June 30, 2012
In the United States, there is a vast market for sperm and eggs to enable infertile couples, single women, and gay and lesbian couples to have children. The Centers for Disease Control and Prevention reported that over 17,000 in vitro fertilization cycles were initiated in the United States in 2009 with donor eggs, with perhaps a third of these resulting in live births. While statistics for artificial insemination are not as carefully tracked, estimates of the annual number of U.S. women who are inseminated with donor sperm are in the hundreds of thousands, and an estimated 30,000 to 60,000 children are born each year through sperm donation, although this number is only an educated guess.
In her new book Sex Cells, Yale sociologist Rene Almeling focuses on the people who provide the raw material sold on this market: the men and women who sell their sperm and eggs. Seeking to understand why people make the decision to sell their gametes, how they view the offspring conceived with their cells, and how the rapidly expanding fertility industry is making those gametes available to patients, Almeling interviewed thirty-nine sperm and egg donors as well as doctors and staff at sperm and egg agencies. These interviews provide the basis for a rich, detailed characterization of the origin and development of the market for sex cells in the United States and the way it operates today. While Almeling aims to describe that market, the manipulation and exploitation suggested by the book’s punning title ultimately raises a question that has not yet been widely asked: Should there be such a market at all?
The decision to sell one’s sperm or eggs — and it is a sale, despite the widespread use of the term “donation” to suggest otherwise — entails letting go of something that carries an important part of one’s personal identity and to make it available to someone else. Those who become sperm and egg “donors” must be able to accept, or even welcome, the likelihood that somewhere out in the world they have genetic offspring — perhaps many of them — whom they will not meet, in most cases being raised by someone they do not know.
Money is usually the initial reason that people decide to become gamete donors, Almeling reports. Compensation for sperm donation ranges from tens to hundreds of dollars per specimen, while women are paid many thousands of dollars per egg donation cycle. The difference can of course be chalked up to the fact that, unlike for men, the donation process for women is burdensome and risky, involving hormone treatments to induce ovulation of multiple eggs. That process can have potentially dangerous side effects, including ovarian hyperstimulation syndrome (OHSS). In relatively mild cases, this condition can lead to nausea, abdominal distension and pain, vomiting, and diarrhea; in rare, severe cases, it can result in liver dysfunction and ultimately in the potentially fatal clotting of blood vessels. While studies seem to indicate that egg donors are at less risk for OHSS than IVF patients, the egg-procurement procedure is identical for both, and severe cases of OHSS have been documented for egg donors. Furthermore, the actual collection of eggs is an outpatient surgical procedure that typically requires general anesthesia, which can pose its own risks.
For some donors, the motives do not run deeper than the financial. But Almeling finds that most donors have a more complicated view of the process. Many donors reported that their motives included a desire to help others, and interviewees included both men and women whose lives had been affected by infertility and who thus had a personal sympathy for the infertile.
One of the great achievements of Almeling’s book, however, is her investigation of the ways that men and women donors understand differently the meaning and significance of their participation in reproduction from afar, and her analysis of how the agencies who procure and sell gametes understand this and use it to tailor their recruiting to the different experiences of male and female donors.
Many sperm donors state frankly that their most compelling, often only, motive is the opportunity to earn money. Sperm donors who agree to contact with their potential offspring, thus becoming “identity-release donors,” are often given additional compensation. One young man told Almeling that the prospect of making $100 instead of $65 easily persuaded him to become an identity-release donor. He also described a common sentiment among donors: “For me to maintain my lifestyle, I need a steady paycheck coming in just like my other job.”
Almeling shows that sperm banks in fact work to reinforce the notion that recurring sperm donation is just like regular job: clinics typically shield donors from the broader context of their work by not letting them know when a pregnancy is established from their sperm; they are typically paid with a biweekly paycheck and they are often expected to produce at least once per week. The link to employment is reinforced by the fact that sperm donors are only paid for being productive — meaning only if their samples are sufficiently fertile — which, for most men, requires around forty-eight hours of abstinence prior to donation. Consequently, many men who are married or in committed relationships end up scheduling their sex lives around their weekly donations. Some reported being reluctant to engage in sex too frequently because of the reduction in wages…