As Demand for Donor Eggs Soars, High Prices Stir Ethical Concerns
By RONI CARYN RABIN
Published: May 15, 2007
Samantha Carolan was 23 and fresh out of graduate school when she decided to donate eggs to an infertile couple. Ms. Carolan concedes that she would never have done it if not for the money, $7,000 that she used to pay off some student loans.
She has since had a second egg extraction, for which she was paid $8,000, and she is planning a third before taking a break.
“The first time, it’s frightening,” said Ms. Carolan, now 24, of Winfield Park, N.J. “It is surgery, and I don’t think I would have done it without compensation. But I had very limited pain, and it was a great experience for me. I would have done it the second time for less money or even no compensation.”
Though many egg donors derive great satisfaction from knowing that they helped someone start a family, the price of eggs has soared in recent years as demand has increased, and the sizable payments raise controversy.
A survey published this month in the journal Fertility and Sterility, “What Is Happening to the Price of Eggs?” found that the national average compensation for donors was $4,217. At least one center told the authors of the paper that it paid $15,000. Many centers did not respond.
Though laws prohibit the sale of transplant organs, sperm donors have always received small payments, and prospective parents in the United States are allowed to compensate women for their far greater expenditure of time and energy. (Many countries, including Canada and Britain, do prohibit payments to egg donors.)
The American Society for Reproductive Medicine considers compensation of $5,000 or more to “require justification” and sums exceeding $10,000 “beyond what is appropriate.”
Meanwhile, advertisements recruiting students from elite universities to donate promise tens of thousands of dollars, and donor agencies have sprung up, appealing to would-be parents with online videos and photo galleries of donors. According to the Centers for Disease Control and Prevention, 5,767 babies were born in 2003 from donor eggs; the number of actual egg donations is probably much higher, however, because the success rate is fairly low.
Ethicists and some women’s health advocates worry that lucrative payments are enticing young women with credit-card debt and steep tuition bills to sell eggs without seriously evaluating the risks.
“The real issue is whether the money can cloud someone’s judgment,” said Josephine Johnston, an associate for law and bioethics at the Hastings Center, a research group in Garrison, N.Y., that specializes in medical ethics. She does not oppose compensation, but she does worry about high prices.
“We hear about egg donors being paid enormous amounts of money, $50,000 or $60,000,” Ms. Johnston said. “How much is that person actually giving informed consent about the medical procedure and really listening and thinking as it’s being described and its risks are explained?”
Adding to the debate was a proposal by lawmakers in Maryland to ban payments for eggs. Proponents of compensation say if payments are lowered or eliminated, the supply of eggs will dwindle or dry up.
“Women aren’t exactly lining up to be donors,” said Dr. Mark Sauer, director of the Center for Women’s Reproductive Care at the Columbia University Medical Center. “There are a lot more recipients than donors.”
Part of the problem is that the risks of donation have not been thoroughly studied. Although the consensus among most reproductive endocrinologists is that extraction is safe, five deaths have been reported in Britain. There are enough unanswered questions that stem cell researchers have promised not to pay for eggs.
“One of the most striking facts about in vitro fertilization is just how little is known with certainty about the long-term health outcomes for the women who undergo the procedure,” a recent report by the Institute of Medicine said.
The 2005 guidelines of the National Academy of Sciences for human embryonic stem cell research discourage paying for eggs for research. The California Institute for Regenerative Medicine reimburses women only for out-of-pocket expenses like lost wages or cab fare.
“As a public agency, we felt we shouldn’t be putting money on the table that might induce someone to take a risk,” said Geoffrey Lomax, senior officer for medical and ethical standards at the institute.
So far, women have not come forward to give away eggs for research. “I just completed an outreach initiative to 21 institutions across the state that we’ve funded,” Dr. Lomax said. “No one has had an egg donated specifically for research.”
The reluctance is understandable. The process of egg extraction is time consuming, and it is not comfortable. For some women, it can be painful. A woman first has to take medications to stop her menstrual cycle and then daily hormone injections for several weeks to stimulate her ovaries to produce a crop of mature eggs at once.
The drugs may cause bloating, weight gain, moodiness and irritability, and there is a risk of a rare condition called ovarian hyperstimulation syndrome that can cause life-threatening complications, blood clots and kidney failure.
The egg extraction itself is a surgical procedure in which a thin needle is inserted through the vagina into the ovary to retrieve the eggs and liquid from the follicles. Risks include adverse responses to anesthesia, infection, bleeding or the inadvertent puncture of an organ.
It is the long-term risks, both physical and psychological, that are harder to assess. Questions have been raised about whether extraction may jeopardize the donor’s fertility, and critics worry about the potential psychological harm to a donor of eggs as a young woman who later finds that she is unable to have children.
And since egg donors go through much the same process as women trying to conceive in vitro, there are concerns that they may be prone to the higher rates of certain cancers that some studies have found among infertility patients. Still, said Dr. James A. Grifo, director of the division of reproductive endocrinology at the New York University School of Medicine, “There is no credible evidence of long-lasting effects or health consequences down the line.”
That does not necessarily mean that the procedures are safe.
“There’s no health-outcome data collected by anybody other than some voluntary reporting, and there’s no postmarket testing on how these drugs are being used,” said Susan Berke Fogel, co-founder of the Pro-Choice Alliance for Responsible Research, a project of the Public Health Institute in Oakland, Calif.
In a recent article in The New England Journal of Medicine, a Harvard Business School professor said the controversy over the price of eggs was obscuring questions of women’s health. The author, Debora L. Spar, an economist who wrote “The Baby Business” last year, calls for more studies of the drugs being used, more long-term follow-up of donors and federal regulations to ensure proper informed consent.
When Ms. Carolan went to donate, the short-term risks were described to her in detail, but she said she did not recall any mention of possible long-term risks. Her family opposed her decision because they worried about her health, she said, and her friends did not understand.
“They all think I’m crazy,” she said. “If the topic comes up, and I tell friends I’ve done it, they’re like: ‘Why? Oh my God, aren’t you afraid you have a baby out there?’ They’re so stunned and shocked.”