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Sarah Berson: Natural Instincts

February 14, 2013

Curiosity, power, and uncertainty in the human experiment of egg donation.

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Image from Flickr via Steve A Johnson

By Sarah Berson

Last August, I donated my eggs for cash. It was my summer break during grad school, and a friend had told me about the eight-thousand-dollar paycheck per round. One twenty-five-page application later, I had an appointment at a reproductive services clinic in Manhattan for blood tests and a psychological evaluation. After a highly specific selection process, I was accepted as a donor and began to feel like I’d strapped myself into a very slow log ride at an amusement park. I’d researched the health concerns, such as the probability of cancer from taking so many hormones and the chance that my ovaries would rupture. Ultimately, I decided the process wasn’t that risky, especially considering the payout. I had moral qualms about anonymous donations and IVF itself, but I didn’t know the answers, and I didn’t know how I’d feel until I tried. I was curious.

IVF (in vitro fertilization) was first successful in 1978 with the birth of Louise Brown, the first “test tube” baby. Today, it is estimated that 350,000 babies are conceived in this way worldwide each year, and the month before I donated eggs, the five millionth child conceived through IVF was born. A woman using her own eggs for in vitro fertilization is first prescribed hormones to stimulate her ovaries into hyperproduction. Later, she is given another hormone that causes ovulation. The resulting egg follicles are extracted during a surgical procedure using a transvaginal ultrasound wand and a long needle, inserted through the wall of the vagina, that aspirates, or sucks out, the follicles that have moved toward the outside of the ovary. An egg donor goes through the very same process. In either case, IVF continues when the resulting eggs are fertilized in a lab and then inserted (or reinserted) into the hopeful-mother’s womb, about five days later. New data is somewhat difficult to come by, but by 2008, at least 100,000 women had donated their eggs for financial compensation. (“Donating” is a carefully chosen misnomer: it’s illegal to sell or buy eggs, so fertility clinics say that donors are being compensated for their time.)

I chose a clinic that mostly performs anonymous donations, in which the donor and recipient never have any contact. Once eggs are extracted from the donor, they belong to the recipient, who may fertilize, freeze, or discard as many as they wish. The terms of anonymity I agreed to meant that I would never know if a fertilization was successful. And, if a child was conceived, I would never have access to it, nor it to me.

The truth is, I believe that IVF is unnecessary: there are innumerable parentless children in the world. Was it hypocrisy? I’m still not quite sure.

Before I’d signed the contract, I thought I was glad that I wouldn’t get a knock on my door in eighteen years. I didn’t want a part in a Lifetime movie story where my genetic offspring and my actual children grew to know each other, forging a quirky, unconventional family of love and acceptance. But, a friend pointed out, is that fair to the child? Do they have a right to meet the person who provided 50 percent of their genetic material? And, what if laws change, allowing the child to research their parentage and find me? I was told repeatedly by the donation coordinator, the clinic psychologist, and the gynecologist that the egg was not my child. I wasn’t even giving away my own body cells: by the time the fertilized egg would be implanted in the mother, any of the nutrient-filled cells would have been consumed by the blastocyst as it began to develop in the lab. The recipient would get only my DNA, and her body would provide the nutrients that would make a baby—her baby. I decided I wouldn’t mind meeting a genetic descendent, and if that didn’t happen, okay.

Once selected by the agency, I had to complete a questionnaire that egg recipients could choose to read or ignore. It asked things about my habits and hobbies, hopes and dreams. The final section was a space for a message I could write to the recipient or a resulting child. I wasn’t required to fill it in (though my favorite food and movies were compulsory). All I could think to say was ‘Don’t screw it up.’ I ended up writing something bordering on the profoundly banal—about always being happy, or seeking happiness. Another question asked what I would do if I couldn’t conceive. The truth is, I believe that IVF is unnecessary: there are innumerable parentless children in the world. I wrote that I’d adopt. Was it hypocrisy? I’m still not quite sure.

I felt that I was benefitting from this system of unfairness, exploiting the genetic lottery from which I had favored.

The average round of IVF costs twelve thousand dollars, some of it covered by insurance. Only relatively wealthy people can afford the treatments, which, even if you disapprove of the process generally, still seems unfair. Some who oppose egg donation say that the exchange, in turning a natural function into a commodity, exploits women and their bodies, referring most often to the donor. But, on the contrary, I felt that I was benefitting from this system of unfairness, exploiting the genetic lottery from which I had favored. Egg donation is a capitalist scheme that allows wealthy people to lead their ideal lives and genetically-desirable to make relatively easy money.

And that’s just the thing. The money was really good. Though there aren’t many longitudinal studies on the hormone treatments (they’ve only been around for thirty years), the possibility of cancer wasn’t enough of a deterrent, and the clinic seemed to keep my own safety in mind, if not necessarily my comfort. Whether I participated in donation or not, IVF exists and will continue to exist.

***

I signed the contract. Blood was drawn for genetic testing. My eggs would be matched with a recipient who was using sperm that didn’t contain any of the genetic malformations I carried. My donation coordinator then gave me birth control pills to regulate my cycle and synch me up with the recipient, who was also on birth control.

