Abortion

What Price the Human Egg?

Morganne Rosenhaus

With spring here and Easter in the rearview mirror, you can't help but think a bit about eggs of all types, among them human eggs. Amidst research on marketing of human eggs, I found this Latin proverb, “All life comes from an egg.”  I find this sentiment a bit dated.  Instead I’d like to suggest something a bit more up-to-date, “All life comes from an egg, but that egg comes at a price.”

After a weekend of being bombarded by the image of an egg, in all flavors, colors, textures and sizes, every time I walked into a grocery store or CVS, I decided to research the history and meaning of this shape, which is so ubiquitous during this time of the year.  I found, centuries ago, the egg was a symbol for life and rebirth, themes especially relevant as spring kicks off and this Easter weekend comes to a close.

However, if we fast-forward hundreds of years to today, colorful candy and plastic eggs are not the only eggs associated with life sold on the marketplace.  Human eggs, or oocytes, appeared in the public marketplace in the late 1970s as part of what has become the fertility industry.  The demand for human eggs developed in two settings: fertility clinics, helping women get pregnant, and research labs, investigating embryonic stem cells.  In fertility clinics, finding a woman willing to supply eggs for another woman who cannot produce her own (egg procurement) began as a very personal affair, one where the recipient’s friends or family were the primary egg providers.  Almost forty years later, this scenario has become a rarity.  Now, egg procurement has taken on a “commercial” feel, as eggs are bought and sold with little personal interaction between the egg provider and the egg recipient.

Accompanying the ‘commoditization’ of human eggs and egg procurement are some moral implications.  Like any consumer, parents are looking for a high-quality product and willing to pay any price; in this case that product is an egg.  We have seen evidence that parents want their egg “donor” to have certain characteristics, from physical attractiveness to intelligence.  On one hand, these parents are the ones paying the exorbitant amount to get the best product they can.  On the other, by seeking out egg “donors” with certain characteristics, the fertility marketplace ascribes monetary worth to some human characteristics over others, which is morally and ethically problematic.

Although the American Society for Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART) have issued guidelines regarding compensation for egg “donors,” these guidelines lack the necessary teeth to force compliance.  A study done in 2008 indicated that many member clinics of ASRM and SART are not in full compliance with these guidelines. The guidelines emphasize that $5,000 is the reasonable price for a woman to be paid for her time and risk, but up to $10,000 can be paid in rare cases.  Further, the guidelines take a stab at addressing ethical concerns by stating that compensation should not vary according to the donor’s characteristics.

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Nevertheless, only a week ago, the Hasting Center Report featured an article by Aaron Levine, who discovered that particular women are being solicited and offered more than $10,000 for their prized eggs.  After examining college newspapers from all over the country, he revealed that women at top Ivy League schools are being offered $35,000 to $50,000 dollars for their eggs.  When women have “high quality” characteristics, as defined by those seeking their eggs, the aforementioned guidelines are tossed aside.

Few legislators are interested in placing regulations on any aspect of the fertility industry, so long as its major purpose is to assist in creating children and building families.  Since regulations placed directly on the fertility industry, and more specifically egg procurement, are unlikely, solutions that support and educate individuals about existing guidelines are particularly important.  One of the suggestions provided in the Hasting Center Report is a viable option that takes both into account: encouraging ASRM and SART to contact college newspapers and suggest that ads asking for human eggs be accompanied by ASRM and SART guidelines.  This option has the potential to discourage various egg-procurement agencies from placing ads that counter such guidelines and has the potential to inform prospective egg “donors” of possible risks and reasonable payment.

Amidst my research, I found this Latin proverb, “All life comes from an egg.”  After researching the human egg market, I find this sentiment a bit dated.  Instead I’d like to suggest something a bit more up-to-date, “All life comes from an egg, but that egg comes at a price.”

Commentary Law and Policy

Personhood Amendments Would Hurt Families Who Want Children

Keiko Zoll

The amendments in Colorado and North Dakota giving legal rights to fetuses would leave people seeking in vitro fertilization in the dust.

Read more of our articles on “personhood” measures here.

