Nest Egg

Asian women command a high price for egg donation, but is it worth the risk?

June 19, 2013

Photo by Damien Maloney

The ad wasn’t exactly subtle: “Genius Asian Egg Donor Needed — Above Average Compensation.” The author of the ad, which ran this past January in MIT’s student newspaper, left little to the imagination as to the ideal candidate. “21-year-old Chinese MIT student with ‘A’ grade point average, near-perfect SA T score, several awards in high school and university,” he wrote. “She wants to be an egg donor in order to help bring a child into the world with the same special gifts she has.”

In an age where infertile couples can option the ovaries of healthy young women for a fee, prospective parents can now choose the race, body type, IQ — even alma mater — of the egg donor who will contribute to their future offspring. The more specific or rare the desired trait, the more compensation donors can expect. And increasingly, it pays to be an Asian egg donor.

While the majority of egg donors are paid between $5,000 and $7,000 per donation, Asian or part-Asian donors can demand upward of $10,000. Part of the reason may be basic supply and demand: Infertility is equally common across races, but Asian American women may be more desperate to have children. A 2006 US military study found that, in an equal-access to fertility treatments setting, Asian American women had a rate of utilization that was four times higher than the general US population. This may be due to many Asian societies still placing a high social premium on childbearing.

On the supply side, Asian egg donors are harder to come by than other races and are therefore among the most sought after, according to many egg donor agencies, with Chinese, Japanese and Korean egg donors in highest demand.

But the procedure may come with a personal cost. Unlike nearly every other medical procedure offered in the US , egg donors take on their physical burden without knowing the risks involved — largely because the medical community has never studied them. Whereas the Food and Drug Administration requires a lengthy vetting for the vast majority of pharmaceuticals, fertility clinics are permitted to provide drugs whose long-term effects have never been studied on the target population — the young, healthy and usually poor women who donate eggs.

The reasons for this oversight are founded in the complex history and politics of assisted reproductive technology in the US . But it amounts to a medical sector devoid of government regulation, standardized protocols and risk information for a large percentage of its participants — including, increasingly, Asian women.

The Truth About Harvesting

Raquel Cool’s tan, oval face appears on a screen against a dark background. The high-powered studio lighting turns her rosy Vneck sweater a hot pink and illuminates her long, dark hair like a shampoo commercial. Facing the camera, she launches into an explanation of her hobbies — her love of yoga, travel and triathlons. At several points, she giggles and blushes. “Family is huge to me,” she said with a mix of humility and coquettishness.

The woman in the egg donor advertisement video bears only a little resemblance to the one standing in front of me in real life. On the day I meet her at her art studio, Cool’s hair is short and unstyled, her face devoid of makeup. She wears a simple black dress, sandals and no jewelry. She is also standing in front of a neon light installation shaped like a uterus. When I mention the differences between the video and her current appearance and personality, she smiles. “That’s egg donor Raquel,” she said. “It’s the version of me that recipient parents want to see.”

Cool, 27, is a former egg donor and performance artist living in Santa Cruz, CA. Her latest exhibit, “Live, Nude Eggs” chronicles her experience through mixed media art and a heavy sense of metaphor. Inside the studio, we walk past a series of portraits depicting various medical slides of Cool’s body. One picture focuses on her hormone-stimulated ovaries overflowing with developing oocytes. On top of each one is drawn a tiny arrow with a price tag.

“Based on this past donation, I calculated that each of my eggs is worth $233,” she said.

Biologically speaking, egg donation is simply the female version of sperm donation. In practice, however, the two are very different. “You can’t just give women a cup and tell them, please put your eggs here,” said Aimee Eyvazzadeh, a reproductive endocrinologist in the San Francisco Bay Area who works with both egg donors and recipients.

Women start life with all the egg cells they'll ever have, stored in their ovaries. Once a month, an adult woman will start maturing a few dozen of these cells, also known as “follicles,” as our body prepares for ovulation. Normally, only one of these will make it to full maturity. But egg donors use hormones (a month of daily injections) to trick their bodies into producing more eggs, which means more chances for the recipient to get pregnant. Once the eggs mature, they are retrieved through surgery.

When Catherine Jones, 29, first began researching egg donation, the surgery didn’t bother her so much as the hormones. It took a while for her to get used to the medications — first Lupron, then Gonol and finally Menopur — which she had to inject into herself, sometimes into the tops of her thighs, other times into the small, soft region of her belly.

She went through with it because she liked the idea of helping others have a family. Like the couple that would receive her eggs, Jones is of mixed race. The recipients, a gay couple, told her that they wanted to use her eggs to have two children — one biologically from each father. How perfect that she was half-Asian. She was exactly what they were looking for.

But Jones wanted to have children of her own someday and worried that donating might risk her fertility. She grilled the doctors at a Connecticut clinic not far from her home in New York, asking about the longterm risks associated with egg donation. They reassured her there was no evidence that egg donation was linked to infertility.

