The Baby Business

A new U-M egg donor program tries to balance commerce and compassion
Originally published in the Detroit Free Press

Wanted: Healthy, athletic women. Under age of 29. 1300+ SAT score. Compensation: $10,000.

This ad, featured in the University of Michigan newspaper, was placed by an agency looking for women willing to donate their eggs to an infertile woman. So-called donor agents are placing ads like it at colleges across the country and on the Internet. They’re courting smart, responsible, beautiful young women.

Now, some of those women can donate through a new egg donor program at a U-M clinic. The program’s first egg transfer — from donor to infertile recipient — is scheduled for the end of September.

But medical procedures are not the most difficult part of egg donation, said Dr. L. April Gago, who oversees the new University of Michigan Center of Reproductive Medicine Oocyte Donor Program (www.med.umich.edu/obgyn/clinical/repro.htm or 734-763 4323).

A swirl of legal, business and ethical considerations must also be navigated.

With the Sept. 23 premiere of the NBC drama “Inconceivable,” which chronicles the happenings at a fertility clinic, the public is sure to grow more interested in the medical technology that has evolved over two decades.

The procedure works like this: Doctors give estrogen to a young fertile woman, which causes her to produce multiple mature eggs. The eggs are surgically removed and fertilized — most often with the sperm of the male of an infertile couple — in a laboratory. They then are implanted into the uterus of the recipient.

Egg donation is generally safe for both parties, said Dr. Eric Surrey, a Denver, Colo., endocrinologist who is president of the Society for Assisted Reproductive Technology. About one in 100 donors suffers from ovarian hyperstimulation syndrome, which causes bloating of the abdomen. In rare cases the syndrome temporarily shuts down the kidneys. There have been reports of a heightened risk of ovarian cancer among donors, but no long-term studies evaluating the cancer risks have been done, he added.

GAGO SAYS U-M started its program to address the growing number of infertile couples. The most recent numbers, from 1995, from the Centers for Disease Control and Prevention, estimate that more than 6 million people in the United States have fertility issues. That’s about 10% of the women in the childbearing-age population.

U-M refers infertile couples to Alternative Reproductive Resources, a regional agency with an office in Beverly Hills. (248-723-9979 or www.arr1.com). The agency matches them with a donor with similar physical characteristics. They also try to match donors and couples based on their interests like religion, but don’t always succeed. Gago says ARR was chosen because it provides comprehensive counseling and legal screening for potential donors.

But one agency will not be enough, Gago says. The program needs more donors, particularly minorities. To find them, Gago says, she plans on entering relationships with more agencies that have wider pools of women from around the nation.

Six years ago, San Diego, Calif., residents Tom and Darlene Pinkerton’s A Perfect Match — which placed the ad in the Michigan Daily — was criticized for having requirements for donors that were too specific and for paying them too much. The couple was offering leggy, thin blonds with high SAT scores $50,000 for donating eggs to A Perfect Match’s clients.

“They compared our finding women to creating a master race, like Nazis,” Tom Pinkerton said. “We’re not Nazis. We’re not killing people. We’re creating families.”

With the advent of the Internet, the 110 donor agencies in the United States have a broad reach. For instance, on Web sites such as www.craigslist.com, agents in Oregon have looked in Detroit for South Asian Indian donors.

“We were one of few agencies then,” Tom Pinkerton recalled. “We wouldn’t even dream about charging that much now.”

EGG DONORS who work through A Perfect Match are paid an average of $10,000, said Darlene Pinkerton. The infertile couple sets the prices. The company then advertises for women who have the characteristics the couple is searching for, mainly on college campuses.

Some couples pay hefty fees to the prettiest, brightest women. They also pay a fee, usually around $5,000, to the company that matches them to a donor.

Tack that on to the thousands spent on doctor appointments, medications and travel for an operation that is not covered by insurance in Michigan, and the cost can top $25,000 at U-M.

