Sex Cells: The Medical Market for Eggs and Sperm (15 page)

Olivia, a twenty-three-year-old who had completed three cycles, experienced more negative reactions to the fertility medications and the retrieval surgery but only in some of her cycles.

Olivia: The very first time I was fine. I didn’t even think about it. I just took my shots every day. I thought, oh they’re gonna take my eggs, and if she gets pregnant, yay, and if not, then at least I tried. I had no side effects. In fact, after
the retrieval, I was up literally running around the office, because the nice head nurse Holly, she allowed me to go watch the retrieval of another woman. My mom had taken me out for lunch right after, I went home, watched TV, I was fine. The second time I did it [
laughs
] I was moody! I could be really happy one minute and then all of a sudden I would be like roar! Get out of my face!

Rene: Did they change the medication?

Olivia: Same medication. It’s just your body responds differently different times. It’s like a pregnancy. You never have the same pregnancy twice. I was moody, irritable, bloated. My stomach got all big. I had cramps. Bluh! It was horrible. I just went right home and was in bed for two days. And then the third time I was moody, no cramps, my tummy got big. They retrieve the eggs, and then it goes back to normal. I didn’t have to go back to sleep or anything. I was fine.

Olivia was one of two women who reported not being given enough anesthesia during an egg retrieval. In describing the surgery for her third cycle, she said, “I won’t say [it was] like someone stabbing you in your stomach, but if you could just imagine a big needle going into an area that’s really tender and how much that would hurt and then the tender area being your ovaries.” She was even awake enough to tell the doctor about the pain, but the procedure is so quick that there was not time to administer more anesthesia. However, this negative experience was not enough to deter her from donating again. She signed on for a fourth cycle, which just happened to be with the same physician. “I told the nurse, ‘Next time, they’re going to have to put me all the way under.’ ”

None of the egg donors I interviewed had severe reactions to the fertility medications or serious complications from the retrieval surgery, but on the far end of the side effects spectrum for this sample, four women (who were associated with three different donation programs) described experiencing a great deal of pain during the cycle. Moreover, “returning to normal” after the retrieval took a week or two instead of just a few days. Heather, who had just finished her first cycle, felt more pain as the cycle went on.

I went to [an ultrasound appointment] in the middle [of the cycle]. The [ovarian] follicles had gotten a lot bigger. That’s when I started to actually feel my ovaries. It felt like cramps, not quite as uncomfortable. I was just very sluggish, almost bloated. Toward the end, like right before the surgery, it got really painful. Just sitting down kind of hurt because my ovaries were huge. There’s like twenty-three enlarged follicles in my right one, and then in my left one, there were seventeen. [The nurse] described it to me: the ovaries sort of sag down a little bit because of all the weight and the fluid. I was like, “It makes so much sense now [
laughs
].” The ultrasound was the neatest part because you got to see everything growing, and I could feel everything that was going on. They were testing my hormone levels, and at the right stage, that night I take a trigger shot. Then I had a day off where it was pretty painful, so I just laid around. It wasn’t like overbearingly painful. It was pretty much just cramps. It just felt like there were heavy ovaries.

Although most women reported producing between ten and twenty-five eggs during their cycles, the four donors who experienced more pain produced considerably more, between thirty and forty eggs. One woman said that after her first cycle, it “hurt to bounce or move too much” for several weeks, so she took matters into her own hands to ensure that she did not “overproduce” during subsequent cycles.
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My stomach was really distended. I was very uncomfortable. It was just not a good experience at all, so the second, third, fourth [cycles], I was very adamant about what I would and would not do. I would tell them, “You can’t increase dosages on me, because I overproduce.” The first time, I had thirty-three eggs, so then they knew we can’t go this high. The second time, it went down to twenty-eight eggs. The third time, I started administering on my own, so it was like twenty-two. I had to take care of myself, and I know that’s so against the rules. But they don’t know how it goes for me. I just have to trust that my body is always going to react the same, which it does [
laughs
]. So it hovered around twenty-two the last two times, but that’s still a lot of eggs. Some people, it’s only like fourteen or ten. I would always start off, and they wouldn’t be blossoming. By the tenth day, everything would go into overdrive. I didn’t respond right away, so they’re thinking they should step it up. They always err on the side of caution, which means get as many eggs as you can. So they would step it up from two ampoules to three, and that’s when I didn’t step it up. I didn’t tell them. I just didn’t do it. I hate saying this because if I really thought that I was wrong, then I wouldn’t have done that because I wouldn’t want anybody to be x’d out of their [chances for conceiving], but I couldn’t go through the discomfort again. It’s like you’re pregnant, but you’re not. It’s just water, and it’s hard. Even after the eggs are out, it doesn’t go down right away.

