Like a Virgin

by Prasad, Aarathi

  Not so solo parents, who are generally, at this moment in reproductive history, single women in good financial circumstances who are approaching or just past the menopause, and who have made a conscious decision to use advanced technology to go it alone. These women have not necessarily experienced infertility problems; instead, they turn to assisted conception techniques in order to have a child of their own without a partner. The families that result are not always a solo mother and a solo child alone. Some solo parents want to give a sibling to an only child who may or may not have been the product of a partner’s sperm.

  Because of their age, many solo parents must use more than one reproductive technology when they decide to have a child. A woman nearing menopause and lacking a male partner will, for instance, usually need a donated egg, donated sperm, and in vitro fertilization to bring the two together and then successfully implant them in her womb. On some levels, such a pregnancy is natural – it’s just that all of the bits and pieces are happening outside the usual conception. The family that results isn’t related genetically, but its members are related biologically. The births mimic everything that happens when a man and a woman have a child. In some cases, the solo mother might try to find donors that will provide genetic material that, on the surface, appears to be their own, making it impossible for the person on the street (or at the nursery) to distinguish a solo-parent family from more ‘traditional’ types. Indeed, while most solo mothers say they plan to tell their children that their father is a sperm donor, many admit that they probably will not tell their children that the egg that made them was donated too. We still put a great deal of emphasis on the meaning of that genetic contribution, after all, and the desire to become a parent is wrapped up in those definitions.

  How does this affect the welfare of the children? So far, research has focused on the effects of growing up fatherless, and most of it involves households where a single-parent family has been created by force, not by choice. Yes, there are negative consequences for a child’s cognitive, social, and emotional development when economic hardship, parental conflict, or parental death is part of the family story. But these effects should not be generalized to include children born into solo-mother families. From the early accounts, children of solo parents experience neither trauma (from the break-up of the family) nor financial hardship. For many, in fact, the situation is quite the opposite.

  Although there have been few studies of solo parents, a remarkably consistent theme emerges in the interviews that have been conducted: the women (and solo parents are almost always women, given the limits of today’s technology) realized that they had no other viable options for becoming a mother. Time was running out, and they had no long-term partner in their sights. The risk of having a child through a casual sexual liaison was too great, be it the chances of contracting a sexually transmitted disease or of being deceived about the other person’s intentions towards any child that might result. A few said that they simply wanted to have a child without the involvement of a man.

  Of course, this all assumes that a woman is seeking to become a mother biologically. As it happens, most of the solo mothers studied mentioned that adoption was their first choice – they described it as a ‘more moral’ solution to the desire to start a family. But adoption wasn’t a viable option either. In the US and the UK, most adoption agencies prefer to place very young children with couples in their twenties or early thirties; older, single women reported that their only real option was to turn to international adoption bureaus, which charge at least £20,000, or $32,000, for their services. In contrast, buying an egg or sperm costs ten times less. Given that raising a child involves a considerable amount of expense, spread over twenty or more years, this financial decision could be interpreted as a first signal of parental responsibility.

  In at least one recorded case, the decision to become a solo parent was tightly bound with the woman’s religious beliefs. The woman, part of a small group study of solo mothers, said that having a baby using medical interventions was her only moral choice since she wasn’t married, and her religion considered sex outside marriage to be a sin. She effectively took the scientific route to a church-sanctioned virgin birth.

  While buying eggs from a younger woman is a highly effective way for an older woman to have a child, having to use donated eggs is not ideal – especially for the donor. Donating eggs is an invasive, inconvenient, and, at times, painful process, requiring daily hormone injections and the extraction of eggs from the ovary. Truly altruistic donations of eggs are few and far between. As in the case of wombs-for-rent, there is scope for abuse. Women from poor socio-economic backgrounds may submit to – or be coerced into – successive egg donations to make money, or even to gain access to fertility treatments for themselves. This phenomenon has been called ‘fertility tourism’ or, in its more nefarious forms, ‘egg trafficking’.

  Since the first successful birth from a donated egg in 1984 at the UCLA Medical Center, the trade in eggs has grown exponentially – and offers a classic study in free-market supply and demand. Originally, egg donation was developed as a therapy for young women with premature ovarian failure; only more recently has it become more widely used as a means of overcoming the age-related decline in fertility. In the early days, egg donation as a charitable act was the norm, but as the demand for eggs has increased – because of both technological and social change – the motivations for supplying eggs have shifted. In the UK, the egg-donor market shows just how few egg donations are motivated purely by altruism, since very little money is paid to a donor for her eggs, and very few eggs are donated. Donors are not paid for their services beyond their ‘expenses’. For some, this is enough money to make the effort worthwhile, but the donation rates in the UK are lower than in places where women are paid more. Further, egg and sperm donors are no longer permitted to be anonymous in the UK, which discourages some who do not want to be faced with a genetic child eighteen years down the road. In France, the most restrictive of European countries when it comes to egg donation, the eggs must be deemed to be a completely free gift from one woman to another. In one recent year, just 144 French women volunteered to undergo the donation procedure. There is no financial compensation in Britain either, but in the same year, 1509 women donated eggs in the UK (although 999 of them were sharing eggs while undergoing fertility treatments themselves).

