SPEAKER 1: Well, let's switch over to talk about eggs,
and I'm going to ask you some of the same questions
and also to draw some contrasts.
You've already been doing that to some extent.
So the first is just to say, tell us about the kind
of women who become egg donors.
SPEAKER 2: So, again, in my interviews with egg donors,
I found two groups of women.
So the younger college students who were interested in being
donors to make money in order to pay for their education.
There was also a not insignificant number
of young mothers who were in their late 20s.
They had had children of their own.
They might be staying at home, and being an egg donor
allowed them to contribute to somebody else having the joy that they
had experienced with their own children, as well
as to make some money without having to work a 9:00 to 5:00 job.
SPEAKER 1: And what are the criteria for being an egg donor?
You kind of suggested earlier that they're not quite as
stringent as being a sperm donor.
SPEAKER 2: Like sperm donors, egg donors are providing a bodily substance,
and so they're subject to some of the same screening mechanisms.
So they have to provide the three generations of family health history.
They're doing genetic testing.
They're doing contagious disease testing.
They're doing blood testing.
But the difference is, in addition to the height and education requirement
that I talked about before, one of the expectations that isn't really
written down anywhere is that women donate for the right reasons.
And so for women who call an egg agency and say, well,
I'm really interested in laying my eggs for some cash-- that's
a quote from one of the people I interviewed-- those women would not
be allowed to continue, because they're not doing it for the right reasons.
And, again, we have these expectations of femininity,
where women are going to be helpful, sort of naturally
caring, wanting to help people have children
that are suffusing the expectations for donors in this area.
So those motivational expectations really exist for egg donors,
and they don't at all for sperm donors.
SPEAKER 1: So it sounds like there's a real gender
difference between sperm donation as employment, make some quick cash;
egg donation as help build a family, do it for the right reasons,
very deontological.
Is that kind of what you found in your research?
SPEAKER 2: Yes, absolutely.
And it's not only something that affects how the egg agencies and sperm
banks operate.
I mean, it's how they're recruiting people.
It's how they're screening them.
It then affects the donor's experiences.
So women walk away from egg donation with this narrative of,
I helped somebody, and I made $5,000 or $10,000.
And so women can feel good about what they've done and helped
make this contribution.
And, in contrast, the sperm donors I interviewed
felt as if they had been milked for a resource they could provide.
They felt a little bit alienated and objectified as sperm donors.
And so that's the last thing I expected, having started
this research, interested in these gender comparisons,
to walk away from this research, thinking,
wow, you know, sperm donors get kind of a bum deal.
They, too, are helping people create families.
They, too, are making a huge difference, but nobody
is writing them thank you notes or giving them gifts or telling them
how wonderful they are.
SPEAKER 1: And it's interesting, because it's
a little bit of a flip of the typical gender narrative,
right, in that the men are being treated as a piece of meat, as kind of objects,
rather than partners, whereas the women seem to have-- on the one hand,
it flips the gender narrative.
On the other, I guess it reiterates a gender
narrative about caregiver and warmth and altruism versus work, right?
SPEAKER 2: Exactly.
SPEAKER 1: Say a little bit more about the payment and the recruitment.
So you'll hear in many courses on bioethics,
they'll show you an ad run in the Harvard Crimson or another newspaper
at a college campus, saying, this tall, this SAT score, this ethnicity,
and then promising a very high amount of money,
it would seem, for egg donations.
Is that the way it typically works?
How are they paid?
How are they recruited?
SPEAKER 2: So these advertisements that you're mentioning really
get a lot of attention, but the standard issue, first time egg
donor who's going through an agency can expect to make $5,000 or $10,000
for that donation.
So this is something that is changing right now.
So there was just a lawsuit brought by egg donors against the American Society
for Reproductive Medicine for price fixing,
for setting these expectations for what a good amount of money
is for egg donation.
So this will be interesting to see as we move forward in the next couple years
how that affects the prices of egg donation.
SPEAKER 1: So this case was settled, actually.
It was an antitrust case, and the solution
was to remove the recommendation from the American
Society for Reproductive Medicine to pay between $5,000 and $10,000.
So as you say now, without this recommendation in place,
it's possible prices in the market will fluctuate or change.
But the typical egg donor, you say, the first time through can expect in the US
to make between $5,000 and $10,000.
SPEAKER 2: That's right.
SPEAKER 1: And where do egg brokers-- and you've used that term,
and maybe we should ask about that.
Do you use the term brokers or agencies with eggs, which we typically
don't use that term for sperm.
What are these entities, and how do they recruit women?
How do they find women?
SPEAKER 2: So this, again, is an interesting, historically infused
difference in the language that's used.
So the idea that there are banks of sperm,
and sperm donors are paid-- Kara Swanson has written a really interesting book
about the history of that bank language.
And, in contrast, egg agencies really grew out
of fertility agencies, the idea of adoption agencies,
and so that language of agency versus bank,
again, sociologically, is coming from the industry,
and I think that we need to pay attention to it.
And egg agencies think of themselves as matching recipients and donors
in the same way that adoption agencies match recipients and donors.
Several egg agencies also grew out of surrogacy firms, originally,
and so there's sort of a historical timeline through which these
technologies emerged and built on each other or didn't.
The thing that's interesting to me is that, when egg donation started,
they didn't look to sperm donation as a model.
They looked to surrogacy, or they looked to adoption.
And, again, I think that's because we think of eggs and sperm
as different kinds of bodily goods.
SPEAKER 1: And it's interesting, because the market, too,
has supply meet demand, but in a very impersonal sort of way,
whereas the agency seems to be a much more artisanal kind of way
of matching people.
