PAT DUGGINS-- If I were to say, ‘man, have you seen the price of eggs these days?’ You're probably thinking, Oh, he's talking about inflation and the price of groceries and how it became an issue in the presidential race and how nothing has changed, and so on and so on. That's not what I mean. I'm not talking about the kinds of eggs that build omelets. I mean the kinds of eggs that build families. The Alabama Supreme Court created a political shock wave last year when it declared that frozen human embryos were children. The legal case involved people looking to start families through in vitro fertilization. These couples allege that their eggs were destroyed. Some moms and dads to be like these, use their own fertilized eggs. Others have reproductive issues that require donated eggs, and there's a whole industry in the US to supply them. It's a story of money, racism and a process that can reportedly harm both female egg donors and the children that result. Diane Tober is in the middle of this issue. She's a professor at the University of Alabama and the author of the book eggonomics, published by Rutledge press, she's my guest on APR notebook.
PAT-- Diane Tober, thank you so much for talking to me.
DIANE TOBER: Absolutely. I'm so happy to be here.
PAT-- You know, I've been in the news business for 40 years, and I like to think that I'm on top of stuff, but when I read on the website co fertility that there were, like, according to them, 10,000 births in the United States last year with donated eggs, I was kind of wondering, Where's the news coverage on that? I mean, I read another report from the Grandview Medical Center that this process generally close to $400 million in 2024 and it just seems as though it really doesn't make an awful lot of news. So are we asleep at the switch as an industry, or do I need to get out more? Or what do you think?
DIANE-- Well, I think there actually is some coverage. There's been I was recently interviewed for a piece in Bloomberg, another piece in Forbes, and so there is some out there. And I think maybe it could be an issue of who's paying attention and to what, right? So there is coverage, but it doesn't necessarily mean that everybody's paying attention to that coverage, right? So, and you know, at this point, the fertility industry is a multi billion dollar per year industry, and and much of that industry is driven by human eggs, whether it's donated eggs, where the donors get paid and they supply eggs for the larger fertility market, or whether it's people freezing their own eggs for, you know, future use, but, but eggs have just exploded, so to speak. That might not be a great image, but exploded on the market in terms of their value and how they drive the business.
PAT-- When the Alabama Supreme Court made their ruling last year regarding frozen embryos as children, what was, what was your reaction to that?
DIANE-- There's obviously, in my opinion, in the opinion of science, there's a vast difference between a living, breathing human being that's been born into the world and an a dish filled filled with fertilized fertilized eggs or embryos. So that that Supreme Court, the Alabama Supreme Court decision, was at least temporarily devastating for the fertility industry in the state of Alabama, and it has repercussions across the United States. You know, other other states, like Texas, other red states, have been looking at trying to do the same things and to declare embryos as persons. I was there in Montgomery when they were trying to debate this bill to enable IVF to continue. And it was really interesting to me that the that the Republican side was trying to determine, well, maybe an embryo was a person when it's in a womb, rather than in a dish or rather or in a, you know, a freezer, whereas the Democrat side was trying to argue, saying, Well, wait a minute, you know, we need to talk about viability. That's the elephant in the room. So whether it's in a dish or, you know, in a uterus, that isn't really the issue. The issue is viability.
PAT-- Your book economics spells out how burdensome and how dangerous this process is for human egg donors, it almost seems right up there, right next to surgery. Can you talk about that?
DIANE-- To get to collect eggs from a woman's body, the woman first has to self inject hormones for several weeks in order to be able to grow more eggs than she would normally produce. So on a regular monthly cycle, when a person ovulates, they produce one egg, potentially two, rarely, but one egg that comes to maturity and it either gets fertilized or it passes out the body and then in. Menstruation. When it comes to retrieving eggs for fertility purposes, or for retrieving eggs and ovulation stimulation, you have to inject what's called follicle stimulating hormones. The donor then administers a trigger shot to release the eggs from the follicles, so that then the following 48 hours later, the position can go in with an ultrasound guided needle to go up through the vaginal canal and pierce the ovaries and and suck out basically the egg from each particular each single follicle in that ovary. So if a woman has, you know, 10 10 follicles on one and 12 on the other, and they all have eggs. They will drain the fluid containing the eggs from each of those follicles. I've heard some donors having been stimulated to produce as high as 80 eggs in a single cycle, which can dramatically increase risk and pain for the donor.
