Putting a Price on a Human Egg

We have gotten over the reality that things which used to be quite literally invaluable can - and must - now be priced. The challenge is developing trust in the methodologies by which such analyses are done and then getting agreement on the outcomes. JL

Ashby Jones reports in the Wall Street Journal:

Lawsuit claims price guidelines used by fertility clinics artificially suppress the amount women can get for their eggs.
How much is a human egg worth? The question is at the heart of a federal lawsuit brought by two women who provided eggs to couples struggling with infertility.
The women claim the price guidelines adopted by fertility clinics nationwide have artificially suppressed the amount they can get for their eggs, in violation of federal antitrust laws.
The industry groups behind the price guidance—which discourages payments above $10,000 per egg-donation cycle—say caps are needed to prevent coercion and exploitation in the egg-donation process.
But the plaintiffs say the guidelines amount to an illegal conspiracy to set prices in violation of antitrust laws. The conspiracy, they argue in court papers, has deprived women nationwide a free market in which to sell their eggs, and enabled fertility clinics to “reap anticompetitive profits for themselves.”
“It’s naked, illegal price-fixing,” said Michael McLellan, a lawyer for the women.
The lawsuit, filed in the Northern District of California, could go to trial next year. In February, Chief Magistrate Judge Joseph Spero allowed the suit, first filed in 2011, to move forward on behalf of women who have donated eggs in recent years. Later this summer, Judge Spero will consider whether to broaden the case to include women who plan to donate eggs in the future and want to eliminate the caps entirely. If successful, it could upend the industry of egg donation, which has increasingly become an important option for women who have trouble conceiving because of advanced age or other problems.
The technology behind donated human eggs dates to the late 1980s. The fee hovered around $2,000 until the late 1990s, when demand went up and clinics began paying more, said Rene Almeling, a sociology professor at Yale University and author of a 2011 book on the business of egg and sperm donation.
The market for sperm donation, which has also ballooned in popularity in recent years, works differently than that for egg donation. Sperm donors generally contract with a sperm bank to give weekly samples for a year, for which they are paid about $100 each. There are no price caps on sperm donations, which are sold for between $400 and $700 per vial.
Sperm banks generally don’t charge a premium for sperm from men with particularly desirable characteristics of looks or intelligence. Such screening is often done by sperm banks, said Ms. Almeling, by requiring donors to either be enrolled in a four-year college or have a college degree, and to be taller than around 5 feet 8 inches. “Short doesn’t sell,” she said.
Rising prices for donated eggs prompted concern within the American Society for Reproductive Medicine, a nonprofit medical-specialty group focused on reproductive medicine and a defendant in the lawsuit. In 2000, the organization, made up largely of doctors who pay to join, suggested that payments should not go above $5,000 without justification, and said that payments greater than $10,000 went “beyond what is appropriate.”
The price guidelines aren’t mandates. But more than 90% of the nation’s clinics belong to the society, which has adopted the guidelines.
Fertility clinics generally charge patients $12,000 to $20,000 for each donor-egg cycle, a weekslong process, which, with the help of hormones, can yield more eggs than the one or two normally released by a woman each month. About half of each payment goes to the donor. Whether a donor makes $5,000 or $10,000 or something in between depends on, for example, whether the woman has donated successfully before, and whether a clinic thinks her profile will suit the needs of an infertile couple.
Location also matters. Payments in urban areas with high demand tend to fall between $8,000 and $10,000.
More than 9,500 babies were born from embryos created with donor eggs in 2013, the latest annual figure, according to the Society for Assisted Reproductive Technology—a nonprofit organization of doctors and others who practice in assisted reproductive technologies and the other defendant in the suit.
A spokesman for both defendant organizations declined to comment, as did representatives from several fertility clinics. But many fertility clinics clearly state in promotional material that they adhere to the guidelines.
The organizations have claimed in court papers that the purpose of the pricing guidelines isn’t to enrich fertility clinics or doctors. Rather, they say, the aim is to lessen the chance that outsize payments will entice women to donate and either hide health risks that might disqualify them or ignore the possible side effects of donating.
The problem is finding a payment amount that fairly compensates women for their time and effort, but isn’t seen as too hard to pass up by college students or low-income women. The $5,000 price recommendation “might be enough to coerce some women into donating, while for others it wouldn’t be nearly enough,” said Ms. Almeling.
Leah Campbell, a 32-year-old writer in Anchorage, Alaska, suffered complications following two donor-egg cycles while in her 20s and said she became infertile as a result. Ms. Campbell, who saw fliers around her college campus promising thousands of dollars to egg donors, said she worries about the effects of unlimited compensation. “The money entices women to take on risks that they probably wouldn’t otherwise,” she said.
Ms. Campbell said she preferred the policy in other countries, including the U.K. and Australia, which don’t allow payments for eggs. “If you want to donate for altruistic reasons, go for it,” she said. “Otherwise, let’s leave the money alone.” The price caps strike others as unnecessary, even sexist. “It’s overriding a woman’s ability to choose what she wants to do, even if it’s risky,” said Julie Shapiro, a law professor at Seattle University and author of a blog on law and reproductive technologies. “We don’t ban people from cleaning nuclear waste sites because it carries some risk, we allow them to charge more to make up for it.”
Other egg donors say a robust market depends on compensation. “I helped couples achieve their dreams, and in return they helped me go to law school, buy an apartment, pursue my dreams when I was in my 20s,” said Gina-Marie Madow, a four-time egg donor now working as a lawyer at Circle Egg Donation, a Boston-based egg-donation agency. Ms. Madow said $10,000 “feels like the right amount for women to get” for a cycle but didn’t understand the reason behind the price cap. “I just don’t think the [organizations have] done a good job explaining why it exists,” she said.
The price caps might also guard against worries that women might pay more for eggs from mothers of certain ethnic or racial backgrounds, or with such traits as physical beauty or high intelligence. Such a market exists, largely through a small number of agencies that cater to couples willing to pay a premium.
“It’s a concern about eugenics, that women will pay more for eggs from an Ivy League grad,” said John Robertson, a professor of law and bioethics at the University of Texas.
Kimberly Krawiec, a law professor at Duke University who has studied the egg-donor industry, played down such concerns, adding that mothers-to-be generally aren’t looking to build a genetically superior child. Ms. Krawiec said she had little issue with couples paying more for eggs from women with, say, high SAT scores. “Fertile people have been screening for beauty and intelligence for years and years,” she said. “It’s called dating.”