  In other countries, where it is legal to pay vast sums of money to egg donors, the fertility clinics are in demand. Spain, for example, boasts more private IVF clinics than any other country in the world – and the country’s clinics also claim to get the best results. Good enough that French women flock there to receive donor eggs, since so few are available at home. If you undergo IVF in Spain and use ‘donated’ eggs instead of your own, you will probably pay an extra £2000 for your treatment, which gives some sense of what these eggs cost to ‘buy’. There’s a very good reason for the wonderful success rates: the Spanish clinics advertise to young women, at the peak of their fertility, and offer lucrative compensation – around four times the UK rate, from £800 to over £1000. Spanish law allows payment for the donor’s time (as compared to her eggs), which skirts EU regulations to avoid exploitation of reproductive material. This is the case in Cyprus, one of the other hotspots for continental egg donation procedures. And in some US states, it is quite legal to pay young women huge sums of money for their eggs. Young women are often recruited through private clinics or online agencies; a Google search will bring up tens of thousands of results. But especially desirable donors – usually university-educated women, offering the ‘right’ geneticmake-up – are also targeted through ads posted at university campuses and in student newspapers. One fairly typical notice reads:

  Egg donor wanted – $35,000 compensation. We are a couple seeking a high-IQ egg donor to help build our family. You should have or be working on a university degree from a world-class university; you should have [high] standardized test scores and preferably some outstan
ding achievements and awards.

  When an ad isn’t lure enough, there’s always the alternative of seeking help from the universities themselves. The medical school at the very prestigious Yale University, for one, runs an egg donation programme under the legalistic label ‘third party reproduction’. Yale is, after all, a member of the Ivy League, and according to a 2009 report in Marie Claire, payment for the eggs of blonde, blue-eyed, athletic undergraduates have sold for as much as $100,000. That’s an attractive sum for a student who is likely to be staring down a massive debt bill for her higher education. At Yale, tuition fees alone now stand at $40,500 per year – which adds up to roughly $160,000 over the course of a standard four-year undergraduate degree.

  In the US, donor eggs generally come from American women, but in Spain and Cyprus eggs may come from women who live anywhere in Europe, so that women from places that are experiencing tough economic times may travel quite a distance to make some much-needed cash. One Eastern European woman, who decided against donating her own eggs but witnessed many others do so, told the Observer: ‘They work the cabarets, they’ll sleep with men, they’ll sell their eggs, and then they go back again.’ She seemed to equate each of these activities – reflecting on the various ways in which women, desperate for money, may try to earn a living. And since women are highly unlikely to be sleeping with men and selling their eggs simultaneously, you almost have to assume that egg donation might be an escape from the other. In Russia, the £800 often paid by a Spanish clinic for one cycle of egg donations equals a year of average wages. The Observer noted that one clinic even offered a $500 ‘signing’ payment to women willing to be flown from the Ukraine to Cyprus for egg-donor screening.

  Because this is a ‘free’ market, clinics offer all sorts of bonuses. If a woman is willing to donate more eggs, she can earn an extra fee – but producing more eggs means taking more hormones, twice the dose that is recommended. This can be very bad for the health. Premature menopause, uterine cancer, and ovarian hyperstimulation syndrome can result. The therapy has also put several women at risk of death. In one case, a Stanford student who had agreed to donate eggs for a fee of $15,000 experienced a rare adverse reaction to one of the fertility drugs she was given. The side effects were devastating. She suffered a massive stroke, which left her in a coma for eight weeks with long-term brain damage.

  The money paid to the sellers of eggs is probably dwarfed by the revenues that stream into the ‘middle-man’ clinics. Because these private clinics are able to pay top price for eggs, they have little to no donor shortage and are also able to perform what some have called ‘personalized baby marketing’: if the client pays a fee over and above what the clinic has paid to the donor, then the client may select a donor based on her height, weight, eye colour, educational attainment, and other criteria.

  In an effort to curtail the influence of money in egg and sperm donations, in April 2005 the European Parliament adopted a resolution banning trade in human cells and embryos. The legislators were moved to act after reports emerged that a clinic in Romania was sending ‘mail-order eggs’ to the UK, with the UK government proposing to pay up to £1000 as an incentive to entice more donors in the future. While compensation for donor expenses is allowed under the European resolution, the regulatory body responsible for administering the rule stated that a payment in the range of £1000 would be well above the allowed limit.

  Despite the new law, the market continued to prosper. In Romania, five people were arrested and held in detention in the summer of 2009 over suspicion of trafficking human eggs. The chief prosecutor of Romania’s organized crime department also held the suspects on broader charges, including allegedly practising medicine without a permit and being involved in a criminal group. Before their detention, two of the group, gynaecologists from Israel, had run an IVF and plastic surgery clinic in Bucharest. The gynaecologists were suspected of recruiting women aged between eighteen and thirty and paying them around £150 ($300) for their eggs. The eggs were then sold on for £5000 to £7000 ($10,000 to $14,000) to clients from Israel, Italy, and the UK. According to the Romanian newspaper Gardianul, the clinic’s annual earnings were around €20 million (£14 million, or $25 million). The case closely followed the arrest, on similar charges, of thirty Israelis who worked in a separate fertility clinic in Romania, which suggested that the scheme was not an isolated case of a few bad apples taking advantage of an otherwise finely controlled system.