“It’s just become a real amazing dilemma because people want to get pregnant and they’ll pay almost anything for who seems to be giving the better chance,” said Shelley Smith of the Los Angeles-based Egg Donation Inc. “That makes them vulnerable.”

At Smith’s company, donors are rejected if they fail a psychological evaluation, weigh too much or have low grades.

“It’s unfortunate, but no one wants a fat, ugly, stupid donor,” Smith added.

THE DONATION PROCESS isn’t easy. Potential donors at Alternative Reproductive Resources must fill out an 18-page application detailing their medical history, as well as a 500-question psychological test. They undergo hours of psychological counseling to prepare them for parting with their DNA.

Donors must inject themselves with hormones that raise their estrogen levels, so they produce more eggs. They also take shots of a drug called Lupron to get their menstrual cycle in sync with the recipient. That’s necessary for the eggs to be successfully transferred from the donor’s ovary to the recipient’s uterus.

In the two weeks before the egg retrieval, donors must go to the doctor for ultrasound tests almost daily.

Federal law prohibits selling body parts, so donors can be compensated only for their time and energy. But no one can agree on standard compensation levels.

A 2000 report from the American Society for Reproductive Medicine states donors should receive about $5,000. More than $10,000 is to be questioned, the report states. The report is available online at http://www.asrm.org/Media/Ethics/financial_incentives.pdf.

Teo Martinez, vice president of operations at the Los Angeles-based Fertility Futures, said he tried to keep fees at the ASRM level, but recently had to raise the fee to $8,000.

“Offering more money to donors was a direct result of the increase in competition,” Martinez said. “We need to make sure we are marketable.”

One egg donor from Ferndale made a total of $15,000 donating eggs going to a fertility clinic at Oakwood Hospital. She has given 200 eggs in five retrievals since 2001. At her first retrieval, she gave 88 eggs and between 20 and 30 her other four times. Like most donors, she could not give her name because she pledged to remain anonymous.

“It’s a nice little sum of money,” she said. “I put most of the money in the bank or used it to pay the bills — tuition, loans.”

The woman went through a smaller agency, which typically compensates donors at a lower rate.

“Giving $8,000 would change the type of donor I’d get,” says Mitzi Heineman, who runs the Saginaw-based Egg Donor Program of Michigan. “I’d get someone who wants to make a career out of it — and I’m not interested in those people who aren’t doing it for altruistic reasons.”

“(Charging more money) cheapens the process,” says Debra Chaney, a donor agent for Alternative Reproductive Resources. “Other people need options. If you want a brainy girl from Stanford, we’re not the ones for you.”

Regardless of how many times a woman donates at the U-M program, she will not receive more than $4,000, Gago said.

The fees “can seem outrageous or ridiculous,” Gago said. “But that changes when you understand the stories and how the years have slipped away from people.”

ROCHESTER HILLS COUPLE TURNS TO TECHNOLOGY IN HOPES OF HAVING A CHILD

FREE PRESS STAFF WRITER

Sunday, 9/11/2005

Jittery, Susan Keehn waits at the fax machine for the pages that describe a woman whose eggs could produce her first child.

Page 1 is about the young woman’s physical features: The shape of her eyes. Whether she has a cleft in her chin. If she has dimples.

Page 2 is more personal: Whether or not she’s religious. Her race. If she speaks any foreign languages.

Page 3: If she’s clumsy. Her favorite book. On Page 4, her philosophy of life. A thorough medical and reproductive history on pages 6-15.

And on Page 16, the answer to the most important question: “Why did you decide to become an egg donor?”

Susan and Rick Keehn don’t know her name, as they haven’t known the names of the other 11 women who faxed profiles during their long quest for parenthood. The names, to protect their identities, have been replaced with four-digit-numbers.

But they’ve seen photos of the women’s faces — and they’re not necessarily the perfect faces featured in ads for egg donors in college newspapers and alternative weeklies. Those ads, placed by agencies that link would-be parents with would-be egg donors, offer thousands of dollars to women who are so healthy, so pretty, so smart that any infertile couple would covet their DNA.

