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It was a Facebook ad that propelled Ashleigh Griffin to act. She had heard about egg donation from her mother, a nurse, but never thought of it as anything more than an esoteric medical procedure.

The ad in her Facebook feed in 2011 told a different story. It intrigued Griffin, promising her thousands of dollars for something her body produced on its own, with the bonus of helping another family. It even specified that the opportunity was tailor-made for young cash-strapped women in college, as she was. She clicked through, and only grew more curious. She tried to sign up, but quickly hit a wall. Griffin was 18, and the agency required donors be at least 21.

Just before her 21st birthday, she typed “egg donation” into Google, and off she went. Over the next four years, Griffin donated her eggs six times at three different clinics. On four of those occasions, her ovaries became painfully swollen and she experienced weight gain, abdominal pain, severe nausea, and had trouble urinating; one time she was hospitalized. For her efforts, she was paid $61,000.

A 2016 Facebook ad for A Perfect Match, which connects aspiring parents with egg donors.
A Perfect Match

Egg donation is designed to help families who are having trouble conceiving. The process involves taking eggs from one woman, fertilizing the viable ones, and then transferring them either to the aspiring mother, or to a surrogate, in the hope of achieving pregnancy. In practice, it’s often more complicated.

The first US child conceived from a donated egg was born in 1984. Since then, the procedure has grown into a thriving industry. Demand from aspiring parents, along with a dearth of regulations, have spawned matchmaking agencies that offer to help parents find the perfect young woman whose eggs will result in the equally perfect child.

Donating eggs can be lucrative, with agencies paying as much as $50,000 per cycle in some cases. But donors say it also can be confusing and frightening, leaving the women on whom the industry depends feeling isolated and unaware of the risks. Some donors find the experience—which involves injecting yourself with hormone-filled syringes for 10 days or more, until a doctor pierces your vaginal wall with thick needles to suck out the extra eggs you’ve produced—differs greatly from the marketing.

Pain, safety, and taxes

In response, some have joined private Facebook groups to share the nitty-gritty details, including how best to deal with the pain of your ovaries swelling to the size of grapefruits, how to negotiate with doctors for safer hormonal doses (even if that produces fewer eggs), and even how to report the payments on tax returns.

“There's a huge lack of data there to really [allow women] to make informed decisions,” says Dr. Diane Tober, an assistant professor at the UC San Francisco, who studies egg donors. “And that's really problematic, obviously, when you have people making decisions that could affect their future health, well-being, and their ability to have children.”

Ads or marketing materials targeting potential donors rarely mention the risks or common complaints. Liz Scheier donated eggs three times between 2005 and 2007, and says she was told there were no known risks associated with egg donation. Today, Scheier is a media liaison for We Are Egg Donors, a women’s health organization that works with more than 1,500 donors to promote transparency and advocate for their concerns. She says that donors nowadays hear the same line she did, delivered almost verbatim. But it’s missing one key detail. “There are no known risks because no one has looked,” she adds.

Tober aims to change that. She has spent the past five years interviewing hundreds of egg donors and studying the short- and long-term impacts of the procedure. Her findings suggest that donating eggs is riskier than some agencies say, and that many egg donors don’t understand how the industry operates.

Some women suffer a reaction to the fertility injections known as ovarian hyperstimulation syndrome, which in extreme cases can be fatal. Tober says clinics often downplay the risks by citing statistics that apply only to the most severe cases, and glossing over other potential side effects of egg donation. She also says her research has found that mild to moderate cases of ovarian hyperstimulation—including symptoms like abdominal pain, nausea, vomiting, diarrhea, and sudden weight gain—are “quite common” among egg donors, sometimes requiring hospitalization. Other donors suffer complications including ovarian torsion or surgical mishaps.

Looking back on her first donation, Griffin marvels at how little she knew about what she signed up for. “I had no idea what was going on,” she says.

That’s understandable. The process is complicated, involving screening, multiple tests, drug regimens, and finally, harvesting eggs.

Screenings and tests

The screening alone can be arduous. Here are some of the requirements for donors working with A Perfect Match, an agency in La Mesa, California: Potential donors must be between the ages of 19 and 29; have no criminal record; not be overweight; not taking antidepressant drugs; fill out a medical and genetic questionnaire about themselves and their extended family; and submit academic transcripts and SAT/ACT scores. Potential donors must also submit to genetic testing; a psychological screening, the results of which they can’t see; a medical screening; and to an ultrasound, vaginal culture, and STD screening. A drug, nicotine, and alcohol screening is required as well.

