Don't Call Me Princess

by Peggy Orenstein

  Back then, doctors extracted women’s eggs surgically under general anesthesia. The risks of infection, organ damage, and even death from the procedure may have been justifiable for an infertile woman going through IVF, but not for a donor. So early researchers borrowed a trick from animal husbandry: when the donor ovulated, she was inseminated with the recipient’s husband’s sperm, the embryo formed in her body and, four to six days later, was flushed out of the uterus and transferred to the intended mother. This adapted procedure “was problematic in many ways,” said Dr. Richard Paulson, chief of reproductive endocrinology and infertility at the University of Southern California’s Keck School of Medicine in Los Angeles and a pioneer in the development of egg donation. For one thing, if the doctors missed the embryo, the donor could wind up pregnant.

  By the late eighties, though, European researchers perfected a new method of retrieving eggs by using a thin needle, guided by ultrasound and inserted through the vaginal wall. The procedure took ten minutes and required only light anesthesia. As Liza Mundy writes in her book Everything Conceivable, this technique would revolutionize—or, you could even argue, create—the fertility industry by unhooking clinics from their dependence on hospital operating rooms. Suddenly, any doc with a lab and the right equipment could set up his own shop. Using that advance, Paulson and his team made a breakthrough of their own: some of their patients had aged past forty, which was considered the outer limit for medical intervention, while waiting for donors. Would it be possible, Paulson wondered, to push that threshold? He tried transferring multiple embryos created from a young woman’s eggs into the body of a forty-year-old . . . and she became pregnant. In 1990, Paulson published an article in The New England Journal of Medicine announcing that as long as the eggs were young, the age of the recipient appeared immaterial. And just like that, the market for donor eggs was born.

  One day this spring, Becky, who is thirty-eight, met me at the loft where she works in the music industry. She is a tiny woman—just over five feet tall—with dark blond ringlets pulled back in a ponytail, and three earrings ascending one ear. A wedding photo on her desk, taken last summer, showed her tucked beneath the arm of her husband, Russell, a public school teacher who is more than a foot taller than she and who asked that I use only his middle name. Next to the photo was a clutch of supplements and prenatal vitamins that she was downing to prepare her body for pregnancy. Behind those sat a small statue of Ganesha, the pachyderm-faced Hindu deity, lord of both obstacles and beginnings.

  Becky, who asked me to use a nickname, sat down and began scrolling through pictures on the Web site of Ova the Rainbow, one of the (regrettably named) agency sites she browsed last fall during her search for an egg donor. “When I first started doing this it was really emotional for me,” she said. “I kept thinking about that kids’ book, Are You My Mother? I’m looking through these pictures of young women and feeling like: ‘Oh, my God! Is this the mother of my future child? Is this the mother of my future child?’”

  I stood behind her, watching the young women go by. Each was accompanied by an assortment of photos: girls in caps and gowns graduating from high school, sunburned and smiling on family vacations, as preschoolers in princess frocks, sporting supermodel pouts in shopping-mall glamour portraits. Sperm banks rarely provide such visuals, which is just one disparity in the packaging and treatment of male and female donors, according to a study published last month in the American Sociological Review. Egg donors are often thanked with presents and notes by recipients for their generous “gift.” Sperm donors are reminded that they’re “doing a job,” providing a “sample,” and performing an act they’d presumably do anyway—which may be why many men in the study were rattled when told a pregnancy had actually occurred. And although the men could admit they were in it for the cash, ovum donors were expected to express at least a smidge of altruism.

