The Price of Eggs

Here I am again.  Been traveling and what-not, but back now.  And just in time.

There’s an article in today’s Wall Street Journal–front page–about the price of eggs.   (Because the Journal is subscription only, I cannot effectively link to it.   Sorry.  You may be able to get it through your favorite library, perhaps?)   Anyway, I’m especially sorry not to be able to post it because I am actually (briefly) quoted in it.  But that’s not really why it is noteworthy.

This actually dovetails reasonably well with the consideration of egg freezing that was underway just before I went traveling.  (And on that subject, see this recent Time Magazine article.)

Part of the hook for the WSJ article is the anti-trust suit that began five years ago.   The idea here is that there is a suggested cap for what is paid to women providing eggs.   You can see that (whether worthy or not) it looks like a form of price fixing.  (Technically I think this is called monopsony.)   Turns out the law suit is, ever so slowly, moving along.  But the article raises many more issues than that, just as paying money for eggs does.

For instance, there are some obvious ways in which paying a person for eggs is like paying a person for sperm.   In both cases you are paying for a remarkable component part–one that is used to create a new human being.   That’s a pretty massive similarity.  To the extent you have issues about how we think about this kind of material, and the ethics or morality of creating a market for it, the issues could be the same whether it is eggs or sperm.

Similarly, with both eggs and sperm it seems to me we have to consider the possibility that the person who makes the decision to provide them at twenty or twenty-five comes to regret that decision when they are forty.   And in both cases you have the prospect that the person created using the egg/sperm will come back and find the provider many years later.   Again–important similarities.   These are reasons why you might say that paying for sperm and paying for eggs are should be thought about similarly.

But as clearly as there are similarities, there are differences.   The process by which sperm is collected is nothing like the process by which eggs are collected.   I don’t really think that anyone contends that providing sperm means undergoing a medical procedure.  But providing eggs does just that.   And it is a procedure that is of no benefit to the patient (the woman providing the sperm) except for the fact that she gets the money or satisfaction of providing the eggs.  I suppose what I mean is there is no health-reason for the procedure.

Now paying someone to undergo an otherwise unnecessary medical procedure–one that does carry risks–seems quite different from paying someone to provide sperm.   This difference might be a justification for treating the role of money in the transaction differently when you’re thinking eggs vs. sperm.

In this context you can think about capping the amount of compensation.  Part of the reason for doing that is to avoid what is sometimes called “coercive compensation.”  The idea here is that we don’t want people to do things they really ordinary wouldn’t do just because there’s money involved–to take a risk they wouldn’t take.  It comes, as I understand it, out of the literature around paying human subjects of experiments.  If someone is willing to be a subject you can compensate them for time and trouble but you don’t want to override their will by offering too much money.

Frankly, this is an idea I can only sometimes grasp.  Sometimes it seems to me to ignore an awful lot about how the world works.  But this may be grist for the mill a different day.  Let’s just assume there’s such an idea and it makes sense for now.

Because egg providers face greater risks (physical risks, in particular) than sperm providers, the concerns about coercive compensation might be present (or at least larger) for egg providers than sperm providers.    And maybe this leads you to say that because of the differences, you treat them differently (even though there are also samenesses) and cap compensation for egg providers and not sperm providers.

But when I’m all done going down that particular branch of thinking I find myself wanting to take a step back and think about gender.  Because, of course, all this is deeply gendered.  Egg providers are women.  Sperm providers are men.  And we’ve just (tentatively) reached a conclusion that the rules for men and women will be different.   (Granted that the conclusion was grounded in “real” differences between men and women.)

Notice, too, exactly how the different treatment works.   Men can get what the market it paid.  Women are “protected” from their own bad decisions.    Surely it is not surprising that this worries me.   Is it enough to make me insist that the treatment of sperm and egg providers should be the same?  I cannot say that, yet, but it sure makes me want to go back and revisit the question.

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43 responses to “The Price of Eggs

  1. I don’t think it has anything to do with gender in the way you suggest. If the roles were reversed and men needed the medical procedure the same reasoning would exist to put a cap on it. Just like in medical experiments, it’s what’s being done to either the male or female that requires the cap, not their gender. Unless you can explain what makes it a gender issue and not just an unnecessary medical procedure that includes real risk to inject drugs into your body and then have your eggs surgically removed.