After they are chosen by an aspiring parent, donors take medication to synchronize their menstrual cycles with the recipient’s. Then come the injections.

Normally, women produce one egg each cycle. To increase the chance of success, donors are given drugs to promote the production of additional eggs. Typically, donors are given dozens of lengthy syringes and tiny glass vials, and instructed to inject themselves with up to four drugs multiple times a day to coerce their ovaries into producing dozens of eggs, according to interviews with donors. Women are urged to stick the syringe in a fatty place on the body, like the stomach or thigh, to minimize bruising and pain from the needles, some of which are longer than an inch.

During this process, donors are instructed to abstain from sex, alcohol, drugs, tobacco, staying up late (or waking up too early), jumping, walking up stairs too aggressively, or any other activities that might jostle their swollen ovaries. Every one to three days they must visit a doctor—chosen by the intended parents or agency—for blood work and ultrasounds.

Griffin’s first donation was through the Pacific Fertility Center in San Francisco. She recalls meeting with a doctor to discuss potential risks, many of which she now thinks were downplayed. The clinic allowed her to choose when she wanted to donate and how many cycles she’d like to complete. She was in college at the time and needed cash, so she opted for two cycles, for which she was paid $8,000 each—in June and August 2014.

The first cycle was uncomfortable, she says. “I remember crying every single time they said I had to wait longer to donate the first time because I was so bloated and in so much pain that putting my heels on the ground hurt too much,” she recalls.

Once injections have been completed, the extraction surgery is scheduled at a clinic. The donor is sedated and a catheter is inserted. A needle is used to puncture her vaginal walls to get to the follicles, which are then drained. Because of the sedation, the donor is advised to rest at the doctor’s office for at least one hour following the procedure and be escorted home. Lab personnel inspect the extracted eggs and combine the viable ones with sperm in the hopes they’ll be fertilized.

Griffin says the doctor she met with at the start of her cycle reviewed potential side effects of the medication, like bloating, and told her ovarian hyperstimulation is “extremely rare.” But she says she experienced severe hyperstimulation, which left her extremely bloated, and suffering from nausea, vomiting, and abdominal pain. She spent one night in a hospital, while fluid was drained from her abdomen; she experienced similar, though less severe symptoms during three of her other donations.

Griffin couldn’t stand—much less work at her summer job at a child care facility—for three weeks after the procedure; she says it took two months for her to return to normal. By that point, her second donation date was looming. Given her previous complications, Pacific Fertility staff said she could drop out, but she chose to continue.

“I didn't feel super pressured into it, but I felt like I had made a commitment, and I was counting on the money,” Griffin says. “And I felt confident after conversations I had with them that they were going to do the medical part differently this time around.”

They did. For her second donation, she notes that clinic staff, at her behest, gave her less of the follicle stimulating medication, and it went well.

In a statement, a spokesperson for Pacific Facility said: “Our physicians and clinicians work with patients on custom care plans to ensure each individual receives the highest and most personal level of care." The spokesperson declined to comment on Griffin’s version of events, citing patient privacy rules.

A Perfect Match CEO Darlene Pinkerton says these Facebook ads were "successful."
A Perfect Match

Griffin says the experience left her feeling isolated. “That first time when I got really sick, the worst part of that was feeling like doctors didn't understand what I was going through, the ER staff didn't know, my friends didn't get it.” She had a difficult time finding information online about egg donation from a donor’s perspective. Then she found the private, invite-only Facebook group created by We Are Egg Donors.

The group quickly became an invaluable resource for Griffin. It was the first time she had seen anyone, online or elsewhere, talk realistically about compensation and about the day-to-day realities of the process: “It's a huge deal for me to have other people, even virtually, who have any idea [what it’s like].”

In the group, donors post about their experiences, ask questions, and give advice to first-timers. The group screens potential members and enforces strict confidentiality rules; some donors have been banned for sharing information or screenshots of the group’s activities. The collective knowledge available through the group inspired Griffin to donate a third time.

Some of the group’s conversations veer into the unusual, and trying, aspects of the process. There are more than a dozen posts about how best to travel on a plane with your syringes full of hormones—which must stay refrigerated—without causing a panic at TSA (short answer: carefully, in an iced carry-on lunch box) and what to do if you’re in the air during one of your daily injection times. (The plane's lavatory is your best bet.)

Darlene Pinkerton, the CEO of A Perfect Match, is well aware of the Facebook group, though she’s not a member. “I can almost always tell when someone is in [the group] because of the things they request,” she says. One common request among group members, she says, is for Lupron—a synthetic hormone that studies have shown decreases the likelihood of hyperstimulation.

