In March, Canadian Member of Parliament Anthony Housefather said he’ll put forward a new bill that would allow sperm donors, egg donors, and surrogates to be paid for donating. Naturally, this announcement raised a few eyebrows, both in Canada and in the rest of the world.
Laws around egg donor compensation differ greatly all over the world. In countries like Australia, compensating egg donors is prohibited. In the United States, egg donors can be compensated, and they can negotiate the amount of compensation given to them. In countries like South Africa and the UK, compensation is permitted only to cover medical costs.
As a three-time egg donor, I am ambivalent about the question of compensation, which I’ve personally struggled with a lot. Given that there isn’t a clear consensus on the issue, it deserves more careful attention, as it raises various ethical and personal dilemmas that require some unpacking.
In 2004, Canadian legislators passed the Assisted Human Reproduction Act, which expressly prohibits the compensation of egg donors, sperm donors, and surrogates. The law aimed to provide a legal and ethical framework for assisted human reproduction, including egg donation.
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Housefather, who has since introduced his bill, argues that such a law is “paternalistic, misguided, and unnecessary” and that it harms people who are trying to start families with the assistance of donors or surrogates. Without the promise of compensation, Canadian egg and sperm banks are reportedly struggling to attract potential donors, which means many intending parents rely on imported sperm and eggs. This, Housefather says, makes it difficult to maintain reports and records on donors, which can harm donors, intending parents, and any children resulting from donation.
One could argue that egg donors—who often donate out of generosity—should be compensated, as it’s a form of reproductive labor that is invisibilized. The egg donation process takes time, sometimes away from one’s studies, work, or family.
Specifically, it involves nearly two weeks of injections, blood tests, and ultrasound scans before the eggs are retrieved; prior to that, one must undergo medical and psychological screenings. Between administrative tasks, medical appointments, and traveling, it can take quite some time.
Without compensation, many would-be donors can’t afford to do it. Such a system ensures that certain people—especially those without the ability to take time off work or school—struggle to donate, which particularly affects those who lack privilege. Also, doing work “for the love of it,” especially emotionally charged labor like teaching and nursing, is a line typically used to argue that such work shouldn’t be compensated fairly. It’s no coincidence that these jobs are traditionally associated with women, who on average are paid less than men.
Housefather argues that his proposed law would ultimately make it easier to keep a donor registry, which could provide further insight into the potential health risks of egg donation. Many donors and experts have been calling for an international donor registry for this very reason.
Perhaps ironically, the issue of compensation is something that complicates consent when it comes to egg donation. Donors might overlook certain health risks in order to get compensated. “It’s very hard to give informed consent, when there has been no meaningful regulatory oversight, at least in the United States, preventing ovarian hyperstimulation syndrome [OHSS], reporting medical complications, reporting long-term health outcomes—none of that,” says Raquel Cool, co-founder of the international egg donor forum We Are Egg Donors (WAED), one of the organizations calling for a donor registry as well as further studies into the long-term risks of egg donation.
Cool is currently writing a book that includes personal accounts from egg donors. While many experts claim that there’s enough research out there to conclude that egg donation is relatively safe, groups like WAED call for further long-term studies on the health risks.
Of course, it’s up to individual donors to weigh the potential risks and benefits when they donate, regardless of compensation. But it’s hard to conceptualize those risks without solid data. Some clinics and agencies claim, for example, that only 1 percent of donors get OHSS, but many donors and experts dispute that number.
OHSS is one of the more common risks of egg donation, and it often occurs when donors are given a high amount of follicle-stimulating hormone during their donation cycle. When the ovaries are overstimulated, they become swollen and painful as they fill with fluid. This can cause nausea, vomiting, dehydration, and fatigue. In more severe cases of OHSS, one might need to be hospitalized. Higher amounts of follicle-stimulating hormones can lead to more eggs for donation purposes. While this might be appealing to the clinics and recipients of the donation, it can be dangerous for the donor.
Bioethics expert Françoise Baylis argues that allowing compensation for human tissues leads to the “commodification of the human body.” Are egg donors treated better in countries where they’re compensated or not? It’s hard to say, Cool told Rewire.News, especially because nobody is tracking health outcomes. “It’s too simple to say that compensation results in categorically worse treatment,” Cool said. “There have been altruistic egg donors who get severe OHSS that requires hospitalization. There have been compensated egg providers who recover quickly and are happy with their standard of care,” she said.
In her personal experiences as a compensated donor, Cool said the experience was different from when she donated blood or hair. “It felt transactional and with it came a very specific subtext, expectations of professionalism and compliance,” she explained. Because you’re paid, it can feel like you’re employed to carry out a job—and if you want to back out of that job, you might face certain consequences, such as financial penalties.
