Jack and the Beanstalk tells the tale of a boy lacking understanding of relative worth playing the game of "bigger or better" and getting it all wrong. In the end, however, Jack's trade of the family cow for a few bean seeds reaps a beanstalk that reaches the clouds, and, after a hostile take-over of the cloud-dwelling ogre's castle, enough gold to "live happily ever after." Today's macabre version of the old tale could be entitled, Jill and the Egg-Stalk.
Once upon a time, young women went off to college armed with the usual warnings about staying safe, studying hard, and avoiding people and activities that might disrupt their education. Today, young women heading off to college need to be forewarned about those who would wish them to "donate" their eggs in exchange for dollars. Prices quoted in some campus newspapers could fund more than a graduate degree! The following tells the story.
When Louise Joy Brown was born in 1978, more than the world's first test-tube baby arrived. Her birth breathed wind into the flagging sails of women who, for a variety of reasons, could not bear children. In 1982, there were 4.5 million infertile women in the U.S. By the latest reckoning, there are about 6.2 million infertile American women, or approximately 10 percent of U.S. women of childbearing age.1 Assisted reproductive technology (ART) has become a thriving business in the years since Louise Joy Brown's birth, and egg donation is an integral part of the industry.
At birth, females have approximately 1 to 2 million ova, or eggs, in their ovaries.2 By the time of menarche (puberty), that number has decreased to 200,000-400,000, but there are still more than enough for the usual one egg to mature and be released per cycle until menopause.3 Simple calculation shows that most women have eggs to spare, but that does not tell the entire story. As a woman ages, so do her eggs. Embryos formed with the eggs of women in older age groups are "less likely to implant and more likely to spontaneously abort if they do implant."4 Therefore, donor eggs are used primarily by women over the age of thirty-nine years who are undergoing assisted reproduction. In 2003, donor eggs were used in 14,323 ART cycles. What is the source of these eggs?
Early in the history of ART, eggs were donated by family members, close friends, or previous college room mates. As the demand increased and technology advanced, however, the methodology of procuring egg donors changed. Now advertisements by egg brokers seeking donors appear in college newspapers and on Web sites, usually with specific characteristics in mind. Women younger than twenty-nine years are targeted. Those with high IQ or SAT scores, collegiate-level athletic ability, or particular musical talent, are especially desired. These brokers match donors (or should we say "manufacturers") with infertility clinics or with infertile clients. Payments begin around $2,500 per cycle. At the upper-end, they can total $35,000-$50,000, with the occasional ad offering more; this, for one cycle, with no guarantee of a resulting pregnancy.
If a donor has a "proven" track record (donation resulting in pregnancy), the fee paid is usually increased for subsequent "donations." Although other countries, including Britain and Canada, do not allow such practices, the United States allows "market prices" to be paid for egg "donation." Because of the lack of regulation of such practices in the U.S., women's eggs have become a hot "commodity" and our country has become the primary "egg mine" for the rest of the developed world. Is it surprising that some women (and sympathetic, astute men) have risen in protest to say, "Hands off our ovaries!"?
How does one evaluate the competing interests in this matter? The desire for children is innate and as old as humankind. Sarai and Abram were promised a child, and waited. Impatience prevailed, and they entered a surrogacy arrangement with Hagar, resulting in much suffering and strife that continues to this day (Genesis 16). Rachel cried out to Jacob, "Give me sons, or I will die!" (Genesis 30:1). The pain of infertility is acute and pervasive. As Dr Alison Murdoch, IVF expert and chair of the British Fertility Association in 2002, said, "If a twenty-year-old woman is told that she will never be able to have a baby, a typical reaction would be, 'Well, so what?'... But for a woman in her late thirties, when the reality kicks in, well, it's not, 'So what?' She can be suicidal."5
For young women who have plenty of eggs, the temptation to give some to those who are struggling with infertility, and/or a desire/need for money, can be quite compelling. They are giving up something they probably will never need to someone who is hurting, and they can pay for needed or wanted items (including, but not limited to, a graduate degree), or pad their bank account for the future. Is this a perfect match, or is it simple commodification of a woman's reproductive capacities?
Increasingly the language of biotechnology is suffused with commercial language. As biolaw professor Lori Andrews and sociologist Dorothy Nelkin have observed: "Body parts are extracted like a mineral, harvested like a crop, or mined like a resource. Tissue is procured — a term more commonly used for land, goods, and prostitutes. Cells, embryos, and tissue are frozen, banked, placed in libraries, or repositories, marketed, patented, bought, or sold. Umbilical cords, whose stem cells are useful for therapeutic purposes, are described as 'hot clinical property.'"6 We are right to be worried that the biotechnology and assisted reproduction industries are reshaping the way we understand human procreation.