    The reason for the cap is protect the person at risk, in this case it’s a women’s only club, if there was a market for replacement testicles it’d be a man’s only club. And lets not forget that not all professionals will provide accurate details about the risk and educate the patient, some will simply couch the warnings in words that make it sound so very rare that I’m only mentioning it because it’s a regulation requirement, so feel free to stick your head in the sand because it only happens to other women.

    I don’t agree with paying for either, other than specified and limited expenses so that it is held to the same standards an organ donation is.

    • I agree that the reasoning oughtto run both ways–i.e. if men needed the medical procedure then the cap would apply to them. I don’t share your confidence that it wouldwork that way.

      It may be that we are starting with different assumptions about how things work. I probably worry about gender discrimination in this area more than you do, so I see a rule that restricts the freedom of women but not of men and suspect gender is at work. You see the possibility (which I acknowledge) that it is neutral and say it isn’t gender. I don’t know how we’d ever prove the correctness of our respective positions.

      I suppose I look at a long history of “protective legislation” that applied to women and prevented them from doing dangerous things like going to law school. Much of this was justified by the idea that men and women were different. And this seems like it is in that spirit. So I wonder if gender at least plays a part. Perhaps the only part it plays is in figuring out what the cap is, rather than whether there is a cap. But still, I wonder and I worry. In fact, we let people (mostly men) do many socially useful but very dangerous things (like clean up radioactive waste) and we never worry about overpaying them. It seems to me we are perhaps overly worried about women’s ability to make intelligent decisions.

      I agree that the risks should be explained clearly. And I’ve little doubt that some people don’t explain the risks or minimize them. This seems to me a separate problem, one that crops up in lots of other places. I wonder, for instance, if those offering elective medical services generally are slightly inclined to minimize risks. I don’t particularly think setting caps or setting caps in particular places addresses this concern.

      • I think in medicine you can identify if gender plays a role by looking at studies, do they protect women by not allowing them to be part of a paid study that should by the subject being studied include both genders. You can also prove it by how many non-medically necessary surgeries that always come with risk are performed on women, although men are catching up in the craze to make them better, younger, better looking. And egg donation is not a profession, at least not one that lasts past the age of thirty. It can also cause a host of issues from minor to life threatening, sperm donation – not so much.

        • I agree that you can examine whether gender plays a role in the ways you identify. But that’s not necessarily a complete list. And it can lead to more questions.

          So I think we agree that more elective surgeries/procedures are performed on women than on men. (Seems like we are both thinking here about cosmetic type stuff?) Let’s assume we’re right. (I do not have statistics on it.) What does this tell us? It might tell us that women are subjected to greater pressures about appearance than men–though as you suggest, it might well be that men are “catching up” in this regard. That seems a suspiciously gendered point. Does it mean we should be taking steps to discourage women from electing these procedures? If so, how? And if we impose procedural hurdles to accomplish this (waiting periods? more elaborate consents?) is that equality of difference?

          In the background I worry about the tendency towards paternalism (which is a gendered term right there–“parentalism,” which I sometimes use as the gender-neutral equivalent, is not really widely accepted). In the past, paternalism has worked in ways that restrict women far more than it has worked against men. Historically society has been much quicker to say that women aren’t capable of making big decisions, or at least not of making them without “safeguards” to protect them from hasty choices. I don’t want to make this whole discussion explode here, but I think this is in part operating in all the attention paid to informed consent with regard to abortion choices. It taps into that line of thinking.

          All I’m trying to do here is to explain why I am suspicious and how hard it is to verify or dispel suspicions like this. It’s hard to isolate factors.

          • “All I’m trying to do here is to explain why I am suspicious and how hard it is to verify or dispel suspicions like this. It’s hard to isolate factors.”
            I understand ‘suspicious’ and ‘biased’. It’s hard to separate the two. BUT there is a MUCH bigger picture here about human dignity (for all) that is hard to see because of it. Slippery slope – Forest from the trees. I suspect it’s not something “the law” (suspicion/bias) can really address.

            • I’m not sure what you mean here. Is it that focusing on the same/different argument with regard to men/women may blind us to the broader ethical/moral questions about selling gametes at all?

              • Yes, and it goes back to what you wrote in response to my other comment, “Once you figure out the lists of things that can/cannot be sold you have to figure out which place eggs or sperm belong. Are eggs like hair or are eggs like children? And crucially–are eggs and sperm the same or different?”

