YOUNG WOMEN'S EGGS ARE HOT COMMODITIES ... - Coroflot

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Sell YO U N G WO M E N ’S E GG S AR E H OT COMMODI TI E S:

MORE AND MORE CO UP LE S WHO C AN’ T CONC E I VE ARE VYING FOR THEM. MEA NWHI LE , FE RTI LI TY C E NTE RS ARE OFFERING SINGLE WOMEN THE CHANCE TO PUT THEIRS ON ICE FO R T HE F U T U RE. W H INVESTIG ATE S HOW THI S B OOM I NG BOTH GOOD AND B AD WAY S Photog raphs by Trav is R athbone

PROP ST YLING: JAMIE FR ASCA

EGG MARKETPLACE IS AFFECTING REPRODUCTION—IN

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Egg THE

(DONOR)

MARKET

THE ECONOMIC DOWNTURN HAS MEANT AN UPTURN IN THE NUMBER OF WOMEN VOLUNTEERING TO HELP INFERTILE

CO U PLES. B U T AT WHAT COST TO THEIR HEA LT H A N D THEIR OWN ABILITY TO CONCEIVE? BY JENNIFER WOLFF

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he ad in the college newspaper was striking: It featured a photograph of a newborn’s pudgy feet, and dangling above those tiny toes was the promise of thousands of dollars in compensation for donating one’s eggs. The bold print assured the chance to give “the gift of life.” Wow, I can do this, thought Abigail, who saw the ad in 2006, when she was a 21-year-old junior at Northern Illinois University. At the time she was working at a tuxedo-rental shop to earn money toward her college tuition and paying the rest with school loans and financial aid. She surfed the Internet for information on the physical and mental-health risks of egg donation, talked with her family, and decided that helping couples in this way “was a good match for me.” Over the next four years, Abigail donated her eggs five times. Recently, she was matched with a couple for her sixth donation. By the time she’s finished with that round, she will have earned some $50,000. “I liked that the ad was not just about the money,” says Abigail, “and that I would be helping people too.” In fact, she had wanted to donate since she was 15, after an egg donor helped her aunt and uncle create the baby they couldn’t have on their own. “That child made them so happy,” she says. “I wanted to do that for someone.”

Egg donation has become an increasingly popular means of family building for infertile couples undergoing in vitro fertilization (a.k.a. IVF, in which eggs meet sperm in a petri dish, and the resulting embryos are transferred to 144

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the woman’s uterus). And, as a result, donating eggs has become an increasingly popular way for struggling young women to make ends meet. In 2007 (the last year for which data is available), 12 percent of the nearly 143,000 IVF cycles in the United States used eggs from donors, many of them recruited through ads in college newspapers, on highway billboards, on the radio, and even on Craigslist. The ads are often found “in places where people who have debt are likely to see them,” says Nancy J. Kenney, Ph.D., a psychologist at the University of Washington. The average fee paid to an egg donor is around $5,000, but it’s often higher for those living in certain metropolitan areas or who have specifically desirable characteristics, such as athletic ability or high SAT scores. Fees are supposed to max out at $10,000, according to voluntary guidelines set by the American Society for Reproductive Medicine (ASRM)— however, just about 25 percent of college newspaper ads to recruit egg donors offer amounts well above that, according to a report by the Hastings Center, a bioethics research institution. Not surprisingly, Kenney’s retrospective study of egg donors, published in January 2010 in Fertility and Sterility, found that nearly two-thirds of women who were paid to donate their eggs did so for financial reasons. But as this mini industry explodes, the medical and legal oversight of it has not kept pace. Very little research exists that looks at the long-term health effects of IVF, and almost none of it focuses exclusively on the potential dangers of egg donation itself. Some who study the industry worry that there are long-term effects that have yet to be discovered. In the short term, the side

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effects of the hormone drugs that donors take range from the minor (mood swings, breast tenderness, and fluid retention) to the rare but serious. These include ovarian hyperstimulation syndrome, or OHSS, in which the ovaries swell, sometimes causing blood clots, kidney failure, fluid buildup in the lungs, and the potential loss of one or both ovaries. How common are these side effects in egg donors? No one really knows. For sure in this allegedly recovering yet still stumbling economy, more women than usual are signing up to donate their eggs, no matter the consequences. “We used to get 12 to 15 applications a day; now it’s up to around 25,” says Andrew Vorzimer, CEO of Egg Donation Inc. in Encino, California, whose website features nearly 1,000 available egg donors. “We’re getting a lot of women in their twenties who have college loans to repay but have an entry-level job. It’s a way for them to get a jump-start.”