There are a number of serious concerns about egg donation. In any medical procedure, informed consent is always an issue. Does the patient indeed understand what is involved in the process? Egg donation is not as simple as sperm donation. Are the known risks of the procedure fully understood? After all, how one looks at a situation can change over time.
Procuring eggs from a "donor" is not a simple process. First of all, after the donor is screened to determine if she meets the criteria established by the egg broker and matched with an infertile couple, there is the matter of stimulating the ovaries to produce eggs. This entails daily injections of powerful hormones (usually for at least two weeks), serial blood tests, and ultrasounds to determine if eggs are ready to be harvested. Typically, the hormone injections are tailored to the response. When the eggs are ready to be "harvested," or surgically removed, the "donor" undergoes an outpatient surgical procedure, known as needle aspiration, whereby (usually) ten to twenty eggs are removed. If all goes well, the bloating and discomfort will only last a few days. Needle aspiration may cause bleeding. As in any procedure utilizing a needle, it is possible to puncture surrounding tissues; in this case, the bowel, bladder, and major blood vessels are located nearby. Serious damage to the pelvic organs, although rare, could require major abdominal surgery to repair.
Another possible complication of egg donation is the development of ovarian hyperstimulation syndrome (OHSS), which occurs when too many eggs develop following the hormonal stimulation of the ovaries. This is at least uncomfortable, but may be more harmful, and in rare cases, death can result. In mild OHSS, there may be abdominal pain, pressure, and swelling. In moderate OHSS, careful monitoring, bed rest, and pain medications may be necessary. Severe OHSS is rare, but can cause serious medical complications, which may include blood clots, fluid build-up in the lungs, kidney failure, and shock. The donor's own future fertility may be at risk due to these factors. Add to this mix the emotional baggage of relinquishing parental rights, and the fallout can be substantial.7
With the advent of embryonic stem cell research and human cloning, women are increasingly being valued for their egg-producing properties. If some scientists and politicians have their way, embryonic stem cell research and human cloning will become routine. An important question for lawmakers is, "where will sufficient numbers of human eggs come from for research?" The numbers are gargantuan. Let's do the math. There are about 17 million diabetes patients in the United States alone. Based upon current data, because of the high failure rates, ten to one hundred eggs would be needed per patient to clone enough human embryos to extract sufficient numbers of embryonic stem cells. Therefore, somewhere between 170 million to 1.7 billion eggs would be needed. Since ten eggs are typically retrieved from one donor, somewhere between 29 million and 170 million donors would be required just to treat diabetes.8 And every one of these egg donors would face the health risks outlined above.
In addition, the use of egg donors for therapies would probably lead to subtle forms of coercion. Women in subordinate laboratory positions may feel compelled to give up their eggs for research and treatment. Public sentiment toward altruistic egg donation may likewise be coercive toward women of reproductive age. Already egg brokers are expanding their bases beyond their own borders. In March 2005, The Scotsman, the national newspaper in Scotland, revealed that a clinic in Britain was paying Romanian women for their eggs and exporting them back to England, where British couples were using them for ART. The Romanian women were being paid between £200 and £300 (about $350-$550 US), significantly below the going market rate in other countries. Women who are well off financially will not sell their eggs for those prices, thus, poor women will likely be exploited for their eggs.
Because of the health risks, commodification, the potential for exploitation, and the coercive nature of a growing egg donation industry, pro-life and pro-choice women have joined together in common cause to encourage lawmakers to pass a moratorium on egg extraction for research purposes until adequate data can be gathered to ensure that women are able to give truly informed consent to the procedure. Under the slogan, "Hands Off Our Ovaries!" women and men from a number of nations and with a wide spectrum of social and ethical views have added their names to a growing list of people who want women to be warned of the risks of egg donation. Supporters of the initiative say, "losing even one woman's life is too high a price to pay."9
While a number of states supervise some aspects of egg donation, other states, like Louisiana and Missouri are considering a ban, and at least one state (Arizona) has considered attaching criminal penalties to commercial egg donation. Nevertheless, the fertility industry is largely unregulated. Concerned Christians should contact their state legislators to discover what policies are in place to insure that women who are thinking about donating are adequately informed and their health is protected.
