The Red Market (13 page)

That surprised me. The clinic’s website told a different story. In early February 2010, for example, it listed a menu of egg donors including a raft of Russians and Ukrainians. With stays as short as two or three days on the clinic’s site, they receive their hormone doses at foreign clinics, the eggs are surgically extracted in Cyprus, and then they are flown home. There were no photographs, but the menu offered detailed descriptions. One entry read:

No. 17P, Ukrainian, Height 175, Weight 59, Blood type B+, Hair color: chestnut, Eye color: brown, Education: University, Profession: artist, Age: 23, Date of arrival: Feb 2 10, Estimated aspiration date: Feb 05–07.

While fertility tourism has traditionally meant flying patients to cheaper locations for budget treatment, Reproductive Genetics uses Cyprus as a convenient transit point and exploits it as a legal gray area for foreign patients from Israel, the United States, the United Kingdom, Spain, and Italy and egg sellers from Russia and Ukraine. The innovation means that no local Cypriots ever need to know what happens inside the clinic’s walls. Most complications to donors only manifest themselves once the women are back in their home countries.

Despite Verlinsky’s admonitions, I drive out to see the Petra clinic for myself. With its redbrick walls bearing crucifixes and gargoyles, it has the look of a partially rehabbed Old World monastery. I am received by its Russian administrator, Galina Ivanovina. She was initially reluctant to speak to me, saying that journalists have purposely and erroneously portrayed the clinic in a bad light. Over the years several London papers have reported that the clinic intentionally hyperstimulates their donors to produce more eggs than is safe so that the clinic can split the batches among different patients. Splitting the batches means that the clinic can reap profits multiple times for each egg cycle they conduct; however, large batches often don’t produce top-quality eggs and success rates tend to plummet. A story that appeared in the
Independent
also reported the clinic offers illegal sex-selection procedures. Another piece in the
Guardian
in 2006 detailed links between Petra and a group of questionably legal fertility clinics in Moscow and Kiev.

The allegations seem to have taken a toll on Ivanovina. She feels singled out. She starts wringing her hands and speaks in a whisper. She says that if the Petra Clinic has taken liberties with the laws on tissue selling, then it is just as guilty as every other clinic on the island, or for that matter, the world.

She says the women who come to the clinic “do it for economic reasons, nothing else.” They get about $500 for their time and potential risk to their bodies; all of the donors come from abroad. Despite the tacit admission of buying eggs, she says that the allegations of overharvesting are false and that at most, batches are only split between two customers. The sellers receive the bulk of their hormone injections before they even arrive, as Petra is only here for harvesting. The staff at Petra is at the mercy of whatever protocols the foreign clinics run. She says she could only recall one patient who reacted negatively to the hormone regimen. It “was a shock, and we sent her immediately to Nicosia for treatment.”

I’d heard about the girl’s case before. Savvas Koundouros, an embryologist who directs the Genesis Clinic in neighboring Limassol, was on hand when the girl came in. She was on death’s door. “What they do is horrible. They get the women sick and then ship them home so that doctors back in the Ukraine can deal with them,” he said.

With the clinic in the limelight of suspicion for two straight years, Ivanovina is already preparing for the worst. It almost seems like she expects the police to knock on her door at any minute. She doesn’t have to wait long. Three months after my visit the Cypriot police raided the Petra Clinic, accusing the staff of trafficking human eggs. At a press conference in Nicosia the police said that they had taken statements from three women who were flown from Ukraine to be egg donors and that they were illegally paid for their services. But that wasn’t the official reason the authorities had it shuttered. They said that the doctors there were licensed only to treat the blood disorder thalassemia, not for egg donation. After the raid Verlinsky conceded that the Petra Clinic “was supposed to be a major center for thalassemia, but centers opened up in other places. There wasn’t huge demand. And we saw that people required egg donation.” After all, the clinic had its bottom line to consider; it had to provide services where there was demand.