  Then, in 2010, a fertility clinic in Cyprus came under surveillance after authorities received claims of human egg trafficking. The clinic, run by mostly Russian staff, relied primarily on donors from Eastern Europe. Three Ukrainian women in their thirties, all of whom were living and working legally in Cyprus, were questioned after donating eggs to the clinic, and said that they had received more than reimbursement for their expenses. According to media reports, the women claimed to have been paid €1500 (about £1000, or $1900) for their services, though the police would not confirm the figure. Officially, the clinic was shut down in May 2010 on orders of the health ministry for failing to provide full data for the provenance of embryos, eggs, and sperm. This effectively meant that the donors were untraceable. Indeed, Cyprus had become a favoured destination for the egg trade because of its clinics’ low prices and donor anonymity. The police investigation into illegal egg trafficking had to wait for the Ukrainian government’s approval.

  The free movement of people across the European Union makes it difficult to crack down on the trade in eggs, all the more so since the demographic changes over the past few decades mean that some countries have a shortage of eggs and others have a youthful supply. Jacques Testart, the research director at INSERM, a medical institute in Paris, was not particularly surprised by the stories coming out of Romania and Cyprus. ‘There are rumours circulating about trafficking in Europe, although they are difficult to prove,’ he told the news agency AFP. ‘There will always be a need for the “hens” and there will always be women who do that to earn a bit of money… especially in the current economic crisis.’ One gynaecologist, who spoke to AFP on condition of anonymity, claimed that egg trafficking is common in Cyprus. ‘Everyone knows that, but we don’t do anything [about it],’ the doctor alleged.

  Eric Blyth, a professor in the Department of Human and Health Sciences at the University of Huddersfield, has identified three key characteristics of the countries that have become popular destinations for fertility tourism: ‘First, the lack of regulation affording adequate protection for the parties most directly affected, i.e., donors, surrogates, patients, and children; second, the operation of a commercial market in human gametes – especially eggs – and women’s gestational services; and third, a level of secrecy that helps to conceal unprofessional, unethical, and illegal practices.’ Because of these issues, the UK’s Human Fertilisation and Embryology Authority (HFEA) has called the use of foreign egg donors a ‘profoundly exploitative and unethical trade’.

  There have also been shenanigans involving sperm acquired by ill-gotten means. In the past decade, a number of internet businesses have cropped up that claim to be able to put people desperate to become parents in touch with potential sperm or egg donors, or to supply donations directly, serving as a middle man. The online services may appear to be an easier, cheaper, and less bureaucratic option than going through a government-licensed clinic; they also rarely advertise, say, the sperm shortages that characterize the market, which makes them seem more likely to deliver the goods. But such sites may pose a risk to people trying to find help. In fact, since April 2007, it has been unlawful to ‘procure, test or distribute’ human eggs or sperm for human reproductive use in the UK without a licence from the British government authority that regulates fertility work. Regulated clinics in both the UK and the US are required to freeze and store sperm for six months before it is used by a woman, during which time the clinics test it for HIV and other diseases, but internet traders selling ‘fresh sperm’ had not been required to do such
checks. The law, called the Human Fertilization and Embryology Act, was brought in to regulate the use of fresh sperm, with a view to ensuring it is safe. In addition, via the internet there is generally no way to confirm that the donor is who he says he is, and, as a result, the safeguards that UK and European law offers to parents and any resulting children may not apply. And given the internet’s ability to cross borders, there is little that can be done to force a site based in another country to follow local law – an issue made even thornier in the US, where state laws may vary considerably.

  In 2009, the UK saw the first prosecution of an internet sperm trader under the new law. The case involved a website called Fertility First, through which fertility patients could select from a database of anonymous sperm donors and order ‘fresh sperm’ to be delivered, for a fee, direct to their front door. A customer, Melissa Bhalla-Pentley, paid £530 to receive this convenient sperm supply, a price tag that allegedly included reimbursement of the sperm donor’s expenses as well as a site membership fee, a courier charge, and a per-cycle cost for the sperm itself. When she failed to get pregnant, she arranged for another donation – an extra £300 charge. She had requested the donor’s medical records, but when they arrived she noticed that his name was visible, ‘just lined through with a black marker’. Something seemed amiss. At the very least, the company had breached protocols of donor privacy. When her request for a refund was refused, Bhalla-Pentley went to the police with her complaint.

  When the case came to court in 2010, it emerged that the entrepreneurs behind Fertility First had earned up to £250,000 from about eight hundred customers. Two men were found guilty of procuring and distributing sperm without a licence, as required by UK law. The sperm donors were reported to have received no payment at all for their services, nor had they realized, by their account, that Fertility First was unregulated. In the Daily Mail, reporter Laura Topham related how the enterprise had been hatched after the men overheard a childless woman in a pub talking about her desire to get pregnant – ‘she wanted sperm delivered like milk in the morning’.