Sex Cells: The Medical Market for Eggs and Sperm

Sex Cells

The publisher gratefully acknowledges the generous support of the General Endowment Fund of the University of California Press Foundation
.

Sex Cells

THE MEDICAL MARKET
FOR EGGS AND SPERM

RENE ALMELING

University of California Press, one of the most distinguished university presses in the United States, enriches lives around the world by advancing scholarship in the humanities, social sciences, and natural sciences. Its activities are supported by the UC Press Foundation and by philanthropic contributions from individuals and institutions. For more information, visit
www.ucpress.edu
.

University of California Press
Berkeley and Los Angeles, California

University of California Press, Ltd.
London, England

© 2011 by The Regents of the University of California

Library of Congress Cataloging-in-Publication Data

Almeling, Rene

Sex cells : the medical market for eggs and sperm / Rene Almeling.

p. cm.

Includes bibliographical references and index.

ISBN 978-0-520-27095-4 (hardcover : alk. paper)—

ISBN 978-0-520-27096-1 (pbk. : alk. paper)

1. Artificial insemination, Human—Economic aspects. 2. Artificial insemination, Human—Moral and ethical aspects. 3. Infertility—Treatment—Economic aspects. 4. Surrogate motherhood—Economic aspects. I. Title.

HQ761.A46 2011

381'.45618178—dc22

2011008654

Manufactured in the United States of America

20  19  18  17  16  15  14  13  12  11
10  9   8    7  6  5   4  3   2  1

In keeping with a commitment to support environmentally responsible and sustainable printing practices, UC Press has printed this book on Rolland Enviro100, a 100% post-consumer fiber paper that is FSC certified, deinked, processed chlorine-free, and manufactured with renewable biogas energy. It is acid-free and EcoLogo certified.

Contents

Acknowledgments

Introduction

PART I ORGANIZING THE MARKET

1. Characterizing the Material

2. Selling Genes, Selling Gender

PART II EXPERIENCING THE MARKET

3. Producing Eggs and Sperm

4. Being a Paid Donor

5. Defining Connections

Conclusion

Appendix A: Egg and Sperm Donors’ Characteristics at Time of Interview

Appendix B: Demographics of Donors Based on Profiles at Egg and Sperm Donation Programs

Notes

Bibliography

Index

Acknowledgments

As a nineteen-year-old undergraduate, I read an essay by Katha Pollitt on the Baby M surrogacy trial. I became fascinated by the complex issues associated with the prospect of women selling reproductive services and wrote a senior thesis under the wonderful mentorship of Elizabeth Long, the sociology professor who had assigned the essay. More than a decade later, this book is part of an ongoing attempt to sort through the questions raised by bodily commodification, and I am grateful for the chance to express my appreciation to all those who have made it possible.

First, a heartfelt thanks to the staff and donors at the programs where I conducted research. Each person I spoke with was so generous with their time, and I cannot thank them enough for their patience in answering my many questions.

I am also deeply grateful to my dissertation committee: Gail Kligman, Ruth Milkman, Abigail Saguy, and Carole Browner. As chair of the committee, and from my first semester in graduate school, Gail has been an ideal mentor, spending time talking with me about ideas, providing detailed feedback on my writing, and inspiring me with her high standards of scholarship. Early conversations with Ruth, Abigail, and Carole helped orient me to sociological and anthropological thinking on gender, work, medicine, and the body, and ever since, they have provided crucial intellectual guidance and enthusiasm for this project.

There are a number of scholars who have engaged with my research along the way, sharing useful insights and providing helpful comments. First and foremost in this category is Stefan Timmermans, who provided detailed feedback on several of the chapters and was always available to talk over snags in the writing process. I am fortunate to have met Kieran Healy while I was still working on my master’s thesis (which eventually became
Chapter 2
), and ever since, he has been an absolutely essential interlocutor on this project. Both he and Diane Wolf read the entire book manuscript and provided excellent suggestions for refining it. Andrew Deener has provided extremely useful comments on more than one version of most chapters in this book. I thank Greta Krippner for conversations we had as I was crafting the dissertation proposal. Thanks also to the following people who provided helpful comments on various chapter drafts: Gabriel Abend, Jeffrey Alexander, Claudio Benzecry, Elizabeth Bernstein, Elizabeth Ettorre, John Evans, Adrian Favell, Carrie Friese, Kurtulus Gemici, Jerry Jacobs, Rob Jansen, Joanna Kempner, Kimberly Krawiec, Sandy Levitsky, Cameron MacDonald, Suzanne Pelka, Gabrielle Raley, Kevin Riley, Daisy Rooks, Barbara Katz Rothman, Kristen Schilt, Beth Schneider, Sara Shostak, Elly Teman, Emily Wentzell, Owen Whooley, Viviana Zelizer, Lynne Zucker, and anonymous reviewers for
American Sociological Review
and
New Genetics and Society
.

Research funding for this project came from the National Science Foundation, the UCLA Graduate Division, the UCLA Sociology Department, the UCLA Center for Society and Genetics, and the UCLA Center for the Study of Women. A postdoctoral fellowship from the Robert
Wood Johnson Foundation Scholars in Health Policy Research Program included time to revise the dissertation into a book, and while in residence at the UC Berkeley/UCSF site, I benefited from the mentorship of Dan Dohan, Charis Thompson, Joan Bloom, Carroll Estes, Neil Smelser, and John Ellwood. I completed the final draft of the book as a new faculty member in the sociology department at Yale, and I thank my colleagues for our conversations about the project. It has been a pleasure to work with Naomi Schneider at the University of California Press, which is home to many of the books on gender and reproduction that have shaped my thinking.

