Saturday, August 8, 2009

The Business of Nature versus Nurture

The Profit of Starting a Family

Dawn T. Hunt, 39, president, owner, and facilitator of Fertility Alternatives, Inc. has served as an egg donor six times since she was 27 and as a surrogate twice. She’s made approximately $70,000; $30,000 as a donor and $40,000 as a surrogate.

“The first time I did it, it was obviously financial. It helped me take care of my family and start my business,” said Hunt who has two children of her own. “Then it made sense to help (other families).”

Hunt started Fertility Alternatives, an egg donation agency, in 1998, after working with other agencies which she said “weren’t doing a good job.” “I thought I could do a better job,” Hunt said.

“It’s my business and I run it the way I want,” Hunt said.

Now, Hunt works with donors and intended parents from all across the country. As of January 2009, she has facilitated more than 200 surrogate and egg donor cycles, resulting in more than 160 pregnancies and 180 births that would not have been possible without the help of a donor or surrogate.

Fertility Alternatives
advertises to prospective donors through on-campus publications on many universities; Hunt said that 90 percent of the donors that go through her agency are college-age women. Women can start donating at 18, though 20s is preferred. The younger they are the better the chance for producing healthier eggs.

“Older (prospective donors) are probably better because you can make a better decision,” said Hunt, who requires her donors to be at least 19.

Hunt said the cut off age for donors is 35, but prospective donors are most likely to be picked if they’re in their 20s and have desirable physical and mental qualities, which can include preferences, concerning everything from ethnicity to SAT scores.

During the current economic downturn, major news organizations such as CNN, USA Today, CBS News and MSNBC have done stories, claiming that the economy is driving more women to consider egg donation a financial alternative. Donors usually receive between $5,000 and $10,000 in compensation. This has led to questions about the ethical practices of selling human tissue. These are questions which agencies like Fertility Alternatives and the American Society for Reproductive Medicine (ASRM), a voluntary organization that regulates the ethics of reproductive medicine, are quick to address.

“You don’t want to take someone who is doing it just for the money because we don’t want to be seen as coercing,” Hunt said. She also said that donors must pass extensive medical and psychiatric evaluations, as mandated by the FDA, before being chosen as a donor.

Donor Kristen, 28, who has donated through Fertility Alternatives, received $6,500, $8,000, $10,000 respectively for three separate donation cycles.

“I started donating to pay off my student loans mostly,” said Kristen, who began donating at 23, attended the University of California, Berkeley, and is now a high school biology teacher. Kristen has done other interviews and was quoted in a March 2006 article for USA Today. Each time she has declined to use her last name on the basis that her employer might disapprove.

Kristen said she plans to donate as many times as she is allowed.

“(Receiving parents) are looking for someone to look like them. I think people should be able to pay what they want,” she said.

The American Society for Reproductive Medicine (ASRM) recommends that a donor not receive more than $10,000 in compensation for a single donation and only donate up to six times.

“It is arguable that you can’t sell tissue…you can’t sell eggs, that would be arguably illegal,” said Steve Klein, an attorney who specializes in fertility issues and was recommended by Hunt. “The eggs are free, what they’re being compensated for is their time and all the other things that they go through.”