          • Yes the cosmetic type stuff. Agree that women are subjected by society, their S.O., their career, and their ego, which circles back to everything already stated. It’s up to both the parents to model respect and acceptance for who you are, and society as a whole to value people for who they are, not what they can be made to look like physically. That isn’t particularly something a doctor would be on the hook to dissuade a patient from undergoing a cosmetic procedure, although, if the patient presented as someone who possibly needs counseling because it may not just be a want, it may have become an urgent physiological need, then I think in good conscience should suggest counseling first in an effort to do no harm. Hope that makes sense.

            But cosmetic surgery is completely different than undergoing donating eggs. The only ‘benefit’ of donating eggs is at best a feeling of helping someone else, cosmetic surgery is for superficial changes to how you look.

            I read a rather dry and long read on bioethics and informed consent. They describe coercion differently and what I think they would choose to use is undue inducement for egg donors. It’s #5.2 in the link. I think that explains why their needs to be a realistic cap, because without, the possibility of informed consent is probable. #5.3 does somewhat apply depending on who they are targeting.
            http://plato.stanford.edu/entries/informed-consent/

            Thanks for making me think…

            • That’s a very helpful link. Thanks. There’s more to think about, but here is what I wonder about inducement. (5.2 in your link.) $1000 wouldn’t induce me to do anything I don’t already want to do—I don’t need the money that much. But it might induce someone who needed to pay the rent tomorrow and didn’t have the money on hand. It’s the desperate poverty of women in India and Thailand that makes them prey to exploitation as surrogates. In the big picture, I’d say that the problem is poverty/need, not inducement. But I understand that those offering inducements cannot wait around while we fix poverty. So they have to set the level of inducement in this imperfect world. How do they do that? The most vulnerable people may be subjected to undue inducement at very low levels.

              • My son told me that his friend’s sister said she wanted to ‘donate’ (sell) her eggs to help pay for college. She is not in poverty by any means but the money would help her. I don’t necessarily just think it’s a ‘poverty’ issue, but rather an education issue.

                • Sorry, to clarify, I meant education in terms of awareness and understanding of potential consequences. Beyond just the potential health issues associated. (emotional, psychological, social AND medical)

                • I’ve been thinking about the college/law students. As you say, for many of them this is not about poverty. Yet clearly the money in an inducement. At the same time, any compensation for any endeavor works that way. Like offering high pay for cleaning up radioactive waste. The fact that it is significant money and the fact that it may encourage them to do a thing isn’t enough to mean that it is wrong (at least for me.)

                  And that takes me to your point about fully understanding the decision, I think. Clearly consent needs to be informed. But to me, it is also clear that young women are capable of making this decision and should be permitted to make it. In making the decision people have to be given complete and accurate information. I’m not sure what I can add besides that. But it’s all in the nature of “here are things that might happen” and I know some people–perhaps especially 20-25 year olds–may not be really good at grasping the nature of risk.

                  But I don’t see what to do about that unless we’re going to say that people that age cannot make serious decisions, and I’m not prepared to say that.

                  I know I’m just going in circles, but assuming you have reasonable safeguards in place to ensure properly informed decision-making (and I don’t mean to make that sound trivial), it comes back to whether this decision somehow different–because it is about gametes/children. Or whether the subject of the decisions (providing gametes) is different–too close to selling a child.

                  • As I’ve said many times here before, I’m not about “the law” but obviously I do have a strong opinion on this practice. Yes, I’m biased. But I didn’t come to that bias through anything other than an open thoughtful thinking about what all of this entails because of my very personal experience with it all. It’s not about one group vs. another for me. It’s bigger picture. Much bigger picture. Aside from that, my son’s friend’s sister is very lucky that my son cares about her and her brother and family. He doesn’t have the vocabulary to fully explain all the issues but he understands it enough to throw out the strong warning…don’t do that….because he cares.

                  • About caring and saying “don’t do it” because I care. Back in the 1980’s I was a student at Boston University. We (the ‘friend group’ I was apart of at the time) knew a boy/man who was VERY attractive and had quite a bit of pride about that, was approached by a ‘sperm recruiter’ and seduced into the ‘altruistic’ idea of selling his dna (anonymously of course). No one was educated enough or thought deeply enough or cared enough to say,to him, don’t do that, because we know and we care. Instead, he was slapped on the back and told, yea, you go stud! He bought a Fiat with his ‘donations’. Fast forward 30 years now, with dna testing, and more public awareness, I bet he wished that he had a friend who cared enough about him to say, don’t do it.

