For several decades, assisted reproduction technology has helped infertile couples realize their dreams of having children. However, this process requires gamete donors — men and women willing to give up their own sex cells. Thus, while the emerging market for sex cells has ushered in hope for many couples, this promise comes at a price. While sperm donation can hardly be called invasive, egg donation, on the other hand, poses many risks that are not all fully understood.
To donate, a woman must take hormone injections for several weeks. Typically, a gonadotropin-releasing hormone agonist is injected to prevent normal pituitary stimulation of egg development. After one to two weeks, follicle-stimulating hormones are injected to promote artificial maturation of multiple eggs. At the end of the cycle, an injection of human chorionic gonadotropin stimulates egg release. Retrieval requires surgical insertion of an ultrasound-guided needle through the vaginal wall into the ovary.
For some women, maturation of multiple eggs results in severe abdominal cramping. Women preparing to donate might have as many as 40 follicles ripening in their ovaries as a result of the hormone treatments. For some, the problems exceed discomfort. In her book Sex Cells: The Medical Market for Eggs and Sperm, Dr. Rene Almeling, Assistant Professor of Sociology, reports estimates from the American Society for Reproductive Medicine that in one to two percent of egg donors, too many eggs mature simultaneously and produce serious complications. In women with severe ovarian hyperstimulation syndrome (OHSS), fluid can leak out of blood vessels and into the abdomen, causing bloating and, in rare cases, kidney failure or death.
In addition to the risk of OHSS, egg donation may pose long-term risks. Unfortunately, the seriousness of these risks remains fairly nebulous. Several cases of cancer have been linked to hormone treatments, but thorough research has not been conducted. “We do not have good long-term follow-up clinical studies about what happens to young women who are repeatedly exposed to fertility medications,” Almeling explains. “We don’t even really have short-term studies. I think when a woman goes in and is asked to give informed consent, it can’t be true informed consent. They need to be advised that we don’t have good data.”
The increased risk associated with egg donation means that women are typically paid much more to donate sex cells than men. Men are typically paid about $100 per sperm sample, whereas women can be paid more than $5,000 for a single cycle. In other words, egg donation can be quite financially rewarding, which leads to concerns about exploitation of the sex cell market. In response, the American Society of Reproductive Medicine has issued guidelines recommending against remuneration exceeding $10,000. Furthermore, Almeling writes that egg donation agencies tend to use altruistic and “gift of life” language to persuade women to donate. She suggests that this advertising method might be partially due to the need to screen out women who are interested only in making money from donation, since women in dire financial straits are more vulnerable to exploitation.
The effects of such ethical concerns about egg cell donation are present not only in fertility clinics but also in research laboratories. Researchers have established that immature egg cells are excellent candidates for stem cell research. Instead of using embryonic stem cells, scientists could grow their stem cells in the lab from somatic cell DNA and egg cells. This practice would be a win-win for both the public and scientists, eliminating the current controversy concerning the destruction of human embryos. However, the federal government does not currently compensate women who donate eggs to stem cell research, which has resulted in an egg cell shortage in laboratories and a continuation of the stem cell debate.
For the time being, standing ethical and biological issues shroud the sex cell donation market, limiting the potential benefits that a well-regulated market could provide. Although the procedure of obtaining egg cells has been standardized and proven successful for many couples, nuanced questions of how to compensate donors and to prevent incest between children from a single sperm donor have yet to be resolved. But for now, egg cells are a coveted yet controversial commodity for infertile couples.
Cover Image: Three days after conception, this embryo consists of 8 cells. Courtesy of Wikipedia.