The Rochester Hills couple has seen those ads, which seek women who will donate eggs to be fertilized in vitro by sperm from men like Rick. The eggs are then replanted in the uterus of a woman like Susan. The donor must relinquish all rights to the child.

Rick and Susan, both 44, have tried so hard and believe in the those ads. They know they want someone — someone exceptional — to provide half the genes for their child.

SUSAN WORKED as a maternity nurse at Crittenton Hospital, preparing women for what nature wouldn’t give her, but quit to focus on getting pregnant. She’d teach mothers-to-be how to hold their babies, how to wash them and burp them.

She’d send them home, with their little bundles of joys and challenges.

Then she’d come home to Rick, to whom she’s been married for 19 years. Rick’s a mechanical engineer, applying to law school. Sometimes, he plays the bass with a Christian jazz band called Cross Words.

He looks at her through his black glasses and sees the same woman he fell in love with. “She still cares a lot about people,” he says, smiling, “and she still loves to talk. She’s still so … so bubbly and outgoing.”

Together, they lead the Michigan chapter of Resolve (www.resolveofmichigan.homestead.com), a support group for infertile people. Supporting other infertile couples is therapeutic, they say. And, it pleases them to demonstrate that a couple can stay in love even without children.

Their home is crowded with souvenirs from travels around the globe. But on the coffee table sits a frame with room for four photos.

In one, a younger Susan stares away from the camera in a high school graduation photo. In another, Rick smiles broadly. A third captures Rick kissing Susan on their wedding day.

The fourth space is empty, the symbol of an incomplete family.

Yes, they could have adopted. One day they might have to. But Susan wants to go through labor, with Rick at her side. She wants to bear his child, even if it’s with another woman’s egg.

THE KEEHNS TRIED to conceive the old-fashioned way at the beginning.

But there were problems. Alternative means seemed too expensive. So they just kept trying.

Every month, they failed.

In 2003, after Susan passed 40, the biological clock ticked too loudly to ignore. Finally, they tried in vitro fertilization.

It didn’t work. Susan had too few eggs.

Last year, they looked for the first time for an egg donor and, through an agency, found one who seemed perfect. She had donated before, attended nursing school and resembled Susan.

All went well until the day the donor’s eggs were to be removed. Her estrogen dropped unexpectedly and she couldn’t produce eggs mature enough for the retrieval process.

The news crushed Rick and Susan. Worse, it came on Father’s Day.

They had spent almost $20,000, and nothing.

They turned to the Internet.

But they had to understand the lingo.

First: Eggs are donated, not bought. Federal law prohibits selling body parts.

Second: Donors are selected, not picked. They’re human beings, not cherries.

Third: You don’t pay donors. You compensate them for their time and energy.

Susan learned more from ethical guidelines prepared in 2002 by the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology.

Among the lessons: Bodacious bodies shouldn’t be paid more than average-looking people. The acceptable compensation, guidelines say, is no more than $5,000.

Knowing all this, Susan questioned the motives of the donors who pouted seductively in front of a camera, claiming their devotion to others but charging $8,000.

“Sometimes,” Susan says, those ads “kind of remind you of a dating service. I started feeling very uncomfortable with them.”

Comfort eventually would be found in statistics. Susan and Rick sifted through the numbers from a 500-page online document from the Centers for Disease Control and Prevention.

About 13,200 eggs were donated to infertile couples in 2002, the most recent year for which numbers are available. State by state, the document listed fertility centers that specialized in egg donations.

They started comparing costs.

THEY SETTLED ON the Portland Center for Reproductive Medicine, which, according to the CDC, had a success rate of about 70% in 2002. The clinic recommended using a local donor agency affiliated with the center: Exceptional Donors. Requirements to become an Exceptional Donor include good health, maturity and a 3.0 college grade point average. “And if you look at the pictures, I mean, they’re really exceptional,” Rick says.

