How Much Do (Human) Eggs Really Cost?
A Review of Eggonomics: The Global Market in Human Eggs and the Donors Who Supply Them by Diane M. Tober
A recent journalistic investigation of the global egg trade at Bloomberg put the industry’s unregulated practices and their exploitative implications back in the spotlight. Diane Tober’s book Eggonomics: The Global Market in Human Eggs and the Donors Who Supply Them, published in October of last year, delves even more deeply into the industry with a thorough examination of egg donors’ experiences in the United States and Spain––two of the key hubs for egg donation globally.
Tober, Associate Professor at the University of Alabama Department of Anthropology and Institute for Social Science Research, was initially interested in the ethics of egg donation because of her advocacy work with CGS (as she notes in the preface). Her research began with interviews she conducted through the organization We Are Egg Donors. Motivated by the significant health complications described by her initial interviewees and the lack of research on the health risks associated with egg donation, she expanded her project to include a survey component and cross-national comparison. Ultimately, Tober and her team ended up interviewing 77 donors in Spain and several hundred donors in the U.S. and elsewhere, as well as surveying close to 1,000 egg donors––719 in the U.S., 129 in Spain, and the remainder in other countries.
Each chapter of Eggonomics addresses a different facet of egg donation, interweaving ethnographic vignettes with analyses of survey data; policy discussion; and accounts of the changes wrought in the industry by genetic testing, vitrification, and private equity investment. Tober purposefully focuses on the narratives of egg donors themselves because their experiences are typically “relegated to the background and hidden behind the clinical veil of secrecy” (241). Tober’s analysis demonstrates how donors’ experiences vary based on the country in which they donate, the practices of the clinic and healthcare providers involved, their own bodies’ reactions to medications and egg retrieval procedures, and their interpretations of aspects of the donation process. Amid these important distinctions, however, Tober’s overall point is relatively straightforward: with little oversight and limited regulation, the egg donation industry lacks transparency and leaves donors vulnerable to exploitation, abuse, and health complications.
Focusing on the U.S. and Spain makes clear how different national approaches to structuring and regulating (or not regulating) egg donation shape clinical practices and the experiences of donors and intended parents. While egg donation remains largely unregulated in the U.S., Spain has a donor registry that tracks donation cycles, donor health records, and outcomes from donation. The registry does not yet track health complications from egg retrieval, but it does update records in all places if the donor is later diagnosed with a genetic condition.
Individuals have different reasons for donating their eggs, but compensation is often a primary motivator––it is a source of income that can help pay off debt or make ends meet amid increasing living costs and stagnant wages. Compensation varies wildly––on the low end were donors receiving a little more than a thousand dollars; on the high end were the rare donors who received six-figure sums for their eggs.
Egg donation is not only commodified––it is also racialized. Tober found that the maximum compensation for White and Asian donors she surveyed ($75,000–$100,000) was significantly higher than the maximum compensation for Black and Hispanic donors ($12,000–$21,000). She describes how White South African women who come to the United States to donate are viewed as a “better option than standard US donors” not only because they will accept lower compensation, but also because agencies believe (inaccurately) that they offer “unmixed White racial purity at a more affordable price” (138).
Tober’s results suggest that while most egg donors found egg donation rewarding, their experiences were far from ideal. For instance, among U.S. donors surveyed, half reported moderate, severe, or critical ovarian hyperstimulation syndrome (OHSS), a complication that can require bed rest or hospital treatment, and in rare cases, can be life-threatening. Troublingly, only 57% of U.S. donors surveyed said that they felt informed about immediate risks of egg donation, and only 27% felt informed about long-term effects. More donors in Spain reported being informed about both immediate and long-term risks (79% and 61%, respectively).
As Tober makes clear, the lack of research on the long-term risks of egg donation make it impossible to know whether later health complications are a result of the egg retrieval process. Many interviewees have their own theories about links between egg donation and later experiences of infertility, cancer, auto-immune disorders, and menstrual and hormonal irregularities. These uncertainties make it all the more urgent to conduct research to assess long-term risks of egg donation––and to inform potential donors that almost no research on the topic has been conducted at this point.
In addition to the health risks that egg donation may pose, the rise in cross-border donation means that donors must navigate the rapid relocation of repro-hubs amid ever-changing government policies and global conflicts. Some donors reported being asked to deceive or mislead border officials about the purpose of travel.
Cross-border egg donation also intensifies issues of “race, class privilege, and power” (136). Tober details the dynamics of “White desirability” through the perspective of a German reproductive endocrinologist:
Intended parents he worked with were primarily from Israel, Germany, and the Netherlands. The donors were of mostly White European or Mediterranean backgrounds, mostly low-income, and from countries like South Africa, Russia, Ukraine, Georgia, and others. The eggs from White donors were used to create embryos to be carried in the bodies of poor Nepalese and Indian surrogates, who were paid far less than donors considering their time and embodied commitment to the process. The global movement of traveling donors and intended parents flows on a multi-directional network and serves to minimize cost of reproductive labor while maximizing profit and efficiency. (138)
Egg donation is commonly framed as a matter of choice. Tober’s analysis makes it clear that broader forces powerfully influence the process. Dynamics of race, nationality, class, and egg donor/surrogate role are at play, as in the description above. Tober also details what happens when donors choose not to donate anymore––some clinics pressure them to reconsider even if they decline because of significant side effects. In some instances, agencies continued to contact former donors who had already declined to donate again; in other cases, donors were pressured with emotional appeals or additional compensation after they decided to withdraw partway through the process.
Tober’s concluding chapter turns to reproductive justice as a framework to assess ethical issues and policy shortcomings of egg donation. She emphasizes issues of financial coercion, informed consent, exploitation, racialization and commodification that affect egg donors, as well as how access to fertility treatment affects intended parents and access to information affects donor-conceived people.
Tober suggests several policy changes in the U.S., including better informed consent processes for donors, changing recruitment to avoid financial coercion, providing donors with independent legal support, improving donors’ medical treatment and access to their medical records, enforcing a limit of six egg donation cycles, establishing a donor registry that can facilitate follow-up on donor health, and recognizing the rights of donor-conceived people to access information relevant to their medical history and identity.
Tober’s final paragraph summarizes two central takeaways of her rich, well-researched book: First, egg donors “are human beings with their own lives, emotions and physical bodies they put on the line––for a whole range of complicated reasons––to help create families for the more affluent” (258). And second, “Until extensive longitudinal research into egg donor health and wellbeing is conducted, and care for donors is prioritized, there will be no justice for egg donors or the families they help create” (258).
