Drowning in credit-card debt and student loans, young women are selling their eggs for big payoffs. But can they really make the right medical and moral decisions when they're tempted with $15,000?
JAMIE GALBRAITH SITS SLIGHTLY HUNCHED OVER AT JAKE'S, THE RESTAURANT in a Marriott hotel in Woburn. She's uncomfortable, and she hasn't eaten much, because yesterday morning she spent 45 minutes in stirrups at the Brigham and Women's Hospital Center for Assisted Reproduction while a doctor suctioned 66 eggs out of her ovaries.
A little cramping is a small price, Galbraith tells me, considering that a Boston couple is paying her $15,000 for her trouble. She is 5-foot-8 and has green eyes and naturally blond hair. She lives in Michigan, but human eggs don't stand up to shipping, so she came to Massachusetts and to her clients' fertility clinic for the operation. This is her fourth procedure in three years; she has another scheduled in July in New Jersey.
It would be nice to say that she is only here to help someone. That this mother of two and military wife wants to spread the joy of family life - and she does. But there's another reason why Galbraith, who turns 27 this week, has spent so much time in stirrups. She needed to raise a down payment for a house and relieve some of the $14,000 in loans she's using to pay the University of Phoenix online, where she is studying for a bachelor's degree in business.
Galbraith's fee is on the high end of the spectrum, which starts at about $5,000 per donation cycle. That's the process by which eggs are artificially stimulated to mature, then surgically "harvested," or extracted. Prospective clients are shown pictures of Galbraith now, as a baby, and during adolescence. They also see photographs of her children, now 6 and 9. But what sells even more persuasively is her track record. Each of her three prior donations produced egg counts in the 40s - more than double what is typical - and each resulted in offspring. So her price has climbed, from $5,000 to $8,000 to $15,000.
What's more, she and her sister, a nursing student in Illinois who is also a donor, are starting their own agency to recruit other donors and match them with patients. The sisters have already recruited a few of their friends and are actively looking for more donors.
And they know where to look: college towns, where the perfect specimens - young, SAT-tested women deep in debt - can be recruited through school newspaper ads, websites like craigslist, and photocopied fliers stapled to trees. The ads probably won't mention the medical and psychological screenings. Or the injections of hormones. Or the suctioning. They will mention families in need. And they will promise cash.
"That's why it's tempting," Galbraith says. "If they can squeeze in $10,000 in a couple of months, that's good money."
THIS EMERGING MARKET REALITY - THE DEBT DONOR - WORRIES healthcare professionals and bioethicists. And Boston, a city crawling with young women saddled with high rent and credit-card and college debt, is fertile territory.
Look under the category "Business Opportunities" in the May 5 edition of Harvard University's student newspaper The Crimson: "A warm, loving Jewish couple wants your help to achieve our dream of becoming a family. . . . Compensation $8,000+." Check out a listing posted on boston.craig-slist.org in late May by California-based broker Alternative Conceptions: "Fulfill some of your own aspirations by earning $6,500 and higher for your time and effort while helping others create a family."
But "loving" and "helping" are not the whole equation. "I wouldn't do it to help out a woman I never met without being paid," says Geri, a Yale University graduate school alumna in environmental management and international relations with brown eyes and wavy brown hair who spoke to me on the condition that only her first name would be used. A week before her graduation two years ago, she was paid $7,500 for a donation cycle that yielded eight eggs at the Yale Fertility Center. "I used it toward credit cards and loans," she says. Geri, 30, works as a market research analyst in Minneapolis but is looking for a new job, possibly in the Boston area. Once she settles somewhere, she says, she'll likely look into donating again to pay off another steep bill and her remaining loans. "I'm not embarrassed to say that," she says.
"The hook is the money," says Lauren Berliner, a documentary filmmaker who spent eight months last year following egg donors for her Emerson College master's project, a 22-minute film called All in One Basket. "It can be addicting," says Berliner, now a doctoral student at the University of California, San Diego. "Once you get paid $5,000 and you pay off your credit cards, if [a woman] is working her butt off to try to make money at $8 or $10 an hour, here she just can undergo this procedure."