Marna Gatlin connects and counsels donors and recipients for Exceptional Donors. She describes her agency as “a village.”

The Keehns began looking on the Web into the faces of her donors. Whomever they chose would get $5,000 of the $16,000 this effort would cost them.

And, they asked for profiles, to see how the most exceptional, 4-digit-numbered, anonymous women defined themselves.

AFTER SUSAN READ the profiles at the fax machine, she’d bring them to Rick. Together, they’d read them and discuss them at the dinner table, asking questions like: Has she proven herself by donating before? Is she educated? Does she look like me? Would we want to hang out with her?

They filtered some out. If they were unsure, Susan would call the agency to ask more questions: “So is she nice? “What about polite? Is she polite?”

After a month, Susan and Rick narrowed the gene pool down to two profiles. One of the two seemed like the nice, polite woman they were looking for.

The other candidate, however, could pass for Susan’s cousin. Still, the Keehns couldn’t decide.

Susan meditated about the choices in her living room, asking for guidance below the print of Raphael’s angels.

“I felt like I was playing God,” Susan recalls.

Eyes closed, she sat in front of the frame with the missing photo. She hoped for a sign.

And she got it when she called the Portland fertility clinic for advice.

The nice, polite woman, she learned, had just completed a donor cycle for another couple. She couldn’t donate again for a month.

The second donor had a lot in common with Susan, a doctor told her. Community service was important to both of them. There was a resemblance in looks and personality.

Then came the magic words: “And, she’s outgoing.”

Outgoing, exactly the way Rick would describe his wife, and perhaps, his future child.

THE DONOR the Keehns selected agreed to provide them with eggs.

In Michigan, Rick injected Susan with hormones. She swallowed vitamins and Lupron, to time her menstrual cycle to that of the donor. Two weeks remained before they were due in Portland.

A day after 18 eggs were removed from the young donor, Rick and Susan arrived in Portland at Exceptional Donors.

Gatlin ran down the stairs to meet them.

Months ago, Susan and Rick entrusted Gatlin, a woman they’d never met, with the biggest wish of their marriage. Now, Susan gives her a big hug. Rick pats her back and shakes her hand.

Susan’s voice had always held hope. Now, in her eyes, Gatlin sees joy.

“You know, there are some couples who come, and of course you want them to succeed, but something just, just isn’t there,” she says. “But you really, really want things to work out for the Keehns. They’re loving and educated, and they’ll make great parents.”

The joy would continue that week; Rick’s sperm fertilized 14 of the donor’s eggs.

The embryologist gave the Keehns a picture of two of them. They look liked fuzzy balls.

By the time Susan is ready for the egg transfer, 10 embryos are suitable to be replanted in her uterus. She is sedated on Valium, then an endocrinologist raises her legs and, standing between them, begins to search for just the right location for eggs to implant on the uterine wall.

Three hours pass before he finds a spot he’s confident will work. He implants two fertilized eggs into Susan’s uterus.

If those two don’t attach to the uterine wall, Susan has eight more frozen embryos to try.

After the egg transfer, Rick gives Susan some water. He makes sure she rests and takes her medicine, like a maternity nurse.

“I just can’t believe we’ve got this far,” Susan repeats, starting to cry. “We’ve never been so close to having a child. We’re almost there. This is the best part of our trip. Rick, what do you think is the best part?”

He pauses. He picks up that fuzzy photo of the embryo. He smiles and says: “This is the best part.”

Editor’s note: In late August, Rick and Susan Keehn learned that both embryos had successfully implanted. Susan is officially pregnant, due in the spring, with a 70% chance of having twins.

MATERNAL SACRIFICE

EGG DONOR SHARES HER LOVE OF CHILDREN, BUT NOT WITHOUT PAIN TO HERSELF

Monday, 9/12/2005

Becky Crawford held the angel in her hand. For the first time in months, she was going to meet the woman who gave it to her.