A magnet for overseas couples

Egg donation has thrived in the US in part because there are few laws regarding the transfer of unfertilized eggs for reproductive purposes, according to industry experts. They say a handful of states have policies that touch on some aspect of egg donation, generally from the perspective of the recipient.

With few regulations, the US has become a magnet for well-off wannabe parents in other countries where egg donation is regulated, or outright illegal. Egg donation is barred in China, Germany, Italy, and Norway; paying women to donate eggs is prohibited in most of Europe, as well as in Canada and other nations.

“One of the main reasons people are coming to the United States [for egg donation] is because the laws and regulations make it so difficult in other countries,” says Dr. Lauren Jade Martin, an associate professor at Penn State studying the social impact of assisted reproductive technologies. A Perfect Match works with many intended parents from outside the US, Pinkerton points out.

Though the process is labeled a “donation,” money is usually involved. And, as in many fields, donors are rewarded for past performance: The more cycles a donor has under her belt, the more she can make. A first-time donor typically will make about $8,000, with the payment rising to $10,000 for a second, according to interviews with donors and agency staff. Women with certain traits in demand from prospective parents—a high IQ, Ivy League education, modelesque features, sought-after ethnic backgrounds, or unique skills—are routinely offered $20,000 to $50,000.

At A Perfect Match, the typical first-time donor makes $15,000, says Pinkerton; some get $25,000. Jewish, East Asian, and Indian donors get paid even more, she says. “There's a higher demand for a smaller number of people” in those groups, adds Pinkerton. “So they can ask for higher compensation.”

American egg donation agencies rarely, if ever, refer to these transferred funds as payments, describing them as “compensation” for a donor’s time. The difference is important, as it’s illegal to sell human tissue in the US.

It wasn’t always like this. The American Society for Reproductive Medicine, the leading medical organization for fertility centers, used to have suggested guidelines for donor pay. For more than a decade, the ASRM recommended that compensation not exceed $5,000 without justification, and that anything over $10,000 went “beyond what is appropriate.” The guidelines weren’t technically mandates, but they were widely followed.

“When you're in the medical industry and you get 'suggested guidelines' from someone who does audits … they are not suggestions, they are rules,” says Valerie McMorris, who donated eggs in the '90s and now owns her own egg donation agency, Donor Services of NY.

Pinkerton of A Perfect Match says that when the ASRM guidelines were first set in 2000, she attempted to follow them, but quickly discovered that she couldn’t attract the highly educated, attractive, successful donors her clients sought without offering tens of thousands of dollars. “When ASRM restricted everyone to $10,000 I just felt it was so unfair to parents to send them back into the dark ages of having to choose a donor that really didn't match their family or their values,” she recalls. “So I gave up after a month and just kept doing my own thing.”

In 2011, an egg donor sued ASRM over the organization’s compensation guidelines, which the donor claimed were a form of illegal price-fixing; other donors later joined the case. In a 2016 settlement, ASRM agreed to eliminate its payment suggestions, pay $1.5 million in legal fees, and give the plaintiffs $5,000 each. Agencies were freer to offer donors more money.

Following the settlement, McMorris says agencies from outside New York started targeting donors in the state, offering higher payments. “We were losing donors—the desirable donors, the ones that you want to share with your couples, the ones who are really motivated to move forward,” she says.

A screenshot of Donor Services of NY's website.
Donor Services of NY

Since then, donor pay has soared, particularly for attractive, well-educated donors. But the more criteria in play, the harder it is to find a woman who not only matches the specifications, but is fertile and eager to donate.

McMorris says intended parents have become more demanding: “Sometimes they're ridiculously specific. I'll get a call from someone who'll say 'I want a woman who is 5'11", blonde hair, blue-eyed, beautiful like a model, really bright with an Ivy League education.’” She recounts one person asking to only see donors with those credentials, plus each of their grandparents had to have lived past the age of 86.

Two of Griffin’s donations were arranged by A Perfect Match, for which she was paid $15,000 in 2015, and $20,000 in 2016. She says the higher compensation made it worth going through the agency’s more extensive screening process. Those procedures were done at a clinic near San Diego. For her most recent donation last summer, Griffin went back to Pacific Fertility, and was paid $10,000.

“Everybody every single step of the way is either getting a child or making money,” Griffin says. “The donors are making money, but the doctors and clinics are making money [too]. It's an industry, so I don't know why it's only taboo for the egg donors to [treat] it as an industry.”

Read more: https://www.wired.com/story/inside-lucrative-business-donating-human-eggs/