U.S. draws foreigners in search of human eggs

Several clinics on the West Coast report increasing numbers of women from Asia, Canada and Australia seeking fertility help

Tuesday, December 21, 2004

SAN FRANCISCO -- The building occupies a piece of prime real estate in one of America's most beloved cities, just blocks from North Beach and Fisherman's Wharf. But the address, in the shadow of Coit Tower, is not in any guidebook.

And though the visitors to the salmon-colored structure at 55 Francisco St. carry tourist visas in their passports, sightseeing is only marginally on the agenda. The dozens of women from Japan, Australia or Canada who journey to the Pacific Fertility Center each year come to do what they cannot do at home: obtain human eggs for in vitro fertilization.

Such visitors are part of an expanding international marketplace in pursuit of one of nature's strongest desires: children.

In all but a handful of other countries, egg donation is difficult to come by. That is because only a few nations, including Spain, Romania and Ukraine, allow donors to be paid for the procedure.

In the United States, donors are routinely offered $5,000 or more for eggs; those with distinctive ethnic backgrounds, such as Japanese, East Indian or Jewish, are in high demand. Ads such as "Be an Angel: Donate Your Eggs" appear in college and alternative papers, as well as ethnic weeklies.

As part of their marketing efforts, fertility clinics in California and Oregon offer biographical sketches and photographs of women who have completed applications. Potential recipients choose from among the fertile young women. They come to the United States, synchronize their ovulation cycles with the donors and proceed with the procedure, which can cost upward of $12,000.

"We're providing a service that many people just can't get elsewhere," said Carl Herbert, a reproductive endocrinologist at Pacific Fertility. He sees many foreign patients every year, mostly from Japan, where egg donation is forbidden. "This is as important, real and sacred as any other medical procedure."

In 2000, fertility clinics listed with the federal government cited about 1,000 assisted reproductive procedures performed on foreign women. In 2001, the number rose to 1,700. The figures are not broken down by procedure, but doctors say most women come for donor eggs.

The Portland Center for Reproductive Medicine has had Australian patients and is currently assisting French and British couples. Seattle Reproductive Medicine has a half-dozen or more Canadian patients yearly. Herbert, in San Francisco, began treating a handful of international patients in the mid-1990s. Now, he said, he sees 60 to 80 a year.

The egg donation procedure takes as long as three weeks, and there are risks. Without financial incentives, few women are willing to undergo it for strangers. And undergoing it for pay, ethicists say, edges the practice toward the commercialization of body parts. In the United States, it is illegal to receive money for other human tissue, such as kidneys or bone marrow.

"Please, let's not call these young women 'donors,' " said Patricia Backlar, professor of bioethics at Portland State University, who served on the National Bioethics Advisory Commission. "A donor is someone who gives something without expecting anything in return."

Fertility doctors say egg donation is a safe procedure that helps women who would be otherwise unable to experience pregnancy.

"It is a wonderful thing that allows many people to become parents, and to have the joys of pregnancy, childbirth and nursing," said Robert Matteri, a reproductive endocrinologist at the Portland Center for Reproductive Medicine. "Our donors are precious young women, and we monitor them carefully."

At most U.S. clinics, doctors make the matches between patients and donors. Some recipients review applications. Pictures, if they are included, are childhood snapshots that protect the adult donor's privacy.

But a few years ago, some clinics, including the Portland Center and Pacific Fertility Center, began operating differently. Agencies began posting online profiles of donors that resemble personal ads, showing artful photographs, educational achievements, SAT scores, grade-point averages, IQ scores, weight, eye color and ethnic background.

Some agencies embrace the extraordinary nature of the enterprise. One, in Portland, is called "Exceptional Donors" (www.exceptionaldonors.com). Another, in Stevinson, Calif., is called "Ova the Rainbow." (www.ovatherainbow.com)

Kendis Argo, founder of Ova the Rainbow, apprises donors of three options: closed, anonymous donation; open donation, in which the parties exchange information and may even meet; and what she called "flexible" arrangements, in which the parties may decide at a later date to contact one another.

"My recipient clients call from all over the world," she said.

In the past two years, several dozen recipients at Pacific Fertility have asked to meet with their prospective donors, reproductive endocrinologist Isabelle Ryan said. "It gives them an extra, tangible piece of information to know that this is really a right decision," she said.

Such straightforwardness, Ryan said, leads to better outcomes for recipients, donors and, eventually, the children.

A woman in Switzerland, where egg donation is illegal, chose a California clinic because it allowed her to select the donor. "We wanted to get as much information about the donor as possible, with an option to have her be contacted by any offspring that might result from the cycle," the woman, 54, wrote in an e-mail.

The mother of 3-year-old twins asked not to be named because of the stigma against the procedure in conservative Switzerland. Still, she wrote, "I am sure we would most likely take the same decisions today."

As she watches her twins grow, she often wonders about her donor. She has kept the donor's extensive profile, as well as photographs, and sends the women flowers on the children's birthday.