Becky’s angel pendant is just a bauble. But it holds a secret that only she and her husband know.

Someone believes she was heaven-sent.

Becky is 33 and lives in North Middlesex, Ontario, north of London. Five times she had donated her eggs to infertile couples she never met. She suffered over that, wondering: “What happened to the eggs I donated? What if I run into someone with my DNA? Will they look like me?”

And, worse: “Will they look like my own kids?”

Becky tried to keep it in perspective. “It’s just tissue,” she’d tell herself. “It wasn’t a person.”

But then, the sixth time, she couldn’t donate anonymously anymore. In 2003, she found a Michigan woman on the Internet who wanted to be open and available, not anonymous.

It’s not a typical arrangement. The vast majority of eggs are donated anonymously, according to the Society for Assisted Reproductive Technology.

Donors almost never hear if their recipients conceive. Baby pictures never come, nor does an address to send birthday cards.

But anonymity made Becky uneasy.

So she searched on the Web and found prospective parents who wanted a relationship with the woman who would give of herself and her body. They e-mailed, talked on the phone. Becky even attended the woman’s baby shower.

“This is our angel,” the woman said as she introduced Becky to her closest friends.

But the uneasy feeling returned in January 2004. Becky was about to meet the mother and her 4-month-old child. She would stare into the eyes of a baby born of her DNA, but not her body.

What if the child reached for her? What if she wanted him back? “Please, don’t let me,” Becky thought.

Anxious, she held the angel in her hand.

It’s no mystery why a couple would ask Becky to donate her eggs.

She’s striking, with turquoise eyes. She has a bit of an overbite, but you notice only when she smiles and dimples indent her cheeks.

She runs three days a week, 30 minutes each time, through rural Ontario. Her husband, John, owns a gym. She sometimes runs on the treadmills there.

She loves to take her children, ages 10 and 11, to hockey and lacrosse practice. They are blond like her.

“The kids are my life,” says Becky, a title certification agent. “From April to August, it’s hockey.”

On summer weekends they go to Sarnia and hang out on a small boat. They call it Pilikia. That’s “trouble” in Hawaiian.

Sifting through a magazine in 2001, Becky says, she read about the criticism that California agency A Perfect Match received for advertising for a leggy, blond egg donor with a high SAT score. The donor would be compensated $50,000, the ad read.

Crazy as it seemed, Becky understood. Raising children was so important to her. She wouldn’t even want to think how bland life would be without them.

She thought that maybe she could donate close to home.

“My husband didn’t want to have more kids and I had my tubes tied,” Becky says. “So, I thought, I might as well. …”

John supported her.

“It’s her body,” he says. “She can do what she wants.”

The first time, Becky chose a clinic in Toronto, a two-hour drive. The staff gave her a barrage of psychological tests and counseling.

They asked about her favorite book. The music she likes.

And, they asked the essential question: Why did she want to be an egg donor? She told them she wanted other people to experience the joy of parenting, as she had.

That was enough: A beautiful, healthy woman who had an unselfish reason for wanting to donate her eggs. In less than a month, a donor selected Becky and she was on her first cycle. She’d be compensated $3,000.

Becky’s first hot flash came at age 29, courtesy of Lupron, a drug that suppresses ovulation. She injected herself until her menstrual cycle was timed with the menstrual cycle of the anonymous woman who would receive her eggs.

As many as four times a week, she’d drive to Toronto to have her estrogen levels checked to determine the optimum time for the eggs to be retrieved. She’d be late to her job She’d start crying. She always hated needles.

“Why are you doing this?” she recalls a nurse asking.

Her answer: “I want to help someone.”

At home, she kept the syringes for the Lupron injections in “a duffle bag in a duffle bag in a duffle bag, under her bed.”

“I wanted to keep it from the kids,” Becky says. “First, so they wouldn’t find the needles and get hurt. And, I didn’t want them to ask questions.”

