Sex Cells: An RWJF Scholar Looks at the Market for Eggs and Sperm in this Country
Human Capital Blog: “Sex Cells: The Medical Market for Eggs and Sperm” takes an in-depth look at the business, rather than the science, behind in vitro fertilization. It’s a fresh perspective on a controversial topic. How did you come to choose that as the subject of your studies?
Rene Almeling: As a 19-year-old undergraduate, I read an essay by Katha Pollitt on the Baby M surrogacy trial that took place in 1987. I became fascinated by the complex issues associated with the prospect of women selling reproductive services and wrote a senior thesis based on interviews I conducted with surrogate mothers. More than a decade later, this book is part of an ongoing attempt to sort through the questions raised by bodily commodification.
HCB: How big is this industry, in terms of both people involved and money? How many people does it touch?
Almeling: There are more than 400 fertility clinics in the United States, and they serve thousands of patients every year, making this a multi-billion dollar industry. However, the idea of selling bodily goods makes people very uncomfortable, so the euphemistic language of donation suffuses the market for eggs and sperm. Staffers at egg agencies and sperm banks consistently use this rhetoric, even as they make profits on the sale of sex cells. Egg and sperm donors use it, even as they earn thousands of dollars for their genetic material. And recipients of sex cells use it, even as they purchase eggs and sperm in the hopes of conceiving children.
HCB: Among your key findings is that gender and cultural norms significantly influence the way donor banks pitch to potential egg and sperm donors. Tell us about that.
Almeling: The market for sex cells is structured both by traditional economic forces, such as supply and demand, and also by cultural expectations of women and men that are associated with reproduction and the family. Fertility clinics frame paid egg donation as a gift, while they frame paid sperm donation as a job. These gendered organizational framings have profound implications for egg and sperm donors.
Egg agencies are constantly thanking women for the wonderful difference they are making in the lives of recipients, so egg donors spoke with a great deal of pride about helping people have children. Some egg donors even described the money they received as a “gift” for the gift they had given. Sperm banks treat men more like employees who are expected to clock in on a regular basis, and sperm donors respond by calling the money “income” or “wages.” More importantly, several of the sperm donors said they felt like “assets” or “resources” for the sperm bank, which reveals a sense of self-objectification. I didn’t hear that kind of language from the egg donors, even though they are making much more money than sperm donors.
These kinds of differences demonstrate the power that fertility agencies have in shaping donors’ views. Framing donation as a gift or a job is not just a matter of rhetorical flourish. There are actual effects on how women and men experience the exchange of sex cells for money.
HCB: Are there biological explanations for the difference in how egg agencies and sperm banks frame paid donation?
Almeling: For most people, the first thing that comes to mind when I talk about comparing egg and sperm donation are biological sex differences. Women who provide eggs must self-inject fertility medications for several weeks before undergoing outpatient surgery. Sperm donors do not face any such physical risks, to say the least. But many people do not realize that sperm banks require men to donate on a regular basis, usually once a week, for at least a year. It costs a lot of money to screen donors, so sperm banks have to make sure that the tiny fraction of men who are accepted as donors will produce enough samples to make the investment worth it. All that is to say that there are biological differences between women and men and there are technological differences between egg and sperm donation, but neither biology nor technology explains why producing eggs for money is a “gift” and producing sperm for money is a “job.”
HCB: Please share a few other major findings.
Almeling: One of the most surprising things I found in doing the research was that sperm donors have a straightforward view of themselves as fathers to the children who are born from their donations, while egg donors insist they are not mothers. This is unexpected because egg and sperm donors each provide half the genetic material needed to create an embryo, so they have the same biological connection to offspring. Moreover, it is the opposite of what many people would expect, given the greater physical commitment of egg donation and our beliefs about maternal instinct.
However, it begins to make sense when you take into account the emphasis that egg agencies place on recipients. Egg donors consider the recipient to be the “real mother,” because she is the one who will carry the pregnancy, give birth and raise the child. Women can make this distinction because, thanks to technology, maternity is more easily separated into different parts than paternity. One woman can provide the egg, another can carry the pregnancy and a third (or more) can raise the child. All of these women can lay claim (or not) to the label of “mother.” Fatherhood is more often reduced to a cultural equation in which sperm equals dad. Sperm donors rely on just this definition of fatherhood, particularly because they are not asked to think much about the people who use their donations to become parents.
HCB: Did your study identify a need for more regulation of this industry? If particular, did you find that egg and/or sperm donors – particularly those who are young – need more information and support than they get right now?
Almeling: Based on my interviews with egg and sperm donors, one of the recommendations I would make is that men be encouraged to seriously consider the ramifications of sperm donation. Most egg agencies require that women undergo psychological screening, with one of the primary goals being to ensure that they have thought through the prospect of biological offspring. Sperm banks do not require this kind of screening. They are content to let men focus on short-term financial gain rather than long-term implications, and I think it does sperm donors a disservice. In terms of egg donation, there is a critical lack of data about the long-term effects of taking fertility medications. The egg agencies where I did research did a good job of informing women of risks associated with egg donation, but for women’s consent to be truly informed, those clinical studies need to be done.
HCB: How did your experience as a Robert Wood Johnson Foundation Scholar in Health Policy Research help you with this work?
Almeling: I am very grateful for all of the opportunities I received as an RWJF Health Policy Scholar. Not only did it provide the time and resources to transform my dissertation research into Sex Cells, it allowed me to do so in an incredibly intellectually stimulating environment. Interdisciplinary conversations with economists and political scientists shaped my thinking about medical markets and spurred collaborative research projects that are ongoing to this day.