The question at hand, though, was why the police decided to raid the clinic at that moment. In a way, Petra was a perfect target. Owned by foreigners, Petra only performed egg implantation for people who flew in from abroad—scrupulously avoiding local patients as both donors and recipients for human eggs. The exotic nature of the allegations, involving poor Ukrainian women from abroad, showed that the issues were much more thorny than only a licensing irregularity for expanding past thalassemia treatment. At stake wasn’t only the question about whether it was right to split the egg donation between international jurisdictions, but what it meant to pay for tissue in general. And busting Petra for illegal harvesting instead of bureaucratic irregularity could put other Cypriot-owned clinics in jeopardy if they have a similar business plan. As Ivanovina pointed out, the problem isn’t confined to Petra. Every embryologist in the world has to contend with where to draw the line between compensation and payment. If the human body can’t be treated as a commodity, then where are clinics supposed to get raw materials?

AS THE WORD
DONOR
SUGGESTS
, the preferred supplier of human eggs is a woman who gives away her eggs in an altruistic act. According to EU law, member states like Cyprus must “endeavor” to ensure voluntary, unpaid donation of human oocytes, though compensation covering lost wages and travel is permissible. The key, says EU health commissioner Androulla Vassiliou, is “where member states draw the line between financial gain and compensation.” Customers and suppliers easily get around all this sophistry. “It is twice as difficult to adopt a cat as it is to procure a human egg,” writes Glenn McGee, the bioethicist. According to a 2010 study by the European Society of Human Reproduction and Embryology, nearly twenty-five thousand egg donations are performed for European fertility tourists every year. More than 50 percent of those surveyed traveled abroad to circumvent legal regulations at home. There are approximately seventy-six thousand women in Cyprus between the ages of eighteen and thirty who are eligible egg donors. Dr. Trokoudes estimates that each year fifteen hundred of them (or about one in fifty) sell their eggs. The number is staggering. By comparison only one out of every fourteen thousand eligible American women donates.

Perhaps even more alarming is that most of the egg donors in Cyprus come from the relatively small population of poor Eastern European immigrants who are eager to sell their eggs at any price. Though no government statistics break down egg donation in the country, all clinics emphasize their large Eastern European donor pools because their light skin and high education standards make them easier to market to Western European customers. Of the thirty thousand Russians, Ukrainians, Moldavians, and Romanians on the island, some estimates say that as many as one in four have sold their eggs.

Sandwiched between employment ads on the back pages of a weekly Russian-language newspaper is an overture to egg donors. Translated, it reads simply, “An egg donor is needed to help families without children,” and a phone number to get in contact with the unnamed clinic. Anyone who reads the ad knows that payment is part of the deal.

While ads like these are common across Cyprus’s media landscape, they seem to be less common now than three or four years earlier. It could be that Cyprus is reaching a saturation point where most potential donors have already been recruited and it is a now more difficult to find new sources of eggs. To get over the hump, many clinics now rely on scouts to actively pursue and cultivate potential donors. Natasha, a scout for one of Cyprus’s best-known fertility clinics, agreed to meet me to discuss what her job entails on the condition that I changed her name.

Most clinics want Russian donors because Western patients prefer to pass on a lighter complexion to their children, she says. It’s a win for the clinics because as immigrants with fewer job prospects, Russians are also easier—and cheaper—to recruit than locals. Natasha, who hails from a small Russian village and came to Cyprus fifteen years ago, describes a typical donor: “She starts a relationship with a Cypriot that she meets on the Internet. And comes here thinking she will have a good life. But in two or three months they have broken up and she has no job, no visa, no place to stay, and no way to get money. For Russians here it is hard to get legal papers, and she needs to make money quickly. All she has is her health and, if she is lucky, she is also quite beautiful.” Natasha tells me that in all of her years scouting she has never met a woman who gave up her eggs for any reason other than money. She says she convinced one woman who got stuck in Cyprus and ended up crashing on Natasha’s couch for a month to sell her eggs at a clinic. “She used the money to buy a plane ticket home.”

