Inside The Industry Of Egg Donation

Andrea, a 51-year-old mother of two, still struggles to talk about the painful ordeal she endured when trying to have children 15 years ago. As a younger woman, she'd had several abortions. Then, in her late 20s, she identified as a lesbian and met her partner, Barb. At 35, she and Barb realized they wanted to have a baby together.

It took several attempts — and five miscarriages — with donor sperm before the doctor told Andrea the worst news she could imagine: It would be impossible for her to conceive. Andrea was in shock. Given her earlier pregnancies, she had always assumed she was particularly fertile. Devastated, but not ready to give up, the couple turned to egg donation. They eventually found a woman that met their expectations — Andrea primarily wanted someone who looked like her — and prepared to finally have the child they’d fought so hard for.

The Society for Assisted Reproductive Technology reports that in 2012, the all-time highest percentage of babies ever were born through IVF procedures. According to statistics released by the Centers for Disease Control, 1.5% of all babies born that year were conceived through IVF. While egg donation and subsequent IVF is essential to many families and has a current success rate of approximately 50%, the process is replete with problems and ambiguities. Andrea’s case falls on the extreme side. At the eleventh hour, her perfect donor backed out.

The donor said she couldn’t handle the thought of one of her own children being “out there.” The situation was no one's fault — donors are not contractually obligated to donate. But, again, Andrea was left heartbroken. “I thought about throwing in the towel,” she says, “but then I got this almost competitive spirit.”

After another difficult search, Andrea settled on a different donor, and with Barb’s chosen sperm donor, the in-vitro fertilization was successful. Andrea gave birth to twin daughters, who are now 7-years-old.

Barb and Andrea had the happy ending they’d dreamed of, but, unfortunately, their attempts took eight years and cost them not only an emotional roller-coaster ride, but also over $40,000, which included their savings and 401(k)s. At the end of the day, their biggest worry was the state of their finances. “There needs to be more funding,” says Andrea.

According to Tom Wilemon of The Tennessean, and as published in USA Today in 2013, political discussions of funding contraception often overshadow the opposite issue—an inability to conceive. While a few states require insurance to cover IVF treatments, most do not, as IVF treatments are viewed as an “advanced procedure.” Additionally, the National Conference of State Legislatures notes coverage for IVF and other reproductive procedures is highly controversial in the public eye because it is so expensive. So, while initial diagnostic testing — which provide insight into why individuals are having difficulty conceiving — is often covered by insurance companies, many individuals end up paying for infertility treatments out-of-pocket.

The inability to conceive, according to Wilemon, is an issue not as readily discussed as contraception or abortion rights, because many affected couples choose not to talk openly about it. Couples who decide to go the IVF route are often confronted with a barrage of questions about their fertility and personal choices.

On the other side of the issue, the screening process for donors is also far from perfect. Andrea explains egg donors are taken at their word during screening. As a large percentage of donors are college students or recent graduates, they may, for instance, be deceptive about their alcohol use.

Brooke Wilson, of Decatur, Georgia, was 23 when she graduated from Appalachian State University and first donated her eggs. She describes her donor screening process as easy, saying, “It seemed less like ‘screening’ to me and more like ‘interviewing [for a job].’" She remembers being asked about her educational background and SAT scores. However, some on the clinic side describe a much more rigorous process.

Dr. Hal Danzer, co-founder of the Southern California Reproductive Center, explains that at his practice, screening is in fact quite comprehensive, and no one slips through the cracks. His clinic’s process includes everything from BMI to IQ scores to a full psych exam and a history of any infectious diseases. While this rigor is certainly present in some clinics — often the same clinics that offer donors a higher "price" for their donated eggs, it's by no means standard or even regulated. It seems rigorous background checks are better explained by a clinic's desire to provide eggs from quality donors — whatever that might mean — than any sort of official pressure.

Pre-screening and the enormous cost of such procedures pales in comparison to the widespread ambiguity about the safety of these procedures, which varies depending on who you ask. According to Dr. Danzer, there have been studies analyzing the safety of IVF and no risks have been found. But, when it comes to egg donation, no legislation currently exists . There is a general guideline handed down by the American Society for Reproductive Medicine that a woman should not donate before the age of 21 and then no more than six times. However, in certain cases, seven donations — or even more — are permitted at a particular clinic’s discretion. The donation limit is further complicated by the fact that many clinics pay more for a woman to donate her eggs following a successful previous donation (one in which a child was successfully conceived).

In line with Dr. Danzer’s assessment, the decision ultimately lies within the state or clinic when it comes to the number of times a woman can donate. There is no clear explanation for the precise number of six, but there are some possible explanations floating around.

As the New York State Department of Health notes, “There are no firm rules about how many times a woman can donate her eggs, but there are several reasons why a program may limit repeat donations. For one thing, there are still unanswered questions about the possible long-term impact on a woman's health and fertility. Because of this, programs are often reluctant to expose a healthy woman to the process more than a few times.”

