Diane Tober considers how different compensation schemes for donation affect the experiences and choices of egg donors and announces the launch of her research project which analyzes egg donation practices in the US and Spain.
Compensating egg donors is currently a hot button issue. Opponents argue that permitting egg donors to be paid could lead to “undue inducement,” which is concerning given the known and unknown risks related to the injectable hormones and surgical procedures required for egg extraction. Proponents bemoan the shortage of women willing to provide eggs purely out of altruistic motives, and see payment as a solution to the shortage problem and reasonable in light of the time, trouble, and potential risks women endure when they become egg donors.
Despite the controversies, there is little understanding of how different compensation structures actually affect donors’ decisions and experiences.
I have been conducting mixed methods research with egg donors since 2014. I have interviewed close to 100 egg donors from around the world, as well as intended parents and professionals working in the fertility industry.
In my own research, a handful of participants provided eggs without compensation, for a family member or a friend. Most egg “donors” were paid, and (in the US) taxed on their “donation” income. The amount donors received for their eggs ranged from as low as $1500 to as high as $150,000. In the US, the average payment is between $5,000 and $10,000 per cycle. The highest payment amount that I have heard is $250,000, which was told to me by the founder of a US egg donation agency that specializes in “elite” Asian donors. The egg recipient was a wealthy woman from China, who wanted the egg donor to meet a specific set of criteria, such as small hands and a degree from Massachusetts Institute of Technology.
In my research, I ask: What accounts for this large range in monetary compensation?
In the US, the egg donation industry is largely unregulated or under-regulated, and varies from state to state. Intended parents typically choose their egg donors from online profiles. Women with certain traits—such as blonde hair or blue eyes, education from a prestigious university, or Asian or Jewish ancestry—are more popular (and costly) than other types of donors. Also, egg donors whose previously donated eggs have resulted in a pregnancy may be paid about $2000 more for each cycle. The US represents a multi-tiered market in human eggs, which includes all the uncomfortable eugenic implications surrounding how we think about race, class, intelligence, gender, and attractiveness.
An unregulated compensation system has implications for egg donors. In my research, most egg donors provided eggs to pay off student loans and tuition costs. The majority of these donors report feeling compelled to undergo repeat donation cycles because it is difficult to turn down the money. Many also expressed that the feeling of helping someone have a baby is “addictive.”
Egg donors in my research report producing between as few as 10 eggs to as high as 80 in a single cycle, with most between 25-35 every time they donate. Women have a range of reasons for providing eggs. Yet the promise of high compensation in the US system—coupled with the high cost of education—may result in donors doing more cycles, often with little rest in between, and also potentially increase demand on donors’ bodies to produce higher quantities of eggs per cycle than the 10-20 generally considered safe.
Anecdotally, most of the donors I’ve spoken to who provided eggs in Canada, South Africa and Australia—all countries where compensation for egg donation is banned—reported far fewer eggs per cycle, usually between seven to fifteen. In Spain, where compensation for egg donation is regulated, the average reported egg count per donation cycle is 16. Is this just coincidence? Do fertility practices in countries that ban or cap compensation use less aggressive medication protocols than their US counterparts?
To explore these questions, I am launching a National Science Foundation funded research project to compare egg donation practices in the US and Spain.
Spain’s regulated market prohibits recipients from choosing their own donors, requires anonymity, and limits donor compensation to €1100 per cycle. There is no compensation variation based on traits or education; although, intended parents still attempt to request students. In Spain, since physicians choose the donors on behalf of their patients, they avoid the high competition for specific donors we see in the US, where recipients may attempt to outbid each other for popular donors and “high-demand donors” feel pressure to commit to back-to-back cycles, at greater risk to their own health.
Does Spain provide a reasonable compromise between “altruistic,” “reimbursed,” and “for-profit” egg provision? Do egg donors experience different standards of care under these different regulatory structures?
By examining how these different systems operate on the ground we can gain insight into the interplay between money, medical markets, medical care—and the impact of egg donation/provision on women’s lives, under different regulatory settings around the globe.
Diane Tober is a medical anthropologist and assistant adjunct professor at the University of California, San Francisco, Institute for Health and Aging and a documentary filmmaker.
She is the author of Romancing the Sperm: Shifting Biopolitics and the Making of Modern Families (Rutgers 2018, and is finishing her documentary film on egg donation, The Perfect Donor. @Diane_Tober