. We spend quite a bit of time with them. They're in our office about four hours. They do go through an interview. They fill out a massive amount of paperwork. They're having to write their motivation. And then--but I think it's really the subjective interview that pulls out of them what they're hoping to gain from this. And I have--and I'm sure that my other counselors have and that other reputable agencies have--turned young women down that they're only hoping to gain a check out of it.
NORRIS: How do you know that? How do you discern that? Do you--are there certain clues that you're looking for, certain things you're hoping to hear?
Ms. STERN: Yes, and most of the time it's provided in the letter that they write to the couple. They write a one-page letter about what they hope to gain from this experience. But if I don't find it somewhere in the paperwork they have filled out, I will ask them, `What are you hoping to gain from this experience, outside of the check that you are going to receive?' And if they can't give me a good answer, then they would be screened out.
NORRIS: What's considered a good answer?
Ms. STERN: Usually a good answer is that they are really wanting to do something to feel good about themselves and what they have done. And sometimes they sum it up--and it may not be an exact quote, although some have used it, but `I know I am never going to find the cure for cancer. I know that I am never going to do anything that tremendous for the society at large. However, having a baby for someone or providing the means for someone to have a baby is something that I can do, and I know that it's something I'll feel good about for the rest of my life.'
NORRIS: Kathy Stern works with egg donors in Houston, Texas.
There are many who argue that the current system works, principally because it encourages a high rate of egg donation, and that in turn helps thousands of infertile women bear children. Others worry that a system targeting financially vulnerable young women as potential donors is exploitative, particularly since little research has been conducted on the long-term risks. One thing is certain: With minimal government regulation, the prevailing laws for now are those of supply and demand.
SIEGEL: Tomorrow Michele's series continues with the medical and ethical question: How old is too old to become a parent?
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