The truth is a little more complicated.

Donating a few dozen eggs, even several times, won't put a woman at risk for running out of them, but egg donation hasn't precisely been proven to be safe for donors. That would require at least one comprehensive long-term study following donors in the long run, tracking outcomes like cancer, infertility or onset of menopause. To date, no such study has taken place.

A few studies on infertile women (a different population than egg donors, who tend to be younger and poorer) have linked fertility hormones to an increased risk of ovarian cancer. Whether or not this translates to an increased risk for egg donors is unknown. However, the hormones used in in-vitro fertilization, a common treatment for infertile women, are the same used by egg donors.

“We are supposed to think carefully about the matter of ‘risk-benefit’ ratio when making decisions about whether to approve a research protocol,” said Judy Norsigian, pro-choice author of Our Bodies Ourselves. “That’s a fundamental rule in bioethics. Yet, how can we weigh the case of egg donation when no one knows what sort of risk we’re talking about for egg donors?”

Some fertility doctors are better than others at explaining the gap in research. Former egg donor Kate Chu, 31, remembers the careful phrasing her physician at the University of California at San Francisco used when describing the long-term risks of egg donation. “Like any medical institution, they said there’s always risk. That was the disclaimer,” Like Jones, Chu wanted to have children someday. The doctors reassured her that egg donation wouldn’t affect her own fertility.

She found out about egg donation through her college newspaper, which frequently ran ads recruiting potential Asian donors. Chu fit the bill: highly educated, healthy and Chinese American. She liked the idea of helping a couple start a family. She said she wasn’t tempted by the money and decided to donate through UCSF rather than a private egg donor agency, which would have paid more.

For Raquel Cool, 27, it was definitely about the money. She earned $7,000 from her first cycle, which she spent on a combination of travel, adventures and meals. The next time around, she raised her price.

“I read that, because I’m part Asian, I could ask for more money,” she said. “So I started contacting clinics asking for $10,000 instead of $7,000. At first, they were like, ‘You’re not supposed to be doing this for the money.’ ”

But Cool sees it this way: If the industry were honest about the fact that women are selling their eggs rather than donating them, then maybe “donors” would have a little more power in the process. This is, in part, the catalyst behind her exhibit.

As she was creating the layout of the installation, she tried to imagine a storefront for a freelance egg donor — not in the mushy altruistic terms that clinics use, but the reality of the financial and medical commitment that donors face.

As we walk through the showroom, Cool takes me to a red-curtained box that spans from floor to ceiling. On the front is a small black sign with white letters that read: “porno booth.” Inside, a small television set is playing her egg donor video on loop. The five-minute spot was produced by a Los Angeles-based egg donor agency to include in their donor catalog for prospective clients. As we watch, the video-Raquel smiles and giggles again and again.

“I was so uncomfortable while they were filming this,” she said. She explains it’s common practice for agencies to tell donors how to dress, which hobbies to highlight, what ‘look’ to go for.

“At one shoot, when I got there, they took one look at me and asked me if I had any more makeup,” she said. “I was already wearing a ton. But I offered to touch up the photos later with Photoshop. They said it was OK.”

When she laughs at the memory, it is a deep chortle. Not like a giggle at all.

Cool said the egg brokers eventually agreed to her new fee.

“I don’t see anything wrong wanting to get paid for this,” she said. “Yes, I want to help people, but come on, this isn’t like donating blood. There are risks to consider.”

Cool is only too aware of some of the health risks of egg donation. After her cycle, she developed a mild-to-moderate case of ovarian hyperstimulation syndrome, where the ovaries produce too much fluid, filling the abdominal cavity with liquid and putting the donor’s health at risk. Cool was confined to bed rest for over a week.

The worst of it was that I was experiencing labored breathing,” Cool said. “It was scary.”

Individual clinics often cite conflicting statistics as to how common ovarian hyperstimulation syndrome is, but the Society for Assisted Reproductive Technology estimates up to 30 percent of women taking fertility hormones will develop a “mild” case of the condition, meaning it will resolve itself. But up to two percent will develop severe hyperstimulation, characterized by “excessive weight gain, fluid accumulation in the abdomen and chest, electrolyte abnormalities, overconcentration of the blood and, in rare cases, the development of blood clots, kidney failure or death.”

Fertility procedure-associated death rates for the US are have never been published, but according to a British report looking at infertile women who underwent similar hormone regimen between 2003 and 2005 about the risk of death from ovarian hyperstimulation syndrome seems to be about one in 30,000. No information is available on the frequency of the syndrome among egg donors, but they are thought to be at higher risk compared to infertile women as, according to the Mayo Clinic, the risk factors for ovarian hyperstimulation include being young and thin.

