Early in the spring of last year a classified ad ran for two weeks in the Yale Daily News: "EGG DONOR NEEDED." The couple that placed the ad was picky, and for that reason was offering $25,000 for an egg from the right donor.
As a child I had a book called "Where Did I Come From?" It offered a full biological explanation, in cartoons, to answer those awkward questions that curious tots ask. But the book is now out of date. Replacing it is, for example, Mommy, Did I Grow in Your Tummy?: Where Some Babies Come From, which explains the myriad ways that children of the twenty-first century may have entered their families, including egg donation, surrogacy, in vitro fertilization, and adoption. When conception doesn't occur in the natural way, it becomes very complicated. Once all possible parties have been accounted for—egg donor, sperm donor, surrogate mother, paying couple—as many as five people can be involved in conceiving and carrying a child. No wonder a new book is necessary.
The would-be parents' decision to advertise in the News—and to offer a five-figure compensation—immediately suggested that they were in the market for an egg of a certain rarefied type. Beyond their desire for an Ivy League donor, they wanted a young woman over five feet five, of Jewish heritage, athletic, with a minimum combined SAT score of 1500, and attractive. I was curious—and I fit all the criteria except the SAT score. So I e-mailed Michelle and David (not their real names) and asked for more information about the process and how much the SAT minimum really meant to them. Then I waited for a reply.
Donating an egg is neither simple nor painless. Following an intensive screening and selection process the donor endures a few weeks of invasive medical procedures. First the donor and the woman who will carry the child must coordinate their menstrual cycles. Typically the donor and the recipient take birth-control pills, followed by shots of a synthetic hormone such as Lupron; the combination suppresses ovulation and puts their cycles in sync. After altering her cycle the donor must enhance her egg supply with fertility drugs in the same way an infertile woman does when trying to conceive. Shots of a fertility hormone are administered for seven to eleven days, to stimulate the production of an abnormally large number of egg-containing follicles. During this time the donor must have her blood tested every other day so that doctors can monitor her hormone levels, and she must come in for periodic ultrasounds. Thirty-six hours before retrieval day a shot of hCG, human chorionic gonadotropin, is administered to prepare the eggs for release, so that they will be ready for harvest.
The actual retrieval is done while the donor is under anesthesia. The tool is a needle, and the product, on average, is ten to twenty eggs. Doctors take that many because "not all eggs will be good," according to Surrogate Mothers Online, an informational Web site designed and maintained by experienced egg donors and surrogate mothers. "Some will be immature and some overripe."
Lisa, one of the hosts on Surrogate Mothers Online and an experienced egg donor, described the process as a "rewarding" experience. When she explained that once in a while something can go wrong, I braced myself for the fine print. On very rare occasions, she wrote, hyperstimulation of the ovaries can occur, and the donor must be hospitalized until the ovaries return to normal. In even rarer cases the ovaries rupture, resulting in permanent infertility or possibly even death. "I must stress that this is very rare," Lisa assured prospective donors. "I had two very wonderful experiences ... The second [time] I stayed awake to help the doctor count how many eggs he retrieved."
David responded to my e-mail a few hours after I'd sent it. He told me nothing about himself, and only briefly alluded to the many questions I had asked about the egg-donation process. He spent the bulk of the e-mail describing a cartoon, and then requested photos of me. The cartoon was a scene with a "couple that is just getting married, he a nerd and she a beauty," he wrote. "They are kvelling about how wonderful their offspring will be with his brains and her looks." He went on to describe the punch line: the next panel showed a nerdy-looking baby thinking empty thoughts. The following paragraph was more direct. David let me know that he and his wife were flexible on most criteria but that Michelle was "a real Nazi" about "donor looks and donor health history."
This seemed to be a commentary of some sort on the couple's situation and how plans might go awry, but the message was impossible to pin down. I thanked him for the e-mail, asked where to send my pictures, and repeated my original questions about egg donation and their criteria.
In a subsequent e-mail David promised to return my photos, so I sent him dorm-room pictures, the kind that every college student has lying around. Now they assumed a new level of importance. I would soon learn what this anonymous couple, somewhere in the United States, thought about my genetic material as displayed in these photographs.
Infertility is not a modern problem, but it has created a modern industry. Ten percent of American couples are infertile, and many seek treatment from the $2-billion-a-year infertility industry. The approximately 370 fertility clinics across the United States help prospective parents to sift through their options. I sympathize with women who cannot use their own eggs to have children. The discovery must be a sober awakening for those who have always dreamed of raising a family. When would-be parents face this problem, however, their options depend greatly on their income. All over the world most women who can't have children must simply accept the fact and adopt, or find other roles in society. But especially here in the United States wealth can enable such couples to have a child of their own and to determine how closely that child will resemble the one they might have had—or the one they dream of having.