Donation Dilemmas
Selling of eggs gives birth to controversy

By James Herbert
STAFF WRITER

SUNDAY, SEPTEMBER 3, 2000 Donation dilemmas Selling of eggs gives birth to controversy By James Hebert STAFF WRITER September 3, 2000 "If (a couple) doesn' t have an egg of their own, they' re faced with a choice. Do they just pick a donor out of a hat? Can they not choose hair color? If they can choose something, then what shouldn' t they be able to choose?" "Why is there an end to what they can choose?" In early June, as the semester was winding down at UCSD, the classified section of the campus newspaper was full of the usual ads for moving sales and vacant apartments. Tucked in among the blurbs for bunk beds and computer desks, just under the label "Wanted," was a modest-looking notice with the catch line: "EGG DONOR, $25,000." It went on: "Loving, educated couple seeks egg donor, age 18-32, Caucasian, 5' 3" to 5' 9", fit, healthy lifestyle, cheerful disposition, high SATs (1300+)." Take away the first few phrases, and this could have been just another personals ad. Yet the ad' s matter-of-fact phrasing belies what it symbolizes: An ongoing revolution in the way humans bring new life into the world, and in how we think about the consequences of that act. And at the intersection of the ethical, legal and emotional issues that swirl around egg donation stand the people who placed the UCSD ad: a San Diego County couple named Thomas and Darlene Pinkerton.

Thomas, a lawyer, and Darlene, a former real-estate agent, operate an Internet-based egg "brokerage" out of their home near Alpine. The agency, run by Darlene, is one of many that have sprung up nationwide in the past few years. All of these agencies perform essentially the same service: They act as matchmakers between egg donors and prospective parents. The Pinkertons, though, have gained a certain visibility for offering donors something the other brokers generally don' t: large amounts of cash. Last year, the couple began placing ads in Ivy League college newspapers offering $50,000 for egg donors who met certain stringent height and SAT-score requirements. Later ads were placed in other college papers including UCSD' s. The money caught people' s attention, since donors in other programs are generally paid $3,000 to $5,000. Suddenly, the spotlight was on the Pinkertons. Thomas was quoted in The New Yorker and grilled on CNN. "We weren' t looking for publicity," he says. "We were just looking (on behalf of) a client, who I guess was one of the first not to be able to find what they were looking for. They were a very tall family who were highly educated. They were looking for a very tall person who was highly educated." Not surprisingly, the high fees caused alarm among people in the infertility field. "It represents commodification of infertility services, really, which is something we don' t like to see," says Margaret Hollister, executive director of the national infertility support group RESOLVE. "We support family building with dignity for all involved, and we certain ly support egg donation. I think there are some very successful programs that operate with more modest fees." The Pinkertons have heard the criticism. When Thomas appeared on CNN' s "Crossfire," he laments, "they were accusing me of baby-selling. No matter how many times you say it, we' re not selling a baby." As Darlene explains, "It' s not a son or daughter. It' s genetic material that gives the possibility of a life. But it' s not a life."

Personal Experience
What adds some emotional resonance to the service the Pinkertons offer is that they once were in the same position as their clients. In 1990, their daughter, Kati, was born. Dad was at bedside. So was Mom. Kati was conceived in vitro from Darlene and Thomas' egg and sperm, but she was carried by a surrogate -- her aunt, Thomas' sister Judy. But even though Darlene was, in legal terms, the "intended parent," the state Health Department wanted to list Judy as Kati' s mother on the birth certificate. Thomas had to get a court order for Darlene to be listed as the mother instead. That experience is what eventually steered Thomas away from real-estate law and into work on surrogacy and egg-donation cases. It is now 100 percent of his practice. The egg-donation agency was born about a year and a half ago, after the Pinkertons were approached by the couple on whose behalf they eventually placed the $50,000 ad. Some 75 donors are on its rolls now, says Darlene, with three to five new ones arriving each month. "This is hugely emotional," Darlene says of her work with the agency. "It really is. When it doesn' t work, I cry. When it does work, I cry. "We get to know these families, and we' re very, very involved with their lives."

