Professor Julie Shapiro weighs in on the issue of compensated egg donation:
First, some general context might help. That CNN story reports that as the economy collapsed, more women were considering selling their eggs. Disturbing or not, this makes total sense. People had greater economic need and were more willing to consider more options to get money.
Now with more suppliers, my admittedly rudimentary understanding of economics suggests that prices paid to women for their eggs should drop. I’d expect to see this, too, because the economic realities might actually make the demand for eggs decline as well, as hard-pressed people defer expensive fertility treatments as well as the inevitable expenses incurred in raising children.
These market conditions–more sellers in greater need with fewer buyers–would appear to set up a dreadful dynamic. And it is in this context that I consider the concern that offering women too much money somehow crosses a line from compensation (which I take to be acceptable to the blogger) to inducement (which I think she finds unacceptable.)
It’s clearly true that as you raise the price you’re willing to pay, you will induce more women to offer up their eggs. To put this slightly differently, some women would not sell their eggs for $5,000 but might sell them for $10,000. I’m perfectly prepared to believe this is true, but should I be concerned about it?
I realize that providing eggs (and perhaps here I should note that I’m trying very hard not to use the word ”donate”, because many have pointed out that those being compensated are not donors) is dangerous and painful. I worry, too, that women contemplating this option are not fully informed of the risks they incur.
It’s here that I think the role of money is most problematic. Those harvesting and selling the eggs have every reason to get the donor to agree, for this is how they make money. And yet I’d guess they are the same people responsible for ensuring informed consent. So it’s not really in their interest to impress the woman with the magnitude of the risks.
But this concern is quite different from the one about offering the women themselves too much money. Given that providing eggs carries risks, what’s wrong with offering high pay for the job? Would we raise this objection if other people in the world who do dangerous work (coal miners, hazardous waste handlers, soldiers) were offered higher compensation because of the nature of their work?
I see only two possibilities. Either the work is so dangerous that we should bar payment for it entirely, or it reasonable to pay people to do this dangerous job, in which case it ought to be perfectly fine to pay them more–something in the nature of hazard pay.
I think there are factors missing from Madsen’s analysis. For example, women who are desperate will sell their eggs whether you offer them $3,000 or $10,000. That being the case, I’d rather they get the higher sum. The risk to them is the same no matter what they’re paid.
What happens as you raise the compensation is that more women are willing to consider the proposition. That means, perhaps, you begin to draw in women who are not quite so desperate. Capping the price you’d pay might keep these women out of the market, but it won’t directly help those who are truly desperate. (You might think that limiting the supply will allow the providers to raise prices, but then you’ll just be back to the higher compensation which will draw more women into the market.)
There’s a final point I haven’t worked in here. Not all women’s eggs are equally valued. I pretty confident, for example, that women in graduate school can demand more for their eggs than women who didn’t finish high school. I’ve glossed over this in order to simplify my analysis, but I don’t think this market bias changes much.
Of course, many places (Canada and the UK are one’s I’ve written about) do not permit women to sell their eggs. This raises a host of different issues, some of which are discussed in those posts I just linked to. But if we’re going to pay women for their eggs, I don’t see any basis for limiting the amount they can get.
Professor Shaprio’s analysis is thoughtful and provocative. I do have to take exception, however, to her concern that:
I worry, too, that women contemplating this option are not fully informed of the risks they incur. It’s here that I think the role of money is most problematic. Those harvesting and selling the eggs have every reason to get the donor to agree, for this is how they make money.And yet I’d guess they are the same people responsible for ensuring informed consent.
Of all the issues raised by Professor Shapiro, this is of the least concern to me. While there is little uniformity throughout this industry, there are certain givens and one of them is that the egg donor will be provided with considerable information regarding not just the medical risks of donating, but the emotional and legal ramifications as well. In addition to meeting with (hopefully) an independent attorney to review her contract and the risks inherent therein, the prospective egg donor will have to undergo an exhaustive medical examination where a physician will, in painful detail, describe the entire donation process and all the risks that are involved. Moreover, the egg donor will be screened by a licensed mental health professional who, in addition to discussing the obvious risks of donation, will address the psychological and emotional implications of the process.
The ASRM has done a commendable job in addressing many of the informed consent issues articulated by Professor Shapiro. Beyond that, the ASRM has attempted to step into the breech by establishing parameters as to the appropriate financial remuneration for egg donors. Unfortunately, because they are merely guidelines and not binding upon non-members, we are faced with the current situation where good ole American capitalism is threatening to curtail a reproductive choice option that is essential for couples struggling with infertility.
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