Sex Cells: The Medical Market for Eggs and Sperm (4 page)

Table 1
Overview of Donation Program Characteristics and Data Collection

In each of these six programs, I interviewed staff at all levels, including those with decision-making authority, such as founders and executive directors, and those who have the most contact with donors, including coordinators, office assistants, and lab technicians.
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I asked open-ended questions about donor recruitment, the procedures for screening and monitoring those who were accepted into the program, payment protocols, and how the staff would define a “good donor” as well as reasons why applicants might be rejected. Most of the interviews with staff lasted between thirty and sixty minutes, but a few were as short as fifteen minutes, and some went on for several hours over several meetings.

My request to interview donors in these same programs was granted in all four egg agencies, but I was only able to interview sperm donors from two of the four sperm banks.
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At Creative Beginnings and University Fertility Services’ egg donation program, I selected donors to interview. At Gametes Inc., the staff asked all of the sperm donors who came by the week I was there whether they would be willing to speak with me. At OvaCorp, Western Sperm Bank, and Gametes Inc.’s egg donation program, the donor coordinator chose a group of donors for me to contact after checking in with them first about their willingness to be interviewed. To the extent possible, I asked the donor coordinators to select donors of different ages, racial/ethnic backgrounds, occupations, and parental status (i.e., whether the donor had children of his/her own).

In total, I spoke with nineteen egg donors and twenty sperm donors, ranging in age from 19 to 46. Many donors were still in school, and both those who were students and those who were not had a wide variety of occupations. The majority of donors were single. Seven women and two men had children of their own (see Appendix A for more information about the donors’ characteristics). Nearly all of the sperm donors are “identity release,” meaning they have agreed to let the sperm bank share identifying information with interested offspring after the children turn eighteen.
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(Egg donation programs do not generally offer identity-release programs.)

As I was interested in whether the experience of donation changed over time, I interviewed donors who were at various stages in the process: those who had applied to donate but not yet started, those who were in the midst of donating, and those who had donated several years before our interview. I asked open-ended questions about their experiences, including how they first decided to pursue donation, what they thought of the screening process, where donation fit into their daily lives and their financial situations, and about their relationships with program staff, recipients, and offspring. The average egg donor interview lasted a little more than ninety minutes while the average sperm donor interview lasted about sixty minutes.
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From the files and websites of these same six programs, I collected more than a thousand donor profiles, which are designed to help recipients choose a donor but which also provide a demographic portrait of each program (see Appendix B). In programs that allowed it, I also spent several days observing daily business practices with a focus on how staff interacted with one another, with donors, and with recipients. The observations allowed me to compare what the staff reported in interviews with how they responded to everyday situations. I usually had my tape recorder running, and I jotted brief notes that I wrote up as more extensive field notes at the end of each day. I also gathered written materials such as office protocols, advertisements for donors, legal contracts, and informed consent forms.

In addition to research at contemporary donation programs, I studied the historical development of the market for sex cells. Beginning in 2005,
I conducted historical interviews with prominent physician–researchers and others who had been in the field of assisted reproduction for decades. Many worked in Southern California, a hotbed of both technological developments in assisted reproduction and their commercialization. Those who are mentioned in this book include a university-based physician–researcher who has served as president of ASRM and editor of
Fertility and Sterility
; a second physician–researcher who pioneered IVF with egg donation at a university before starting his own fertility practice and later served as president of the Society for Assisted Reproductive Technology (SART) (the nurse-coordinator who ran this physician’s egg donation program in the late 1980s opened Creative Beginnings in the late 1990s); a third physician–researcher who has published widely about egg donation since the mid-1980s and who is currently chief of reproductive endocrinology and infertility at his university; and a therapist who founded a commercial egg agency that was one of the earliest and is now among the largest programs in the country. Most of these interviews lasted between thirty and sixty minutes.

To supplement these historical interviews, I read articles published in
Fertility and Sterility
, starting with its inception in 1950 and going through 2005, both to verify dates and also to gather information about how donation happened in other times and places. I searched LexisNexis for newspaper and magazine articles about the six donation programs where I did research. I also attended several medical conferences to observe clinicians discussing gamete donation. Finally, to analyze the visual and linguistic strategies used to recruit egg and sperm donors, I collected a national sample of newspaper advertisements from top universities and major media markets in 2006.

All of the interviews were conducted in person, recorded, transcribed in full, and entered into Nvivo, a software program that facilitates coding. To code the staff interviews, I relied on a chronological accounting of the donation process, which is most clearly visible in the structure of
Chapter 2
. For the donor interviews, I created forty codes based on my theoretical interests and themes that emerged from reading the transcripts.
⁴⁵
I analyzed the interviews, observations, and historical materials with several different themes in mind, including the relationship
between the historical development of the market and its contemporary organization, the organization of the donation process in different kinds of programs, and how different kinds of donors experienced bodily commodification. Most of the interview excerpts from staff, donors, and founders have been edited for brevity and clarity.

OVERVIEW OF THE BOOK

The first part of the book examines the organization of the market for sex cells, and the second part of the book analyzes egg and sperm donors’ experiences in that market.
Chapter 1
traces the emergence of the market for sperm and eggs, from the secretive history of artificial insemination at the beginning of the twentieth century to the development of IVF with donated eggs in the 1980s. Nested within this broader history, I explore the development of organizational protocols for managing the production of bodily goods in each of the six donation programs where I did research. Physicians running the earliest sperm banks emphasized anonymity and considered donation a quick task to be performed in exchange for cash. This provided an already-established model of gamete donation by the time it became possible for women to provide eggs, but physicians had different expectations for egg donors than they had had for sperm donors. They relaxed their requirements for anonymity and sought altruistic women who were donating for the “right reasons,” that is, women who wanted to help infertile couples have families.