It’s Complicated

During the injections leading up to her own egg retrieval surgery, Catherine Jones felt fine. Doctors monitoring her blood work and ultrasounds estimated that she would produce about 17 eggs, a good number for the couple using her eggs to have a shot at starting a family. On the day of the surgery, she was sedated but not unconscious. Using a long, hollow needle attached to an ultrasound wand, the surgeon removed the mature eggs in her ovaries. Rather than the expected 17, her surgery yielded 31.

Afterward, Jones felt the usual sores but became worried after it persisted for a few days. She noticed her abdomen was becoming more swollen. She was throwing up, and couldn't keep anything down. She was having trouble breathing. She went to the emergency room, where doctors tested her blood and told her she was pregnant, based on high levels of a hormone called HCG in her blood. She told them that the HCG was due to the trigger shot she had received from her egg donation. They didn't know much about that, they told her. That's when she called her fertility clinic.

Her fertility clinic doctor told her to come in. It was ovarian hyperstimulation. This happens every once in a while, they said. They needed to draw out fluid from her abdominal cavity, which was filling with liquid from her hyperstimulated ovaries.

Jones came in, and her doctor asked her to lie down. The doctor inserted a needle into Jones' cervix and began drawing out fluid. One liter. Two liters. It was painful, but the nurses were soothing and chatty. Three liters. Four liters. By the fifth ler, the chattiness was over. The doctor explained they had to stop because they were afraid she would black out. Two days later, Jones came back to the clinic and they drew out two more liters of fluid — seven in all, the volumetric equivalent of almost four party-size soda bottles.

For Jones, the physical pain wasn't the worst part. She felt mishandled, objectified. This was not the “uncomfortable swelling” she had been told happened to five percent of patients. “No one told me what happened to me could happen,” she said. “If they didn't know, they should have said so.”

They didn't know. Or, more precisely, they couldn't know, because there is no database that tracks the percentage of egg donors that develops some degree of ovarian hyperstimulation syndrome. Because of the lack of follow-up studies on egg donors, any risk statistic associated with the procedure is, at best, an estimate and likely an underestimate. As in Jones' case, egg donors who go to traditional hospitals are often misdiagnosed because few doctors outside the fertility field are familiar with hyperstimulation. And for the vast majority, who are treated at the same clinics where they do their donation, their cases are not required to be reported to any national database.

While the lack of adequate health information is concerning for all prospective egg donors regardless of their race, there is something to be said for its particular impact on the Asian American female community. As the group Feminists@MIT wrote in an op-ed response to the “Genius Asian Egg Donor” classified post, clinics advertising for egg donors often neglect to mention the risk to the prospective donor, instead focusing on her reproductive potential.

“When this couple requests a ‘Genius Asian Egg Donor,’ they are perpetuating a colonialist and predatory lore with only the sheerest facade of false reverence,” Mitali Thakor and Linda Chen wrote on behalf of the group’s executive board. “It is a sad reminder of a long history of the sexualization, stereotyping and objectification of Asian women.”

Cool agreed. She felt the agencies were trying to play up her Asian heritage. Cool’s mother is ethnically Chinese, and her father is white, but her parents met in Panama, where Cool was born and raised. While egg brokers portray Cool as strongly Asian, Cool sees herself as a cultural and racial mix.

Jones and Chu, on the other hand, emphasize the significance of helping other Asian Americans.

A 2007 UCSF study found that Asian American women had almost one-third fewer pregnancies and live births after invitro fertilization compared to white women. The reasons why are still unknown, though it may relate to the fact that Asian Americans tend to wait longer before seeking treatment compared to other races. The delay is usually explained by stigma associated with not being able to have children, as well as a cultural emphasis on privacy in personal matters.

“I saw it as a disparity issue,” said Chu, who was 28 at the time of her donation. “It reiterated that this was something I wanted to do. Knowing that there was a couple out there, that felt more real than a lack of research.”

With recipients spending upwards of $30,000 for the entire process (with about $5,000 to $10,000 going towards egg donor compensation), it’s understandable that they would have some preferences. But, as the “Genius Asian Egg donor” MIT ad showed, it’s a thin line between having preferences and throwing money at a nameless, faceless vessel for reproduction.

On Behalf of Donors

Unlike Jones and Cool, Chu’s first donation was an uncomplicated success. She went on to donate two more times over the next three years through UCSF and looks back on her egg donation experience positively.

Jones, who is now two years out from her donation, said the pain of hyperstimulation was worth it as long as it didn't affect her fertility. Even now, she can't bring herself to think about that possibility. It's too heartbreaking.

Cool recently closed her “Live, Nude, Eggs” exhibit to positive reviews. She said she hasn't ruled out the possibility of donating her eggs a second time. Besides, she has a new project to work on now. In March, Cool co-founded an online organization called “We Are Egg Donors,” the self-described “world's first self-advocacy community for women who have (or are considering egg donation).” Her goal is to reach out to other former egg donors so they can share stories, advice and, when the time comes, health outcomes.

Teresa Chin is a science reporter whose work has appeared in several outlets including MATTER, KALW and The Cleveland Plain Dealer.

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