PAT-- Your book really does a nice job of comparing how the United States handles egg donations compared to Spain, and it covers a lot of territory. But if you were to pick one thing that the United States does differently compared to how the Spanish handle it, what would that be?
DIANE-- Yeah, good question. So Spain has a more regulated system when it comes to egg donation, and the United States has a very unregulated, or spottily regulated system. And Spain has also instituted a registry, a donor registry, which tracks the number of cycles a donor does. It tracks where the eggs go, and if it's found that any of the children born from her eggs have a medical condition that's can be genetically linked to the donor. They have a system where they where the clinic can go back and contact the intended parents and say, hey, look, your donor has this heart condition, you know, in her genetic code. And so therefore some of the offspring from this donor have the same heart condition you might want to get your child checked. And then they, they pull the donor from from the from not being able to donate anymore. So it's in Spain, they stop the donor at either six cycles or six live births in a geographic area. And they also, you know, have a way of tracking medically, at least, the least for the donor conceived people. They don't necessarily track donor health yet, which I wish they would, but they but they at least have a registry to to stop the donors from from going over six donation cycles. And in the United States, I've seen donors do quite a number. Of donors in my study have done between 10 and 19 donation cycles, and that is a lot to put your body through. Even, you know, the three to six times that the American Society for Reproductive Medicine recommends,
PAT-- Did I read right that in the United States, parents can actually say, well, we like blonde hair, blue eye, high cheekbones, and the Spanish are like, what?
DIANE-- Exactly? Yes, so, and that's another thing that you told me I could only say one, but that would be two. But yes, in the night in the United States, we have a very tiered market in human eggs because it's very consumer driven. And so, you know, I'm an intended parent. I can go through an egg donation agency or a clinic website. I can pick my donor, and I can choose sort of what kinds of traits I want. I wanted to have a Harvard education. For example, I want blonde hair, blue eyes I want, or I want Asian or I want, you know her to be a volleyball player, or any of these things. And so the the means of selection being so so consumer driven also drives this market, with some donors get paid dramatically more than others based on these traits, which obviously has these sort of Neo eugenic overtones that make us, that make some of us feel a little uncomfortable, and it's also a very commercialized market. In Spain, it still has some commercial elements, but it's still more along the lines of medical practice. So the clinics determine the donor recipient matching based upon phenotypic similarity. Now it's not a perfect system, so intended parents have no say over the donor that they that they get matched with. This it's supposed to only be done based on how well they resemble one another. But you know, and donors are all compensated the same, so it's more egalitarian in that way. But there's also other other aspects, like in Spain, they they have mandatory anonymity, so the donor and recipient must remain anonymous to each other in perpetuity.
PAT-- On the subject of money. A few years back, one of our student interns did a story on sugar daddies, and for everybody out there thinks I'm talking about the candy. I'm not what it is. Is a a wealthy man or woman who contacts a college student, male or female, and they come up with a financial arrangement that the people that we spoke to ultimately leads to sex. But that's almost like I'm digressing a little bit. The whole point of it is we kind of focus more on the power imbalance. You've got people with money and. Got college students with debt, and every time I was reading that section of economics about how the money goes, I kept going back to the sugar daddy bit. Can you talk, can you talk about the pressure that some of these women are?
DIANE-- Well, yeah, that's an excellent question, because, you know, a lot of egg donors have, you know, substantial student loan debt or they need they're doing this because they're doing this because they want to help somebody, on the one hand, but they're also doing it because they're also doing it because they need the money, right? So it is a commercial transaction, you know, eggs for pay. And, you know, somebody's 21 years old, 20 years old, whatever. They're going to school, they've got bills, they have tuition to pay, and, you know, maybe they also want to take a vacation. I've heard that story as well. So, so, yeah, so some, some will undergo these repeat cycles to try to, you know, gain income, and at the same time, you know, the intended parents, they have the wealth, and the donors do not. So the intended parents essentially are the paying customers. And, you know, they sort of drive how those negotiations go. They drive the terms of the contracts and so on. And not to demonize intended parents either. There's a lot of people out there that would not be able to have their families were it not for egg donation. And so, you know, I don't want to, you know, throw anybody under the bus.
