Savvas Koundouros can't answer every question that I ask him. A handsome embryologist with sterling credentials from the top scientific institutions in the world, he has stimulated the ovaries of almost ten thousand women in his career—all in the pursuit of bringing new life into the world. When he walks through the streets of Cyprus women kiss his cheeks and men slap him on the back and greet him with warm smiles. He is the reason that many of them have children and so has cemented his reputation as one of the most loved men on the island. He has impregnated more women than Ghengis Khan.
But when I talk ask him about the motivations of women who donate their eggs in his program he lets out a heavy sigh and takes a break to smoke a cigarette on the roof of his clinic. "What I want to tell you, I cannot tell you," he says.
Egg donation and invitro-fertilization, or IVF, is one of the fastest growing medical procedures in the world—and one of the most effective—ways to kick start a pregnancy when traditional methods fail. By the time a woman reaches puberty she has approximately 300,000 proto-eggs in her ovaries. These potential eggs are stored in bunches of follicles. Every month a single proto-egg, or oocyte, matures and drops into her uterus where it waits for fertilization by a sperm. Yet as a woman ages the process tends to break down, eggs mature poorly, fallopian tubes get blocked and any other number of complications can make pregnancy impossible.
With IVF, the doctor takes control of the ovulation process, and does the work that a woman's body should do naturally under the strict controls of a laboratory. Typically this means stimulating individual follicles with hormones, maturing five to fifteen eggs in situ, and then extracting them, selecting the most promising of the batch and implanting sperm in a Petri dish to create an embryo. Presto: life via laboratory.
The clinical intervention can make a women's own eggs come to life, however in 30%-50% of cases IVF is not enough to achieve pregnancy and the only option is to retrieve eggs from a donor. When this happens, both women synchronize their fertility cycles with hormone treatments and eggs are matured in the ovaries of the donor, fertilized in a lab, and implanted in the woman who wants to get pregnant.
IVF with egg donation is one of the fastest growing medical procedures in the world and the new social relationships that it creates challenges some of our most basic notions about the beginning of life.
Procreation is no longer an intimate act between one man and one woman. It is a heavily mediated enterprise that involves doctors, patients, donors, airlines, insurance companies, ethicists, governments and psychologists.
Pregnancy separated from passion is a strange animal, rather than rely on random chance, every facet of the future child is managed, scrutinized, valued and assessed. If they're unable to contribute their own genetic material, infertile couples will scour the world for the very best donor sperm and eggs, and many are willing to pay any price to get the right results.
No matter the promise of the procedure, there is a bottleneck in the system that a laboratory cannot cure. It's a problem that Savvas Koundouros contemplates every day. The demand for donor eggs vastly outstrips the available supply. Most countries have outlawed direct payments to egg donors, but in Cyprus and Spain it is legal to give donors a small amount of money to cover the time that they spend in the clinic as well as whatever lost wages they might have missed.
"Obviously the donation is described as an altruistic act and that means no contribution. But it sounds strange to all of us that a person would receive so many injections over several weeks and then go under general anesthesia just because they are so kind," says Koundouros. He presses out the rhetorical response with his tongue pressed firmly against the wall of his cheek.
The distinction, however, is not lost on the British social anthropologist Michal Nahman, who interviewed 20 Romanian women who gave their eggs. In a 2008 article in the European Journal of Women's Studies she wrote "To call the women I interviewed 'donors' would be a great misnomer. They are explicitly there to sell their ova for a specified sum of money...not out of 'altruism' or wanting to donate."
Regulatory bodies perpetuate the confusion over the proper way to recruit donors. "Compensation is allowed. Paying is not allowed" says Catalana Stylianou Chief Inspector of Tissue and Cell Centers for the Cyprus Ministry of Health.
Doctors like Koundouros have to pretend that the transaction to procure eggs is based on altruistic ideals in order to avoid regulatory pressure from the government. Donors who come to his clinic are paid about $1400 to compensate them for their time.
It is an amount that begs the question: Can altruism be bought?
The altruism/payment double speak creates the exact sort of social stratification that regulators wanted to avoid in the first place. An altruistic system is supposed to take the lure of financial reward out of tissue donation programs and draw flesh from across social classes. However by offering low payments, only the most desperate women are going to come forward to sell their eggs. It's a Catch-22 where people on the fringes of society start to see egg selling as their only option. It can also turn fertility clinics into predators who face out of control demand for their product, but are constrained by low fees. In order to maintain a strong supply of donors they are sometimes forced to recruit only the most desperate women to give their eggs.