For their ability to manage any and all questions and problems, I am deeply appreciative of Marlies Dietrich and Linda Schulman (UCLA Sociology Department), Carlene Brown (UCLA Center for Society and Genetics), Seana Van Buren and Stacy Gallagher (Robert Wood Johnson Foundation’s UC–Berkeley site), and Pam Colesworthy (Yale Sociology Department). Susan Paulukonis, Cecily Miller, Carmen Krol, Hae Jin Kang, Winifred Ko, and Christine Ilagan provided excellent research assistance. Lynda Klopatek efficiently and accurately transcribed the majority of the interviews.

Earlier versions of part of the Introduction and most of
Chapter 2
were published as “Selling Genes, Selling Gender: Egg Agencies, Sperm Banks, and the Medical Market in Genetic Material” in the
American Sociological Review
72 (2007): 319–340. A few paragraphs in
Chapter 1
were included in “Gender and the Value of Bodily Goods: Commodification in Egg and Sperm Donation” in
Law and Contemporary Problems
72 (2009): 37–58. An earlier version of
Figure 2
in
Chapter 2
was published in “ ‘Why do you want to be a donor?’: Gender and the Production of Altruism in Egg and Sperm Donation” in
New Genetics and Society
25 (2006): 143–157.

Thank you to the family and friends who hosted me as I traveled for research and writing: David Almeling, Warren and Veronika Ostergren, Briana Patterson and Chris Dente, Carla Eckhardt, and Matt Carrigan. Thanks also to all of those who e-mailed news stories and sent clippings over the years. My late grandmother, Lorraine Almeling, was particularly indefatigable in this regard, even writing to
The Oprah Winfrey Show
to request a transcript for an episode on sperm donation.

My parents, Guy Almeling and Linda Sebastian, probably never thought I would build on their professional interests in economics, health care, and psychology by writing a sociological study of the market for sex cells, but there is no question that their curiosity about the world has shaped me in more ways than I realize. I especially want to thank them for teaching me how to ask questions and how to listen to the answers.

For the last fifteen years, I have had the unbelievable good fortune of sharing my life with Jeff Ostergren. In a million different ways, he has been supportive of everything I ever wanted to do, and the words to properly acknowledge him do not exist.

Introduction

Rushing from class at the university to her job downtown, Megan tuned in to the radio and half listened to an advertisement calling on young women to give the gift of life. Her ears perked up on hearing that financial compensation would be offered to those who are caring, healthy, and willing to help infertile couples have a child. Thinking about the tuition bill that was coming due next semester, she decided to call for more information. The men at Megan’s school hear a different kind of pitch. Flipping through the pages of the college newspaper, they might come across a cartoon drawing of sperm floating above a call for a few good men, those who are healthy, in their twenties or thirties, and in pursuit or possession of a university degree. The copy suggests that they put their sperm to work and “get paid for what you’re already doing.” These ads are for egg donors and sperm donors, women and men who
are paid to provide sex cells to people who are using reproductive technologies to have children.

Unimaginable until the twentieth century, the practice of clinically transferring eggs and sperm from body to body is now part of a multi-billion dollar market.
¹
Hundreds of fertility clinics in the United States offer services ranging from artificial insemination to more complicated procedures such as
in vitro
fertilization (IVF), and they are dependent on a constant supply of sex cells for clients who do not have or cannot use their own eggs and sperm. Tens of thousands of children have been born as a result of such technologies, and the number of people attempting to conceive via assisted reproduction rises every year.
²

Although it would be shocking to see a child listed for sale and it is illegal to sell one’s organs, it is routine for egg and sperm donors to receive financial compensation. Payments to women in the United States range from a few thousand to tens of thousands of dollars, depending on the characteristics of the donor and the program where she is donating.
³
In contrast, there is much less variation in the rates paid to men; most sperm banks offer around $100 per sample.

Despite the monetary exchange, staffers in egg agencies and sperm banks consistently refer to this practice as “donation.” Depending on the sex of the donor, though, there are subtle differences in how donation is understood, differences that are already apparent in the language of the ads mentioned above: egg donation is portrayed as an altruistic gift while sperm donation is considered an easy job. Given that eggs and sperm are similar kinds of cells—each contains half of the genetic material needed to create an embryo—what explains these different understandings?

The answer to this question is not reducible to biology or technology. In this book, I bring together sociological theories of the market with gendered theories of the body to create a framework for analyzing markets for bodily goods, both in terms of how such markets are organized and in how they are experienced. Eggs and sperm are parallel bodily goods. But they are produced by differently sexed bodies, and looking closely at this market reveals the extent to which it is shaped by economic and cultural understandings of biological sex differences as well as gendered expectations of women and men. The chapters that follow offer an inside
look at egg agencies and sperm banks. Listening to the staff who organize the market and hearing from the donors who sustain it reveals the many ways in which the gendered framing of donation as a gift or a job matters: it influences how donation programs do business, and it profoundly affects the women and men whose sex cells are being purchased.