PAT-- I'm struck by the notion, and several people mentioned this in EGGonomics, that if they knew what it was going to be like before they donated, they would not have right any thoughts on that in terms of, like, you know, the commoditization of women that way?
DIANE-- well, you know, some people have fantastic experiences donating eggs. They are in contact with the families. They're in contact with the children, and they are, they are grateful for the children they help bring into the world. So you some, some you have have very positive experiences. So I want to make sure that I don't, you know, put gloom and doom on everything, but at the same time, a lot of people that I've spoken to had some very serious medical consequences. Again, a donor that had gone into a donation, you know, in the book, thinking that it was going to be a known donation, that she would have contact with the intended parents, going throughout the process, be able to be in contact with the child, etc, that was in her contract. Once again, once the intended parents received her eggs, they basically said, Well, you know, we'll contact you if we ever need a kidney, you know, yeah. And so obviously she was devastated, because that was not what she was going into it for. She didn't even really get paid that much, I think maybe two, $3,000 for, you know, a two month long process. So it's not like she was doing that for the money, either.
PAT—APR Notebook is broadcasting on Alabama Public Radio, but it's also being provided as a podcast. So the podcast can be heard by just about anybody around the world, but the people listening in the radio are mostly in Alabama. And I'm kind of curious, you know, I try to get numbers on all of this for our state, and I couldn't find a whole lot. I mean, the website, don't donor solution said that it worked with egg donors in Huntsville and Birmingham and Montgomery and CO fertility says that like, okay, one in every 400 births is associated with a donated egg. So if that's true, in Alabama, if my math is right, that could mean about maybe 150 births from donated eggs in 2024 if my if my math is correct. So if that is true, would that? Would that surprise you, considering Alabama's position as a right to life state?
DIANE-- No, it doesn't. Because when I was at the Montgomery hearings, the legislative hearings, trying to look at the impact, you know, the the legislation surrounding this, the IVF, the fetal personhood or embryo personhood bill. Most of the women that were in there testifying or in support of the bill to allow IVF to occur in Alabama. And most of the you know, you know, when you're at a legislative hearing, you get all these supporters. You might have hundreds of supporters, you know, on one side or another. So the room was filled with Alabama women, predominantly conservative, conservative Alabama women who want the rights to create a family however, they need to do it. But they want their rights to have a child right and if they need donor egg to not have IVF available, for example, would be truly devastating for these for the people who who rely on donor eggs to have a child.
PAT—We were talking earlier about families here in the United States who can say, Oh, I'd like blonde hair, blue eyed, high cheekbones, blah, blah, blah, blah, blah, which kind of dovetails into the portion of your book that talks about the racism that's involved in this. Who gets paid, what, what is desirable, what is not can you talk about that?
DIANE—What I keep hearing from, you know, intended parents in the industry, et cetera, is like, we can't find enough black donors, right? Or we can't find enough donors of Asian donors also. But it's really interesting to me. 18 that. So I started thinking about, I wonder if there's a difference between what donors are paid based on race and I and in my survey, I have questions about compensation. I have question questions about their ancestry. You know, I've got 85 questions in there. So it covers the gamut everything you can think about egg donation. It's in my survey. So and I started noticing that, you know, an egg donation agency recruiter will tell me, Oh, we just had a donor. We paid $250,000 because, you know, the intended parents were from China, and they wanted a donor from MIT, and with small hands, and, you know, with high, high test scores, or what have you. So, there you have. You know, one donor paid $250,000 in my survey. The the maximum that I've saw for donor compensation was about 100 $120,000 and that was for an Asian donor, and also for some several white donors. And then if you compare the highest compensation I had for black and Hispanic donors in my in my survey, was about $12,000 so there's a huge discrepancy in donor compensation along, you know, ancestral racial lines, and I, and my thought is, obviously, is, is that there might not be as many black donors because you're not paying them. You know, it's the same thing where you have economic injustice throughout many levels of our society. You know, where white people might be paid more than black people, or women might be paid less than men, et cetera, et cetera. And I think my hunch is, is that it's playing itself out in this space as well,
PAT-- And layering on top of that, there's another edition of APR notebook where we talk about the situation over in Ukraine. And I am completely ignorant about what's going on over there, but I've heard stories of the missile strikes and children being abducted, but also the refugees, particularly female refugees. Can you talk about the commoditization, if that's even a word, yes, it seems to be coming out of that.