Still, egg donors themselves rarely attribute their motivation to money alone. Indeed, Kenney found that only some 19 percent said they did it purely for the cash. Most others who admitted to financial incentives also cited altruistic reasons. “The [egg donor] industry doesn’t like to talk in market terms, but this is a market transaction,” comments Aaron Levine, Ph.D., an assistant professor of public policy at Georgia Institute of Technology, who authored the Hastings Center report. “I don’t ever have any doubt that I am giving these people an irreplaceable gift,” says Abigail, who doesn’t know how many kids she has helped to create. “It’s not all about the money, that’s not why I do it.” Nor is it an easy job. To qualify as a viable egg donor, Abigail spent six months undergoing medical tests, psychological counseling, and legal vetting. During each donor cycle, she gives herself daily hormone injections, which trigger her ovaries to produce multiple eggs. The doctor then removes these eggs by inserting a microthin needle into each ovary through her vaginal wall. She gains 15 to 20 pounds each cycle, suffers severe headaches, and breaks out in a face full of pimples—side effects that dissipate over time after she is done. Abigail is now 25 and a dietitian in South Carolina. In college she earned $5,000 for her first donation, and then was paid between $7,500 and $10,000 for each of the next four, plus expenses. She continues to be a popular donor because “she is tall and has a beautiful smile and a great wholesome look, and also because she

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has almost always been successful,” says Nancy Block, president of Center for Egg Options in Northbrook, Illinois, where Abigail has made her donations. Plus, she’s Jewish, a relative rarity in the eggdonor pool, as are Asian and East Indian donors. “It’s not as culturally acceptable for those nationalities,” says Block. Abigail hopes to have children of her own someday and isn’t terribly concerned about any long-term health implications of the procedures. Like most donors, she was counseled on the immediate risks, including OHSS and infections. “With most things there is always a risk,” she says. “I had been on birth control previously, so I didn’t think the extra hormones would make a difference.” Shana Corcoran, a two-time egg donor who’s now 32, also says she pursued donation for mostly selfless reasons. Ten years ago, as she commuted to her job at a pharmaceutical company in Atlanta, she would hear the same ad on the radio each day. The ad was soliciting egg donors, and it tugged at her heart. It never mentioned money, only what donors’ eggs could do for women who wanted to be mothers. “The tagline was a woman saying, ‘To that wonderful person who made our family possible: Thank you,’ ” remembers Shana. “It was so touching, and it made me curious.” She attended an orientation, and when she learned that she could make $5,000 helping infertile women become moms, she says, “I was shocked. It was like winning the lottery. I signed right up.” A nurse did explain the health risks “and alluded to the fact that there wasn’t much research and were no guarantees that there wouldn’t be long-term effects,” says Shana. But, she admits, “if this big, nice doctor’s office was doing this, it couldn’t be too bad.” And she wasn’t about to change her mind “when there was so much money being dangled in my face.”

The fear that certain fertility drugs increase the risk of ovarian cancer was debunked in a large 2009 study. But concerns that frequently and artificially stimulating the ovaries leads to other cancers or maladies (one of them infertility itself) have yet to be quashed. “The little research that has been done has been on infertile women, not on egg donors,” says Jennifer Schneider, M.D., of Tucson, Arizona, whose article about her daughter Jessica’s losing battle to colon cancer four years after multiple egg donations ran in Fertility and Sterility in 2008. 146