“It doesn’t mean that they’re desperate (for money), it just means that they have an opportunity to pay off or help pay off loans,” Klein said, “Is that a bad thing? I don’t think it’s a bad thing because once she finds out what she has to go through, she still has to (volunteer).”
Egg donation requires about 12 visits to the doctor, most on specific days during the menstrual cycle. The appointments require vaginal ultrasounds and blood testing; towards the end of the cycle, this is done almost every day.
Donors must also take birth control pills every day until the time that they are told to stop. Then the donor must give herself 1-3 injections of hormone treatments daily for 2-4 weeks. Sexual intercourse is prohibited during the cycle.
The egg retrieval requires IV sedation and a 20-30 minute procedure where needles are inserted through the vaginal walls into the follicles of the ovaries where the eggs are located.
Normal side effects are a few days of cramping, discomfort and, possibly, nausea. The donor may also experience a few days of spotting and bloating, but she should resume her normal menstruation cycle in two weeks following the procedure.
Dr. Ezekiel Emanuel of the National Institutes of Health said in a February 2009 story for The Early Show, “The ethical concern is about doing something to a woman not for her benefit, and especially just in trade for money.”
“The primary concern is what's called Ovarian Hyper-stimulation Syndrome, and that's when fluid leaks out of the vessels. It causes pain, bloating, nausea, and occasionally it can be severe, causing failure of the kidneys and failure of the liver. There've even been reported deaths. A study in the Netherlands showed between six and ten out of 100,000 women had actually died,” he said.
Emanuel was countered by Kathy Benardo, co-founder of the Northeast Assisted Fertility Group who said, "Hyper-ovarian Stimulation Syndrome occurs in one percent, and I don't think it's necessarily for egg donors exclusively, but for all women who undergo IVF (in-vitro fertilization).”
Susan Yahiro, physician’s assistant to Dr. Mark Surrey medical director of the Southern California Reproductive Center said, “If we thought it was a health risk, we wouldn’t do it.”
“Basically with egg donation, there is a lot to go through and a lot of commitment and the donor needs to have a flexible enough schedule to attend all the appointments,” Hunt said, “the compensation is there to cover the time and expense the donor needs to put in as well as any risks involved.”
She said if her prospective donors have concerns about the health risks, she refers them to a doctor who can answer those questions.
“You’re more likely to get into a car accident than lose an ovary through donating,” Hunt said.
Hunt said that for most women, the process is easy once they get used to it. As for herself, Hunt said she hasn’t experienced any difficulty because she’s not “very hormonally challenged.”
Kristen said that each cycle is different experience. She said her first cycle was very easy but during her second cycle her medication had to be doubled, she was nauseous and she gained weight.

“I don’t think I did a lot of research (about the process). I kind of just figured if you’re doing it under a doctor’s watch it’s not a problem,’” Kristen said.

Legal Bonds

Klein, an attorney who has worked with Hunt explained that with every cycle, a donor contributes 10-25 eggs. Doctors then implant two to three eggs into the receiving mother and freeze the other eggs for future implants.

The recipients of the donation can keep the other eggs for future use, destroy the eggs, donate them to science or give them to another recipient. However, many donors are not comfortable with their eggs being passed along to other recipients and can stipulate this in the contract.

“It is a felony in the state of California to give away those embryos without the knowledge and consent of the donors,” Klein said.

Klein said that when women agree to donate, they are “introduced to the fact that this is a legal relationship.”

Once a donor passes the evaluations, a lawyer, usually hired by the egg recipient, works with the agency to draw up a contract. The contract stipulates the terms of the donation and the amount of compensation.

“It’s not unfair nor is it unreasonable nor is it unethical for a woman to be compensated for all she goes through to make a donation,” Klein said.

After the contract is drawn up, the donor’s lawyer looks it over and ensures the donor understands the terms. Before the donation can happen, the doctors involved need to know that there is a legal contract. In some cases, the clinic or hospital may even want a copy of the contract.

The egg recipients are responsible for any fees that the process incurs, including fees resulting from medical complications that are not the donor’s fault. The recipients even have to pay the premium, usually about $400, on a special health insurance policy for the donor.

Klein said that he’s only been involved in, at the most, 20 cases where the donor’s actions resulted in complications. He also said that out of the approximately 2,500 donor/recipient relationships that he’s been involved with he’s never had a lawsuit, mediation or arbitration.

Even though there are no regulations on egg donation besides those set up by the FDA and ASRM, Klein said that doctors and lawyers have been good at policing themselves. Four times a year doctors, psychologists, lawyers and agencies meet to talk about current issues.