A few weeks later, I received news that the clinic had matched me. I was given an enormous bag of hormonal medicines, syringes, needles, a red sharps container, and alcohol swabs. The coordinator explained how I would prepare the shots and inject myself, and I practiced on a rubber “fatty area” that was glued to a flat piece of plastic, like a pincushion made by Hannibal Lecter. I would have to go into the office almost daily for a sonogram and blood work that the doctors would use to determine my dosages. I needed two to four injections per day for ten days while follicles developed. On the final day, I would take only one injection, at a designated time, stimulating my ovaries to push the follicles outward for retrieval.

I was powerful. I was easily making something someone else desperately wanted.

Injecting a rubber butt cheek was nothing like injecting my own skin. After fifteen anxious minutes staring in the full-length mirror, I worked up the adrenaline and courage to poke the tiny, half-inch long needle into the fat I’d pinched up just to the left of my belly button. The second shot was no easier, probably because my hands were shaking so much, and the next morning was the same. On the third day, I went to the clinic for monitoring, and the doctor seemed pleased with my body’s response to the drugs. Pea-sized, white-rimmed follicles were dotted throughout the grainy grey blobs that were my ovaries.

For eight more days, it carried on in this way. I anticipated the daily dosage instructions from my doctors with a sense of excitement, like getting a new gadget and figuring out all the buttons and features. I felt like I was accomplishing something when I saw that the follicles were no longer pea-sized on the monitor, but dime-sized, and then as big as nickels. I was a human science experiment, and it was thrilling. I was powerful. I was easily making something someone else desperately wanted.

The hormones I was taking tend to induce bloating, tenderness in the lower abdomen, irritability and lethargy, known to most women (and those who love them) as PMS. I noticed feeling tired a bit more often, and later in the cycle, something felt definitively different where I knew my ovaries to be. Their expanding size became uncomfortable, like a mixture of menstrual cramps and having to urinate really badly. As my ovaries grew, the doctors warned me against running, doing yoga, and any other activities that were “bouncy” to prevent the free-floating ovaries from twisting. I became more aware of the way I walked and the stairs I didn’t jump down.

In the beginning, I wasn’t really sure that I’d make it through the whole cycle to retrieval. The hormones I’d taken home had other women’s names on the prescription labels—Laura R, Kelly P, Rachael M—women who’d bowed out before it was finished. But I wanted to stay on the ride, to test my endurance. I watched from the outside as I gave myself injections and went to appointments. I needed to know what it was like.

By the tenth day of injections, my ultrasound showed almost twenty follicles per ovary—three or four times more than usual, and that night, I got my most important instructions. It was time for my final injection. I had only one pre-loaded syringe of the hormone that would set off a ticking-clock of biological events: the drug would go into effect thirty-six hours after being taken. After thirty-nine hours, the follicles would begin to slough off as in ovulation, and at that point, they would be impossible to find or use.

I took on some shame, as if selling my eggs was somehow inherently bad, as if it was detached entirely from natural instincts.

That night, I was at my regular Wednesday night knitting circle. Rather than tell my friends in the group what I was doing, I brought the shot with me, and yes, I secretly injected myself in the bathroom. I hadn’t told many people about the donation. I’d heard too often that giving away your eggs was for someone without a maternal compass, and I didn’t need to hear more. I went back to the group unexpectedly giddy. I was storing a secret, an invisible force that I’d never made use of before. My choice was made more powerful by the fact that my friends would never consider doing it themselves: I felt intrepid.

On Friday morning I was at the clinic by 6:45, before any staff member had arrived. The procedure would only take about twenty minutes total, and was “minimally invasive.” After a couple hours waiting in my hospital gown, I was led into a dimly lit room with an impossibly low ceiling. In the corner, above my head, a TV monitor displayed only my name; it would later show the sonogram images the doctor would use to navigate through my vaginal wall and extract each follicle. The nurse deftly transitioned from smalltalk to anesthesia, and I was out.

***

In the days following surgery, I was stiff and achy. My lower abdomen was sore, and it was uncomfortable to release the muscles necessary to go to the bathroom. As the discomfort persisted, I called the clinic repeatedly, trying to find out what was normal and what wasn’t. It seemed that the office wasn’t terribly interested in my well-being after I left, thirty-nine follicles lighter. This realization was disheartening—they’d lavished so much attention on me before. This was a business transaction. But still, the thought recurred: no one had thanked me.

In the past, I’ve never understood stories of women who plan to give up their baby to another couple but change their minds after holding it. But now… I didn’t know what was happening to the extracted eggs. I kept reminding myself I’d done it for the money, and this was all part of the arrangement. A week after the surgery, I got my check, cashed it, and knew that my last semester of graduate school would be a bit more flush. It was about two weeks after surgery when my body felt completely healed.

When I was in the clinic, I was referred to in code so the other patients wouldn’t know I was a donor—it was a dirty secret. I took on some shame, as if selling my eggs was somehow inherently bad, as if it was detached entirely from natural instincts. It’s now been six months since I donated, and when someone asks me if I want to have kids someday, I mostly think about the genetic offspring that I might have somewhere out there soon. If I really think about it, I would like to know who they are. I imagine an embryo’s state of development, a crib in a stranger’s house, and someone’s happiness at having a baby to lay there soon. It doesn’t really feel like I’ve reached the end of the ride.

I thought I was just in it for the money. But maybe I was in it for a little more.


Sarah Berson is a freelance writer based in Brooklyn, NY. After two years as a Peace Corps Volunteer in Ukraine, she earned her master’s degree from New York University’s journalism school. When she’s not writing or thinking about writing, she’s knitting, sewing, or planning her next meal.

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