Next week, voters in Colorado and North Dakota will take to the polls to vote on amendments that would give legal rights to zygotes, embryos, and fetuses, also known as “personhood” laws. Measure 1 in North Dakota seeks to recognize and protect the “inalienable right to life of every human being at any stage of development”; meanwhile, Colorado’s Amendment 67 asks voters to add “unborn human beings” to the state’s criminal code. Though Personhood USA, which is backing Amendment 67, may define “personhood” as the “cultural and legal recognition of the equal and unalienable rights of human beings,” make no mistake: The personhood movement is an attempt to undermine the legality of reproductive choice in America. This doesn’t just put abortion in danger; it also leaves some of the people wanting children the most—the infertility community—in the dust.

My own journey to motherhood was a textbook case of in vitro fertilization (IVF). Five years ago, I was diagnosed with premature ovarian failure, a sort of “end of the line” infertility diagnosis. In order to get pregnant, my doctor told us, I had a single choice: IVF with donor eggs, as my own were virtually nonexistent at the age of 26. While I grieved the loss of having a child with my own genes, I found hope and healing in the possibility of experiencing pregnancy and birth. Without IVF, we wouldn’t have the family we have right now.

I still have the grainy black-and-white photograph, taken just before my embryo transfer, of our two three-day-old, ten-cell blastocysts. I often wonder which of those two nearly transparent spheres became the charming, talkative toddler I now chase after.

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Even though I know that my son and one of those two balls of cells are the same, however, at no point when I look at that photo do I see a family portrait, much less a person. At that stage of human development, they were merely dividing tissue to me: They had no names, no genders, no sentience. But proponents of the personhood movement, who would legally define life as beginning at conception, evidently see a completely different picture. And it’s one that could make it much more difficult, if not impossible, for the as many as 7.4 million American women with infertility to create a family of their choice by seeking the treatments they need.

Here’s a basic primer of how IVF works: A woman’s ovaries are stimulated to produce multiple eggs. She may be the prospective parent, an egg donor, or even a gestational carrier who both donates her eggs and carries the pregnancy. Doctors then retrieve the eggs and fertilize them in the lab with the prospective father’s sperm from a provided sample. Three to five days after fertilization, medical professionals transfer one to three tiny embryos into the recipient uterus. Any excess embryos—on average, there are about 15—are often frozen and kept in cryopreserved storage until patients use them or discard them.

If personhood amendments were to pass, doctors would presumably have to treat all those embryos, or even the fertilized eggs, as if they had human rights. This, care providers point out, has no basis in medical fact—and it could severely hamper their ability to do their jobs safely and effectively.

“Among the many, many problems with these so-called personhood measures is they simply do not in any way reflect scientific reality,” Sean Tipton, chief advocacy and policy officer for the American Society for Reproductive Medicine (ASRM), told Rewire. “For physicians providing infertility care, the disconnect between the legal language and actual medicine is very dangerous. The reality is that most fertilized eggs will not develop into babies.”

Tipton fears that Amendment 67 and Measure 1, among other personhood measures, would place a question of potential murder on physicians trying to give their patients the best care possible. About those extra embryos, for example, he wondered, “Will doctors be forced to transfer them into their female patients anyway? Do they provide the best care for their patient, or do they risk facing a homicide charge?”

When it comes to the matters of how many embryos to transfer at once, there is no “one size fits all” recommendation. However, current ASRM guidelines call for the use of elective single embryo transfer (eSET) whenever possible in most favorable conditions, such as if it is the patient’s first IVF cycle or the embryos are of good quality. For most women younger than 37, ASRM recommends that doctors transfer a maximum of two blastocysts at once; for patients older than 38, it recommends no more than three. ASRM and the Society for Assisted Reproductive Technology (SART) specifically set up these guidelines to reduce the number of potentially dangerous multiple births resulting from IVF, including twins, triplets, quads, and higher-order multiples.

In our case, our egg donor—with whom my husband and I are close friends—provided us with 20 eggs then fertilized with my husband’s sperm. Six of those developed into embryos. My doctor transferred two embryos into my uterus; one implanted. Currently, we have four high-grade embryos “on ice”—and no hard-and-fast decisions yet on what to do with them.

Had personhood been in effect at the time of my IVF cycle, however, I wouldn’t have had the option to transfer only two embryos. Our donor would have had to understand that any of the extras couldn’t legally be discarded. We, as prospective parents, would be left with only two options: Donate the remaining embryos to another couple trying to conceive, or transfer them all to my uterus.

The first option, explains New Hampshire reproductive and family lawyer Catherine Tucker, could dissuade known donors from trying to give an altruistic gift to a close friend. “Your known donor might be willing to donate only to you and not to strangers,” Tucker noted. “So [she] might refuse to donate to you simply because she’s not comfortable with her genetic material going to other prospective parents in the event you cannot use all the embryos yourself.”