                  • I do think about this sort of scenario a lot, in part because it seems to me this is an area where the differences between men and women are largely erased. But I also don’t quite know what to do with my concerns here. Isn’t this basically that young people may make decisions they come to regret with the wisdom of age? That’s true in a number of contexts, but I think we usually let young people (over 21, or whatever age, but still young) make their own choices. I suppose if they are lucky they have wiser friends, but I don’t know if they listen to them.

                    I’ve written in the past about regret. I think we all live with the risk of doing things we regret all the time. But I’m not sure we can protect against that.

                  • “But I also don’t quite know what to do with my concerns here.” I don’t think there really is anything legally that can be done. Education and awareness is all we really have to work with.

                  • Perhaps that is true. And I suppose I shouldn’t underestimate the value of education/awareness. After all, I am willing to assume that people are basically competent to look after themselves, given appropriate education and opportunity. As I think about what you’ve said I think you are quite right–there isn’t much else one could rely on.

                  • “given appropriate education and opportunity” Which is why it’s so important to allow, share and educate on all POV’s, especially the ones people don’t necessarily want to hear (without name calling or accusations of ill intent). I appreciate that you are open to this here. Thank you.

              • I don’t know Julie, I think capable minds could assess a medium ground cap for the target market of potential egg donors. There is no one-size fits all solution unless it is to only compensate for expense and time in a very limited amount. Education could be a tool as well.

                Glad you enjoyed it, read it years ago and it stuck in my mind as I didn’t realize there were so many different ways informed consent could be seen.

                • I think you are probably right–one chooses a medium ground cap. What bothers me is that even that WILL probably be “coercive”–in the sense used in this field–for some people. It’s situational. Maybe we just accept that? Not sure what else can be done, as you note.

        • If it is a medical procedure that applies to men and women equally or almost equally, then it is becoming more difficult to justify disparate treatment. However, if something applies primarily/only to women or to men, then disparate treatment is easier to justify and more difficult to prove as being discriminatory. I share Julie’s suspicions.

          • I find myself wondering what one should do about suspicion when you cannot really verify that it is justified. Perhaps it means you look at things a bit more skeptically? In law that means court’s would give less discretion to the original decision maker and/or be more willing to intervene. And maybe that’s all I want–a more searching consideration of the question rather than a specific outcome?

  2. i have previously stated that the people whose profits should be capped are the facilities performing such procedures, not the patients themselves. if we are concerned about exploitation, we should regulate the folks most likely to be doing the exploiting, not the persons who will be potentially exploited.

    • i may add that low pay is exploitive in itself and ensures that the people targeted will be the most impoverished and vulnerable

      • I completely agree. Because I have a well-paying job I am not subject to the coercion someone who is poor is. I wonder if the real problem with allowing higher compensation is that a different class of women would be tempted by it. (And I do mean “class.”)

    • Indeed you have, and I think it is a really interesting suggestion. What would the world look like if profits for the ART were capped? I don’t mean if you didn’t allow them to make money, but if you limited how much money? Presumably they would not all vanish. But they might behave somewhat differently? Hard to know but good to think about.

    • good point.

  3. In reading all the medical consent forms I think the way it’s supposed to work is that women become patients of the physician (with their own medical insurance) and so did men in the old days before freezing and cryobanks. Now it seems the men become like quasi customers of the cryo bank. They come seeking assistance in harvesting their gametes for the purpose of either reproduction or research or long term storage or whatever. All their consent forms indicate that they are desirous of undergoing this medical procedure or harvesting or whatever. In a way that sort of creates a loophole for the physician or cryo bank not to discriminate against working with someone based on their private reasons for going to the cryobank or physician. With women I know it gets weirder because often times the women are not officially patients of the doctors who are giving them pills and operating on them all the perscriptions will be in the name of the woman paying for the procedure as if she’s the one having her eggs harvested and I think that’s super shady. Something tells me they are not really supposed to go about things that way.

  4. So long as they are paying women for their eggs at the very same amount whether they consent to give up their kids at birth or not I see nothing wrong with it. I mean women donating eggs for research purposes unrelated to reproduction should fetch the very same amount as those giving up their kids if and when any are born right?

