Egg donation in America

Many young American women may be risking their health, their future fertility and even their lives for cash, to provide donor eggs for those who can't conceive. Anna Moore reports on a growing trend…

Many young American women may be risking their health, their future fertility and even their lives for cash, to provide donor eggs for those who can't conceive. Anna Moore reports on a growing trend…

In the USA, the egg market is booming, with thousands of women (most of them under the age of 30) selling their eggs through online agencies and thousands more women (mostly over 40) trawling through the websites, matching up IQ and eye colour, picking the genes they would like their offspring to have.

In America, as in England, the birth rate among women over 40 has rocketed. While women undergoing IVF under the age of 39 are more likely to use their own eggs, older women frequently have no choice but to use donor eggs, as eggs decline in quality and quantity once we're over the age of 40. In fact, donor eggs are now used in 12 per cent of all IVF attempts in the US, making it the country's fastest growing infertility treatment.

Egg donation in the US has become big business. Largely unregulated, it has developed like any other consumer-driven industry, with the most in-demand donors commanding the highest prices. Quite simply, for attractive, educated young women, selling their eggs is a way of making serious money.

In the UK, it's illegal to pay a donor more than £250 in 'compensation' for each egg cycle donation. Consequently, there is a shortage of donors and the waiting list for would-be mothers can be three years long. In America, couples pay whatever they want. While the average payment per donor cycle is $4,217 (£2,795), it's not uncommon for a donor to be paid $15,000 (£9,940), and in special cases (typically, a blonde, blue-eyed, athletic Ivy League student) fees have hit the $100,000 mark.

Shelley Smith, founder of eggdonation.com, says she receives about 750 applications a month. A steady stream of these are from British women, all of whom are now rejected since US guidelines restrict the use of eggs from anyone who lived in Britain between 1980 and 1996, the peak BSE years. And according to Robin von Halle, president of Alternative Reproductive Resources in Chicago, this is increasing due to the credit crunch. 'Whenever the employment rate is down, we get more calls,' he says. However, all applicants have a hard time getting through. 'They have to be really bright and really attractive,' says Smith, bluntly. 'No one ever asks for eggs from someone who's ugly.'

According to Smith, the industry has changed beyond recognition – and not necessarily for the better – since she started in 1990. A former actress, she conceived her own twins using donated eggs. At that point, donors were found by word of mouth – a sister, a friend, a nurse at the clinic. Smith had the idea for an agency and put an ad in an actors' journal that read, 'Become an egg donor. Rewarding emotionally and financially.' She received 75 responses.

'Now there are hundreds of agencies, plus the internet,' she says. 'The good thing is that there are lots of donors and lots of information for clients. The bad thing is that that may mean they don't concentrate on the right things. When I was finding a donor for myself, the most important part was finding someone I could connect with. Now, it's about university entrance tests, IQ, bells and whistles. People will come to me saying, "I've been on 23 websites and I can't find anyone with the right eyebrows."'

Connor also admits to a certain amount of cherry-picking. 'I wanted someone intelligent, outgoing, with a great family background,' she says. 'There was one girl they suggested and I just couldn't stand her forehead. It sounds shallow and terrible but she had this big, giant forehead and I just couldn't do that to my kid.' Laura chose to meet her donor – Nicole, a yoga instructor – before going ahead. 'The first thing that struck me was that she had an incredible smile,' she says. 'She loved to read and all the books she liked were my favourites, too.'

For people who can't find the right donor through an agency, there are brokers who, armed with a list of requirements, will search on your behalf. Other prospective parents place ads on student campuses. 'Bright, creative egg donor wanted by loving, playful Boston couple,' reads one. 'We recycle, floss our teeth and respect our elders. Anal personality a plus.' Another says, 'Egg donor wanted – $35,000 compensation. We are a couple seeking a high-IQ egg donor to help build our family. You should have or be working on a university degree from a world-class university, you should have standardised test scores and preferably some outstanding achievements and awards.' In fact, couples in search of 'educated' eggs can now go directly to universities. Many, including Yale, run their own in-house egg donation programmes.

With so many services set up for prospective parents, the welfare of the donors tends to be overlooked. Agencies are unregulated and unlicensed. Guidelines recommending that no one donates more than six times are not enforceable. For some women, the lure of $15,000 for ten days' 'work' is too hard to turn down – they do it again, again and again. Yet, there are almost no long-term studies of the health risks of serial egg donation.

Jennifer Lahl, director of the Center for Bioethics and Culture, is one concerned voice in the wilderness. 'No one is looking at the donors' future. We have not studied or tracked donation long enough to make sure it's safe. These are very powerful drugs they are taking. If you're sick, if you have cancer, then, yes, you'll take a strong drug. But these are healthy young women. It's crazy.'

Some of the immediate health risks are well documented. For ten days, donors inject themselves with drugs to make them produce more than one egg and stop those eggs from being released. The donor is then placed under anaesthetic and the eggs are extracted using a large needle.

Side effects can include mood swings, cramping and abdominal swelling. A more serious risk is 'hyperstimulation', where the body produces too many eggs and the body swells with fluid. In most cases, this is mild to moderate but, in rare, more severe cases, it can lead to thrombosis, and even death.

But these aren't the only risks. Calla Papademas, a Stanford student who agreed to donate her eggs for a fee of $15,000, suffered a rare reaction to one of the drugs, Lupron, which caused a massive stroke, left her in a coma for eight weeks and caused lasting brain damage.

'For every woman, there are risks associated with anaesthetic. Some are left infertile because of infection and scarring during the harvesting procedure,' says Lahl. Nor do we know if these women have eggs to spare. 'Women are not born with unlimited eggs,' she says. 'When you hear of people donating ten, 11 or 12 times, you have to wonder if we're creating another whole generation of women with fertility problems.'

There also remains a question mark over the long-term risk of cancer from the fertility drugs used in both egg donation and IVF. The basic premise is that they lead to high levels of oestrogen – and certain forms of cancer are oestrogen-receptive. Several high-profile women in both the UK and USA have linked their cancer to fertility drugs. The journalist Ruth Picardie, who died of breast cancer aged 33, was one. Paul Merton's wife, Sarah Parkinson, who died of the same disease at the age of 41, is another.

'There are risks, known and unknown – and if we took money out of the equation, there wouldn't be so many women wanting to do it,' says Lahl.

The price of eggs - UK-style

While women in America browse through lists of potential donors, as if shopping for a new lipstick, UK women unable to conceive naturally have fewer options. It's illegal for egg donors to be paid in this country. They can be compensated for loss of earnings, but the total amount cannot exceed £250 per cycle. With such slight financial motivation, there have always been few UK donors.

Faced with waiting lists of up to three years, desperate UK couples have increasingly pinned their hopes on overseas clinics. In countries where donors are paid, supply matches demand and women whose own eggs are not viable can receive fertility treatment almost immediately. Countries such as Spain, where 'expenses' for donor women are much more generous than in the UK (at Barcelona's famous Institut Marques, for example, women receive €900 in 'compensation'), are becoming a mecca for so-called fertility tourists.

Back home, the picture for infertile women is much bleaker, and some resort to extreme measures in their search for egg donors. Last year, 55-year-old Linda Weeks gave birth to a daughter after advertising for a donor on buses across London.

This is an edited version of the feature 'Wanted: Egg Donors', which appears in the March 2009 issue of Marie Claire.

Useful websites: infertilitynetworkuk.com hfea.gov.uk (Human Fertilisation and Embryology Authority) ngdt.co.uk (National Gamete Donation Trust)