[This might seem a bit of a digression from the ongoing consideration of harms that I’ve been carrying on, but I think it will actually fit in nicely. Still, if you were closely following that thread, think of this as a little off-shoot. You may need to bear with me a bit here, though, as there is ground to cover.]
In the last few days I’ve had the opportunity to read Sex Cells, a book by Rene Almeling. I’ve mentioned her work before but hadn’t had a chance to read the actual book until now. My short take? everyone should read it. But until you do (and just in case you don’t) I’ll go on here.
Her work has made me want to revisit a topic I’ve written about before and revise what I said. Actually, it makes me completely want to reject what I said there. Always good to be open to new thoughts, don’t you think? Let me explain.
While Almeling’s work in the fertility industry is new, she is working on some thinking about commodification developed by Viviana Zelizer and it seems fair to give credit to the underlying insights, too. To some people, commodification is an on/off switch. Either you offer money and thereby commodify something or you don’t. Doesn’t matter how you dress up the money–as soon as you’ve offered the money, you’ve commodified and that’s that. The earlier post of mine espouses just such a view.
Zelizer suggests that it’s all far more complicated than that–the details and the context matter. The same basic exchange (money for whatever) can have different meanings to the participants, depending on the surrounding circumstances. Almeling takes this insight and examines the egg/sperm markets.
Let me be a bit more specific and concrete. Some people would look at the money/egg exchange and say that it doesn’t matter how you dress it up–whether you say you’re buying eggs or compensating for time/effort, it’s all commodification and it’s all the same. (And generally once you call it commodification, many people will say it is bad.) That’s basically what I said in my earlier post, though I didn’t conclude it was bad.
Zelizer and Almeling ask us to look more closely: You can offer to simply buy a woman’s eggs or you can ask if she’d be willing to help someone else have a child (stressing the altruistic aspect of the act) and offer to provide money in recognition of the time/effort she’ll need to devote to that altruistic project. From the point of view of a woman being presented with this proposition, there’s a real difference here. She’ll experience the transaction differently.
Now obviously you can reject this view, but it seems to make a great deal of sense to me. Despite what I said before, we don’t just think about money. We think about the whole package deal. And if you talk to egg donors (which Almeling did) you find that they do that as well.
Transactions for eggs are fairly carefully structured to be more like the second transaction outlined above than the first. You’re helping someone out. You get the same money whether there are two eggs or twenty or none at all. That’s because you put in the time and effort no matter what the outcome–and we’re not buying the eggs. (If we were buying the eggs, you’d get paid depending on results.)
I don’t mean to suggest that this tells you whether a particular practice is good or bad, by the way. And it still means that there are a host of questions. But it seems to me an important insight to have in view.
It also suggests an interesting contrast, one that Almeling discusses at some length. Sperm providers are paid generally paid per acceptable specimen. In other words, their gametes are much more simply commodified. If the sperm count is too low, no money–it’s pretty clear you’re buying the sperm and not paying them for time/trouble.
Now of course there are many differences between providing eggs and providing sperm and the practices around them have developed quite differently. You can say that some of the differences are the result of biological differences between men and women. But the difference in how compensation works isn’t dictated by that difference. You could pay for eggs by the piece or you could compensate men for their time and trouble. We don’t. And that, Almeling suggests, is about gender at work. It’s about how we think about men and women and money. Stripping it to its simplest, men engage in paid labor while women care about other people.
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Just a quick technical correction before I comment about the deeper ethics of the whole thing:
You said that men are paid by the sample and only if the sample is good where as women are paid for their time and trouble to help someone out regardless of the number of eggs they are able to harvest and regardless whether they turn out to be duds or not.
Men who want to provide sperm to a clinic, like women, go in and fill out a bunch of papers and waivers and sign release forms and they don’t receive any money for their time for doing that. (Lets assume that time was part of the over-all altruistic effort.) Their paperwork will be reviewed to see if the clinic is interested in harvesting genetic material from them and if they are interested, the man, like the woman will provide the clinic with a sample of their genetic material and the clinic will give them money for their time. Again both of them get paid regardless of how much is harvested and even if the semen is ultimately found not to be potent the same as if the eggs are found not to be fertile. If the semen is not potent his services will no longer be required. If her eggs are found to be infertile her services will no longer be required. They won’t get paid for their time a second time if they’ve demonstrated that their eggs are no good like if the guy demonstrates his sperm is no good.