Berliner followed Leticia Ward, now 29, through the process. Ward, who lives in Waltham, tells me she donated in February 2005 while she was working temporarily as a nanny after being laid off from a job as a flight attendant. "I was looking online and thinking about egg donation and also thinking about some of the financial aspects that come with it," says Ward, who is 5-foot-4, with blue eyes and naturally curly blond hair that falls down to the middle of her back. "I've said that wasn't my first motivation" - she liked the idea of helping out an infertile couple, she says - "but definitely it was my second. I think to say that it wasn't, I would be lying."
She signed up with Dream Donations, an agency in Newton that offered her $5,000. Once she was picked by a recipient, Ward was sent to the Boston IVF fertility center in Waltham. As all donors have to do, she went through a battery of psychological, physical, and blood tests to make sure her eggs were healthy. She stayed celibate for two months. Then, for 10 days, she used a syringe to inject hormones into the fat of her lower belly. The hormones hyper-stimulate the ovaries so more than one egg will mature (without drugs, usually only one egg ripens each month in a fertile woman). She underwent a series of vaginal ultra-sounds so doctors could check on the progress of her ovaries.
When the ultrasounds showed what seemed to be a large number of mature eggs, she went under general anesthesia for a surgical procedure called vaginal oocyte retrieval. An ultrasound probe with a small needle attached was inserted into her vagina. A doctor used the ultrasound to guide the needle toward one ovary, and then one by one into each mature follicle, and then did the same with the other ovary. The needle was attached to a tube, which was attached to a little pump, which was attached to a small pedal. The doctor pressed on the pedal and suctioned out the fluid - and, it was hoped, an egg - from each mature follicle. This was collected into test tubes, which were then passed over to the embryologist to be viewed through a microscope. The embryologist kept a running count; Ward yielded about two dozen eggs.
Two days of cramping afterward, and it was over. She spent $2,000 of the money on a new laptop computer, $1,000 to start an IRA, and the rest went to her credit-card bill.
"You know," Ward says over shrimp salad and ginger ale, "just like anybody else, you get into a point in your life where you're like, 'I just need this little bit of capital to get me through.' " And it did get her through, for a time. She nearly closed out the debt on that card, although, she says, "I racked it back up." Now working at a wine store in Sudbury, Ward says she would consider donating eggs again, but she doesn't want to become "one of those people who do it for the money."
That "little bit of capital" can have a real pull. At Northeastern University, where I teach journalism, I hear undergraduates talk about their financial needs all the time. School loans are usually a given. But so are wallets full of plastic - credit and debit cards, store cards from Victoria's Secret and Gap - most with balances too high to reveal to Mom and Dad. According to a 2004 study by Braintree-based student loan company Nellie Mae, 56 percent of college seniors carry four or more cards and owe an average of $2,864. Where are most ever going to get the money to pay more than the monthly minimum?
Last year, a student came to my class having just seen a flier for egg donation posted in an academic building. It sparked a discussion. I could see some of the women, most of them 19 or 20, growing wide-eyed at the possibility of all that money. Some of them stated, flat out, that they would never donate. But it seemed as if others would consider it.
Because it took me about 15 minutes to get pregnant a few years earlier, I had never really considered the egg trade before that day. Women are born with all the eggs they'll ever have, and I was lucky that one was ready for me when I needed it. Donor eggs are used for in vitro fertilization when a woman is unable to conceive using her own. As for the donor herself, scientists do not know whether undergoing the procedures required to harvest eggs affects a woman's ability to conceive later.
Confronted by the views of these college students, I found myself embracing my inner Pat Robertson. Did those in favor of donation realize that they would not just be clearing their Visa cards, but creating a kid? Granted, sperm donors are doing the same thing - but for considerably less money and with considerably less risk attached. Some students said that if a woman needed the cash and could get it, why not? I can't help but think of so many of my friends, in their late 30s and early 40s, who are trying to conceive but can't because they waited too long. Some of these friends may wind up using donor eggs. Still, I want to know how my students would feel 20 years from now if they were unable to conceive because they waited too long to try, but they had donated eggs when they were younger to create a child for someone else? Worse, how would they feel about having done it for money?