However, concern for the health of donors is not the only factor that should concern Christians. God made every human being in His own image (Genesis 1:26-28). Therefore, women — especially poor women — should not be exploited for their "reproductive capacities." Neither should women be treated as egg farms. The rank commercialization of a woman's eggs objectifies women in the same way prostitution and pornography objectify them.
Though no global consensus has yet been reached on egg donation, some countries have regulations in place that may apply. In the United Kingdom, women can donate their eggs for research only if they are already producing the eggs for reproduction. The Council of Europe's Convention for the Protection of Human Rights and Dignity of the Human Being explicitly prohibits the "creation of human embryos for research purposes." Other countries may be forced to face the issue through litigation. Recently, two South Korean women who worked in the cloning lab of the now-disgraced scientist Hwang Woo-suk have filed a lawsuit against the state and against two medical centers. Both of them donated eggs for research and claim that they were not properly informed about the potential risks of the egg retrieval process.10
Sadly, some women learn too late that egg donation is no fairy tale. In fact, it can be a nightmare.
1 Spar, p. 16, quoting Elizabeth Stephen and Anjani Chandra, "Updated Projections of Infertility in the United States," Fertility and Sterility 70 (July 1998), pp. 30-34.
2 Morton A. Stenchever, William Droegemueller, Arthur L. Herbst, and Daniel R. Mishell, Comprehensive Gynecology, 4th ed., (St. Louis: Mosby, 2001), p. 50.
3 F. Gary Cunningham, Kenneth J. Leveno, Steven L. Bloom, John C. Hauth, Larry Gilstrap III, and Katherine D. Wenstrom, Williams Obstetrics, 22nd ed., McGraw-Hill, New York, McGraw-Hill, 2005), p. 30.
4 "2003 Assisted Reproductive Technology (ART) Report: Section 4-ART Cycles Using Donor Eggs," available at http://mentalhealth.about.com/gi/dynamic/offsite.htm?site=http://www.cdc.gov/nccdphp/drh/art.htm; Internet; accessed 5 April 2006.
5 http://living.scotsman.com/index.cfm?id=1174042002; Updated 4 Oct 2002; accessed 18 Apr 2006.
6 Lori Andrews and Dorothy Nelkin, Body Bazaar: The Market for Human Tissue in the Biotechnology Age (New York: Crown, 2001), p. 27.
7 These complications are outlined in Thinking of Becoming an Egg Donor? published by the New York State Task Force on Life and the Law, http://www.health.state.ny.us/nysdoh/infertility/eggdonor.htm
8 Thanks to scientist Dr. David Prentice of Family Research Council, Washington, D.C., for this insight.
10 Kim Tong-hyung, "Misled Egg Donors Sue for Compensation," The Korea Times, April 21, 2006. http://times.hankooki.com/lpage/nation/200604/kt2006042117371111990.htm
August 6 is Social Issues Sunday on the Southern Baptist calendar. For information and resources on how your church can engage the culture effectively and biblically, go to the Web site for the Ethics and Religious Liberty Commission — www.erlc.com
Killing Clones At Harvard
Harvard University's recently disclosed plans to clone human embryos in order to perform destructive stem cell research is doubly insulting, says a Southern Baptist bioethicist.
Harvard scientists announced in early June their effort to find treatments for numerous devastating diseases, saying two years of consideration by eight committees had determined the research could be justified ethically, according to The Boston Globe.
Not so, says C. Ben Mitchell, a consultant for the Southern Baptist Ethics & Religious Liberty Commission and an associate professor at Trinity Evangelical Divinity School in suburban Chicago, Illinois.
"First, cloned human embryos will be killed for their stem cells," Mitchell told Baptist Press. "Second, women will be subjected to unnecessary health risks through harvesting their eggs. Harvard will require tens of thousands of eggs per year to get sufficient numbers of cloned embryos for their experiments.
"The Puritan founders of Harvard would roll over in their graves if they were aware of the human carnage their legatees are causing," Mitchell said.
Extracting eggs from women can have harmful side-effects on the donors. One of the potential problems is ovarian hyperstimulation syndrome, which is serious in about 1 percent of women receiving fertility treatments and can be life threatening, The Globe reported.
D. Joy Riley, M.D., M.A., is the Executive Director of the Tennessee Center for Bioethics and Culture. C. Ben Mitchell, Ph.D., is consultant on biomedical and life issues for the Ethics & Religious Liberty Commission of the Southern Baptist Convention and associate professor of bioethics and contemporary culture at Trinity Evangelical Divinity School in Deerfield, Illinois, a suburb north of Chicago.