Soaring egg donation prices causing ethical concerns

Monday, October 07, 2002

By RUTH PADAWER

Staff Writer, Bergen Record ( New Jersey )

            The going rate for a woman's eggs has now reached $7,500 - triple what it was just four years ago. It's the latest move by clinics in a fiercely competitive market to supply eggs to patients lining up at their doors.

            The increased fee - which is passed on directly to the infertile couple - puts clinics in a quandary. Higher compensation has helped attract more women willing to inject themselves with ovary-stimulating hormones and give up the eggs. But some fear the spiraling cost of egg donation will further price out many couples for whom a younger woman's egg is their last shot at pregnancy.

            When doctors at the Fertility Institute of New Jersey and New York in Westwood increased their donor fee last spring to keep up with competitors in the metropolitan area, they wrangled with the ethics. In the end, they conceded they had little choice. In April, the clinic - run by one of the pioneers of egg donation - announced it would pay donors $7,500. Almost immediately, the center saw a 30 percent spike in inquiries by potential donors.

"Unfortunately, the way it is right now, egg donation is not very accessible to many patients who would like to use it, and that gives me a lot of pain," said Zalman Levine, a reproductive endocrinologist at the Fertility Institute. "But the alternative of lowering what we pay to the donor so more patients could afford it would mean we wouldn't get any donors at all, and that doesn't help anyone. We're uncomfortable with both choices."

            In the last few years, the once-discreet search for "donors" has become frenzied and commercialized. Entrepreneuring brokers have sprung up on the Internet, posting photos of models and accomplished college graduates naming their own price to rent out their ovaries for a month - sometimes asking (and getting) as much as $50,000, particularly for Ivy League pedigrees.

            And as the fees accelerated, so did the debate over whether the eggs were truly a donation or if they instead were a commodity subject to market whim.

When the St. Barnabas fertility clinic in Livingston broke with the community standard of $2,500 in early 1998 by offering twice that, it was roundly slammed. Medical ethicists said the hike degraded human life; others said it amounted to "pimping for patients." With prospective donors defecting to St. Barnabas, competitors blamed the program for upping the ante in a field already viewed by some as ethically ambiguous.

            Under pressure, the ethics committee of the American Society for Reproductive Medicine wrestled to find a fee that reflected the "time, inconvenience, and discomfort" of egg retrieval. In August 2000, the committee recommended that fees remain below $5,000. Higher rates, it said, could coerce financially needy women to give up their eggs without carefully considering the procedure's physical and emotional risks. The potential to turn human eggs into a commodity was troubling, the association said, and "higher payments, particularly for women with specific characteristics, also convey the idea that oocytes [eggs] are commercial property."

         Fees above $5,000 thus "required justification," the committee said. It did not say to whom the justification should be directed, or what justification would suffice. Fees above $10,000, the committee added, were inexcusable and inappropriate.  

        Federal laws prohibit paying for organs used for transplants. Compensation is allowed, however, for body products, such as blood and eggs.

         But compensation based on the risk and inconvenience of egg retrieval is difficult to calculate.

         Every day for up to three weeks, donors have to inject themselves with hormones once or twice daily. Every other day, they must go to the clinic for blood tests and internal ultrasounds to monitor the growing egg sacs. The donor is then sedated intravenously and a doctor passes a needle through her vaginal walls to collect a dozen or so mature eggs.

         The side effects vary, but often include headaches, cramping, bloating, and moodiness.      

         Occasionally, ovaries respond too heartily to the hormones, quadrupling in size and threatening the woman's health: cardiovascular problems and kidney, lung, or liver troubles. Sometimes, a patient is left infertile.

         It is not easy money.

         Yet the demand for eggs continues to accelerate, as more women reach the end of their fertile years still yearning for children. In 1999, the most recent year for which figures are available, nearly 10,000 women were implanted with embryos grown from another woman's eggs; hundreds more lingered in frustration on waiting lists. Self-styled entrepreneurs sensed an opportunity and seized it. They began marketing donors aggressively on the Internet, highlighting good looks or good grades, and sometimes allowing the egg suppliers to name their own price.

         Conceptual Options is one of many such Web sites. There, "exceptional donors" - those with at least a 3.75 GPA or other notable traits - compose a separate list, with photos and pedigrees available for viewing.

         Mara, a 23-year-old Olympic gold medalist in swimming, is there, asking $50,000 for one month's supply of her eggs. So is Laura, a 20-year-old blonde with a 3.5 GPA at Princeton , asking $ 25,000. There's Robyn, 28, a practicing attorney asking $30,000, and Stephanie at Yale, for $20,000.

"I don't feel I can personally tell some woman what her pain, suffering, and risk is worth," said Mary Anne Lathus , who started the agency after battling her own infertility - and recognizing the business possibilities.

        Clinic administrators have struggled to keep up with the unregulated competition, hoping to assure prospective patients that their clinic's supply of eggs was sufficient.

       Less than a year after the Ethics Committee urged clinics to limit their donor compensation to $5,000, St. Barnabas and New York University were the first to defy the limit.

       "Because there was all that hullabaloo when it went from $2,500 to $5,000, we approached state officials before raising the price," said Maureen Ghosh , program administrator for NYU's clinic. "We wanted to prevent any backlash from legislators. We tried to do it without making anyone think we were trying to make an end run around them. The state had nothing negative to say, so we went ahead."

St. Barnabas - already staggering under a bulging waiting list and a waning donor supply - caught wind that a change was afoot across the river and raced to keep up, said Serena Chen, director of egg donation at St. Barnabas' fertility clinic.

       Who raised their rates first is a matter of contention, but by the summer of 2001, both NYU and St. Barnabas were telling donors they would be paid $7,000. Chen said the hike attracted many donors, allowing it to cut its waiting list in half.

        With the stakes raised, clinic after clinic followed.

        "It was a no-brainer," said Traci Cioppa , ovum donor coordinator for Reproductive Medicine Associates, which has offices in Englewood , Morristown , Manhattan , and elsewhere. "No girl is going to donate eggs with one program if she can get $2,000 more with a program down the street."

         One of the few to protest the hike sweeping across the metropolitan area was Yakov Epstein, a clinical psychologist at Rutgers University who serves as a consultant to IVF New Jersey in Somerset - and who, incidentally, used the egg donation program with his wife in their battle against infertility.

"I was incensed," said Epstein, who wrote the ASRM with his concern, to no avail. "It has become a bidding war, commodifying human life and overshadowing the noble motivation to help someone else achieve their dream. And it adds a burden to infertility patients already financially overburdened."

         Though New Jersey now requires health insurers to cover the cost of infertility treatments, it does not cover egg donation fees.

         Yet the higher those fees go, the more prospective donors take notice.

Consider Donor A, a New Jersey woman who asked that her name not be published. At 31, she was a full-time artist strapped with unpaid bills.

        "It was right after Sept. 11, and I figured no one was going to be buying art - I wasn't even interested in making art," she said. "But I had debts to pay off and I was panicked about money. So when I heard about getting paid for egg donation, I called."

         She slogged through endless forms, twice-daily injections, frequent blood work, invasive interviews, with her eyes on the money that would soon come her way.

        "But then I thought about how sad it would be to not be able to have kids if you wanted them, and I'd sit in the waiting room and see these sad people who were trying so hard to get pregnant," she said.

        "The whole thing was much more emotionally rewarding than I expected, and I would probably do it again. I felt like I was giving someone a wonderful gift. I would have done it for much less money."

Ruth Padawer's e-mail address is padawer@northjersey.com