  5. As long as this is a market, they have a point. But if the lazee faire, free market argument wins, why stop at eggs and sperm? Why not embryo’s or the selling of pre-birthed ‘fetuses’ (born live or sold for body parts pre-birth)? As the market demands?

    • Under a totally free market approach I think this is exactly the line you’d have to follow. So most people wouldn’t endorse that approach and would instead draw a line somewhere. Which leads to the intertwined questions of where/why/how?

  6. Why is prostitution illegal or the buying and selling of body parts? Why shouldn’t I (as a woman, a man, a person of no identifying gender) not be allowed to sell any of my body parts to the highest bidder. I need money, justify it by saying I want to help others, why not?

    • These are both excellent and difficult questions. At least as to some of them (prostitution) there is some debate. Clearly we draw lines all the time–some things you can sell and some things you cannot. (Children come to mind–cannot sell them. That’s pretty much agreed, I think.) Why is that? Why doesn’t my argument about personal freedom carry the day everywhere for everything–because it clearly does not (at least in my view.) In the same way, I think a lot of people are okay with selling hair and other personal services (like escorts without sex?)

      And just to be clear, there’s another level of question here, too. Once you figure out the lists of things that can/cannot be sold you have to figure out which place eggs or sperm belong. Are eggs like hair or are eggs like children? And crucially–are eggs and sperm the same or different?

      I don’t mean to duck your questions–I think they are crucial. I actually might be okay with prostitution if it is reasonably regulated, but that’s a whole other discussion. The eggs/sperm/body part distinctions require more space, but surely you’ve put your finger on a key question.

  7. The price of eggs and sperm and the exploitation of women are excellent distractions from the actual bad thing that’s going on. Comparisons to prostitution fall flat. First prostitution is a service so your not actually trying to sell your body to anyone, your just performing a task with your body for money. Psychologically and socially it may be different than performing other tasks like gardening or cooking or doctoring for money but you are supposedly still in charge of your own body and choices otherwise you are being raped. Trying to sell your body parts is not actually possible, they’ll always be your body parts and you can’t give up your legal right to authority over your body parts and of course nobody can actually by the right to call your body parts their own. Anything they do with your body parts has to be with you in the driver’s seat making all the decisions and consenting all the way. It’s you doing what ever it is your doing with your body parts. If they pay to control your leg to kick someone and you agree it’s still you doing the kicking – so what if it was their idea and they are holding your leg, you agreed to do it. Same with eggs and sperm. Your deciding to have kids that your not going to raise and deciding not to care who it is you have the kids with – you chose the method of IVF to have these kids your not going to raise and chose to get help retrieving your eggs from a doctor. You went to the doctor to ask for help in this activity before any infertile female ever showed willing to foot the bill. It’s not the person writing the check buying an egg at all.

    • I don’t think of this discussion as a distraction, but that is because I don’t share your underlying views. Certainly if one allows for compensation for gamete providers all of these issues really are in play. (I don’t mean to say that there aren’t also other important questions.)

      Also, I hope it is clear that when you say “trying to sell your body parts is not actually possible” (and what follows) you are saying what you think about the topic rather than stating some fact. People do disagree about these things.

      • No I’m not stating what I think about the topic rather than stating fact. I don’t make random baseless statements anymore you taught me not to. Everything I say I can back up with something other than an anecdote, popular opinion or moral platitudes. I care about making a point that cannot be argued by anyone because this subject matters very much to me. I’m actually basing my statement firstly on the uniform anatomical gift act. You know I love the department of health and human services birth certificate and birth stat website. They also have a site dedicated to the laws on tissue and organ donation http://www.organdonor.gov/legislation/.
        Note that donation is distinguishable from selling – you are not allowed to sell your body parts nor is anyone allowed to own your body parts. They remain yours under your control always. They are not property. Other people cannot own your body parts or your right to determine the disposition of your body parts. Consent given can be taken back. That is not my opinion it’s the law. I’ve read at least a hundred sperm and egg donor agreements and they all say they have the right to change their mind. They also all say that the agreement is not legally enforceable but parties agree to behave as if the agreement were legally enforceable. Attached is a standard university consent to donate sperm for research purposes. Donor has a right to change their mind. Nobody owns their sperm.

