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Sexism and the Price of Eggs

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While the sale of solid organs has been illegal in the United States since 1984, compensation for sperm and eggs has been permitted under the guise of compensating "donors" for the time, exertion and risk entailed in the harvesting process. No legislation yet places any specific limits on such remuneration. However, the American Society for Reproductive Medicine rather arbitrarily established voluntary guidelines in 2007 that cap payments to egg "donors" at $5,000 generally and at $10,000 with "justification." That Alabama-based professional organization's code also prohibits payments based upon attributes of the donor--such as ethnicity, height or SAT score. Failure to follow these principles denies fertility clinics and physicians the ethical imprimatur of the ASRM, and the policy implicitly suggests that offering larger sums for ova is inappropriate. Now a study conducted by Aaron D. Levine, a leading bioethicist at the Georgia Institute of Technology, and published in the prestigious Hastings Center Report, documents what anyone who has ever perused the bulletin boards and campus newspapers at Ivy League universities already knows: Many fertility recruiters are offering far in excess of these amounts to young women who meet narrow specifications in terms of age, appearance and talent. Some media outlets have attempted to portray these payments, which run as high at $50,000 in advertisements at Brown University and $35,000 in ads at Harvard and Yale, as unethical. Legislatures in Oklahoma and Arizona, under pressure from in vitro fertilization opponents and the anti-abortion lobby, have even recently debated prohibiting all compensation. A far better approach would be to scrap the guidelines entirely and to embrace an open market for eggs as both ethical and socially desirable.

The primary purpose behind the ASRM's payment caps appears to be concern that higher reimbursement rates will lead to the exploitation of women. Among the risks of egg donation cited by the ASRM's official statement of the matter are "some risk of unintentional pregnancy" because donors must temporarily suspend the use of hormonal contraceptives, some risk of short-term morbidity, an unclear risk of long-term health consequences, a "remote" risk of mortality, and a concern that young women may "dismiss the potential psychologic consequences of donation." Women choosing to donate eggs should certainly be informed that egg harvesting is not risk-free. Some donors develop ovarian hyperstimulation syndrome. Other possible but rare risks include ovarian torsion, cyst ruptures and averse reactions to anesthesia. Moreover, although no long-term medical consequences have yet been demonstrated, health authorities would be wise to track donors over time to ensure that the process is truly as safe as it appears. What is unclear to me is why these risks are any less threatening to women receiving $5,000 per egg than to women receiving $50,000. In other fields of endeavor, from military service to fire prevention, we compensate people more for assuming greater risks. Why then, when the enterprise is one of the few for which women are uniquely suited, do we suddenly decide that additional money will overwhelm common sense? No reasonable person would suggest paying firefighters minimum wage in order to keep them from being exploited by underestimating the dangers of extinguishing blazes. Like firefighters, women who provide their eggs to infertile and gay couples, and increasingly to single women, perform a valuable public service for which they deserve financial rewards commensurate with the sacrifice.

It is conceivable that some egg "donors" will suffer negative psychological consequences -- much as people of either gender can second-guess any life decision. However, other "donors" will use their $50,000 to help pay for an education or to start a business. If we are to have price-controls for egg donation that exist in no other fields, proponents have a burden to explain why such donation is any more exploitative than working low-paying service jobs at McDonald's or Wal-Mart. Egg selling commodifies eggs no more than wage labor commodifies workers. The great irony, of course, is that most cap proponents are not suggesting that women escape the risks of donation. Instead, they will allow women to assume such risks, but then deny them fair market value for their services.

The second objection that the ASRM has to a market-based distribution system for eggs is a concern that couples seeking eggs will pay more to donors who possess traits that they perceive to be desirable--a phenomenon that the ASRM terms "positive eugenics." While this may be true, it is not evident that it is pernicious. Positive eugenics may lead to desirable social outcomes. In the first place, many of these couples will discover to their surprise that, for example, a tall donor is no guarantee of tall offspring. One surmises that IVF parents will still love these children anyway, that they won't suddenly realize when Little Johnny turns eighteen that he stands only five-foot-six--and so cast him out of the house. History has taught us that breeding children is a highly inexact science. But the larger question is why we should be concerned if couples attempt to produce taller or smarter offspring? After all, men and women seeking mates often look for partners who possessed socially-desirable traits and then pass them down to their children? That is also a form of positive eugenics, one that much of our society embraces as truly positive. Why should it matter whether the egg is provided by the partner or purchased from a stranger? Furthermore, nobody complains when parents try to produce outcomes like increased height and intelligence in the postnatal period with glasses of milk and academic tutors. On the list of evils that our civilization faces, a population that is somewhat taller or smarter seems rather benign. As a relatively short person myself, I look forward to having more people to help me change my light bulbs.

The most legitimate concern raised by supporters of caps on payments to egg "donors" is that charging fair value might price some would-be parents out of the marketplace. If raising one's own children is a fundamental and positive right, as suggested by the trend in Western Europe and the United States toward requiring governments and insurers to pay for artificial insemination, then keeping IVF opportunities available to all is certainly important. Price caps may not be the best means of ensuring such equality. If our society's real concern is equal access, the ideal solution might be for the government to purchase eggs on the open market and then distribute them to low-income individuals and couples via public fertility clinics. That would ensure equal access without denying "donors" the right to profit from their eggs.

Another, more disturbing underpinning may explain support for caps among some professional groups and right-wing activist: latent sexism. In a culture that generally allows competent adults to assume large risks in pursuit of financial advancement, we suddenly lower the tolerable risk threshold and wave the bloody shirt of "exploitation" when the financial gain will accrue to women through use of their distinctive reproductive biology. Critics of compensated surrogate motherhood and legalized prostitution and a market for eggs all speak the language of exploitation, but what they actually may fear is that women will harness their own sexuality for economic gain. If Ivy League sperm sold for $50,000 on the open market, "donors" would be viewed as enterprising young men, not potential victims of exploitation. In a world where men could donate eggs, our society would never accept even voluntary price controls, such as the ASRM's, which exert "moral" pressure to keep prices artificially low. That does not mean that selling an egg is without its dangers, anymore than childbirth is without its dangers. In fact, the risks of childbirth are significantly greater. Shouldn't a civilization that not only allows, but often expects, women to assume the hazards of childbearing without any financial compensation also trust these same women to decide whether selling their eggs is worth the risk?

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