The DOH also cites an attempt to limit the number of children created using the same donor. “This limit is necessary, because all children from a single donor will be genetic half-siblings. The small chance that they might meet later in life and be unaware of the relationship raises health concerns about their potential offspring.” Andrea has thought quite a bit about that last one. She and Barb never met their donor —they chose not to — but Andrea admits she still searches for her on Google at least once a year. She wonders how many children her donor has gone on to “have.” Much to Andrea’s amusement, the woman is unfindable, a ghost.

Despite loose guidelines, because there are databases but no official registry for egg donors, there is no way to prevent a woman from clinic-hopping and donating elsewhere once she’s hit her limit with a single clinic or agency, notes Dr. Isabelle Ryan of the Pacific Fertility Center in San Francisco. This is an issue egg recipients might not even be aware of. There is also evidence that clinics and agencies recruiting egg donors might not always act in the most ethical manner. A 2012 study conducted by the Columbia University Mailman School of Public Health that analyzed information from 102 egg donor agencies or clinic websites found some troubling statistics: 34% of these sites mentioned paying women with "desirable" traits more for donating. Further, 56% did not mention short-term physical risks to donating, like Ovarian Hyperstimulation Syndrome, and 77% failed to mention possible negative psychological effects. The study did not assess whether these risks were discussed later in the donation process

As to the issue of compensation, to be certain, money is a factor for many donors, many of whom follow the rules and are well-intentioned. Doctors in the field confirm this motivation but do not view it as problematic. Dr. Danzer explains a particularly in-demand donor, perhaps based on physical appearance, may negotiate a higher payout — That is, if she passes the frequently rigorous pre-screening process (Dr. Ryan says her clinic recently accepted 38 out of 800 applicants, as many did not meet their criteria).

Wilson, for instance, says children have simply never been for her. Meanwhile, college debts were beginning to pile up for the recent grad and the option had its allure. “The idea of giving up my life to care for another — forever — has just never appealed to me that much,” Wilson says. “I admire the sacrifices parents go through for their offspring but never thought it was the path for me.” Wilson has now donated three times. However, motivating factors for donors do run the gamut. Dr. Ryan cites the desire for many to simply help somebody else. She says donors tend to be emotionally invested in the process.

Twenty-six-year-old Cassi Speer, of Santa Rosa, CA, has donated twice with surrogacy agency Growing Generations. She has always been inspired to help out those in need, particularly since she and her now-ex-wife had a son via sperm donation. (They now share custody of him.) “I was trying to give back,” explains Speer, “I was donating blood and doing everything I could think of — I wanted to give back what I received because a lot of families don’t have that.”

The question of whether or not to remain anonymous is another significant consideration. Wilson’s only regret is not meeting the couples who received her eggs. The decision to be in contact with the donor or not is one with which many people struggle. Oftentimes, their initial choice changes down the line. While Andrea and Barb chose not to meet their donor, they also speculate about the day they might need more genetic information on their children for health purposes. Andrea has not figured out how she will approach the subject with her daughters, if she decides to tell them about the donated eggs at all.

Still, the New York State DOH highlights the current health ambiguities and need for more research that remain when it comes to egg donation. “If there are no complications, being an egg donor should not affect your later fertility,” the website states. “However, if you develop serious complications, involving bleeding, infection, or loss of an ovary, it may jeopardize your ability to conceive.” While this may sound like fine print that no one need seriously heed, a lack of substantial research and legislation reveals there could be greater, more transparent, and more standardized awareness about the egg donation process. Neither Wilson nor Speer feared risks at the time, though Wilson now half-jokingly says, “You never think anything bad will happen to you in your early 20s.”

A 2007 study in Regenerative Medicine adds yet another significant consideration that may be overlooked when it comes to egg donation and requires far greater discussion, both within the medical community and in society in general. "The right of all groups to participate in and benefit from equitable and safe research must be developed for egg donors as for other kinds of research participants. Particular attention should be paid to the opinions and desires of women from historically underserved populations as to how to conduct donations and guide research so as to serve all members of society."

In fact, Kari L. Karsjens of the University of Dayton School of Law, argues egg donation perpetuates racism and the commodification of “ideal traits” as many recipients are seeking “the highly sought after...woman who has blonde hair, blue eyes, received a 1400 on her SAT, attends an Ivy League school, and who preferably has some additional talents such as music, sports, or theatre,” ultimately streamlining the kind of baby born through IVF procedures. This perspective echoes Dr. Danzer’s statement that more “ideal” donors are often able to negotiate a higher payout. The cycle is perpetuated as families seek out certain idealized traits, which results in a higher supply of women with these traits at the expense of other women who wind up less in demand. Karsjens adds some troubling statistics from a well-known fertility clinic: “Out of 95 egg donor profiles, only 11 featured women of color. Of these 11 minority egg donors, three were Asian-American, three were African-American, and four were Hispanic-American.”

Andrea, Speer, and Wilson all ultimately walked away with positive experiences. However, there is enough evidence to highlight that, while egg donation is a crucial practice, it should be better regulated, standardized, and attended to as it continues to grow and expand well beyond the 1.5% of total births. Rife with questions around what constitutes "ideal" genetic traits, the long-term effects on both donors and recipients, and the role health insurance plans should play in financing IVF, it's clear that regulation around egg donation is still in its infancy. As demand continues to surge, it's time to reevaluate how this industry functions.