“Doctors are very aware of being sued,” Klein said, “I think there are certain checks and balances in place. The bottom line is that there is a process and if the process is taken seriously then everyone has a clear understanding.”

Klein said he thinks sensational stories like the recent “octomom” incident where a doctor implanted six embryos into a woman, which resulted in her giving birth to octuplets, will bring about tighter regulation.

However, Klein also said that egg donor agencies should have some regulations. Presently, Klein said anyone can open an egg donor agency. There are no education, experience, license, or criminal background requirements.

“Newer ones crop up…that you never know about,” he said. He said he’s heard of cases where agencies have cheated the intended parents out of their money and gotten away with it. The important thing to do when looking for an agency, he said, is to get recommendations from lawyers and doctors.

Though, he can point out good agencies, Klein said that he can’t point out any “bad” agencies. “How do you define what a ‘bad’ (agency) is? You have to be careful not to slander anyone,” he said.

“There is no federal regulation yet and I don’t think we want to go that route because (it would) slow down the process,” said Hunt who has an associate degree in human behavior and is currently starting a bachelor’s degree in psychology from National University.

Hunt’s agency is also registered with ASRM and the FDA.

Her role is to facilitate and moderate the egg donation process.

She charges the recipients a minimum fee of $5,800 for her services, more if they aren’t local; there is a separate fee for the donor. The minimum that the donor can receive is $5000. If she is a successful donor, the fee goes up.

Hunt’s duties include setting up and regulating the donor/recipient/doctor/lawyer relationships, if the parties don’t have their own preferences, and setting up the recipients trust account for the donor.

During the process Hunt will make payments using the trust fund and the recipients will receive a detailed account and receipts for all the transactions. She also travels with the donor, if necessary.

“I’m always involved with the process from start to finish. I don’t leave the donors alone,” Hunt said.

Family Ties

One of the arguments against egg donation is the idea that the donor is giving up a child since the egg carries the donor’s DNA.

“It’s all very clear under California law, as it is in all the states, that eggs are considered private property…when the donor givers away those eggs, she gives up all rights,” Klein said.

For Hunt, the question of parentage is not a problem. She said to her, donating is not an emotional ordeal; she’s just glad that she can give someone a baby.

“I’m so disconnected from (any resulting children),” Hunt said. Once a year, she hears from one of the families she donated to. She said she finds the process interesting from a scientific point of view.

Klein said 25% or less of the contracts contain provisions for the donor to have contact with the resulting child. Hunt said that only 5% percent of Fertility Alternatives matches are open.

Donating eggs or surrogacy services can also have an effect on the donor’s family. For surrogate candidates, both the prospective surrogate and her partner are screened.

“It wasn’t until our kids were born that (my husband) thought it was strange that (our children) have genetic matches running around,” Hunt said.

There are databases to keep track of siblings that can result from a donor’s multiple donations, but, Hunt said, the decision to register the children is up to the recipient.

Like Hunt, donor Kristen, whose education is in the sciences, said her relationship to any resulting children is purely scientific.

“It’s your child when you carry it for nine months and give birth to it and raise it,” said Kristen who has no plans to have children of her own.

She has had some contact with two of the recipient families. The second family she donated to flew Kristen and her husband to New York to meet them. She said she prefers to at least speak to the recipients; one of her concerns is that they be able to support a child.

However, Kristen said, some recipients are opposed to having any contact since they worry that the donor may try to claim some parental rights.

Klein said it would be legally impossible for the donor to claim parental rights to any resulting child.

The second family Kristen donated to was also concerned about the child’s mental health when he/she found that they were conceived with the help of an egg donor. They asked Kristen to write a letter to the child explaining who she was, what the circumstances were, and what makes a real parent.

“Yes, it was really weird,” Kristen said.

“It was really daunting. I put it off for a while. How do you communicate this, you just want to say the right things,” Kristen said, “If you put a name and face to it, it makes it harder to be objective.”

She finally just addressed the letter to “Dear Child.”

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