Sex Cells: The Medical Market for Eggs and Sperm (14 page)

In contrast, sperm donation does not require participation in risk-bearing medical procedures. Men must simply masturbate on a regular basis in the sperm bank, alternating their deposits with periods of abstinence. Scholars know little about men’s experiences of masturbation, so it is an open question whether these are affected by variation in social context, that is in doing it for fun in one’s bedroom versus doing it for money in the sperm bank. In detailing their activities, egg and sperm donors offer insight into the embodied experience of donating sex cells for money and provide evidence that the social context in which physical experiences occur can produce variation in how the body feels.

THE EMBODIED EXPERIENCE OF EGG DONATION

Research on the experiences of infertile women who are using IVF to conceive children suggests that it can be extremely disruptive to lives, careers, and marriages. The technology is portrayed as “all-consuming,” and infertile women routinely describe feeling like they are on an “emotional roller coaster.” In Sarah Franklin’s study, many of the infertile women quit their jobs so as to manage the physical and emotional consequences
of the treatment. She writes, “Women [repeatedly] emphasized that they did not realize how demanding the technique would be, how intensely it would affect them, and how much their lives would feel as though they had been ‘taken over.’ ” Here are descriptions from two of Franklin’s respondents.

Jeanette Ives: It’s a very intense procedure and if you’re up at the hospital every day virtually and you are being monitored all the time so obviously it’s a very intense time and you do get very involved in it all. Much more so than you imagine you will do, it’s not like having one injection, you know, it’s really involved. . . . And it does sort of take over your life to quite a big extent.

Mary Chadwick: I didn’t know what hit me, I honestly didn’t know what hit me, I couldn’t believe the intensity of the programme. . . . All you do is eat, drink, and talk IVF, your dinner conversation revolves around how big your follicles were that day, which side you had your injection in and that sort of thing, you just do, you just live and die IVF.
²

In another interview study, Gay Becker finds that as women become immersed in biomedical fixes for infertility, they may experience “depersonalization” and begin to view their bodies as “defective.”
³

The question is whether egg donors offer similar accounts or whether being paid to undergo these procedures and not hoping for a long-awaited pregnancy alters the physical experiences of IVF. In fact, in explaining how the shots and surgery fit into their daily lives, egg donors described a very different embodied experience of the technology. They use matter-of-fact language to report each step required, from learning how to inject medications to attending medical appointments and recovering from egg retrieval surgery.

Shots and Surgery

The nineteen egg donors I interviewed had participated in a total of 42.5 cycles, including those in progress at the time we spoke.
⁴
Most of the women had cycled once or twice, but their experiences varied. Two donors had been matched with recipients but not yet donated, and one
woman had already completed six cycles and was matched for a seventh. Two of the women had donated years before, but in most cases, the donation experience was much more recent; six women were in the midst of cycles, and five had cycled within the last two months.
⁵
Almost half the egg donors had a future cycle to which they were committed. In addition to participating in cycles organized by OvaCorp, Creative Beginnings, Gametes Inc., and University Fertility Services, some women had donated through other commercial agencies and university programs, and one had donated to a close friend. Within each program, women are sent to a variety of physicians, depending on where the recipient is receiving treatment. Thus, those who had signed on with multiple programs or cycled multiple times could compare their experiences with different programs and different physicians. (More details about the interviews and the donors are available in the Introduction and appendixes.)

Most of the egg donors had no previous experience with giving themselves shots, so the first step was to learn how to mix and inject the fertility medications. Heather, a senior in college, described how the nurse coordinator at University Fertility Services “showed me how to use the needles. The hormones and all the medicine come in one bottle, and then you have to syringe it out. She had to teach me how to flick all the bubbles out of the needle, how to clean the area, and make sure everything is sanitary.”

Those bubbles worried Megan, another college student, who called the founder of Creative Beginnings before her first shot, concerned that she “couldn’t get all the itty bitty microscopic bubbles. [The founder] said, ‘It’s okay; it’s not going into your vein. It’s going intramuscularly, so you won’t have to worry. You won’t get a blood clot in your brain, and you won’t die [
laughs
].’ I said, ‘Okay, just curious [
laughs
].’ Because it was a Saturday or Sunday and the doctors weren’t there.” Several donors indicated that they were nervous about giving themselves a shot the first time, and many turned to roommates or family members for help with the injection.

Like Megan, most egg donors described the staff at egg agencies and medical practices as readily available to answer questions. Rosa could call her nurse at “any time, midnight or whatever.” Samantha described her nurse as “really nice. I could always call up if I had questions, and I had
a lot of questions. She was really helpful. The whole staff there is really friendly. I mean they’re excited when you’re there and you’re participating, so they’re really gracious.”

These once- or twice-daily shots required donors to inject a small needle into their stomachs or thighs. Women gave mixed reports about how much the shots hurt. Some said they “didn’t really feel it,” others described a “little pinch,” and a few said the shots “can be painful, especially if you’re on a schedule where you’re taking several shots a day.” It is very likely that a selection effect is at work here, because these women still decided to become egg donors even after they found out that it involves daily injections. Indeed, several made a point of saying that they are not scared of needles or that they have tattoos, so the prospect of giving themselves shots was not a “big deal.”

The medications must be taken at the same time each day, and women reported slightly altering their schedules to do the injections. A few women hid the needles from people in their households. One of the younger donors, Valerie, a twenty-two-year-old college student, kept her entire first cycle a secret while living with her mother. This secret included the fact that she took her first-ever airplane trip to an out-of-state retrieval. Jane, just nineteen and in the midst of her third cycle, said her mother knew she was an egg donor but did not approve, so Jane tried to do the injections when she was not around. Susan, a twenty-four-year-old single mother, did not want to do the injections in front of her four-year-old, “because he doesn’t understand that. That’s weird to him, and so I’d do it before he got up.” In addition to making time in their daily routines, several women changed other aspects of their behavior during cycles in response to requests from staff, including quitting smoking and reducing consumption of alcoholic beverages.