With our donor, after careful consideration, discussion, and legal negotiation, we collectively decided that any excess embryos would be ours, and ours alone, to use for future cycles, discard, or donate to scientific study as we saw fit—but not to another recipient couple. Our friend made her generous offer to be an egg donor for us, and for no other third parties. Even in cases where the donor is open to the idea of embryos going elsewhere, though, finding other recipients would be a logistical nightmare, especially with no way to guarantee any excess embryos at all.

On the other hand, transferring all of the embryos could put patients’ safety at risk. Assuming my same 50 percent implantation rate, for example, if I had transferred all six embryos, I could have had a triplet pregnancy—and that’s outside of the risk of any of those embryos splitting into multiples of their own. These types of high-order pregnancies put the woman and the fetuses at risk for serious complications, including preeclampsia, gestational diabetes, premature birth, miscarriage, and even maternal death. This is to say nothing of the costs of raising an unexpected additional child, which can be an immense burden on infertility patients who have already spent thousands of dollars on their treatments.

Personhood laws could also cause a number of other legal ambiguities for those involved in the IVF process. Barbara Collura, executive director for RESOLVE: The National Infertility Association, pointed out to Rewire that the vague language of the proposed amendments generates myriad potential gray areas that voters likely haven’t considered.

“What about the infertility patient scheduled for her IVF procedure on November 5?” she pointed out. For that patient, Collura noted, it would be unclear as to whether she had a right to refuse any of her embryos, or if she must cancel her treatment entirely—which would still leave any fertilized eggs retrieved and created before the ballot vote in legal limbo.

Collura also brought up the issue of unused embryos awaiting possible transfer. She raised the questions, “If Amendment 67 and Measure 1 pass on November 4, what will happen to embryos that are currently frozen and in storage in those states? Will infertility patients be able to cross state lines now with these so-called ‘pre-born people?’” After all, if embryos do not survive the trip, their transporters could be held responsible.

Tucker, too, noted that such an action might leave individuals liable to prosecution. “Under personhood laws, IVF physicians and lab personnel who handle the embryos could face criminal punishment should anything happen to these embryos,” she noted in an email to Rewire.

As a result of potential ramifications like these, personhood laws would have devastating effects for reproductive facilities. Reproductive endocrinologists in North Dakota have warned that Measure 1 would effectively shut down the sole fertility clinic in the state, rendering them unable to treat their patients. Amendment 67 would also either shutter Colorado fertility clinics entirely or severely limit their doctors’ abilities to practice recommended standards of care. Although Personhood USA claims that the amendments would not affect IVF, the very nature of the treatment means that some fertilized eggs or embryos are going to be discarded—which is blatantly at odds with the provisions outlined in personhood laws.

Ultimately, personhood initiatives could have a chilling effect on the entire practice of reproductive medicine. While the average person “might think that an IVF laboratory shutting down on account of a personhood law sounds far-fetched,” noted Tucker, “the bottom line is that personhood laws will end the ability of prospective parents to form their families with the help of IVF, egg donation, and even gestational surrogacy.” When legal rights are granted to ten-cell balls of tissue, every aspect of the handling, care, diagnostics, and treatment of those embryos must be taken into consideration. Personhood rights would upend decades of improving standards of best practice.

Personhood proponents argue that they are “working to respect the God-given right to life” and “protecting every child by love and by law.” But for people like me in the infertility community—who want nothing more than to have children of our own—personhood would actually prevent us from having those children in the first place.

I’ll never forget what our friend said when she made her incredible offer to donate her eggs to me and my husband: “I think everyone who wants to have a family should be able to. If I can give you that chance, I want to help because you two deserve to be parents.” If personhood proponents had their way, we’d never have had that chance at all.

Commentary

Silicon Valley’s Egg-Freezing Perk Is Bad for People Across the Board

Marcy Darnovsky

Egg freezing is an individualized, questionably effective technical fix for a fundamentally social problem.

News about Silicon Valley’s egg-freezing perk has ignited many much-needed conversations about the tech industry’s family-unfriendly workplaces and policies that make it hard to reconcile being a mother and having a job. But of dozens of articles and blog posts, only a few have noted that establishing egg freezing as an employee benefit for a small number of privileged women is a bad idea across the board. For women who opt to freeze their eggs, the procedure’s safety is dubious; for everyone else, the practice shifts the focus away from the social changes that working families urgently need.