The stakes are higher with women because it takes a lot more time and effort to get the eggs out than it does to get the sperm out and once its out, its a total loss if it turns out the genes are duds. The clinic bears the financial risk with semen donors because its less money – with egg donors its usually clients of the clinic that bear the financial risk because of all the drugs and people involved in getting the egg out of the donor. Some Ukranian clinics have in-house & on-staff egg donors and sperm donors if they have a proven track record of potency and fertility.
You know reading all their contracts and release forms informed consent forms is part of my little hobby so its just a point of clarification. No moral or ethical judgement or even my armchair uneducated legal opinion of the rightness or wrongness of it all. The process in practice is virtually identical to sperm donation but it just takes so much more time to harvest a female’s eggs than it does to harvest a man’s sperm and of course there are so many more people involved in harvesting eggs than in harvesting sperm. Males and Females both get paid for their time and effort to harvest their genes even if their effort turns out not to be fruitful. But be sure that their first donation will be their last donation if the goods are bad.
That is why many people in the market for eggs decide to go with what they call “proven donors” those are girls who already have offspring – does not matter whether they are raising those children themselves or not, the point is they already have kids so the investment has little risk.
While much of what you say is accurate, I stand by my original point and continue to think it is important.
Based on both the research Almeling discusses and the people from sperm banks I’ve talked to, once men are in the program, they are compensated sample by sample. They may appear twice in one week and get paid for both samples or neither or one. It depends on the sperm count (among other things). If they provide inadequate samples, they don’t get paid, but particularly if they have a good track record, they can continue in the program. I think this conveys an understanding that they are selling a product and that if the product isn’t good enough, they won’t get paid.
By contrast, a woman who sells her eggs will be paid the same if she produces 20 or 30 eggs. Now it is doubtless true that if she produces zero or if they are all flawed she may not be chosen again. But for those who continue in the program, there isn’t a suspensful waiting period to see if they’ll be getting money. The structure of the transaction is different.
It is true, as you say, that proven egg producers as well as sperm producers are preferred and so track record does matter. But I don’t think this erases the other effects of the structure of the transaction even if it does make the whole picture more complicated.
Julie the clinic pays the men and women for their time taken to have their gametes havested, then they take the harvested material and test it. It can 1/4 cup of sperm, or it could 1/16 a cup of sperm, what matters is that the quality is good and so that they can sell whatever they took in to at least offset the clinic’s out of pocket costs for the lab tests and paperwork to process the sample and also to cover office overhead and advertising. I’m sorry but potency does not wax and wane with the cycles of the moon; if a man who was paid for his sample turns out to have sperm that is sterile, it won’t matter how many successful donations he made in the past, he will not be paid to donate again there. But no, they don’t test it before paying him. Just like the ladies they are paid prior to it being tested and prior to proof that embryos will result.
I’m not sure I understand the point here. But here’s what I mean about how men are paid. Let’s suppose a man makes it through all the initial screening. He’ll now be asked to come in to provide sperm that will be sold. He might come in once, twice or even three times a week. If he comes in on Tuesday and provides sperm but the sperm count is too low, he won’t be paid. he is not paid for his time. He can come back again Thursday or Friday or the following Monday and try again. Every time the count is too low he won’t be paid. When it’s fine, he will be. He’s not paid for time but for product.
The sperm count does vary–it depends, for example, on how much rest he gets, how stressed he is, when the last time he had sex was. So he gets paid or not, each time, on whether he’s produced an acceptable specimen. Having done all the initial testing and all, he can probably stay in the program for a while, even if ever now and then his samples aren’t good enough. (Almeling discusses a lot of this in her book.)