SPEAKER 2: Right.
Well, and that ties in also with the technology itself.
So egg donors still typically do provide fresh donations.
And so, in egg agencies, you're matching one woman with one recipient.
They're cycling together in order for the egg donor
to produce eggs right at the time the recipient is ready to receive them.
And that's very different from the logistics of sperm banks, where
the donor's coming in and producing a bunch of samples,
which then get frozen and then sold to a lot of different clients over time.
And so it still is a one to one relationship, for the most part,
in egg donation, although that, too, is changing.
As egg freezing becomes possible, people have now started up egg banks.
And I think that technological shift is going
to be interesting to follow to see if egg banks start looking more
like sperm banks.
SPEAKER 1: And one of the questions will be
whether the current gendered set up of the work
follows from gender stereotypes.
Does it follow from the technology, right?
We have, in some ways, a bit of a natural experiment on this question.
SPEAKER 2: Precisely.
There will be a dissertation to be written there, yes.
SPEAKER 1: How many egg donations does a typical egg donor do?
So you've told us sperm donation is kind of a relatively middle or long term
service, employment, regular thing.
I take it egg donation works very differently.
SPEAKER 2: Well, again here, I don't have any statistics to offer you,
because we don't have any way of knowing how many egg donors there are,
how often they donate, how many children are born.
Egg agencies typically limit women to five or six cycles,
because they are concerned about the long term
effects of young women undergoing fertility medications in order
to produce eggs for the recipient.
However, they've really pulled that number out of the sky.
We have zero longitudinal studies about the long term
effects of women who undergo egg production, either to be a donor
or for their own in vitro fertilization cycles
or now for those who are freezing their eggs for later.
And I think this is an absolutely crucial point about this market,
and one of the things that I think is the biggest scandal about this market
is that we have been doing IVF since 1978.
There has been plenty of time to run those studies,
and we have some retrospective data asking women who later developed
problems, were you an egg donor?
Did you do IVF?
But we haven't tracked women over time, which is
the gold standard of medical studies.
So I actually think that women who undergo
egg donation, women who choose to be egg donors, can't actually give
informed consent, because we don't have the risk information to give them.
And I think it's a really important thing
to think about, especially as we hear stories about egg freezing
being this technological solution to women's biological clock.
These are risky medical interventions that we don't actually
know all the risks of.
SPEAKER 1: One thing that's interesting here
is to separate IVF, going through all this to produce your own offspring,
versus what you might think of as a medical procedure.
OK, there are risks, but there's also benefits.
You'll have a child-- versus doing this egg freezing,
where it's about a potential future use you may never need,
versus doing it for third party donation where you are subjecting yourself
to these unknown risks for the benefit of another person
and for financial benefit to yourself, and whether we should think
about those categories differently.
SPEAKER 2: Right.
Well, and I think we have an ethic and a law in this country
that women have reproductive choice.
They have reproductive agency.
So this is not an area that I would say there
should be a governmental decision about who should
be allowed to do these things or not.
However, I think that we need to have a much more direct conversation
about what we know and what we don't know
about the risks of reproductive technology.
SPEAKER 1: And here, the risk profile is radically different on the egg
side and the sperm side, right?
SPEAKER 2: Absolutely, yes.
So this is one of the questions that I always
get about the study is, can you really compare sperm donors with egg donors?
And, certainly, sperm donors are going in, they're
masturbating in a small room, they're handing that sample over to a lab tech.
They don't really encounter any direct physical risks of that procedure,
in contrast to egg donors who are taking on these unknown medical risks
and injecting their bodies with fertility medications
and going through outpatient surgery, all of which does carry a risk.
At the same time, I think that, if taking
those biological, technological differences into account,
we can still look at the language around these different markets
and see the expectations that are placed on the donors.
So just a thought experiment-- we could think of sperm donation
as a gift from one man to another, in which men
are making this huge difference in helping people have families.
It's technologically possible to pair one egg donor
with a number of different recipients who are cycling at the same time.
But that's not how we've organized those markets.
And so the gender differences that we see
across egg donation and sperm donation really
aren't reducible to technology or biology.
Absolutely, we have to take biological differences into account,
but they don't provide an explanation for why these markets look different.
SPEAKER 1: And one thing that's interesting is the law
and regulation of these areas tends to treat the two more symmetrical.
As you've said several times, very little law and reproductive technology
in the United States, one of the things that
makes us an outlier, but also a market for inbound medical tourism.
But what law we do have, for the most part,
for example, allowing or forbidding compensation,
treats the two markets symmetrically.
But I hear from you that there's actually
big differences in the markets that might have a role in how
we ought to think about regulating.
Is that kind of right?
SPEAKER 2: Well, you know, this is a point
at which maybe I differ from the legal scholars
in the room on reproductive technology.
So I think that when people hear about these markets,
or they hear that we don't know about egg donors and sperm donors,
one of the things I think it's really important for us to have
is some basic data about the size of this market.
How many people are participating?
What are their experiences?
I am much more reluctant to get involved in the business of regulating
this market, and that's because I think about the really long and terrible
history of government involvement in reproductive decision making.
And I think that we have to proceed extremely cautiously.
We don't have a good history of this.
Nobody has a good history of government regulations of reproduction.
And as in France, you can actually write discrimination into the regulations
whenever you think about sort of using democratic processes to do that.
So it's one of the places where I have not come to a firm position on this.
Do we need more data?
Yes.
Do I want to go out and start regulating these?
I get much more nervous when we talk about that.
SPEAKER 1: Fair enough.