- BIOETHICS FORUM ESSAY
$35,000 for One of My Eggs?
My eggs are ripe for the taking – I am a 22-year-old female Yale graduate. On a semi-regular basis in college, I opened the school newspaper to find advertisements soliciting my demographic to donate. Some ads were more specific than others, requiring a Jewish or an Asian donor, an SAT score of greater than 1400 math and verbal, someone “attractive” or with athletic ability, or a height of at least 5’9”. Nearly all offered high sums of money for prospective donors, ranging from $5,000 to $35,000.
In a recent study in the Hastings Center Report, Georgia Tech researcher Aaron Levine showed that my experience at Yale was not unique. Looking at 105 advertisements found in 63 college newspapers, Levine found that nearly half offered payments to potential egg donors of $5,000 or more, with some reaching as high as $35,000 and specifying donor characteristics. Many of these advertisements violated guidelines issued by an ethics committee of The American Society for Reproductive Medicine (ASRM), which state that “total payments to donors in excess of $5,000 require justification and sums above $10,000 are not appropriate.”
The foundation of ASRM recommendations seems to be protection, for a number of parties: prospective donors, prospective recipients, potential offspring, and society at large. According to the ethics committee’s report, high payments could lead to “undue inducement and exploitation” that cause women to discount the physical and emotional risks associated with donation. Such payments could also lead prospective donors to conceal medical information relevant to their biological offspring, make donor oocytes available only to the very wealthy, commodify gametes and devalue human life, or promote the birth of persons with traits deemed “socially desirable.”
Demographically speaking, I am a prospective oocyte donor, and ASRM guidelines regarding inducement and exploitation are aimed at me. Based on my experiences and conversations I’ve had at college, I’ve found that my friends and acquaintances primarily fall into three groups: 1) those who would never donate for moral reasons, regardless of payment offered, 2) those who would donate for sums that fall within ASRM guidelines, and 3) those who are open to being “induced” by high enough payments. ASRM guidelines are targeted at the last two groups, but unfortunately they “protect” the third at the second’s expense.
There are many reasons why young women should consider carefully whether they want to donate their eggs. The process is long and intrusive. To stimulate her ovaries to produce eggs, a donor receives injections of hormones and other fertility medications for several weeks. Eggs are retrieved by surgery. A donor may suffer complications such as bleeding, puncture of the bowels or bladder, infections, adverse reactions to fertility medications (which are in some cases life-threatening), or in rare cases liver failure.
Although long-term risks are unknown, some evidence has shown a link between egg donation and developing cancer or a decrease in fertility. In addition to physical risks, young women face psychological ones, such as stress caused by feelings of attachment to the eggs or resulting offspring. The ASRM hopes that if payments for such a procedure are kept low enough, young women who would otherwise donate will either forgo the process entirely or think more carefully about whether such a process is worth her time and risk.
But what of the young women who choose to undergo the procedure anyway? They are facing the same risks and time commitments, yet they are being paid less than market price for their services. A woman who would donate for $5,000 is more likely to have pressing financial concerns than the one who would only donate for $25,000 or $35,000. So while ASRM guidelines may turn away some women who have comparatively little interest in donating and probably no great financial need, they will cause the woman who actually donates to be vastly underpaid.
The recommendations may even have the opposite effect of what is intended: if a woman is getting paid less than she would otherwise, she may be induced to donate more frequently, putting herself at greater risk. Women are generally advised to donate no more than six times, but the rule is rarely enforced and there is little to prevent a woman from exceeding this limit.
How did the ASRM come up with a specific dollar amount in the first place? The ethics committee used a 1993 analysis that estimated that oocyte donors spent 56 hours in the medical setting, undergoing interviews, counseling, and medical procedures related to the process. The same analysis estimated sperm donors’ time at just an hour. (The ASRM report acknowledged that this failed to consider time spent by sperm donors undergoing interviewing and screening.)
In 2000, the average payment to sperm donors was $60 to $75, and an extrapolation suggests that a payment of $3,360 to $4,200 to oocyte donors is justified. The committee justified the higher payment of $5,000 for oocyte donation on the basis of a lengthier total time commitment and greater physical intrusion and risk.
This analysis is problematic because it compares two processes that are not directly analogous. Its foundation rests mainly on time spent rather than risk incurred in the donation process. The amount of physical risk faced by sperm donors amounts to zero, while risk faced by oocyte donors varies.
By capping the amount that egg donors can be compensated for undergoing this risk, the ASRM is effectively assigning a value to it (and a small one at that). As a deterrent for women who would not consider their physical well-being as worth just a few thousand dollars, the guidelines may work. For women who make the choice to donate anyway, the guidelines heavily undervalue their physical risks.
Who am I? I am not someone who would donate for $5,000. In fact, I don’t know my “price,” or if I even have one. But I also know that there are those who do donate for that sum. My friends, my classmates, and my coworkers could someday be among them. To the ASRM I would like to say: I appreciate your thought behind the guidelines. I understand that they are designed to protect those like me, those who have a price higher than $5,000. But please also consider those who do not.
Shara Yurkiewicz, a 2009 graduate of Yale College, is an editorial intern at The Hastings Center who will enter Harvard Medical School in the fall.
Published on: April 27, 2010
Published in: Human Reproduction