  It was weird to look at these pictures with Becky. I inevitably objectified the young women in them, evaluating their component parts; it made me feel strangely like a guy. Becky clicked on a photo of a twenty-two-year-old brunette with a toothy grin. Each profile listed the donor’s age (many agencies consider donors to be over the hill by thirty), hair color (there seemed to be a preponderance of blondes), eye color, weight, ethnicity, marital status, education level, high school or college GPAs, college major, and evidence of “proved” fertility (having children of their own or previous successful cycles). Some agencies include blood type for recipients who don’t plan to tell their child about his conception. Others include bust size and favorite movies, foods, and TV shows. One newly pregnant woman told me she picked her donor because the woman liked The Princess Bride. “Some donors chose Pulp Fiction, and their favorite color was black,” she said. “That’s just not me. If I have the choice between someone who likes The Princess Bride or someone who likes Pulp Fiction, everything else being equal, I’m going for Princess Bride.”

  Obviously, a penchant for romantic comedy is not an inherited trait. Nor, for that matter, will appearance or intelligence necessarily be passed along, though they are the first things most prospective parents look for in a donor. It’s a curious paradox: couples who conceive a baby this way believe that relationships, not genes, make a family, yet in their search for a donor, they romanticize the potential of DNA. And why not? The culture itself is in conflict over how much genes shape us, even as science and the media claim they determine, or predetermine, more than ever. Consider the schmaltzy news stories of reunions between adopted children and their “real” mothers, or tales of identical twins reared apart who are eerily alike. The notion that blood is thicker than water, that we can pass on our best—or someone else’s best—characteristics (but somehow not our worst) is a powerful one, even though anyone who has biogenetic children will tell you that they can be as different from one another, and from their parents, as strangers.

  Women using donor eggs know that. But the dream, the hope, of replicating oneself dies hard. “Loss is the first stage of building a family with donor gametes,” says Madeline Licker Feingold, a psychologist who works with couples pursuing third-party reproduction. As part of that reckoning, women have to give up not only on using their own eggs but also on the search for the perfect donor, one who is in every way their match. Or, as Becky put it: “It’s this tension between letting go and clinging to this ideal of the donor being ‘you.’” I understood that. My own potential donor was an aspiring journalist. I knew that didn’t mean I’d give birth to a future English major, but I found it reassuring. It felt familiar; more important, it felt familial. And so I, like many potential donor recipients, developed a new mathematical equation. Call it the transitive property of human connection: I liked Charlotte Brontë and she liked Charlotte Brontë, ergo we were the same; I would love our child and it would love me.

  Becky’s search lasted about two months. Russell participated, too, of course, but since it was her genetic material they were replacing, she had the final say-so. Husbands typically defer to their wives for that reason, according to Feingold. The reverse, in her experience, is less true: women are usually more involved in choosing sperm donors than men are in choosing egg donors. That may be, she says, because women tend to be more devastated by infertility than men, regardless of whether its source is male or female.

  Becky admitted, somewhat sheepishly, to checking her donor’s SAT scores, but what clinched the deal for her was a photo of the woman sitting on the floor, smiling, surrounded by camping gear: “I went backpacking through Asia for six months when I was younger,” she said. “I know that has nothing to do with her potential as a donor, but . . . it meant something to me. On the other side of the coin, she’s athletic and I’m not. I thought that was great. She can give the child that, and I wouldn’t be able to.”

  Becky leaned back in her chair, shaking her head. She never imagined she’d be trolling for ova on the Internet, but really, who could? It came as a shock, shortly after her engagement to Russell, to
find out that she was in premature menopause. After an IVF cycle was canceled when she produced just one ovarian follicle, Becky and Russell decided they would use money they had saved for a down payment on a house to pursue egg donation. “That genetic loss takes a lot to overcome,” Becky told me. “And I still feel there’s a small part of me . . .” She squinted, pinching her thumb and forefinger together. “I’m going into this 90 percent there, but—we went down to spring training this year, and we were sitting behind Barry Bonds’s family, and someone asked his daughter, ‘Where did you get those cute dimples?’ She said, ‘From my mommy.’” Becky winced. “Overhearing comments like that, it’s like a miniature dagger.”

  “But I’m really attached to wanting to birth and nurse a child,” she added. “If this doesn’t work I might be ready to move on to adoption. But it’s not like you can say, ‘Okay, I’ll adopt.’ It’s not that easy. And the home visits are so intrusive. And anyway . . . I’m not there yet.”