I think you should be looking at the harvest experience (for men and for women) will net the clinic 1 sample. The Clinic will pay men and women for their time necessary for the clinic to harvest a sample of eggs or semen. The samples are tested after the men and women are paid for their time. Men get a flat fee per sample just like women and the volume of the sperm or the number of eggs won’t inhibit either of them from receiving payment however if the clinic cannot recoup their lab testing and office overhead costs by selling the sample they harvested it will mean the clinic took a loss and they won’t want that person to provide semen or eggs again.
You know that no clinic is going to pay lab test and overhead and processing costs to test a guy’s semen when he just had a bunk load the week before. Even if they did pay him after testing which they don’t….why would they bother testing it if they already knew it was bad. Even if their track record was stellar. Potency does not wax and wane it won’t be getting more potent if he’s on a down swing
That brings me to my second point and its not a moral or ethical one either its just about plain logic and clarity.
As I said above these people only get paid for their time and effort one time to find out if their genes are any good. So when people say its for time and effort you have to ask well would you pay for their time and effort if you knew for sure their genes were not able to be reproduced? Well that depends on what you were wanting the genes for. For research purposes someone might want to study f’d up genes that don’t work. But not for the purposes we are talking about here which is making babies. So its not the person’s time and its not their sperm because the sperm or the egg has to do something more than just be sperm or just be an egg for them to pay for that time.
So fine they’ll pay for your time to get the sperm but the sperm is not the goal so the sperm must be able to accomplish the goal of fertilizing an egg to create an embryo. So they’ll pay you for your time to give them the sperm if its good sperm and can make an embryo. But they won’t pay you for your time to give them that sperm that is good for making embryos if you won’t let them make an embryo with it. You might only want them to do research on your good baby-making-quality sperm and not want them making embryos with it. Well you won’t be paid for your time to give them the sperm then. You could let them make the embryos but say you won’t let them keep the resulting baby all to themselves you want to be named father of your offspring. Well then you won’t be paid for your time to give them the sperm that’s good quality to make a baby because what they really want is for you to agree to not raise your own offspring. The end result Julie is they are agreeing to abandon their roll in their offspring’s life and performance of that obligation begins after they donate their sample when their offspring is born. Its like one of those clauses in the construction contracts I deal with all the time “in the event that this should happen the General Contractor agrees to do blah blah blah” and he may have already been paid in full on the contract but he still has commissioning work to do on the building in the first year. He’s paid in advance and he agrees that for that money he will do some stuff in the future either on a specific known schedule or just on the off chance something comes up and the owner needs his help.
I think your general point here is that they are being paid in part not to have a role in the life of any resulting child–or in the case of providers who agree to subsequent contact, they are being paid to have a carefully defined role. That’s certainly true in the sense you describe. If they wanted something different this would be a deal they shouldn’t take. Indeed, you may be able to see this most clearly where people are offered a premium to allow identifying information to be released later in the child’s life. You could be a provider either way–you get paid more if you are willing to have the child contact you, therefore it sure seems like you’re getting paid to play that (and only that) role.
It’s a useful observation to keep in mind. It doesn’t negate my earlier point though (and really it is Almeling’s point)–that the transactions are structured differently for men and women and that the differences matter. Both observations (yours and mine) can be accurate and telling at the same time.
Egg donor informed consent forms say that they warrant that they have never donated eggs before and that they have no reason to believe that they are infertile and that as far as they know they will produce eggs that are capable of producing embryos.
I imagine that women who know they are infertile because of they donated and had bad eggs could be sued for fraud if they went around to other clinics getting paid to give eggs. Although a good defense would be to say that they thought they were just being paid for their time and not their eggs. I guess that is why that little clause is there – it manages that risk for people
You may well be right that an outright lie will void the obligation to pay. But that doesn’t really change the general nature of the compensation. You are also being paid to act in good faith and with a certain degree of integrity. So for example, my guess is that if you totally blow off all the instructions they give you, you could jeopardize your right to get the money.
When I get paid for my time and effort at my job, its called a salary, not altruism. All Word games and euphemisms trying to obscure whats going one.