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Parenthood ON

FERTILITY CLINICS ARE TOUTING A

ICE

REVOLUTIONARY EGG-F REEZING TECHNIQUE THAT COULD ALLOW WOMEN TO P OSTP ONE MOTHERHOOD FOR YEARS, EVEN DECADES. IS THIS NEW TECHNOLOGY THE BABY-MAKING SILVER BULLET? The fertility industry is viewed by many as a notoriously unstudied and unregulated field. And while clinics that are members of ASRM are compelled to follow its voluntary guidelines, many independent egg-donor agencies—which collectively offer thousands of egg donors on their websites—are not. (The ASRM guidelines state that a woman shouldn’t donate eggs more than six times, and that payments exceeding $5,000 require “justification” and over $10,000 are “not appropriate.” Another guideline: Donors, or the agencies representing them, shouldn’t charge more for certain characteristics, such as high SAT scores. But Levine’s research found that each leap of 100 SAT points at some elite universities equaled an average of $2,300 more in compensation.) “It’s difficult for ASRM to have an impact on [egg-donor agencies],” admits Robert G. Brzyski, chairman of its ethics committee. Schneider can’t prove that Jessica’s three rounds of egg donation—which she did after responding to an advertisement in her college newspaper—caused her colon cancer. Nor can she prove that they didn’t. Even as a physician, Schneider was not aware of the risks, but Jessica assured her that the doctors said they didn’t know of any. “And the reason they didn’t know is because no one has looked,” she says. “Most potential donors don’t understand that when someone says ‘We don’t know of any risks’ it’s very different from their saying ‘There are no risks.’ ” In the years since Shana Corcoran donated her eggs, she has struggled with her own infertility: She spent two and a half years trying to conceive before resorting to IVF to help her become pregnant with her son, who is almost 2. Last spring she got pregnant naturally and then miscarried. She says, “I couldn’t help but ask myself, Was it the egg donation and all of that stimulating that caused this?” The hard truth: There’s no way to know. Q


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BY JENNY DEAM

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ngela Solie was pretty. And smart. And successful. And fun. But if the Los Angeles–based art dealer didn’t hurry up and get hitched so she could finally have kids, she was going to freak out. It’s not like she wasn’t trying. Spanish classes, volunteer groups, speed dating, marathon training, setup after setup— for years, she’d done it all, with high hopes of meeting a mate and the father of her future child. But nothing was clicking, except for the hands on her biological clock, which ticked so loudly she feared it might deafen her dates. As she slid past her midthirties, Angela switched her focus from finding The One to something that, thanks to cutting-edge medical research, she thought she could manage: her ability to someday have a baby. A gyno referred her to a local doctor who boasted great success in preserving women’s fertility. Angela checked him out online. What she found gave her pause: The homepage of reproductive endocrinologist John Jain, M.D., had links to his appearances on The Today Show and Dr. Phil, as well as pledges to help women “take control of [their] fertility.” It all felt a little too slick, too Hollywood for Angela’s taste. But she booked an appointment anyway. And that’s how she found herself sitting face-to-face with Jain, with whom she instantly felt at ease, talking about a new egg-freezing technology called vitrification. The experimental procedure, Jain explained, could be a game changer for women who are facing declining fertility. Angela felt her excitement rise. She was 38 years old and eager to safeguard her chances of having kids. She signed up.

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Of course, egg freezing is nothing new. The first human birth resulting from a frozen egg happened 25 years ago, when the procedure seemed destined to join the hit parade of reproductive advances that followed the first “test-tube baby” in 1978. But while IVF soared in popularity, egg freezing never really took off. The technology was clunky and, more important, rarely successful. “The numbers were dismal,” says ob-gyn Geoffrey Sher, M.D., a fertility specialist and cofounder of the Sher Institutes for Reproductive Medicine. For decades, the “live baby” success rate hovered around 3 percent, and by 2005, only 150 babies had been born from frozen eggs. The problem was in the freezing; eggs were slowly frozen over several hours, and ice crystals could build up on and often destroy the eggs. But everything started to change 10 years ago, when scientists began experimenting with vitrification, a flash-freezing technology that seals an egg in ice in seconds, leaving no time for crystals to bloom. A handful of laboratories began reporting astonishing numbers. Up to 90 percent of vitrified eggs have survived thawing and led, in the past two years, to some 1,500 live births. Today the average success rate of turning a frozen egg into a baby is 50 percent, though many clinics claim higher numbers (Jain, 57 percent; Sher, 66). The process isn’t easy—or particularly affordable. Much like with IVF, a woman must stick herself with daily hormone shots for two weeks to stimulate egg production. During that time, she’ll visit her doc every three days for blood tests and ultrasounds. Then there’s the retrieval surgery, done under general anesthesia, in which an M.D. harvests, then freezes, an average of 10 to 12 eggs. Total price tag? About $15,000. That usually includes one year of storage, but does not factor in any eventual IVF costs, which can run well over $5,000. Though vitrification was first hailed as a fertility-preserving breakthrough for cancer patients, savvy clinics bet it would also appeal to healthy, young single women. And despite the fact that egg freezing for lifestyle reasons is rarely covered by insurance— and the fact that a 50 percent success rate means there’s the same chance that it won’t work—those clinics were right.