"I know the twins are what they are because of my husband and myself, with a major puzzle piece coming from our donor," the woman wrote. "I am fine with that, but that whole period (of in vitro fertilization) was very long and painful. . . . You can't just leave it behind even if the outcome is as wonderful as ours."

The West Coast's level of openness raises eyebrows among many doctors, particularly those on the East Coast. "Some of them look at us at conferences and say, 'You do what?' " Ryan said. "They think it's absolutely outrageous."

"Yes, we do," said Robert Stillman, a reproductive endocrinologist at Shady Grove Fertility in Rockville, Md., one of the largest clinics on the East Coast. There, egg donations are anonymous.

Stillman questioned the wisdom of having a couple in the midst of a painful infertility struggle meet with an attractive, young fertile donor. "I say this with fondness, but people on the West Coast are crazy," he said. "What's next?"

Herbert at Pacific Fertility rejected the criticism. "Our patients are adults," he said. "We don't take a paternalistic view toward them."

Indeed, Diane, a Portland woman who became pregnant with a donor egg, said such meetings were gaining momentum in an online group she runs called Mothers Via Egg Donation. The woman asked that her full name not be used. Even in tolerant Portland, she said, she feared that someone might make her 4-year-old son feel different from other children.

"I know that we are not 'buying eggs,' and that the fee is for the donor's risk and inconvenience," Diane said. "But intended parents want to be able to take stock in what they are getting."

Diane, 41, chose her donor five years ago, before online profiles were available. Her fertility clinic sent her the applications in batches of three, and over a two-month span, she and her husband pored over them. The only photographs were baby pictures.

Good health and longevity were the most important criteria, followed by intelligence, Diane said. She disqualified women who had relatives with diabetes and cancer, diseases that also run in Diane's family.

"If you're losing your own genetic link, why not lose the bad stuff, too?" she asked.

Diane, who is 5-foot-3, asked for a tall donor. Brown-haired Diane and her blond husband asked for a blond donor, as well. Sometimes, Diane even solicited the opinion of her mother and mother-in-law. "We'd sit around and discuss them," she said of the applications.

At times, she worried about her decision. "I wondered, 'Am I being vain? Am I creating a designer child?' "

During the time of the donation, Diane was grateful not to have an adult image of the donor. "I didn't want it taking up head space," she said.

But now, she is confident as a mother, and all that has changed. "I'd love to meet her, hug her and thank her for such an extraordinary gift, which of course is my son."

Although there are no longitudinal studies looking at egg donors and their genetic offspring, Ryan said doctors can find guidance in the way society has treated adoption and sperm donation, which have long histories and were often kept secret.

"That turned out to be difficult for children," said Ryan. "Now, birth mothers choose adoptive parents, and studies show that openness is more beneficial for the child. Reproductive technology raises family questions, too -- and we know that secrets in families are hard to keep. We feel that openness is better."

For many foreign patients, openness is precisely the draw -- even if, once back home, they do not disclose the circumstances involved in becoming pregnant.

"It makes people feel more secure," Herbert said. "Why wouldn't it?"

In San Francisco, Asian women, recruited from Japanese American and Chinese American communities in Washington, Oregon and California, are highly sought after. Throughout Asia, organ transplants, giving blood and egg donation are culturally unacceptable.

A Japanese-born sales representative, who asked to remain anonymous, is in the midst of her second donation cycle. At 27, she is married, but does not plan to have children. When she saw an ad for egg donation on a Japanese-language Web site, the idea made immediate sense.

For her first cycle in March, she was paid $5,000; this cycle, she will receive $6,000. Her first recipient is due to give birth any day.

"No one would approach making a family this way if they really didn't desire a child," she said. "Motherhood is important in Japan. I'm honored, and I'm proud to help. It makes me feel like I'm doing something good."

Alice Hsiung, 23, a San Francisco stage director, answered an online ad for an ethnic Chinese donor. She took a psychological test, answered extensive questions about her health history and submitted photographs. She was soon chosen by a Chinese immigrant and her husband. The parties did not meet, but they knew one another's first names.

At a doctor's office last month, Hsiung sat across from an affectionate man and woman. The nurse called the first names of the couple who had chosen her, and Hsiung realized the woman was her recipient. Hsiung is not sure the couple recognized her, but she was glad for her small glimpse. "They loved each other a lot," she said.

The chance encounter allowed her to picture the family, she said, as she injected Lupron, a drug that halts ovarian function, into her belly, and later, a combination of fertility drugs that stimulated her ovaries, normally the size of walnuts, to approach the size of baseballs. "I thought of them, and really, it wasn't so uncomfortable," she said.

Hsiung is unsure about having her own children someday, but she hopes her eggs -- doctors retrieved 18 earlier this month -- will result in a pregnancy. "It's kind of exciting," she said.

With the $4,000 she received, Hsiung is taking a break from her demanding theater schedule.

"Things happen for a reason," she said. "I hope it goes through, and that they're all happy."

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