Assessing the Risks

PEOPLE IN THE EGG DONATION BUSINESS say they're paying a donor a fee for her trouble, not buying parts of her body from her. But some medical ethicists still worry that those fees may coerce women into putting their health at risk. "It certainly sounds like they're not donors, but vendors, to me," says Dr. Ruth Macklin, a medical ethicist at the Albert Einstein College of Medicine in New York. She points out that when one clinic or program raises its fees, all the others have to follow suit. She says introducing those "market forces" has "a very unsavory quality to me."

Other physicians have also expressed dismay over the rising fees paid to donors. Dr. Mark Sauer, a prominent New York fertility specialist, wrote a recent medical journal article complaining that a neighboring clinic, St. Barnabas Medical Center, raised its donor fees to $5,000. Sauer said at that rate, donors make more than $300 per hour. He called clinics' charging infertile couples what the market will bear "an approach to medicine so flagrantly greedy as to threaten the existence of the field."

St. Barnabas' Dr. Paul Bergh responded that $5,000 may not be enough. He said such a fee is not coercive as long as potential donors are told of the risks and benefits of donation. Bergh pointed out that egg supply does not keep up with demand. "Coercion," he wrote, "is more likely to occur when recipients, faced with long waiting lists, pressure friends and relatives into participating as donors on their behalf."

Most of the donated eggs in the United States still come from paid donors. But some infertile couples do turn to a sister, or a friend.

A California graduate student we'll call Emily agreed to donate eggs to a dear friend and her husband who were having trouble conceiving. "I think they would make great parents," Emily says. "And I saw how much pain this was causing my friend."

Emily says the clinic she and her friend decided to use downplayed the risks of donation. "I was sort of led to believe that this was an incredibly low-risk procedure, that people do it all the time, and that sometimes, something mildly bad happens to maybe one in 10,000 women," she says. But egg donation can lead to complications. No one knows the long-term effects of the drugs used to stimulate the ovaries. And any surgery carries risks. Also, in rare cases, the egg retrieval surgery can essentially cause hormones to poison the body.

That's what happened to Emily. She developed ovarian hyperstimulation syndrome, a complication that can lead to fluid build-up in the chest and abdomen, kidney failure, and even death. Emily had to be hospitalized. She was sick for weeks, barely able to climb the steps to her second-floor apartment. Emily believes the fertility doctor pushed her body too hard because he had made a deal with the recipient couple. If they didn't get pregnant, he didn't get paid. To try to ensure a pregnancy, Emily says, "I believe he went beyond what was ethical in terms of my health."

Emily has never had children, but she wants to someday. She doesn't know whether this incident has threatened her future fertility.