Egg Donation and Surrogacy

“Ova Time: Women Line Up To Donate Eggs – For Money”

Melinda Beck’s piece in today’s Wall Street Journal was overall accurate. It even acknowledged the cost for the recipient side.

It also acknowledges the ASRM’s limit on compensation and mentions one donor agency that ignores it, since “the offer brings in donors who might not otherwise be interested.” But that is just the point of the limit; a compensation of $50,000 can be unduly coercive. Furthermore, since any legitimate clinic is a member of the ASRM and therefore pledges to abide by its guidelines, what clinic would agree to work with these donors? These exorbitant fees depend on ethical breaches by more than just the agency, but the doctor as well.

The ASRM’s compensation limit was set in 2000, and reiterated in 2007 but not updated. I think the changing times require an update to $12,000 or more. But until it is official, in our egg donation program we will keep our compensation at $10,000. It is worth it to keep our ethical standards.

The broadcast networks are catching up with this old story about the alleged “surge” in egg donations. In ABC’s video “Egg Donations On The Rise” (shown on Good Morning America), they had one clinic owner testify that applications are up about 50%. However, the piece assumed throughout that anyone who applied could actually donate eggs; it never distinguished between egg donor candidates and actual donors.

This caused some major inaccuracies. Anyone can apply to be an egg donor; only a small percentage, about 10%, will go on to donate. There was no claim that the actual number of egg donor cycles have increased as well. [See my earlier post: Egg Donation and the Economy.]

Another claim, that a “decline in standards” would be an inevitable consequence of this influx of egg donors, is illogical on two counts. First, the bigger the pool of applicants, the more selective recipients and doctors can be; second, FDA regulations for screening are uniform and not a matter of interpretation. The report implied that egg donation agencies screen candidates, but in fact, medical professionals do. Corners are never cut in order to accommodate any candidate; it’s against the law. Although it provided no evidence, the piece implied, however, that these risks are taken. It puts a sensationalistic spin on the story, no matter how erroneous.

NBC Nightly News did a segment (”Surge in Egg Donations Raises Concerns“) which covered the alleged surge in context of the health of the egg donor, and overall was more accurate. It discussed the need for a registry for egg donors that would track their long-term health. This is a good idea; any privacy issues should be able to be resolved. The ABC piece also discussed a registry for donors so that their offspring could track their genetic heritage. I support this as well. The more we know and learn about every aspect of this process, the better off we will be.

I have been fielding inquiries from reporters recently about the whether the current economic downturn is driving women to be egg donors. Although it makes sensationalistic news copy and sounds plausible, there is no way to draw any convincing conclusions from the actual statistics. According to the CDC, the most reliable source for assisted reproductive technology statistics in the US, the number of fresh donor egg cycles has been steadily increasing every year, irrespective of the state of the economy. [In 2005, the latest year for which complete statistics were posted, there were nearly 10,000 fresh (as opposed to frozen) donor egg cycles in the US.]

But what about the economy’s influence on the recipient’s side? An IVF cycle using donor eggs can cost up to $30,000 (this factors in medical costs, plus donor compensation and agency fees). If the economy is so bad, wouldn’t people have less money to spend on these costly procedures, thus decreasing the demand for donors? The prevailing assumption is that fertility patients are so desperate that they would go to any expense to undergo treatment, despite their incomes or chances of success. We’ll have to wait and see if the numbers continue to increase in 2006, 2007, and 2008 before we begin to draw any conclusions. It is true that those taking advantage of the assisted reproductive technologies are generally wealthier than the general population, since it is prohibitively expensive for most people (and insurance does not cover it in most states). And the possibility of a larger and better quality donor pool, motivated by the need for extra income, may keep the number of donor cycles from slipping steeply.

Of all the pieces I have seen and read on this, Dr. Sanjay Gupta’s video clip was the most sound and reasonable (part of the CNN article “Dim economy drives women to donate eggs for profit”).  I agree that marketing, outreach, and egg donor education has help boost the number of donors in our pool more than any other factor. True, once they hear about it, compensation is the primary incentive for potential donors, in good or bad economic times.  However, the unfortunate impression that impoverished women are driven to sell their body parts for money is way off base, and indicates a complete misunderstanding of the realities of egg donation.

Here are some facts about egg donors and egg donor compensation that most people don’t know:

• The ethical limit for compensation is $10,000, according to guidelines submitted by the ASRM (the American Society for Reproductive Medicine) in 2000 and again in 2007. Any legitimate clinic or agency abides by ASRM guidelines.
• Donors are compensated for their time and effort, not for their eggs. The compensation remains the same no matter how many eggs are retrieved.
• As Dr. Gupta points out, the vast majority of women ages 21-30 are ineligible. Donors must be in excellent health, non-smoking, and fit. They must be free of infectious and genetic diseases (some women are not even aware they are carriers for some diseases such as cystic fibrosis or Fragile X). They go through a whole battery of psychological and medical tests, plus a course of injections for about 8-12 days, and only get paid when it’s all over. It’s hardly a way to make a quick buck.

But here is what most outside the fertility industry don’t know: each donor is chosen specifically by a recipient, who is typically an upper middle class highly educated Caucasian or Asian-American, looking for the same. (Matches for other ethnic groups are made, of course, but with less frequency.) Recipients often demand high academic achievement and test scores, great physical attractiveness, athletic, musical, and/or artistic ability, and other highly desirable traits.

I get many applications from women who are fit, healthy, and fertile. They would likely pass their medical screenings, but for most of them, it would not be easy to find recipients for their eggs. Because of the nature of the demand, the reality is that most egg donors are educated, middle class women looking to supplement their incomes, not poor fertile women exploited by rich, infertile ones.

The best sources for statistics and information are the Web sites for the American Society for Reproductive Medicine (ASRM.org), the Society for Assisted Reproductive Technology (SART.org), and the Center for Disease Control (CDC.org).

Click here for more specific information on egg donation.