Money Matters
Of the many issues raised by egg donation -- the possibility of health risks to donors, the questions it raises about the meaning of parenthood -- the money issue is the one that has generated the most heat lately. The idea of free-market eggs has been taken to such outlandish extremes as last year' s "Model Eggs Auction," an Internet-based gimmick that turned out to be little more than a publicity ploy for a soft-porn site. But to the Pinkertons, trying to place limits on egg recipients' freedom of choice is like stepping into quicksand. "If (a couple) doesn' t have an egg of their own, they' re faced with a choice," Thomas says. "Do they just pick a donor out of a hat? Can they not choose hair color? If they can choose something, then what shouldn' t they be able to choose? "Why is there an end to what they can choose?" Darlene says the reason their agency has attracted clients is that the money it offers brings in donors who aren' t available elsewhere. The clients, she says, may have been at another agency and said, "' Don' t you have any smart donors?' And the agency will grudgingly refer them to us." Some couples will explain to the Pinkertons that they' re both graduates of Ivy League schools: "Intelligence is very important to them... They' re just concerned that in the high-pressure corporate world or whatever that they' re used to, a child that doesn' t at least have a chance of being pretty intelligent just wouldn' t fit in with their family." Dr. Michael Kettel works with egg donors and recipients at the San Diego Fertility Center. Although the center has its own donor program, the clinic' s clients include people referred by outside agencies, including the Pinkertons' . Does he hesitate at the idea of donors being offered upward of $50,000? "Yes and no," Kettel says. "It clearly is above and beyond the typical reimbursement for time and trouble, there' s no doubt in my mind. In our program, we reimburse our donors $3,500. So it' s orders of magnitude different. "And yet I do respect the fact that there are highly successful women with pedigrees that are highly difficult to find," and that "hypothetically" at least some of those traits could be passed on to a child. "It' s not something I would endorse," Kettel adds, "nor do we foster that kind of economic fervor in our donors." The dilemmas of egg donation go beyond money matters. Some observers are concerned that the process may pose long-term risks to donors, who must inject themselves daily with hormones and drugs for several weeks to prepare their bodies for egg recovery. The San Diego Fertility Center, which has 20 to 40 potential donors on its rolls at any one time, restricts each donor to five such "cycles," a commonly accepted limit. "But that' s completely arbitrary," says Kettel. "There' s no science to say that' s good or bad." Then, as Harvard University law professor Elizabeth Bartholet points out, "There are a whole range of children' s issues wrapped up in these reproductive techniques. There' s the issue of not knowing their genetic heritage, there' s the idea of there being a price put on you. "Is the idea that your genetic mother sold you, or part of what became you, problematic?" Thomas Pinkerton counters, "If my child had to have a kidney transplant, would I tell her that part of her really isn' t her? It' s kind of the same thing. I think it' s a very personal decision that each couple has to make for themselves." Darlene has wrestled with these issues in a different form: In 1993, she and her ex-husband donated lobes from their lungs to save the life of their son, Ty Hartup. "I can truly tell you -- and I imagine this is how the (egg) donors feel: that may have been my lung before, but when it went in his body, it was his," she says.

One other issue is the potential for misuse of new reproductive technologies, as with the scandal that broke in 1995 at a fertility clinic run by the University of California Irvine. The university was hit with more than 100 lawsuits after doctors at the clinic were accused of taking donated eggs without the donors' consent and providing them to other women, leading to some 15 births. The clinic' s director, Dr. Ricardo Asch, who also ran a fertility clinic at UCSD, decamped to Mexico when the scandal erupted. He was finally fired in July. Real world Thomas Pinkerton acknowledges that egg donation is a confusing and daunting and debate-stirring subject. "But it should be, because it' s new," he says. "One of the exciting things about it is that we' re breaking new ground. "But we try to keep our eye on the ball, which is the infertile couple. How do we assist them in a way that' s ethical, in a way that meets their needs?" Darlene says the uproar over the money issue obscures the fact that the donors, according to her, really do want to help someone start a family. "What I really have seen is that when I tell people they weren' t chosen by this $50,000 family, they write back and say, ' I' d still like to donate.' "I' m sure the money is an important factor, but it' s not the bottom line." Thomas cites statistics that "one in five or one in six couples are infertile." The essence of their work, he says, is to offer those couples choices so they don' t have to give up their dreams of having a child." "Sometimes I' m very discouraged," says Darlene. "And then we get a call that someone is pregnant. And I say, ' OK, this is what it' s all about.' "

How Far It Can Go
As a sign of the kinds of ethical quagmires that egg donation could create, consider a position paper put out in 1997 by the American Society for Reproductive Medicine. The statement grapples with the possibility that the technology eventually might exist to recover eggs from aborted fetuses, mature them and then provide them to infertile couples. The implications are staggering. A person could have a child without ever having been born herself. Or a woman could be implanted with the fertilized egg of her own unborn child, thus having her own genetic "grandchildren," with an entire generation left out of the equation. Not surprisingly, the ASRM decided the whole thing would be a very bad idea. "The use of fetal oocytes (eggs) for oocyte donation," it concluded, "should not be pursued." -- James Hebert

The Ethics of Eggs
The first successful donated-egg pregnancy occurred in Australia just 16 years ago. Some 5,000 egg-donation procedures now take place each year. Doctors, legislators and support groups have rushed to come up with guidelines for egg donation and other alternative approaches to infertility, such as surrogacy. In February, state Sen. Tom Hayden introduced a bill to regulate egg donation in California. In its present form, SB 1630 would mandate licensing of doctors and clinics who perform egg-donation procedures, and require the state health department to establish a donor registry. It also would ask the department to consult with medical experts and other interested parties about whether there should be a limit on financial compensation to donors. RESOLVE, a national infertility organization, has issued a statement that while it supports donation, it is "concerned about the loss of equitable access for consumers who wish to build families through egg donation, and in the exploitation or improper enticement" of donors. "The point we wanted to make," says Margaret Hollister, executive director of the Massachusetts-based group, "was that this really should be a more voluntary kind of process. And of course these high dollar amounts make it seem more coercive. In other words, harder to pass up."

- James Hebert Copyright 2000 Union-Tribune Publishing Co.