“

1785

1953

1978

A Scottish surgeon performs the first human artificial insemination, using a warm syringe packed with the husband’s sperm.

Docs begin to successfully cryopreserve, or freeze, sperm, about 30 years before egg freezing is viable.

Louise Brown, the world’s first “test-tube baby,” is conceived via in vitro fertilization (IVF), the mating of egg and sperm in a petri dish.

2010 Brown University researchers develop the first artificial human ovary that can pump out mature human eggs.

Egg TIMER THE

A chronology of firsts

2009

1996

1986

A 49-year-old New Yorker becomes the oldest woman to have a baby from a frozen egg (she had put it on ice at age 48).

Actress Jane Seymour credits IVF for her twins, and in vitro fever hits Hollywood. Courteney Cox, Brooke Shields, and Marcia Cross all have babies this way.

The first baby is born from a frozen egg. Two years earlier, a woman had delivered the first baby born from a frozen embryo.

By the time a woman hits age

30, she will have lost 90 percent of her 300,000 eggs. By age 35, infertility risk floats around 22 percent. Yes, these oftreported stats sound scary, but they haven’t shocked everyone into early action. Women are marrying later than ever, or not at all. Nearly 40 percent of all births are now to single moms, and the number of kids born to women over 40 has doubled since 1990. “The reality is that many women are just not going to get married or have kids by their twenties or early thirties,” says Jain. “Egg freezing is a very proactive and responsible thing for women who eventually want children. It’s not for everyone, but it is now an option.” Most fertility docs prefer to freeze a woman’s eggs when she’s between ages 30 and 38 (the older the woman, the longer the odds of getting healthy eggs), though the procedure can be done on anyone past puberty. So far, up to 5,000 women have frozen their eggs for nonmedical reasons, according to experts’ best estimates.

Patients need to understand that the number of children born via a frozen egg is small.”

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1984 Egg donation becomes a real option after a Los Angeles woman has a healthy baby conceived with a donated egg and sperm from her husband.

When La-Keichia Canady was 30, she thought she was perfectly set up for motherhood. The Atlanta-based nurse was happily married, just waiting for the right time. But then her perfect setup crumbled into divorce, and she worried this was the end of her dream of having kids. She had heard about vitrification and knew the success rates, but she was willing to take the chance. Over the past three years, La-Keichia, now 35, has undergone three cycles of egg freezing. Sher, her doctor, also tests each egg for genetic abnormalities; those with problems are discarded. Of the 40 eggs he has retrieved from La-Keichia, 10 are perfect specimens. La-Keichia has given herself a final deadline of age 38. If she hasn’t met the right guy by then, she plans to hit the sperm bank and have a child on her own. “This is my security blanket,” she says. Some people think egg freezing is an unnatural way of tampering with the body’s biological clock, or just some sort of modern indulgence. But Nicole Noyes, M.D., a professor and reproductive endocrinologist at the New York University Fertility Center, bristles at the suggestion that women are freezing their eggs just so they can cavalierly delay motherhood until it’s more convenient. “In general, women, like men, should be able to have babies

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when they are truly ready,” she says. “What egg freezing is doing is providing women with reproductive autonomy.” That’s true—if it’s all it’s hyped up to be.

The American Society

for Reproductive Medicine and its affiliate, the Society for Assisted Reproductive Technology (SART), still consider egg freezing experimental. “I would love for this to be the ultimate solution, but patients need to understand that the number of children born is small,” says Eric Widra, M.D., a reproductive endocrinologist and chair of the SART practice committee. “Our specialty has been criticized for bringing technologies from lab to clinic too quickly. With vitrification, we are keen to avoid that.” Such restraint sounds practical, even ethical, especially considering the procedure hasn’t yet been standardized. But not all clinics are toeing a cautionary line. Scrolling through the splashy print and testimonials on fertility centers’ websites yields very little of Widra’s proposed prudence. Even his own clinic, Shady Grove Fertility in Washington, D.C., makes vitrification sound like a sure thing: “By making the choice to freeze her eggs today,” it reads, “a woman can lock in her fertility for future use, when the circumstances and timing are right for her.” The website for Jain’s Santa Monica Fertility reads: “Egg freezing is revolutionary, not just in its technology, but in the life choices it allows [women] to make.” That kind of message leaves some experts squeamish. “My concern is that egg freezing is too heavily marketed,” says reproductive endocrinologist Mark Perloe, M.D., medical director of Georgia Reproductive Specialists in Atlanta. Women who get caught up in the seductive verbiage may convince themselves that vitrification will definitely work for them. Piling more layers on the “security blanket” claims are the achievements many clinics advertise—but a 90 percent successful egg-thawing rate does not equal a 90 percent live-birth rate, says Perloe. Yet despite any concerns or fineprint disclaimers, egg freezing is poised for breakout popularity. In 2009 alone, 51 percent of U.S. clinics offered egg freezing, and of those that didn’t, 55 percent said they plan to in the near future, according to a University of Southern California survey. Having so many players breeds fierce competition; hence, the aggressive marketing.