The day of the retrieval, John stood at her side as the gurney was wheeled into an operating room. Doctors searched her ovaries for eggs with a tube. It felt, she says, like someone was jabbing her with a butter knife.

She remembers her husband saying, “Look at that needle! It’s huge!”

She says, “I couldn’t look. They’d jab and I’d sing my little song. Over and over, I’d sing ‘You are my sunshine.’ … That was the song I used to sing to my kids.”

Afterward, she began crying in the parking lot and cried all the way home. On and off for two weeks, she’d weep.

After a few days, a nurse called to say that the couple who had received her eggs left a card. Becky picked it up. It was adorned with flowers on the front, graced with dainty cursive inside.

“You opened the key to our family,” it read. “Thank you.”

The message touched Becky. In a small way, it eased her anxiety.

The clinic asked if she wanted to donate again. She remembered the needles, the crying. Then her mind turned to the women at the fertility clinic who brimmed with hope that they could have the children Becky had at home.

She said yes.

Each time Becky received $3,000 in what’s called compensation — not pay — for her time and trouble. The money has paid for hockey uniforms and household projects.

It influenced her decision to continue, she says. But service to others was a bigger motivator.

With each additional cycle, she says, she became more comfortable. And she found a chat room (www.surrogacy.com) where egg donors share tales.

In the fall of 2003, at another computer screen, on the other side of the border, an infertile Michigan woman logged onto surrogacy.com.

That woman didn’t want to go through an agent; she wanted to find the perfect donor herself. She posted a message: Michigan woman looking for a donor, blond-haired, blue-eyed.

Becky e-mailed her. She shared her story: how she started, why she kept on doing it, how much she hated needles.

They met at a restaurant in Canada and made an agreement. Becky’s medical work would be done in the United States, but she’d let the woman know her progress by phone. And if a child were conceived, the recipient would share news of its life.

But, for the first time, Becky’s estrogen levels dropped, making her unable to complete the egg donation.

“It was absolutely bizarre,” Becky says. “But I called her and said, ‘I’ll try, I’ll go through everything again. I really want to do this for you.’ ”

The next try was a success. The day doctors retrieved 25 of Becky’s eggs, the Michigan woman left her a note.

“Somehow I believe it was fate that brought us together and you have a very special place in our hearts that cannot be put into words,” it read. “In the box is just a little something to let you know you are our ‘angel’ and are in our hearts forever.”

In the box was the angel necklace.

Becky wore it every day, rubbing it for good luck. As she eased through the door of the restaurant on that day 13 months later, she spotted the woman to whom she gave her eggs.

She lifts up the baby boy.

His eyes are blue. As he smiles Becky sees his dimples.

She stared, then sighed with relief. “Thank goodness!” she said. “He doesn’t look like any of my kids.”

The two women laughed. They ordered food and the baby cooed throughout the meal, sitting in his mother’s lap and playing with her hair.

Becky felt no inclination to hold him. It was no different from having dinner with any friend and that friend’s newborn child.

The Michigan woman calls less often now. Once, she wanted to know if Becky had any allergies, worried about how her son might react to nuts.

That woman, who requested anonymity, says people say her son resembles her.

“I just laugh and say, ‘Really?’ she said. “I can see Becky in him, when he smiles, when he laughs.”

Sometimes, the woman e-mails baby pictures to Becky. Becky has her address, just in case she wants to send a birthday card. The child is the last baby born from Becky’s eggs. She says she’s too old now, and doctors recommend women donate a maximum of six times.

Dr. Eric Surrey, president of the Society for Assisted Reproductive Technology, says that limit is a bit contrived. It’s aimed at reducing the probability that a donor might one day run into a child born of her DNA, mothered by someone else.

Becky’s life continues, loving her children and worrying less. When a link in the chain popped in her angel necklace, Becky never fixed it.

A part of her feels like she doesn’t need to.