THE EGG BUSINESS HASN'T BEEN AROUND FOR LONG. The first donations on record were in 1986, when only one of 41 known fertility clinics in the United States was performing the procedure, according to the nonprofit American Society for Reproductive Medicine in Birmingham, Alabama. Since 1995, the Centers for Disease Control and Prevention has kept some statistics on the use of donated eggs. By 2003, the latest year for which numbers are available, there were 399 clinics in the nation and seven in Massachusetts, six of which were using donated eggs. As for the number of times embryos created from donated eggs have been implanted inside a recipient, the procedure occurred 4,783 times in 1995 and 14,323 times in 2003.
But no industry or government group tracks how many women donate, or how many times, or how much they're paid for what kinds of deals. "The agencies are not regulated in any way," says Debora Spar, a professor at Harvard Business School and author of The Baby Business: How Money, Science, and Politics Drive the Commerce of Conception.
So, this is how it works: Anyone who wants to can open a business, recruit egg donors, and create marketing materials to entice patients and fertility clinics to use their donors' services. Recipients of donor eggs, patients who are usually already working with a fertility clinic, shop around for a blond donor, a tall donor, a donor who can play the piano or who got a high score on her SATs, or whose last harvest yielded an above-average number of eggs. Agencies cannot pitch the eggs as a commodity for sale; that's akin to selling body parts, which is illegal. Rather, they advertise a "service" - the work a woman does so that a fertility clinic can harvest her eggs. Agencies generally charge recipients an additional fee (Galbraith will charge 50 percent) on top of the donor's price, as well as travel expenses. As for what donors are paid, agencies may set a rate or a range, or they may let donors negotiate their own fees.
The lack of business-practice standards, particularly around fees, is worrisome to many who have watched the industry grow. "This is what we used to think about when people were [paid for] donating blood," says Robert Manning, author of the 2000 book Credit Card Nation and a professor of finance at the Rochester Institute of Technology in Rochester, New York. Blood donors were often using the money to get through some sort of financial crisis. With egg donors, "we're talking about young women who haven't started their careers," Manning says. "They're looking at massive changes in the employment market, higher costs across the board for housing, transportation, things like that." After graduation, a sharp decline in standards of living can be frustrating for those "who had a taste of a pretty nice life" in college, he says. "The pressure of competitive consumption is pretty unrelenting." With such high donor fees, the attraction grows.
There is also a long list of concerns related to the medical practices, legal standards, and bioethics involved, says Gerry Koocher. President of the American Psychological Association, dean of the School of Health Studies at Simmons College in Boston, and editor of the journal Ethics and Behavior, Koocher sat from 1995 to 1998 on the now-defunct National Advisory Board on Ethics in Reproduction.
Most disturbing to Koocher is the lack of knowledge about or studies into long-term health effects on egg donors. "This is relatively new," he says, "and nobody is doing long-term research. If you're a young woman, you need the money, you read the informed consent form, but how much do you pay attention to the long-term effects? . . . I think of my own daughter, who is 24. Would she have made great medical decisions if she had to do it for something like that?"
The ethics board was composed of lawyers, theologians, reproductive physicians, and bioethicists. It considered all kinds of questions, including: What are the legal ramifications when a woman's eggs become a commodity? What if the donor or her family decide to reclaim her biological offspring later on? Another worry is the "incentive to lie or deceive when there is financial motive," Koocher says. What if prospective donors lie about, say, their SAT scores? What if they lie about their family medical histories? And a particularly sticky question for the offspring: What if a clinic takes an embryo, splits it, and then freezes half to be implanted later? "What would it mean to you if you have an identical twin who is five years younger than you?" Koocher asks.
Rabbi Moses Tendler, a professor of bioethics at Yeshiva University in New York, is troubled that donors can set their prices based on their ethnicities, their looks, the competitive schools they've attended, or what kind of students they are. "In Third World countries, [women] go into prostitution," he says. "Here, because they have good SAT scores, they sell eggs?"