  “Why don’t you just adopt?” That is the first question most people ask if you say you’re considering egg donation. It’s the question I asked myself, as had every potential donor recipient I spoke with. Why create a child where none existed? Why spend the money on something that’s not a sure bet? Why ask another woman, even (or maybe especially) a friend, to inject herself with drugs—drugs whose side effects, although unlikely, could require hospitalization and even, in extremely rare instances, be fatal? (Recipients of donor eggs are required to buy supplementary health insurance for the donors in case something unexpected occurs.)

  The answers among the women I met were both deeply personal and surprisingly consistent. Like Becky, these women longed for the experience of pregnancy, childbirth and breast-feeding. Often they (or, more often, their husbands) resisted adoption, reasoning that egg donation would be psychologically easier on the child, who would be born—rather than relinquished—into his or her family. They wanted the opportunity to handpick a donor’s genes rather than gamble on a birth mother’s and father’s. And they wanted to be able to see at least their husbands, if not themselves, reflected in their children’s faces.

  Still, many questioned the morality of egg donation. “Taking into your home a baby who needs one is inherently more ethical than pursuing a very intensive route to have a biological child,” one potential donor recipient told me. Perhaps that’s why public support for and approval of parents who use donor gametes is lower than for those who adopt—the former is presumably perceived by some as a rather selfish act and the latter a selfless one. Yet adoption has often come with its own ethical quandaries, whether it was the girls “in trouble” who were pressured to give up their children in the 1950s or the current State Department caution against adopting from Guatemala in the wake of reports of child smuggling. What’s more, the idea of healthy infants who “need” homes, particularly white infants, is a myth: domestically, demand has always far outstripped supply.

  Which is not to say that egg donation is without complexity—for either donors or recipients. Looking at the screen, Becky paused at a donor who identified herself as Jewish. I recalled waking up in a middle-of-the-night panic shortly before our cycle was to begin wondering, since my donor friend was gentile, whether our baby would be a Jew. My husband is not, and at any rate, Judaism is traditionally passed down matrilineally. How could the Talmudic scholars of yore have anticipated this conundrum? I called a Conservative rabbi who explained that while there’s no general consensus across denominations, his movement’s official stance was that the gestational mother determines a child’s religion. That mollified me. Sort of.

  A gentile donor was a deal-breaker for some Jewish couples I met. “I didn’t want to add to any identity conflict the child might already be experiencing,” said one potential mother in the Midwest who had found a New York agency that recruits young Israelis. “Certainly not about religion. It’s too delicate.”

  Jewish donors, along with Asians, Ivy Leaguers, and those with proven fertility, are considered “exceptional donors” and can command a hefty premium. A recruitment ad on New York’s Craigslist offered up to $10,000 for Asian donors. On some sites I visited, agencies were asking $15,000 for donors with proven fertility. There have been reports of agencies charging more than double that for other highly desirable women.

  Yet there is often no way to know whether the information the donor gives, including her medical history and educational background, is accurate. A 2006 study conducted by researchers at New York University found that donors routinely lowballed their weight, and the heavier they were the more they fudged. Agencies, too, which are unregulated and unlicensed, can easily manipulate the truth. Many advertise IQ and psychological testing as part of their services, though there is no independent verification of either the results or the protocols used. Even if there were, jacking up fees for smarts is a dubious prospect. “Fees for donors are based on time and trouble, so I don’t see how someone who goes to Brown has more time or trouble doing this than someone who didn’t go to college at all,” Feingold, the psychologist, told me. “Parents are vulnerable. People would be willing to do a lot to take charge so that they didn’t need to feel so sad, bad, fearful, and out of control. They’ll pay more money, do testing. But it’s impossible to do intelligence testing on an egg.”