Defenders of the egg-freezing offer have welcomed it as an “option” for women lucky enough to work for Facebook or Apple—itself a highly limited career path, as recently compiled statistics about the lack of diversity in high-tech companies can attest. Like its lexical sister “choice,” “option” often functions as a trump card in potentially fraught debates like this one. I’m not arguing that “choice” or “options” are unimportant, but we need to to situate them in broader social contexts, too, including those of class, race, and gender.

Perhaps it’s unfair to link upscale frozen eggs to the overwhelming issue of economic inequality. But it’s worth noting that the dilemma of “work-family balance,” which seems to have spurred these corporations’ initiatives, is connected to the struggle for reproductive justice. Through that lens, we need policies that support women—all women—if and when they decide to have children, as well as if and when they decide not to bear a child.

Companies like Apple and Facebook are trend-setters, and their decisions about how to spend human resources budgets may well affect other corporate employers. That influence could be wielded in any number of ways. Imagine, for instance, that instead of upping the ante in the escalating “perk war” to attract and retain high-end employees, Apple and Facebook had worked with the HR departments of the security firms, caterers, and other companies with which they contract to develop basic parent-friendly benefits.

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After all, it’s safe to say that few working women in Silicon Valley or elsewhere would otherwise spend an unexpected $20,000 to put their eggs on ice. In every state in the country, $20,000 is more than a year’s salary at the hourly minimum wage. Even middle-income women would be far more likely to allocate such a windfall toward enrolling a toddler in a higher quality preschool, putting more food on the table, taking time off to take care of a newborn or sick parent, or signing up for a better health-care plan. Yet rather than committing to strategies that could conceivably aid families at all points on the employment spectrum, Facebook and Apple evidently chose to put time and money toward an extremely narrow slice of the population.

Furthermore, because egg freezing is a medical procedure, we need to assess its safety as well. In that context, the procedure is an “option,” all right—but one that is risky, invasive, and highly unreliable.

Egg retrieval itself is neither simple nor safe. It involves weeks of injections with powerful hormones, some used off-label, to hyper-stimulate the ovaries. Nausea, bloating, and discomfort are common. More serious reactions requiring hospitalization—including severe pain, intra-abdominal bleeding, and ovarian torsion—occur at low, but not negligible, rates. Deaths, though fortunately rare, have been reported.

Some studies suggest that egg retrieval is associated with higher rates of infertility and cancer. But shockingly, though the fertility industry has harvested eggs for decades, there have been too few follow-up studies to ascertain the extent of these longer-term risks.

With so much that is unstudied or under-studied about the safety of egg retrieval, meeting the bioethical standard of “informed consent” for patients is actually quite challenging. Of course, women who freeze their own eggs for possible later use, like those who undergo egg retrieval when they’re actively pursuing a pregnancy, often say they’re willing to take risks because of their deep desire for a genetically related child.

But even the motivating strategy here—work and freeze now, then mother later—carries low odds of success. According to a 2013 meta-analysis, even the newest flash-freezing method fails up to 77 percent of the time among women age 30, and close to 90 percent of the time in women age 40.

Then there’s the matter of safety for children who result from frozen-and-thawed eggs. The chemicals used in the freezing process are toxic, but no one knows whether they’re absorbed by embryos, or whether that might cause problems as children get older. Even the American Society for Reproductive Medicine, whose fertility clinic members have an arguable financial interest in promoting expensive new procedures, discourages egg freezing for elective, non-medical reasons.

Though it’s unfortunate that Facebook and Apple are endorsing an unproven technique that puts their own employees’ health at risk, it makes sense that this quick-fix engineering approach would appeal to high-tech giants used to reshaping the world with gadgets and gizmos. And while they probably weren’t expecting the backlash, covering the egg-freezing tab to keep more of their female employees “leaning in” for more hours, and more years, may turn out to be a net plus for the companies. A lucky few women among this already tiny minority may also wind up winners, with higher-powered careers, and babies too.

But egg freezing is an individualized, questionably effective technical fix for what is fundamentally a social problem—or, rather, a whole raft of them. Let’s hope the next round of conversations about work and families includes strategies for confronting those issues, too, such as public policies and family-friendly workplaces that support reasonable and gender-equitable wages, paid parental leave, quality health care, and affordable child care for all of us.