To be sure, many companies, profit and non profit alike, correctly or not, attempt to give over to their employees that their work is accomplishing something beneficial for society. It’s good for employee morale, and if employees feel good about their work, the company avoids employee burn out and can actually get away with paying them less. Same with egg donors, see the discussion we had over Hfea CAP.
if the woman does not produce enough eggs , she will be fired, although she will be paid for that cycle. If I fail to meet my employer’s expecations, I will also be asked not to return, although I will be paid for the hours I have already worked.
I return to the closing of your post “It’s about how we think about men and women and money. Stripping it to its simplest, men engage in paid labor while women care about other people.” This is it in a nutshell; the underlying excuse that exploitation of women is somehow normal and natural. Because women ares simply supposed to care about other people, even total strangers, who don’t give a damn about them.
But there’s another insidious assumption hiding here: Men are independent suppliers. Women are hired laborers.
Where once I might have agreed with you I have been persuaded otherwise. For you it may seem like obfuscation and euphemisms, but for women who provide their eggs, I think the sense of altruism is quite real and often important. That doesn’t mean that the money isn’t also relevant.
I don’t think it is so unusual to have both altruistic and financial rewards. I, for instance, find altruistic rewards in teaching. I think I help my students (and some of them at least on occasion agree). Now it’s also true that I get paid. But this doesn’t negate the importance of the other values I place on my work. It may even be true that I’m willing to accept a lower salary and/or contribute more to the job because I find it rewarding in non-economic ways.
It isn’t this way with all paid work. Some jobs don’t have an altruistic spin and are just for money.
It may well be true that if a woman doesn’t produce enough eggs she won’t be kept in a program but she will get paid for her participation that cycle (not true for a man who produces inadequate sperm). That’s all I’m trying to say. My guess is if she is chosen by a person and fails to provide eggs she feels she’s let that person (or those people) down, which is probably not something a sperm donor feels. But that’s not my point here, either–just sometihng that occured to me.
I don’t mean to naturalize or normalize this. Indeed, I meant to do quite the opposite. Men and women providing gametes are treated differently and it isn’t because of the biological differences between men and women. It is indeed because of assumptions we generally make about men and women. It’s important then to take the next step and ask about what follows from this different treatment (which Almeling does and which I’ll come to). I didn’t mean to make it sound like women got a better deal—just a different deal.
I am not saying that altruistic motives is irrelevant, just pointing out that it is irrelveant to the structure of the structure of the payment, whuich is structured similarly to that of any employee.
Sperm donors also frequently quote altruistic motives.
My whole beef goes back to the HFEA post. I am still bent out of shape about that. There is the idea that if someone is acting out of altruism then they are by definition not being exploited. that’s crap. In fact its much easier to expoit someon if you can convince them of the altruistic benefits of the project. There’s the idea that its someone elses paternalistic job to ensure then, than the woman is acting out of altruism and how do they accomplish this? by limiting her authonomy, ability to set price that is worth it for her, and trying to dictate what her motives must be. I know i said this all already but It galls me more every time I think abou tit.
Okay–I totally agree with your point that someone who is acting altruistically can be more vulnerable to exploitation. Well taken. And it’s also true that the structure of compensation for egg providers resembles that for workers generally. Actually, moreso than that for sperm providers, really. What sperm providers do is more like piece work—you know–you get paid per piece of whatever you complete?
Perhaps the question is what connection should be made between altruism and the structure of payment. I think what Almeling suggests (and I find this plausible) is that IF you think you are acting altruistically (at least in part) then it is easier to accept money that is characterized as “something for your time and trouble.” It’s harder to fit altruistic action with piecework. I’m not saying it is impossible, nor am I saying that the money for time/trouble necessarily makes people altruistic. All I’m saying is that the structure of compensation for egg providers makes it a little bit easier to frame providing eggs as an altruistic act.
I agree. My beef is with the framing attempt. When one needs to aggressively market altruism they should at least suspect something not so pure at work.