        I don’t appreciate being told that I’m merely stating opinon. I’ve worked really hard at reading everything I can get my hands on about the rules so that nobody can accuse me of merely stating my opinion. I understand that there have been court opinions where they treat embryos as property. The tissue in those instances does in fact belong to the bodies of the individuals having these notable disputes. Their right to make decisions about the disposition of their own body parts and their reproductive freedom is quite on the line in those disputes. But these are not disputes over a buyers right to keep and use eggs or sperm of a donor who changed their mind and retracted consent. I’m not talking about child custody battles which certainly happen a lot with gamete donors and more often than not I’m reading that they win custody or depending on how they want to view it loose and have to pay child support. I’m just talking about calling the shots as to what happens to the egg or sperm our bodies produce. Nobody but us has control over our own cells.
        Secondly I am basing my statement Because I’ve read a whole lot of egg donor contracts. I’ve also read the uniform anatomical gift act.

        • There’s a lot here and I’m just going to pick one thing to talk about, mostly to try to keep some focus. I apologize in advance if you don’t like my picking/choosing but it is hard to figure out how to respond briefly to everything (and brevity makes things more readable.)

          So you said “Note that donation is distinguishable from selling – you are not allowed to sell your body parts nor is anyone allowed to own your body parts. They remain yours under your control always.”

          First, it surely true that donation is distinguishable from selling, but the line between them can be fine indeed. People who donate things sometimes receive money in exchange. Is that really donating? There’s a lively debate about what can be offered to people who are willing to donate a kidney–offer more and there would be more kidneys available. But to some people this looks a lot like selling.

          Second, I’m not sure that other people aren’t allowed to own your body parts. Suppose I do “donate” (whatever it means) a kidney and it’s transplanted into someone else’s body. I don’t think I own it. It’s certainly not under my control.

          This is not to say you are wrong about the contracts for sperm/eggs you describe. You’ve surely seen many more than I have. I just meant that’s not the whole picture, but rather one important piece of the picture and so really broad generalizations are difficult (in my view) to make.

      • Julie what would be the basis for disagreeing with the fact that people cannot buy and own other people’s body parts? The uniform tissue donation act is clear on the matter. Medical consent forms are clear on the matter and so are egg donor agreements; the donating party can always change their mind.

        • I see several places where I think you will find disagreement. First, not everyone will agree on what counts as a body part. So for example, I wouldn’t count eggs or sperm as body parts, but you might. Hair? Blood? (I think neither is.) Second, and perhaps more fundamentally, whatever the law is, people do disagree about this. There are some serious arguments made that you should be able to sell organs–that allowing this might increase the supply (which I guess is woefully inadequate). I’m not sure I’d subscribe to this view, but I think a statement like the one you made needs to be qualified either with and “in my view” or an “under the law as currently constituted.” Finally, I think different countries probably have different rules, though I don’t know that for certain.

          Really the point I meant to make was that this isn’t a natural law like “the earth revolves around the sun.” I think you can scientifically prove the sun/earth proposition. You can, in the end, only argue about what the laws about selling body parts should be.

  8. I would just like to make clear that not all egg donors agree not to raise some of their kids. So egg donation only means allowing their eggs to be harvested and stored by a particular party. The term does not imply consent to anything other than that and that alone. Some egg donors are participants in research studies at universities and allow their eggs to be studied. That means that they, the donor are participating in a research study. Their eggs are not people their eggs are not participating – they the person are participating by having their eggs studied. Who they are as people is critical to the researchers in understanding the outcome of the study of their eggs. If they agree to reproduce, who they are as people is critical to the outcome of the resulting offspring they have. They are conceiving a child, they chose to do so and put it down in writing.

    • I’m sure it is true that some women provide eggs for research purposes only and there’s probably much to think about there, too.

      • So I think they should all be paid identical same. Don’t you? I mean if it really has nothing to do with paying the women to go away and let other people raise their kids for them. If it is solely about the eggs then agreement to give up a kid should not have any bearing on the compensation. Right?

  9. I take it the “they” here is all the women who provide eggs? I’m not sure if they should be paid the same or not. Suppose for some reason or another you need the eggs from a particular subgroup of women—could be for research or could be for ART. And suppose that group is small and there are cultural taboos that make members reluctant. Could you offer extra $$? Ordinary market forces usually operate in our world and that would argue for increased compensation. But it makes me uneasy. Anyway, I guess the point is that, at least in my mind, it’s not an easy question to answer.

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