DIANE-- Yes, absolutely. And commoditization is a word, good, yes, yeah. So Ukraine has always been a very popular spot for egg donation and surrogacy. Before the war, it was one of the most prominent places where people would go for reproductive tourism. You know, there still is surrogacy, but you know, it's not safe, and anyway, so that now there's a large population of refugees, Ukrainian refugees. And when I was in Spain, many of the egg banks and clinics were very keen on recruiting Ukrainian refugee donors because they could meet sort of the phenotypic profile of a broader Europe, is what people would tell me. So egg donor recruiter or a physician in Spain, or one of the Ag banks that I went to would say, Well, you know, we've got we've got people from France, we've got people from Germany, we've got people from Holland and Ukrainian eggs match very well for them. And so Ukrainian egg donors were very popular in Spain, as well as Russian Romanian to some degree. But particularly, again, the blonde hair, blue eye to meet, that sort of Northern European look. You know, I had one physician in it was a German physician in Spain who told me that he likes to recruit South African donors because South Africans have a pure, you know, racial lines, you know. And I'm like, Well, you know this, these, these fantasies about, you know, what people really are and how, how genes work, even in the medical system, still prevail. And he was saying that his South Africa, his South African donors, were more popular and more affordable than donors in the United States that were white, because the donors in the United States were more more mixed and less racially pure than than the South African White donors, and also more expensive. So, you know, he could pay a South African donor $2,000 whereas a US donor might be 10. So, so these, the way that these dynamics surrounding really is sort of a eugenic mission, in some cases, not across the board, but in some cases, it can be that,
PAT-- Considering the political climate that's going around, do you see that getting worse?
DIANE—I do. I do. I'm very concerned about it. You know, I'm very concerned about, you know, where this country is heading in many ways, but also in, just in the space of assisted reproduction. So you have these people who have these weird, idiosyncratic ideas about, you know, what's going to be, what's going to produce the brightest child, or what's going to produce, you know, the most talented individual. And and they do it. They try to do it through donor selection, sometimes through birthing practices, through through sex selection, through. All these things. And so what we what we're seeing, in my opinion, is that these tools that can be used, these technologies that can be used to help people have families, it's being taken up another level of to another level of, okay, you know, human design in a way that doesn't match the data, right? So it's being used in ways, especially among the particularly wealthy, to create sort of this.
PAT-- Instead of coming up with a child who looks good for prom night, you're actually trying to come up with a purer form of your race
DIANE-- that, and also a child that's like, super intelligent. But it's a myth. They're relying on these mythologies, on on on fake science to create what they think is going to be a master child, right? But it's not going to work out that way. You know, like one donor told me, she said, What did she say? She was talking about, she's in the book. She was talking about, you know, of course, you know, we're like, we're a product as an egg donor, I'm a product, you know, they want the brightest, they want the most, you know, most educated, they want the most attractive, etc. And then she said, but just because you have a donor that went to MIT doesn't necessarily mean you're not going to have a child who turns out to be a junkie, you know? And so there's this whole notion that the idea that free will, that children will will not be carbon copies of whatever it is you think you're going to create, is not being considered by these people who essentially are using reproductive technologies to feed their egos.
PAT-- We talked earlier about egg donors finding that they're related to a whole bunch of people down the road. I'm also curious about the children who may or may not, understandably, kind of wonder where they came from, and what do they do?