How is it not piece work for a multi time donor? If her previous attempt failed that clinic will not use her. She does the process again, gets paid, her eggs get used and if she fails she won’t be used again. How is that not piecework just the same as sperm donation? It just takes her longer so they pay her at the beginning and at the end. If it were able to be done in a single afternoon, she’d be paid at the end also, just like the sperm guy.
Because she isn’t paid per piece (which is to say, per egg). There’s no more eggs/more money relationship. There’s undoubtedly some minimum she needs to meet to seem worthwhile, but once you’re over the minimum the amounts don’t matter.
Many employes are altruistic too.
One more time. Last time. Would you like me to send you a copy of the letter my friend received AFTER HE WAS PAID FOR HIS FIRST DONATION? AFTER AFTER AFTER HE WAS PAID.
It may well be true that if a woman doesn’t produce enough eggs she won’t be kept in a program but she will get paid for her participation that cycle (not true for a man who produces inadequate sperm).
The letter said that his sperm was not good enough mobile or whatever that it was not potent enough. But they did pay him for the first sample for his time to give the first sample. Just exactly the same as had he been a woman donating eggs. They test the sample after it is given. They don’t send him a check after they’ve tested it and the sperm proves to be fantastic. He was then not able to donate to that clinic again he would not be paid for sperm they already knew would be bad. A woman that donated bad eggs would be paid for her time as well but she would not be paid to try again a second time.
I just think that book lead you off course somehow. Maybe this aspect of it is not even necessary to make her point and it does not matter that on this one issue she appears to be exactly and totally wrong. That is if your saying what she said anyway.
Maybe you’re more focused on initally entering the program and I’m more focused on how those regularly participating in the program are treated? That might explain why the first letter is important to you and the subsequent purchase arrangments are important to me. And maybe you are right that it isn’t very important to the larger discussion anyway?
I know this wasn’t the focus of you post but I can’t help but noticiing the altruism pitch “help someone else have a baby. ” how absurd.
I’m not sure why it is absurd and I do think it is the pitch made. I’ll be picking up this tread next time–maybe later today. Why does it seem absurd to you? Isn’t that what the whole ART industry says it is doing?
because for most people the experience of pregnancy, with its fatigue, morning sickness, stretch marks and possible medical risks, is not the goal in itself. Its meaningful for them because that is the traditional way of reproducting. For women who can’t reproduce, it provides the ILLUSION of reproduction. Or else they are doing it for their husbands. Otherwise they would adopt. The “altruism” marketers advertise “Help make another woman’s dream come true.” Uhm I beg to differ. Ask those woman if this is really what they had always dreamed of – to become pregnant with another woman’s child. Many have had to deal with huge emotional conflicts.
there’s another thing that hasn’t been mentioned although its equally important if not more so: Its going to be impossible to induce women to go through all that body invasion if there isn’t a guaranteed payoff for them.
Altruism my foot. Women are not so stupid and easiliy exploited as HFEA might think.
That’s a really good point, one that certainly bears thinking about. Providing eggs is a pretty involved process. I think it is fairly clear that if we leave it to pure altruism (i.e. no money) very few women will do it. Which is to say that you do need to put money in the system of you are going to make it work.
It also actually makes sense to me that some portion of the money is offered to compensate for the risk you undertake and for the hardship and for the actual time it takes–injections and whatever else. I pay for your time and effort. And here is where the structure of the payment matters. If I were really just buying your eggs I might say I’ll pay you some base pay for time and effort and then an added amount for each viable egg. More eggs means more money. This would be analogous to the way sperm providers are paid–maybe some flat fee for going through the process to qualify and then money for each usable batch of sperm. But we generally do not do that with egg donors.
Sometimes I actually think this is unfair. Since women have limited numbers of eggs, shouldn’t a woman who gives up 30 be paid more than a woman who gives up 20? And of course, the buyers do buy per egg, I believe. But my point for the moment isn’t fair/unfair–it’s nothing more than an observation about how the deal is structured.
Question, for analogy purposes: How are payment for kidney donor expenses structured?
Question, for analogy purposes: How are payment for kidney donor expenses structured? And is it legal to advertise for an organ donor? Has anyone seen such advertising?