The injection of fertility medications stimulates the ripening of multiple eggs in the ovaries, a process that is monitored in physicians’ offices through blood draws and ultrasound. Lisa, a twenty-six-year-old in the middle of her second cycle, described how the laboratory technician used ultrasound to view and count the ovarian follicles, which contain the ripening eggs. “They measured me. I was doing the injections for three days, and I went there on my fourth day before I took my fourth injection,
and they found like six [eggs] on one [ovary] and seven on the other. They were still getting larger, and when I went today, they found a couple more. They had gotten a lot bigger since Wednesday. They develop quickly.” Several donors thought it was “neat” to see their eggs, saying that they looked like “honeycomb” or “flowers.” These visits are usually scheduled first thing in the morning, and, as a result, some women arrived late to work or had to arrange child care because commuting to the appointments took as much as an hour each way. Later in the day, women receive a call from the nurse if they need to adjust the dosage.

When the eggs are mature, donors do a final “trigger shot,” which causes the ovaries to release the eggs. There was universal agreement that this injection is painful, as the medication goes in slowly and burns. Thirty-six hours later is the egg retrieval surgery, an outpatient procedure that usually lasts between fifteen and thirty minutes. In most cases, donors recall being prepped for surgery and then waking up in the recovery room. Dana, a twenty-five-year old who had donated four times in the past eighteen months, offers a fairly standard account of the day.

You’re up extremely early [
laughs
]. You can’t have anything to eat the night before, which is horrible for me because I eat all the time. They put you in a room, have you undress, put on a hospital gown and a little cap to cover your hair. They start your IV and basically just let you sit for a while. They take your blood pressure, check your oxygen level, your saturation, your heart rate, make sure you go to the bathroom. They’ll start some fluids and then wheel you into an OR. It’s not the one you usually see in the hospital, but it’s their version in their office. They get you on the bed, knock you out, and then that’s it. You wake up, and you’re back in the room you started in, and you really don’t remember anything.

Women who donate to recipients who live elsewhere will often be asked to travel to the recipient’s location for the last few days of the cycle. More than half the women I interviewed had traveled for at least one of their cycles. It is impossible to determine in advance the exact date of the retrieval, because it depends on how quickly the eggs mature, and this layer of uncertainty can add to the difficulty of scheduling time away from work and family. If an egg donor does have to travel, donation programs
pay for one companion to join her on the trip, and several women considered this an opportunity to explore a new city with family or friends. Megan took her best friend along for a retrieval in the Northwest, saying, “I hadn’t gone on a vacation in years,” because she had been working full-time and taking a full load of classes at the university. Several Gametes Inc. donors had retrievals scheduled in Orlando, and they took their children along to go to Disney World, describing the trip as a “cheap family vacation.” Other women preferred not to travel but had little choice because they lived in small towns. For example, Dana was a very popular donor who often had multiple recipients interested in her at the same time, so she would be asked where she preferred to donate. However, at the end of our interview, she concluded, “I don’t mind the shots. I don’t mind the appointments. I just don’t like the travel [
laughs
].”

Side Effects

There are potential side effects from the fertility medications and the retrieval surgery (the details of which are discussed in the Introduction). Donors hear about these risks from program staff and psychologists as well as clinicians at the infertility practices where they are being treated. Before agreeing to donate, many women discussed these risks with relatives who were medical professionals or consulted their own doctors, and many did research online or in libraries.

As a result, egg donors are more than prepared to experience physical side effects. Of the seventeen women who had completed at least one cycle, eight described very mild reactions to the fertility medications and retrieval surgery, five experienced slightly more discomfort, and four described having serious pain.
⁶
On one end of the spectrum are almost breezy accounts, such as that offered by Erica, a twenty-seven-year-old mother of two who had donated twice in the previous year. “Really it’s pretty simple [
laughs
]. You do a week or so of ultrasounds every day or every other day, depending on the medications, then go [
laughs
]. It’s general anesthesia; you feel like you’ve slept for about four days, wake up feeling good. You just have light cramps for a couple days,
and it’s over and just back to normal life.” Similarly, Jessica, a thirty-year-old nurse, explained,

[Egg donation] really didn’t take up a lot of time. The shots I did at home, and they just took a few minutes. It just didn’t interfere with anything. I actually kept rollerblading and running and doing my regular things. I didn’t have problems with it. They did say that you could have some cramping or bloating or just start to feel different things, and of course if you start to feel very odd, you should go see a doctor. I had a good experience with it, so it was just something that I kind of did and went on, and it never really bothered me, which I was glad. Up until the day we left [for the retrieval], that was actually the first day that I just started feeling like a little cramping feeling, and then for a couple days up until the retrieval and afterwards, but nothing that I can really speak of.

Jessica even referred to the retrieval as pleasant, noting, “Everybody was real nice, real pleasant. The doctor actually came in, introduced himself, and said ‘This is what I’ll be doing.’ I was asleep through all of it anyway. I didn’t get nervous. I was ready, just ready. It was a real pleasant experience.”

For some women, recovery took no time at all, and they described going out for lunch or dinner after the retrieval. But others had cramping and bloating for a day or two. Jane explained how, as a result of the fertility medications, “you gain five pounds, which I think, if anything, is the part I hate most. You lose it after you get your period.” Her cycle ended right before her sorority’s formal dance. The discomfort from the injections made it difficult for her to practice the dance routine, and the extra weight made her feel self-conscious in her dress.