Another donor who cycled multiple times with various agencies before taking a position as a staffer in an egg donation program echoed this suggestion that some physicians are more interested in generating eggs than in safeguarding donors’ health. She explained that the same dose of medication affects women differently, but the number of eggs “also depends on the protocol the doctor uses. Some are a little more conservative than others, and there’s a fine line between getting a good amount of eggs and hyperstimulating.”

It is striking that three of the four women who experienced the most negative physical reactions went on to donate again, and the fourth wanted to have her own family first but would consider donating again in the future. Their subsequent cycles were much less painful, because physicians now knew to prescribe lower doses of medication. For example, Valerie’s second cycle, which she described as “day” to the first cycle’s “night,” resulted in fifteen eggs instead of thirty-seven. In fact, the majority of egg donors—80%—were willing to do at least one more cycle, and many planned to donate several more times.
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Nevertheless, several said there was a limit because of concerns they had about the effects of repeated exposure to fertility medications.

Aside from the four women on the far end of the side effects spectrum, Gretchen reported the most dramatic response to the shots. She was also the only person I interviewed who donated eggs to a close friend before signing up with a donation program. Her friend Barbara and her husband invited Gretchen to come live with them for the duration of the cycle, and given that Barbara had already tried IVF with her own eggs, she was in a position to tell Gretchen how it was going to go. Gretchen explained,

Now Barbara was used to everything because she had already tried going through the cycle, so she knew what to expect, whereas me, I had no idea. I remember the first day of being on the Lupron as being horrible. I think it was just my body was not used to it. My hormones are going crazy. I was so nauseated I lived on popsicles for two days. I mean that’s all that I could stand. And then the second day, I remember getting a really bad headache. I think I popped two ibuprofen, and I was fine. But the funniest was when we were both on the Lupron. Their house is huge, and we kept cranking the air down lower and lower. Both Barbara and I would be walking through going, “God, is it like four hundred degrees in this house?” And her husband, bless his heart. Here we are in the middle of summer. It’s like 95 degrees on a cold day up there. He’s in jeans, a long-sleeved shirt, and a jacket, and he’s like, “Are you kidding me?” He’s like, “I can’t put it down; you’ve got it set at 63. You need to suck it up and get past it.” So that was the worst part about it.

It is possible that Gretchen was primed for this more dramatic response, because she was living with a woman who had already been through IVF once before trying to have a baby.

In fact, Lisa, whose forty-six-year-old mother was using IVF to have a family with her new husband, addressed this point explicitly. Here, she compares her experiences with fertility medications with those of women like her mother.

This particular drug I’m doing gives me a little bit of a red spot where I inject, but it just lasts for about a day. It’s not that bad. The first time, I didn’t have any side effects. No redness, nothing. I just felt normal. It was strange, because they kept sending me all this paperwork saying “This could happen, this could happen.” But, no. They mentioned something about depression or euphoria, and I didn’t really experience either. I think maybe that is more for people who are trying to get pregnant, because they’re so nervous and desperate or whatever. They really want to get pregnant, and they get really emotional about it. I’m not really that emotional about it.

