Dr Krinos Troukudes slaps his hand loudly on my back after I turn off my tape recorder and turn to make my way down the Pedieos Clinic's dark stairwell. For the last hour we've been talking about the biological goldmine inside every woman's uterus: human oocytes, or in common English, eggs. Clinics like his make a fortune selling eggs to infertile couples who will travel across the globe for a chance to get pregnant. Through a trick of favorable currency exchange and lax laws the island nation of Cyprus is one of the fastest expanding markets for human eggs. Here a full-service egg implantation costs between $8,000 and $14,000, where in the United States the price floats between $20,000 and $30,000. As he sees it, the only roadblock to becoming a baron of the market in human eggs is controlling a steady supply. "If you have the donors, you have everything," he says. Everything.
When the first baby was born from a scientific IVF embryo transfer in a London hospital on July 25th, 1978, the market for human eggs took off like a jet plane. Birth control coupled with IVF means that women can delay having children until their professional careers are well under-way. In the last 32 years hundreds of thousands of children around the world have been born to donor eggs. While the miracle of assisted reproduction has changed the way the middle-and-upper classes view childbearing, behind the miracle of each birth is a hidden supply chain where eggs are procured by any means necessary.
Crimes in the egg trade are not hard to come by.
Between 1996 and 1999 and Israeli doctor named Zion Ben-Raphael began stealing eggs from his patients by doping them with hormones without their consent. In once case he stole 181 eggs from a single unknown donor and implanted them in 34 of his paying patients. In the course of his tenure 13 women were hospitalized because of the massive doses of hormones that he delivered triggered a dangerous conditions known as hyper-stimulation syndrome (HSS). Once the Israeli newspaper Haaertz reported on his spree he attempted to evade charges by bribing investigators. Shortly after the scandal, Israel banned all paid egg donation procedures.
Over the years similar crimes have been reported in Cyprus, Ukraine, Spain, Russia and most recently in Romania where a 16-year-old factory worker was in critical condition after she sold her eggs to an Israeli- run clinic. A government raid of the clinic last summer led to the arrest of 30 Israeli doctors, nurses and clinical staff who were offering fertility tours to Israeli patients who were unable to buy eggs domestically.
Most doctors and administrators believe that paying for a body part— including human eggs—creates a system that disproportionately draws raw materials from the bodies of the poor to sell them to the rich. In order to cut back on possible negative social consequences the European Union and the United States have laws that restrict commerce in human tissue. The only way to legally acquire a human egg (or kidney, liver, blood or cornea) is to receive it as a donation, so that money does not unduly influence the transaction. To do otherwise is considered tissue trafficking: An allegation that is the modern equivalent of slavery.
The United Kingdom outlawed even minimal compensation for egg donations in 2007, while simultaneously passing a law that made it possible for children born to donor eggs to be able to track down their genetic parents when they reach eighteen. Many egg-donation advocates say that this one-two punch was the knockout blow for British IVF industry. Since the new laws the waiting list for an egg now stretches two years long. For women already cresting the upper limits of even assisted fertility, the restrictions feel a lot like an outright ban. And yet, most of Europe has passed, or is passing similar laws.
But there are a few holdouts in the European union. Cyprus and Spain have looser restrictions on IVF and have turned into destination spots for the reproduction industry.
In Cyprus, a country with fewer than one million people, there are now more fertility clinics per capita than any other place in the world. In the absence of a formal law to regulate egg selling, or even one that offers clear enforcement guidelines for what to do to clinics that violate ethical norms, Cyprus is something of the fertility industry's wild west. So many people come here for egg donations that it seems to have caught the government by surprise and stretched its donor pool past the breaking point.
There are approximately 76,000 women in Cyprus between the ages of 18-30 who are eligible to become egg donors. Dr. Trokudes estimates that there at least 1,500 egg donations performed each year in the country's dozen IVF centers. Some back of the envelope math indicates that approximately one in 50 eligible women have donated their eggs. It's a startingly high number that dwarfs the comparable rates in America where one woman out of every 14,000 elects to donate their eggs.
Perhaps even more alarming, is that most of the egg donors in Cyprus come from a relatively small population of poor Eastern European immigrants who are eager to sell their eggs at a pittance. In January and February 2010 I visited a half dozen clinics and doctors in Cyprus, most of whose egg donors were of Ukrainian, Moldovan, Russian or Romanian descent. Several clinic directors told me that these women are favored because of their lighter complexion, eyes and hair color. British, German, Italian and American customers tend to favor children with Caucasian phenotypes. While no clinic gave me direct information on their donor registries, all said that Eastern Europeans represent the bulk of donors. There are approximately 30,000 Russians on the island nation and it's possible that in this population the frequency of egg donors of eligible women is as high as 1 in 10.
For fertility clinics bent on increasing their market share of international patients, controlling and cultivating donors is the most crucial part of the business. During my research I found that clinics in both Spain and Cyprus have to play a difficult balancing act between meeting almost insatiable demand from abroad and the recruitment of donors. While many doctors strive to keep the industry safe and legal, internal contradictions in the language of cultivating egg donors makes the boom in international IVF a potential flash point for dangerous practices.
This is the first post by Scott Carney in a series of dispatches on the human egg trade that will be featured on Untold Stories over the next week. Read his Fast Company article on the global egg trade.