Our Bodies, Ourselves (106 page)

Some people are concerned that PGD is being or will be used not only to detect serious medical problems but also to detect a whole array of undesirable attributes or to select for gender or certain physical characteristics or the ability to perform well in sports or music. The American Society for Reproductive Medicine (ASRM) uses different terms for the procedure depending on how the procedure is used. The term PGD is used only when the procedure is performed on embryos from men and women who are known to carry a serious hereditary condition. ASRM uses the term “preimplantation genetic screening” (PGS) to describe the same process when it is done to search for mutations or other traits. ASRM recommends the use of PGD but says that the evidence is insufficient to know if PGS is useful and does not recommend it.

Many people worry that PGD and PGS may fuel eugenic tendencies and make it harder to preserve a society in which people with disabilities will be fully valued for who they are.

The procedure does not appear to have any effect on overall pregnancy rates for IVF. It generally costs an additional $5,000.

One thing I find runs through my head (completely unbidden) is that I am a bad feminist for lamenting the fact that I can't have biological kids; that I know well enough that there are many nontraditional ways to have families that are not lesser than biological families (I have a three-year-old brother adopted from the foster care system, so I have firsthand knowledge of this) and that I need to get over this. But having that option removed feels like a violation of my body by my body, if that makes any sense. Feeling this, feeling like a bad feminist—these are uncomfortable places to dwell in
.

The phrase collaborative or third-party reproduction refers to the process when another person provides sperm, eggs, or embryos or when another woman provides her uterus so that a family can have a child. The donor's or surrogate's involvement is limited to the reproductive process and does not extend to raising the child. Collaborative reproduction is complicated and involves a number of important considerations to ensure a safe and successful experience.

Insemination with donor sperm involves using the sperm of a man who is not your partner to conceive. Families interested in donor sperm can use a known donor (a friend or relative) or find an anonymous donor through a sperm bank.

Sperm from sperm banks have been tested for numerous infections and genetic diseases. Usually you can find out basic information on potential anonymous donors, including their physical characteristics, ethnic and/or racial background, educational level, and career. You may also be able to read a personal profile on the donor and see a photo.

Success rates vary based on your age, past pregnancy history, and infertility diagnosis (if you have one). Costs associated with sperm donation vary greatly from a few hundred to several thousand dollars, depending on the process you plan to utilize, which fertility clinic you are being treated at, and whether you use a known or anonymous donor. Because no one keeps track of sperm donation, it is not known how many children have been born through donor sperm over the years.

Conceiving a baby via egg donation is becoming increasingly common, with more than ten thousand women and families using donor eggs each year. Egg donation allows the possibility of becoming pregnant through the use of another woman's eggs. It is most often used by women who experience primary ovarian insufficiency, age-related infertility, poor egg quality, unexplained infertility, or disorders that may be transmitted genetically. Once a donor's eggs have been retrieved and fertilized by your partner's or donor's sperm, any resulting embryos will be placed either in your uterus or in the uterus of a gestational carrier.

Because the eggs of healthy young women are used, success rates are usually over 60 percent for most clinics. Babies born through this expensive procedure—often totaling between $30,000 and $40,000—are not genetically related to the woman who bears them. Coming to terms with this modern phenomenon can be difficult, as it means accepting that you will likely never conceive your own biological child.

You and your partner, if you have one, the fertility clinic, and/or an independent egg donor agency may work together to locate a potential donor. Sometimes a relative or friend will offer to donate her eggs. In some lesbian relationships, one partner may donate the egg and the other serve as the birth mother, enabling both women to have a biological connection to the child. In most cases, however, egg donors are unknown to the recipient family.

Regardless of how you find your egg donor, it's important she be properly screened, both physically and emotionally. An egg donor should be between the ages of 21 and 30, healthy, and fertile. She will also need to have a thorough psychological screening to identify any emotional problems, evaluate her motivations for donating, and verify that she understands the physical, psychological, and legal risks. It's imperative that you consult an attorney who specializes in egg donation to ensure that all involved are protected.

I felt like an eggless sociopath for even considering asking one of these young women if I might purchase their eggs. How and why do they decide to sell their eggs to someone like me? How do the donor agencies and these young women determine that their eggs are worth $8,000 while someone else's eggs are worth only $5,000?

Egg donors are paid a fee typically ranging anywhere between $5,000 and $10,000. There are also many ads advertising compensation
above $20,000 and even a few approaching $100,000 for young women with very specific desirable characteristics, such as proven fertility, certain physical characteristics or ethnic backgrounds, attendance at prestigious colleges, or high SAT scores. The egg donor fee is intended to compensate the donor for all costs associated with the time and energy needed for donating her eggs, including undergoing medical and psychological screenings, taking drugs to hyperstimulate her egg production, and undergoing a sedated surgical procedure to retrieve the eggs. Almost all egg donor programs encourage anonymous egg donation, although it's possible for you to meet the egg donor in some cases.

Because these procedures carry some health risks, and because the long-term risks of egg donation have not been adequately studied, egg donation raises ethical concerns. Some people believe that while it is acceptable for a woman who desperately wants to become pregnant to accept the health risks involved, it is exploitive to encourage women who receive only money and not a potential baby to donate eggs, especially when there is not sufficient information available to make an informed choice.

A surrogate is a woman who is willing to be impregnated using IVF and carry a baby for the intended parents to help them build their family. Surrogacy is most often considered a family-building option among women who have lost their uterus, were born with a uterine anomaly
that would make carrying a child exceedingly difficult, or are unable to carry a pregnancy to term for other health reasons.

There are two types of surrogacy: traditional and gestational. Traditional surrogacy is when a woman offers to use her own eggs
and
carry the child as well for the intended parents, thus maintaining a genetic connection. A gestational surrogacy is when an egg (from a donor or the intended mother) is fertilized outside the body and then implanted into the gestational surrogate, who has no genetic connection to the child. In both cases, a woman goes through a pregnancy and bears a baby destined for another person or couple.

A surrogacy pregnancy can easily cost over $100,000, including agency fees, escrow fees, attorney fees, insurance, medical bills, medical and psychological testing, clinic fees, cycle medications, travel, missed work, surrogacy compensation, and any miscellaneous expenses. Depending on the state, once the baby is born the contracting parent(s) must legally adopt the child, making appropriate legal counsel imperative. A surrogate is typically compensated between $25,000 and $35,000 for her time, inconvenience to her own life, and all expenses associated with pregnancy and childbirth. Some surrogates develop lifelong relationships with the families they are helping, even exchanging periodic updates and pictures of the family they helped build.