In sum, egg donors do not “live and die IVF.” In stark contrast to infertile women, egg donors use straightforward, undramatic language to describe the injections and outpatient surgery and report that cycles are “easy” or “quick.” Some women actually used the word “vacation” to describe traveling for the retrieval surgery, and even those who experienced more serious side effects went on to donate again. Although egg donors hope that recipients become pregnant, they are not nearly so invested in this outcome as infertile women are, because egg donors are not attempting their
own
long-awaited pregnancy. Moreover, they are paid thousands
of dollars for the cycle, and they will receive the money regardless of how many eggs they produce. Perhaps this is the reason that so few women reference the financial compensation when discussing how egg donation fits into their daily lives. This is not at all the case with sperm donors, who, as will be clear in the next section, talk constantly about the money they make at the sperm bank.

THE EMBODIED EXPERIENCE OF SPERM DONATION

Whereas an egg donor is assimilated into a medical practice as a sort of patient, a sperm donor is required to perform a sexual act that has long been cloaked in shame and secrecy.
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Few scholars have addressed the topic of masturbation, and some of the research that has been done has itself taken on an almost furtive quality. For example, in a landmark study of sexual behavior in the United States in 1992, Laumann and colleagues deemed questions about masturbation too sensitive to be asked out loud. Instead, the interviewer handed respondents a piece of paper with the questions listed, and respondents marked the answers before folding the paper, placing it in a sealed envelope, and handing it back to the interviewer.
¹⁰

This survey revealed that more than 60% of men had masturbated in the last year, and about a third of the younger men (eighteen- to thirty-four-year-olds) reported doing it at least once a week. Selecting from a predefined list of reasons why they masturbate, men most commonly answered that they wished to relieve sexual tension or experience sexual pleasure. About half the men said they felt guilty about it. The researchers concluded that “masturbation has the peculiar status of being both highly stigmatized and fairly commonplace.”
¹¹
They distinguished it from sex with a partner and noted, “in this secluded personal realm, you do not have to pay as much attention to others, and the goal of personal pleasure can become central.”
¹²

Laumann and colleagues produced systematic statistics, but they did not collect qualitative data on the embodied experience of masturbation, a topic on which there has been very little research. In one study of Muslim men in Middle Eastern fertility clinics, Marcia Inhorn found that
husbands, who must produce a semen sample timed to their wife’s egg retrieval, experienced a great deal of anxiety, both from the need to perform and from violating religious mores. One man she interviewed explained, “In IVF centers, they say, ‘Give me the sperm now! After five minutes, I need your sperm. Now, now! Give me, give me!’ This is not good. The male encounters problems when they do that. It’s not good. I start thinking about when I will give the sperm, and I feel uncomfortable.” Pointing to the clinic’s semen collection room, which had a door that opened into the small, crowded waiting room, this same man said it was “like a prison cell.”
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In some cases, the anxiety results in failure to produce a sample, and the IVF cycle is for naught.

Comparing the findings from Laumann et al.’s survey and Inhorn’s interviews raises the question of how sperm donors experience masturbation. In the United States, the physical act is stigmatized, though not to the degree it is in the Middle East. Moreover, sperm donors are not masturbating on demand for a spouse in the next room who is undergoing complicated and expensive fertility treatments, but donors’ payments are predicated on sperm count and semen volume. So do American men producing sperm for money experience masturbation more as paid pleasure or pressured performance?

From Awkward to Routine

Like the egg donors, the twenty sperm donors I interviewed were at various stages in the donation process, from those who had been making deposits for a few months to men who donated a decade before. Unlike the egg donors, none of the sperm donors mentioned being affiliated with more than one program, and all came from either Western Sperm Bank or Gametes Inc.
¹⁴
On average, men at Gametes Inc. had been producing samples for twenty-two months, compared to an average fifteen months at Western Sperm Bank (this comparison excludes one man at Gametes Inc. who had donated off and on for ten years, a very unusual length of time to be a donor). Most of the men—80%—were still actively donating. (More details about the interviews and the donors are available in the Introduction and appendixes.)
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