Even doctors sometimes take an active role in filling the donor pipeline. Carmen Pislaru, a Romanian who used to dance in Cypriot and Greek cabarets, says she was still in the hospital recovering from her fourth unplanned child’s birth when her doctor, who had helped arrange for the child’s adoption, asked if she wanted to sell her eggs. “He knew I was in a desperate position,” she says. “I had no money and no way to support my family.” Now jobless, she cleans houses for a living, but still carries deep white scars across her cheeks from where a jilted lover attacked her with a knife.

Pislaru says that she turned down the doctor’s offer—$2,000 in cash—on the spot. But the relentless physician called her every week for the next month hoping that she’d change her mind. Failing that, he pressured her to put him in touch with women who might say yes. She gave him some names, and several of her acquaintances took him up on the offer. “Many women sell their eggs here to make ends meet. We’re all vulnerable,” she says.

Peter Singer, the Ira V. Decamp professor of bioethics at Princeton, doesn’t necessarily have a problem with selling eggs. “I don’t think that trading replaceable body parts is in principle worse than trading human labor, which we do all the time, of course. There are similar problems of exploitation when companies go offshore, but the trade-off is that this helps the poor earn a living,” he writes in an e-mail. “That is not to say that there are no problems at all—obviously there can be—and that is why doing it openly in a regulated and supervised manner would be better than a black market.”

At the time of writing, the Cypriot Parliament is considering a new law to clamp down on egg trading within the country and institute new, tough penalties to clinics that openly buy and sell human materials. But top embryologists are fighting its passage in fear that it would expose the entire medical community to sanctions.

SAVVAS KOUNDOUROS, THE CYPRIOT
surgeon who received the dying egg donor from the Petra clinic, is one of the most popular men on the island, a Cypriot version of George Clooney on
ER
. Men slap him on the back when they meet him; women kiss his cheeks. A handsome embryologist, he has impregnated more women than Genghis Khan. While we stand on a patio on the third story of his high-tech Genesis Centre in downtown Limassol, I ask him how the new law might affect the process of finding egg donors. He lets out a heavy sigh and lights up a cigarette. “What I want to tell you, I cannot tell you,” he begins.

All fertility clinics are caught between two opposing ethical dilemmas. “Obviously the donation is described as an altruistic act, which means no payments. But it sounds strange to all of us that a person would receive so many injections over weeks and then undergo general anesthesia just because they are kind people.” For him the stakes are huge: In the last year he has invested more than a million euros into constructing a state-of-the-art IVF lab with negative-pressure air locks and three rooms full of impossibly expensive equipment. The investment only makes sense if he can guarantee a supply of eggs for his customers. If Cyprus adopts an altruism-only model and bans all payments to donors, he might not be able to find any eggs to harvest at all.

Consider what happened in the United Kingdom. In 2007 the country went from the cutting edge of the IVF industry to an IVF dead zone when it passed legislation that outlawed even minimal compensation to egg donors. Donor pools that were once plentiful dried up. The wait list for an egg donation in the United Kingdom immediately jumped to two years—an impossibly long wait for women pushing the age limits of safe pregnancy. So British women go abroad when they need eggs. And clinics in Cyprus give women money for their eggs and call it compensation, not payment. They come to the Genesis clinic in droves.

Since the rules are different in every country, most clinics are able to attract customers while hiding in the gray areas of international regulations. Even more important than the laws, though, are the risks associated with egg extraction. Egg donors, though they may not all be informed of it, put their lives on the line with every hormone treatment. Approximately 3 percent of women who undergo IVF develop ovarian hyperstimulation syndrome (HSS), a condition in which the follicles in their ovaries become enlarged and produce too many eggs. If doctors don’t throttle down the hormone doses, the condition can prove dangerous. Even fatal—as was almost the case with the Ukrainian woman who nearly died at the Petra Clinic.

Women with polycystic ovaries are particularly susceptible to HSS because their ovaries are swollen into a perpetual state of stimulation. The hormones effectively kick the ovaries into overdrive and deliver many more eggs than normal. Polycystic women are both prized and feared by egg harvesters because while they give more eggs, they also are at increased risk for serious side effects. For some clinics, however, the temptation for extra profits harvested from polycystic donors is too much incentive not to push the limits of safety.