I’ve written recently about the role of money in adoption, spurred by the furor over the Russian adoption fiasco that continues to reverberate. I’ve also discussed the market for eggs.
I’m generally concerned about the role of money in fertility matters and the potential for the profit- motive to shape human behavior in appalling ways, so this blog post caught my attention. Playing off a not-terribly-recent CNN story, Pamela Madsen (I have no idea who she is beyond being the author of the blog post) raises concerns about whether rising compensation for egg moves beyond compensation to enticement.
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.
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I don’t know how much it brings women to the table (so to speak) that wouldn’t have otherwise considered egg donation, but it definitely raises the intended parents’ expectations and may make the egg donors more willing to consider options they hadn’t before- anonymous or open donation, specifically- and that they may not be comfortable with in the long term.
I’m with you on this one. I fail to see the difference between compensation and inducement.
The interesting reality is that more women were available to donate as the economy deflated, but the numbers of Intended Parents looking for donors decreased at an even faster rate.
The other item that casual onlookers fail to appreciate is the marketability of the donor as quantified by phenotype and genotype. A desire to donate does not necessarily turn into an opportunity.
Finally, I think you will see the numbers of women looking to donate will decrease now that the market is correcting itself. The sky has not fallen.
I’d really love to see someone do some serious work on the effects of the economic crises on the fertility industry. It seems to me that the ART economy should move with the economy generally. As the economy deteriorates, demand for gametes should fall and supply of gametes should rise. This in turn should drive down prices.
But many forces distort this. In particular, people in large portions of the world cannot sell gametes at all, because it is forbidden. And there are these persistent reports of a sperm shortage in the UK. If anyone has seen an economic analysis, I’d love to know about it.
That said, I am concerned about the adequacy of the consent that people give when they provide gametes. I think I’ll have a main post on that shortly.
I’d say as long as the woman understands the risks, she should be paid what the market will bear. I’m not convinced that they fully understand the health risks or the emotional risks to themselves or their offspring. I say this because these women sign waivers before their offspring are born, something the law does not allow in adoption yet the child may grow up and seek her out just as if it were an adoption.
I see a conflict of interest with the inducement issue. The women who conceive children for and with commissioning couples, are often students of the university that runs the fertility clinic. Are universities in a position to sell young healthy intelligent women who are deeply in debt on the idea of conceiving offspring for university “patients”? Do the universitites have detailed information on members of the student body that would allow recruiters to specifically target certain women with the most salable attributes? Obviously its going to cost customers more to conceive children with a woman if she produces offspring that have the most frequently requested genetic traits – people will pay a premium to get her embryo. The women should make the money if people are willing to pay, but I wonder if the fox is loose in the hen house.
The whole question of consent and understanding and the capacity of people to comprehend the nature of the undertaking is something I’ve been thinking a lot about. I will do a post on it shortly.
“hen house.” interesting metaphor.
kisarita – about my “hen house” metaphore being interesting (involving eggs), that was unintentional! Thanks for pointing it out though, I feel clever as hell now.