There is no compensation for "services" attached to Harvard University's research project announced this month that will use donated human eggs to clone human embryonic stem cells. State laws regulating stem-cell research define "donated" for research very differently than practitioners define "donated" for reproduction. "You have two completely different sets of people involved here on the demand side. The stem-cell people are saying, 'This is research,' " Spar says. The fertility people, however, "realized they weren't going to get enough eggs unless they offered compensation."
The American Society for Reproductive Medicine sets ethical guidelines for both brokers and clinics to follow that are designed to guide participants through some of the process's murkier issues. For example, it suggests that no donor be paid more than $10,000 per harvest, be younger than 21 years, or make more than six donations in her lifetime, this last because of the unknown health effects. But since the society has no real authority, fertility clinics and donor agents officially pledge to follow the guidelines in order to attract business. However, most flout them, says Dr. Brian Berger, medical director of the Donor Egg and Gestational Carrier program at the Boston IVF fertility treatment center. "Just about every agency that I'm aware of has self-reported to ASRM that they follow the guidelines. I can say that of the agencies that say they adhere to the guidelines, 90 percent of them are lying," Berger says. "They use all kinds of excuses, but we know it's not true. You don't need to be an investigator to know that. Look at their websites."
To track this in his own small way, Berger says, each time he meets a donor, he notes her age and asks how much she's being paid. He keeps a file on the different agencies and how well they adhere to society guidelines. When it becomes clear that an agency is paying some of its donors considerably more than others, he refuses to do further business with them, telling his patients to go elsewhere.
But that's not always feasible. Boston IVF, which is the largest fertility clinic in New England, refuses to work with two local agencies that Berger wouldn't cite for the record. That's because, Berger says, the two agencies regularly pay more than $10,000 for a single harvest, allow women to donate more than six times - which happens "too often," he says - and allow women with known genetic defects (such as the cystic fibrosis gene) to remain in their active catalogs.
"What we say is, there are only a certain number of agencies we will work with that we have investigated and spoken to and believe are mostly adherent to ASRM guidelines," Berger says. "I say 'mostly,' because if we only worked with those who adhere to the guidelines, we'd be down to one agency. And, so far, that's not an acceptable option."
Asked if he thinks local or federal governments should step in to regulate the agencies, Berger replies: "I don't know what to say. In general, I hate regulators, because once regulators get involved, they impair our ability to practice medicine the way we think it should be practiced."
Harvard Business School's Spar has come to a different conclusion. "I think this area is underregulated," she says. "I don't think it needs a huge amount of regulation, but I think it needs some basic, simple rules of the road, and those would be rules that focus on the health of the parties involved. And I would include among the parties the donors, the recipients, and the children, and none of those folks right now receive protection by law the way I think they should."
IN HER NEW ROLE AS A BROKER, JAMIE Galbraith is hoping to recruit primarily Ivy League students, because she knows they can earn $8,000 right out of the gate. "They're going to make a lot more money," she says, "and the more money they make, the more money I'm going to make." Still, Galbraith insists, she wants her donors to do it for the right reasons. The pay is important, but the point is to help people, she says.
But what will she do, I ask, if a prospective donor says that all she cares about is the money? Will Galbraith really turn her away?
"They've got to come to terms with their own reasons as to why they're doing it," she says. "As long as they do the procedure right, and they can follow instructions and get through it, it's not up to me to decide why they do it. It's up to them."
We're sitting in the restaurant in Woburn, and Galbraith is trying to talk. But her 6-year-old son, who is at a nearby table, keeps coming up behind her to tug on her long hair. Galbraith brought him along, as well as her mother-in-law, who drove her back to the hotel from the hospital. It's nice to have the help, especially since it didn't cost her anything. All of their expenses are being paid - including airfare, $129 a night for the hotel, $50 a day for food, plus a rental car and parking - by the recipient of her 66 eggs.
Carlene Hempel is a freelance writer and teaches journalism. E-mail comments to firstname.lastname@example.org.