Cool pointed to a popular article on the WAED blog, which details how when one egg donor decided not to go through with the procedure, her agency told her she needed to pay $3,400 for backing out. Cool said this article has led to more people reaching out to WAED because they too received a hefty bill. “There have been several cases in which donors try to withdraw, with no contract in place, and they have been met with invoices in the thousands or even threats,” Cool said.
This professionalization of the egg donation process means that donors often feel compelled to go through with donations, even without a contractual obligation. “Generally speaking, I’d say that an egg donor who volunteers her eggs has more autonomy over the process,” Cool says. In other words, they were more free to back out without facing consequences, as long as it was stipulated in their contracts.
Being compensated for your time is one issue, but egg donors are not only chosen for their time. They’re often chosen for their genes. While prospective recipients are encouraged to choose donors with similar characteristics to them, there is still a kind of hierarchy when it comes to donors: Some are considered desirable candidates, while some are not.
In the United States, donors are not only compensated for donations; they can also negotiate their compensation fee based on how desirable their eggs are. A 2011 lawsuit made this possible. An egg donor sued the American Society for Reproductive Medicine (ASRM) in 2011 on behalf of herself and other egg donors, arguing that the current cap on compensation for egg donation was akin to price-fixing. The ASRM, which sets the guidelines for pricing of egg donation, settled the case in 2016, and from then on, donors have been legally allowed to negotiate their compensation fee beyond the previous $5,000 price cap.
Although negotiating can feel empowering for a donor, the effect of the case extends beyond the issue of equitable compensation. Donors with more “desirable” traits are now able to receive more money for their egg donations. “People with ‘in-demand’ traits are able to leverage their bargaining power a little more,” explained Cool. “It’s just interesting to see, for example, an Asian egg donor with an Ivy League education being able to request five-times the compensation of someone who is a high-school graduate in a state where compensation is around $3,000,” she said. In this example, both donors will probably spend the same amount of time donating, yet they’ll be paid wildly different amounts.
Knowing this, it’s easy to see how ableism can become an issue when it comes to egg donation. Cool noted that a lot of the criteria for egg donation is rooted in ableism and oppressive ideas about desirability. A potential donor is deemed fit or unfit based on her genes that she could pass onto her potential offspring.
Cool recently helped a donor with an autistic son. While the donor disclosed to the donation agency that her son was autistic, the potential recipients backed out when they found out. Naturally, she was hurt by the implication that having an autistic child would make her an undesirable candidate. Some clinics or agencies might not even let you donate if you have a family history of autism, which implies that autistic children are less desirable than non-autistic children. “It’s kind of like the genetic Olympics: Who deserves to create more children? It borders on eugenics,” said Cool.
Adding compensation to the equation makes it an even trickier issue. Speaking to Rewire.News, Baylis argued that when we make it legal to compensate egg donors, we’re creating a marketplace. Much like any marketplace in any capitalist society, inequalities can be replicated there: Those with certain traits will be offered more money than others. “I think that’s one of the first places where eugenic aspects of this will become clear,” Baylis said. Donors may not be compensated for time and skill; instead, they’ll be assigned values based on their genes.
This is an issue because, as Cool mentioned, it borders on eugenics. Eugenics is a set of beliefs that focus on “improving” the gene pool of a population by encouraging people with certain genetic traits to reproduce while preventing others from reproducing. The international eugenics movement, which gained steam in the early 1900s, included racist and ableist policies around reproduction and immigration. Namely, the movement sought to prevent the so-called mentally unsound, disabled people, and people of certain racial and ethnic groups from reproducing. It did this through forced sterilization and, in the case of Nazi Germany, through genocide. Eugenics also became associated with apartheid-era doctrines in South Africa, and horrifically, eugenicist practices still exist today.
If we create a market for egg donors, and then assign value to people based on their perceived attractiveness, weight, genetics, and health, we’re replicating ableism, lookism, fatphobia, and eugenics.
It’s understandable that people want their time valued and to receive compensation for their reproductive labor. After all, as I’ve explained, egg donation can take time, and when you’re not compensated for that time, you might feel undervalued. This is especially true when it comes to egg donation, where a donor might be the only unpaid person in the process: Doctors, lawyers, coordinators, and nurses will all be paid for their time. However, paying the donor doesn’t automatically make the process fair.
Baylis pointed out that there are so many instances of unfairness and inequality in existing commercial markets; therefore, egg donation won’t be immune to this inequality. “The way the market works isn’t fair. We don’t have a way to have a capitalist system that fairly rewards people,” Baylis said. “So what [decriminalizing compensation] will do, is import all the unfairness of capitalism into this area, which is what I worry about.”
Should we allow egg donors to be compensated? The issue isn’t black and white, and the answer is way more complex than one would think. However, it’s clear that we need to have more candid and informed discussions about compensation than we’re having now.