And it’s not just fertility clinics pimping their own stats. Six years ago, when Christy Jones, then 34 and single, froze her eggs, she’d already recognized a potential business niche. She started Extend Fertility, the nation’s first firm devoted solely to getting the word out about egg freezing. Half a dozen clinics across the country now pay Jones for marketing services and to guide patients their way—and patients she delivers. More than 450 women have walked into fertility centers courtesy of Jones, and about 70 babies have been born from eggs frozen at her partner centers. (Jones predicts that number will rise as more of her clients opt to use their frozen eggs.) But what about the worry that women are being manipulated into thinking egg freezing works better than it really does? “We think we’re being very responsible about that,” insists Jones, who says Extend Fertility’s mission is not to make promises—overt or implied— but rather to give women state-of-the-art reproductive options. Her company’s motto? “Fertility. Freedom. Finally.”

Kay Hadaway knew she

couldn’t have kids. At least not without a little help. So at age 37, the married Atlantan opted for IVF. It worked. And although Kay was grateful for her daughter, she’d always imagined a bigger family. But the timing wasn’t right to have another kid right away, and she was pushing past her fertile years. So she joined a vitrification study run by Sher, in which she could freeze her eggs before she passed 40 and give IVF another shot later on. Kay’s frozen-egg baby, Ciara, is 3 years old. “She is truly a miracle,” says Kay, now 44. Yes, her case shows the enormous promise of egg freezing, admits Perloe, but it doesn’t mean all women will have the same experience. “To say this can preserve fertility, that’s a stretch,” he says. And if women focus only on the success stories, he adds, “there are going to be some very unhappy patients down the road.” Back in L.A., Angela, now 40, remains optimistic. Her vitrification surgery yielded an unusually high 28 usable eggs and, since the procedure, she met and got engaged to a great guy. She says her doc, Jain, did indeed tell her there are no guarantees, and she hopes to have a baby the old-fashioned way before turning to the freezer. “I hope that in that tank,” she says, “is my second child.” Q

THE INCREDIBLE EGG Everything you never knew about this ova-tion sensation It’s the single largest cell in the entire body… …yet the average egg is 10 times smaller than the period at the end of this sentence. (Sperm, by comparison, are much more petite. It takes 15,000 sperm to match the size of one egg.)

Healthy eggs are smooth and spherical, almost like perfect little balls. If one or more of your eggs is oblong or develops vacuoles (think: mini moonlike craters), it could signal fertility problems.

Every egg in a woman’s body is fully formed before she’s even born. The growth takes place during the fetus’s 10- to 20-week gestation period.

Yes, a woman’s egg has a yolk. It’s packed with proteins that nourish the embryo during the first three days after fertilization.

Your body begins to prepare an egg for fertilization three to four months before it falls from the ovary during ovulation. Your eggs follow a strict path of order: The first egg created by your body when you were a fetus was the first egg that dropped during your first period. And so on. Every woman is born with more than a million eggs. By the time she reaches puberty, she has about 300,000 left. By the time she’s 30, about 10 percent remain. The average woman ovulates about 450 eggs in her lifetime; the leftovers just disintegrate. Younger eggs are colorless and translucent, like thick glass. As an egg ages, it takes on a slightly brown tinge.



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Eggs are monogamous— they’ll let in only one sperm. And then the zona—the egg’s coating—permanently mutates (i.e., closes its door) to make sure no other swimmers get access. Eggs carry only half as much genetic material as other cells in the human body, leaving room for a sperm to supply the other half. A week after fertilization, the embryo has already grown to the size of a pinhead. After five weeks, it’s the size of a grain of rice. A handful of ill-advised lifestyle choices can prematurely kill off your eggs. One of the deadliest? Smoking. Puffing away can decrease your egg count by half. The oldest frozen egg to yield a healthy baby had been on ice for 25 years.


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