Published August 12, 2010
Krinos Trokoudes knows this much about women: "If you pay something," he says with a smile, "you get lots of girls." Coming from a silver-haired man in a white lab coat, the remark sounds a little unseemly, but he does not mean it the way you may think.
Trokoudes is an embryologist. His business is harvesting human eggs, and every year, hundreds of women are impregnated at his Pedeios IVF Treatment Centre in the Cypriot capital, Nicosia. In 1992, he made the Guinness Book of World Records after a 49-year-54-day-old patient he had impregnated via in vitro fertilization delivered a healthy baby girl; at the time, the mother was the oldest person ever to have given birth after IVF. Trokoudes's record has since been shattered (two years ago, a 70-year-old Indian woman birthed IVF-conceived twins), but his achievement helped establish Cyprus's reputation as a home of doctors who are willing to push the frontiers of the fertility industry.
Over the past decade, global demand for human eggs has grown uncontrollably, proliferating in lockstep with a fertility industry that has become a billion-dollar global behemoth. Three decades after the introduction of in vitro fertilization, some 250,000 test-tube babies are born each year. While the vast majority are still the products of their biological mother's eggs, the desire of older, often postmenopausal women to become moms has fed the rapid growth of egg trading, a business that now reaches from Asia to America, from the richest neighborhoods of London and Barcelona to backwaters in Russia, Cyprus, and Latin America.
This business features well-meaning doctors and assembly-line charlatans, desperate parents and unlikely entrepreneurs, and the most unusual sourcing: women of childbearing age. It is unevenly regulated when it is regulated at all, producing startling, tech-driven examples of the comparative advantage that economist David Ricardo described in the early 19th century. Poor women from poor countries sell their eggs to entrepreneurial doctors, who then sell them to rich aspiring parents from rich countries. This has given rise to a set of spectacularly engaging issues: Is it really okay to treat a woman the way we treat a hen, pumping her up with hormones so we can farm more eggs for sale? Do the standards we apply to produce ball bearings also apply to the stuff of life and the women who bear it? Is a human egg a widget and the donor nothing more than a cog?
These are fundamental questions about outsourcing and efficient markets, except that they involve people, not things. Unfortunately, nearly all of the Western world has punted on the ethical dilemmas. Some countries, like Israel, prohibit egg harvesting on their own territory yet still reimburse citizens for IVF, even if it's done with donor eggs, as long as they're acquired elsewhere. U.S. law says nothing about egg donation, though the American Society of Reproductive Medicine has nonbinding guidelines that deem unethical any payment beyond reimbursement for lost wages and travel. In Cyprus as in the rest of the EU, "compensation is allowed, but payment is not," says Cypriot health ministry official Carolina Stylianou, who leads the regulation of the island's fertility clinics. Yes, that is as murky as it sounds.
All this mystery has helped create a vibrant marketplace, with a wide range of prices and available services. In the U.S., a full-service egg implantation -- including a donated egg, the lab work, and the IVF procedure -- costs upward of $40,000. In Cyprus, you can get the same service for $8,000. In the U.K., a prospective parent might wait two years to get an egg, given that country's strict limits on egg donation. In Spain, on the other hand, waiting times are extremely short -- you can have an egg implanted two weeks after requesting one. And as for selling (or donating, if you prefer) an egg, the price is truly all over the map: An American woman gets an average of $8,000 per batch of eggs, but can ask upward of $50,000 if she's an Ivy League grad (a 100-point increase in SAT score correlates with a $2,350 rise in egg price); on the other hand, an uneducated Ukrainian flown to Cyprus for the extraction process will get a few hundred dollars -- and a few days in the sun -- for her eggs...