A handful of medical centers have begun offering infertile couples a new but very expensive option in their quest for a baby of their own. They are providing lists of healthy young women who, for a fee, will supply eggs that can be fertilized in the laboratory and implanted in the infertile woman's womb.
Although the first programs that provided strangers to donate eggs began in 1987, they were until recently tiny endeavors, with very few donors. But as word has spread among doctors and infertile women that egg donors are an option, the programs have blossomed.
Even though it costs an average of $10,000 for each attempt at a pregnancy with donated eggs, many infertile couples consider it money well spent. Health insurance almost never pays for the procedure, and each attempt has only a 25 percent to 30 percent chance of resulting in a live birth.
"There is a lot of consumer demand," said Dr. Mark Sauer of the University of Southern California. He runs one of the nation's largest egg donor programs, which has used donor eggs 150 times for women 24 to 58 years of age, and said that "there are a lot of patients out there in their late 30s and 40s who have had a very difficult time of it."
These couples shun publicity, telling almost no one that they used donated eggs, the directors of donor programs say.
The women usually have reached an age when their biological clock has almost stopped ticking. A woman in her early 40s ordinarily has only a 1 percent or 2 percent chance of getting pregnant with her own eggs, infertility experts say.
Others have no eggs because they have entered menopause. They say donated eggs are their last best hope of having a baby.
But some say they are troubled by the practice of recruiting egg donors and paying them an average of $2,000 each time their eggs are removed. They say there is something exploitative about the possibility that affluent, infertile couples will buy eggs from poorer women. They anticipate lawsuits over who is really the mother of the child.
They also say that even anonymous donors may end up having their identities disclosed as children born of their eggs grow up and seek information about their genetic backgrounds.
Although some of the same questions arise about sperm donors, men are paid much less, about $40 for each donation, making the money less important.
And sperm donation entails no risk and not much trouble. Because egg donation is so much more intrusive, risky, uncomfortable and time-consuming than sperm donation, egg donors will be the genetic mothers of fewer babies and will be more likely to someday seek their genetic offspring, ethicists say.
They suspect that the children may be more likely to want to seek their genetic mothers because there can be no doubt that their birth mother did not supply her own eggs.
Dr. Arthur Caplan, director of the Center for Bioethics at the University of Minnesota, said the unaddressed ethical questions about egg donation argue against its use.
Others are unperturbed. "I think it's a good thing to donate eggs to help people have a baby," said Dr. John Fletcher, an ethicist at the University of Virginia.
The American Fertility Society has declared that egg donation is ethically acceptable, but it says egg donors should be paid only for the risk they take, their expenses, their time and their inconvenience.
Directors of egg donor programs say that is all their fees are meant to cover. The women must be injected with hormones to hyperstimulate their ovaries, must have frequent blood tests and ultrasound scans to determine when their eggs are ready to be fertilized, and must be anesthetized when their eggs are removed.
According to the fertility society, 48 medical centers said last year that they offered donor egg programs, compared with 26 centers the previous year and 17 in 1987.
But Dr. Sauer, who has surveyed the centers, said almost all required the women to find their own egg donors. Only the center that Dr. Sauer runs and a few others, mostly on the East and West coasts, provide donors. The fertility society has no figures on how many centers provide donor eggs or how many women received these eggs.
Women often cannot bring themselves to ask friends or relatives to donate eggs, directors of egg donor programs said.
Dr. Zev Rosenwacks, who runs an egg donor program at New York Hospital-Cornell Medical Center, agreed. "I don't know many women who want to become donors," he said, adding that the scarcity of donors has been the biggest hindrance to egg donor programs.
So the few programs that provide donors have grown rapidly as word of them spread. HC