  To discourage both fraud and undue inducement, the ethics committee of the American Society for Reproductive Medicine (ASRM) issued a position paper in 2006 on donor compensation: $5,000, they determined, was a reasonable but not coercive fee. Anything beyond that needed “justification,” and sums over $10,000 went “beyond what is appropriate.” What’s more, the committee denounced paying more for “personal attributes,” saying that the practice commodifies human gametes.

  Those guidelines, however, are unenforceable among both ASRM physician members and the donor agencies listed on the group’s Web site as pledging compliance. A survey published in May of medical clinics with egg-donor programs (which are presumably under greater pressure to act ethically than unlicensed agencies) found that although donors received an average of $4,217 nationally, at least one clinic brokered a $10,000 fee and another $15,000; a recent Craigslist post directing new recruits to Columbia University Medical Center offered $8,000. One in five clinics considered the donor’s fertility history or ethnicity in establishing rates.

  The word “donor,” then, may actually be a misnomer—at least in this country, where the free market prevails. Internationally, when governments say it, they mean it. Canada and France ban payments to egg donors. Britain reimburses expenses up to about $500 after submission of receipts; before deciding to forbid donation, Italy experimented with a partial “mirror” system, a kind of genetic tit-for-tat in which a husband donates sperm to shorten his wife’s waiting time for donor eggs. No nation has a pool of donors anywhere near the size of that in the United States.

  The agency Becky eventually used charged her a flat $6,500 donor fee (there would’ve been a comparatively reasonable $500 premium if she had requested a Jewish or Asian donor) along with a $3,800 agency fee. Additionally, there were the costs of the donor’s medical screening and health insurance; legal fees; reimbursement for the donor’s and possibly a companion’s travel expenses if the donor was from out of the area (Becky’s wasn’t); and reimbursement for lost wages and child care. There were also the costs associated with any IVF cycle: not only the fertility drugs but also physician, clinic, and lab fees. And fees for freezing any unused embryos, in case the transfer failed or the couple wanted to have another child. Becky estimated that she and Russell would eventually be out about $35,000.

  Beginning in February, Becky and her donor each took a month’s worth of birth-control pills to synchronize their cycles. Then, for about two weeks, the donor injected herself with fertility drugs. Her progress was monitored by a doctor who telephoned Becky after each appointment with a report. “The first call, he said there were twenty-four follicles developing,” she told me. “I was
over the moon! And he raved about the donor as a person. I don’t know if he always does that, but it made me feel good.”

  Meanwhile, Becky followed a regimen of her own, taking twice-weekly shots of estrogen to ready her uterus for implantation. After the egg retrieval, the donor’s job was done. A few days later, the doctor transferred two embryos to Becky’s womb. She added nightly shots of progesterone, which, if all went well, would persuade her body to accept them. If it did, she’d continue the injections until the end of the first trimester, when the placenta would take over and the pregnancy, miraculously, would proceed as naturally as any other.

  Deborah curled up on the cozy couch in her living room, gazing out at the kind of flat, sprawling Midwestern yard where a child could run himself to exhaustion. Her dark hair hung to her shoulders and she was barefoot, in jeans and a loose, embroidered blouse. Deborah, who asked me to use the name she calls herself in donor-recipient Web groups, had endured multiple abdominal surgeries in her twenties and thirties for ulcerative colitis. Despite that, five years ago, a year after she married her husband, Steven, a lawyer, she conceived her son via IVF using her own eggs. She was forty years old.

  “We brought him home from the hospital and I was really . . .” Deborah paused, searching for the right word. “Happy,” she finally said, smiling wistfully. When her son was nine months old, though, Deborah began thinking about a second. She knew another pregnancy was a long shot, but the idea took root, blossoming from fantasy to obsession. “I had my sense of self-worth tied up with having a ‘normal’ family,” Deborah explained. “You know, the family with two children. It was always this destination to be counted upon. It was what made tolerable all the losses along the way, the surgeries, the ostomy bags, everything. So when this path felt threatened, all those other losses suddenly took on more substance.”