DIANE--Yeah, well, I mean, ancestry testing has been huge in helping donor conceived people not only find one another, but also find their donors. So, you know, in the case of sperm donation, you obviously have the potential for a lot more genetically related half siblings. So you know, I know, I know of some people who have over 200 300 by genetic half siblings from sperm donors. There's even been cases where doctors have used their own sperm, which we that's a whole other topic. With egg donors, you're not going to necessarily have as many kids as you can with sperm, because there's fewer eggs as compared to sperm. But I do know one egg donor who thought she maybe had between 10 and 20 children out there, later find out that the clinic used her eggs for far more recipients than she knew, and she probably, according to one of the staff at the clinic, probably has closer to about 50 children, and That's the highest I've heard for an egg donor. And her perspective is, is like, if they find me, great. She she's from the Caribbean. She's like, you know, I have land, I have money, I'm a physician. I could, you know, they could all be welcome, you know. So her perspective is, she would never turn anybody away that wants to find her, which is fortunate, because, you know, for the kids, because you know, if you seek out your donor, because either you want a connection or you want medical information to be rejected, is quite, quite painful for donor conceived people. But most of the donors that I, that I have been, been in contact with, especially the ones you know 10 years or so post donation, they want to meet the children born from their eggs. They put themselves in the DNA databases so they can be found, or on some of the private registries that are out there that so they can be found, and so donor can see people are finding each other and they're finding they're finding their donors as well.
PAT-- I've always heard the complaint that in medical research, the work focuses on ailments impacting white men now, women's issues get overlooked and for the problems that they share with men, women respond differently. If you take that and look at human egg donation, how does that particularly impact research going forward?
DIANE-- Well, yeah. And also, I should point out that black men and men of color have also been used as research subjects, especially, yes, you know, often without their own informed consent. So that's important, so, but men in general, have been predominantly used as research subjects. And the assumption is, is because men don't, you know, ovulate and don't have hormone fluctuations, that there are more reliable physical source for, for for for research, because you're not going to have all these other factors like, you know, rising estrogen levels and progesterone and these kinds of things coming into play. But you know, one of the things that is is really important, and is being been overlooked for quite some time, is, is women. It's women's health research, and there's and the women, the little research that there is on women's health tends to focus on on important topics, like cancers, Alzheimer's, heart conditions, you know, and those kinds of things. But there hasn't ever been any substantial longitudinal research on the impact of of hormone injections or fertility treatments on on women's women's health in the short term, over time. You know, I've started a little bit of it, but it's, it's, it's, it's not even remotely what's what actually still needs to be done. And you know, currently, the funding situation in the United States is very challenging, especially when it comes to women's health. So for the foreseeable future, for the foreseeable future, in the short term, anyway, I don't have a lot of confidence that we're going to make any progress when it comes to women's health research. I'm hopeful, but seeing again, how the NIH and National Institutes of Health and National Science Foundation funding has been so so dramatically cut, it's going to be quite challenging to get any kind of research off the ground, particularly women's health research overall.
PAT-- How much do we blame that on the fact that most lawmakers in the United States are guys?
DIANE-- Well, I think that's an important, important issue. I mean, you can have a room full of men debating, you know, women's reproduction, and not have a single woman there, you know, you know. So I don't know how well that's going to give one a nuanced perspective in terms of what's needed to be done in order to increase health. But you know, when it comes to egg donation, I would really like to see more longitudinal research. I would like to see one of the projects that I've been trying to develop, and hoping I can find funding for somewhere, is to compare egg donors and egg freezers to look at the impact, because, because egg freezers tend to be a little bit older. So these are going to be women that want to freeze their own eggs for their own future use. So maybe they're they're 30 and they're not ready to have a child yet. Or maybe they're married and their partner, they and their partner are not ready to have a child yet. Whatever the case, most are single, and they're hoping to find a partner and freezing their eggs, you know, between, you know, late 20s to late 30s in the with the idea that they would use them later. And so one of the things that I'm really interested in to look at is, you know, are these two groups comparable, and in terms of the medication protocols they get, in terms of the health outcomes they have immediately and in the long term, and in terms of their satisfaction with the medical care. Because if you have one group that's, you know, a paying patient versus another group that's a paid patient, is there a difference in terms of how they interpret the care they receive in the medical setting? So that's something I'm hoping to do, but yeah, I'll have to find the funding for it.
PAT – Diane Tober, author of the book economics, published by Rutledge. Thank you so much for talking to me.
DIANE—Thank you. I enjoyed our conversation.