As physicians ceded control over the procurement of sex cells to commercial agencies, these gendered understandings of donation carried over into contemporary programs.
Chapter 2
is a detailed comparison of two sperm banks and two egg agencies, where staff rely on extensive screening rubrics in determining who is allowed to be a donor and assign economic value to cells based on the type of person producing them. Drawing on cultural ideals of maternal femininity and paternal masculinity, staff frame egg donation as a gift and sperm donation as a job. This rhetoric combines with systematically different strategies for managing the monetary exchange to produce gender-specific regimes of bodily commodification.

Turning to the donors,
Chapter 3
describes how they incorporate donation into their daily lives: women managing their bodies through the shots and surgery of IVF and men managing their bodies through routine masturbation and abstinence. In conversation with previous research, I look at how infertile women and egg donors talk about IVF and find that the embodied experience of this technology differs if women are doing it for pregnancy or for profit. Analogously, I analyze how men experience masturbation if they are doing so for pleasure or for profit and find that being a sperm donor requires a surprising amount of bodily discipline.

Turning from the donors’ physical experiences to how they conceptualize the money they receive,
Chapter 4
reveals that most women and men are motivated to donate by the prospect of financial compensation, and they spend the money in similar ways. However, as they go through the process of donation and interact with staff, egg donors mobilize gift rhetoric in defining what it is they are being paid to do while sperm donors rely on employment rhetoric in categorizing donation as a job. More than just language that “obscures” or “masks” what is really going on, these gendered conceptualizations of donation have consequences. Women talk with pride about the “huge” gift they are giving to recipients, and men reference feelings of alienation in defining themselves as “assets” or “resources” for the sperm bank.

In
Chapter 5
, I explore the extent to which donors feel connected to the children who result from their donations. Despite their equivalent genetic contribution to offspring, sperm donors think of themselves as fathers to these children while egg donors are adamant that they are not mothers. Egg donors define their contribution as “just an egg,” a fragmented understanding of reproduction that is buttressed by the connection they feel with recipients, whom they identify as the mothers. Sperm donors hear little about recipients and are encouraged to sign up for identity-release programs, which underscore the importance of men’s genetic contribution. In seeing themselves as integral to the lives of offspring, sperm donors reflect broader Western notions of the male role in reproduction as primary.

Eggs and sperm are similar kinds of bodily goods, but they are produced by differently sexed bodies, and this results in different donation processes and different associations with cultural norms of gender. It is
this combination of similarity and difference that makes possible a systematic study of variation in how bodily commodification is organized and experienced. In medicalized donation programs, cultural and economic understandings of the reproductive body combine to produce a market in which women are paid thousands of dollars to give the gift of life while men are paid piece rate based on bodily performance. In the Conclusion, I return to the themes introduced here to offer an explanation for why it is that egg donation is considered a gift and sperm donation a job, contending that it is not just sex cells on offer but visions of traditional American femininity and masculinity, and more precisely, motherhood and fatherhood. Building on the findings from this study, I propose a new way of theorizing bodily commodification, which raises new questions that can best be answered with detailed, empirical studies of what exactly happens when people are paid for parts of their bodies.

PART ONE
Organizing the Market

ONE
Characterizing the Material

In 1909, a short article appeared in
Medical World
, a “practical medical monthly.” The author, Addison Hard, described a scene from twenty-five years before, when he and fellow medical students were observing Dr. William Pancoast’s practice in Philadelphia. The doctor was approached by a wealthy merchant and his wife who confided their difficulties in conceiving a child. After discovering that the merchant had no sperm in his semen, one of the students joked that it was time to “call in the hired man.” The doctor requested a sperm sample from the “best-looking member of the class” but did not inform the couple of his plans. He called the merchant’s wife into his office, administered chloroform, and inseminated her with the student’s sperm sample. She gave birth to a healthy baby boy. Eventually, Dr. Pancoast informed the merchant, who was “delighted with the idea,” but both decided not to tell his wife.
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Several aspects of this story foreshadow the organization of gamete donation in the United States, including the centrality and power of physicians, the endemic secrecy associated with what was considered a morally questionable practice, and the selection of donors thought to have superior qualities. In tracing the development of the medical market for sex cells, from its earliest incarnations to the present day, focusing on
information
—what physicians wanted to know about the men and women providing gametes as well as what they shared with recipients—reveals stark differences in the management of sperm and egg donation. In this chapter, I look at how the process of characterizing reproductive material and the people donating that material have changed over time.

SPERM: FROM MEDICAL SERVICE TO
COMMERCIAL PRODUCT

As the nineteenth century gave way to the twentieth, physicians began coupling the technology of artificial insemination with the use of donated sperm, but they did not trumpet the availability of this service, either to patients or to other physicians. An American doctor writing in the 1930s reported finding just a few scattered articles about this “therapy” for male infertility in the medical literature.
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In part, this was due to continuing questions about its legality, as there had been court rulings defining the use of donated sperm as adulterous and the offspring as illegitimate. The rulings concerned physicians in the newly formed American Society for the Study of Sterility (later the American Fertility Society and now the American Society for Reproductive Medicine), who singled out artificial insemination as one of the issues they intended to address in the very first issue of their journal,
Fertility and Sterility
, published in 1950.
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