March 11, 2009
What’s the Risk in Donating an Egg
Two years ago, Megan Shield decided to become an egg donor at what is by industry standards, the ripe old age of 30.
Like so many, Shield had moved to Los Angeles to work in the entertainment business. A Jewish woman with dark hair and pale skin, today Shield works for a nonprofit here while she continues to wait for her big break.
Shield, whose name has been changed at her request to protect her privacy, remembers first speaking about the idea of egg donation with a neighbor as they sat on the front porch chatting. Something about egg donation had always appealed to her; she saw it as a way to help someone in need, like donating blood. But it wasn’t a decision she took lightly.
“I just had so much fear about donating my eggs and having my biological child grow up in an unhappy situation,” she said recently.
Still, not long after that conversation, Shield went online and met an egg-donation coordinator who was searching for a Jewish donor. And not long after that, she found what was in her eyes an ideal couple.
“I was just very specific in the way that I wanted to do it, and I kinda didn’t think it was going to happen, just because I didn’t think my criteria would be met, but all of my criteria were met, and so it worked out really well,” Shield said.
At the top of Shield’s list was her desire to know that the child — throughout his or her life — was doing well. In other words, Shield wanted an “open” egg donation. Her egg broker suggested that a gay couple might create the ideal situation — whereas a heterosexual couple might feel threatened by the outside presence of a donor, a male couple could, potentially, remain more open.
And after what was initially an awkward phone conversation with a Jewish gay couple from New England, Shield met with the pair in Los Angeles.
“We sat and talked for hours ... it was like family,” Shield said of her first meeting with the couple who, for nearly a decade, had tried to adopt but was continually rejected.
After going through what she referred to as a casual psychological interview and weeks of daily injections of hormones (similar to the hormones her own body produces, but at much higher doses), Shield produced approximately 26 eggs.
She then flew to the New York area for a minor surgical procedure to extract her eggs. The rest was left to the fathers, a surrogate who would carry the fetus and the medical team. The whole process, Shield says, took about six to eight months. She received $8,000 for her part in the procedure.
Shield made it clear that it wasn’t money that motivated her. She said that today she even thinks about putting that $8,000 into a college fund for the child.
She also noted that the process wasn’t easy.
“It was kinda grueling to do all the medication,” she said. “It was like having the worst PMS you’ve ever had, for weeks on end.”
Shield is among the thousands of women who donate eggs every year. Although the precise number of donors is unknown, doctors performed more than 10,000 transfers of embryos using fresh donor eggs in 2006, according to the Centers for Disease Control and Prevention. Egg donation is not regulated in the United States, and its long-term effect on donors remains unknown. Yet some argue that the fertility drugs used in high dosages for the procedure may be dangerous for women’s health, and for the sake of the thousands of donors who participate (including the many Jewish donors), doctors need to learn more about the long-term effects of the procedure.
According to Dawn T. Hunt, an egg broker in San Diego who has been an egg donor herself and who specializes in matching Jewish donors with Jewish couples, Jewish egg donors are among the most sought after.
“I would say they are in equal demand but low supply,” she said, when asked about the reason behind the frequency of online and college newspaper ads calling for Jewish donors.
Rabbi Elliot Dorff, rector at American Jewish University and author of “Matters of Life and Death: A Jewish Approach to Modern Medical Ethics” (Jewish Publication Society, 2004), said Jewish women, in particular, frequently suffer from infertility because many postpone having children for the sake of a higher education and career. He noted, for example, that women ages 27 to 35 already encounter an infertility rate of close to 30 percent.
Given the shortage of Jewish eggs, one might assume couples would start to widen their base of potential donors. But egg brokers report the ethnicity of a donor is in most cases still of critical importance among Jews.
“I think the reason Jewish people want a Jewish donor is that that way it’s not going to be so much of a stranger. It’s going to be one of us,” said Sara Vogel, an egg broker who helps run the Web site, Jewish Egg Donation.
While Reform Judaism says a child is Jewish as long as one parent is Jewish and as long as the parents and child identify with Judaism, Conservative Judaism requires the gestational mother to be Jewish, according to a 2006 article in The New York Times that explored the issue. A conversion would be necessary in Shield’s case, for example, where the surrogate mother did not identify as Jewish — despite the fact that Shield herself is Jewish.
Rabbis within Orthodox Judaism are more split on the issue, with some worrying that the use of anonymous Jewish donors may “lead to unwitting marriage between family members.” Most, however, encourage the use of Jewish donors.
A recent article in The Forward noted that demand for Jewish egg donors in the United States is so great that a growing number of Israeli donors are traveling here to help infertile Jewish couples.
But money can be an incentive for some donors, too. Due to the current economic downturn, the number of women turning to egg donation is on the rise. As early as the summer of last year, a Las Vegas-based FOX affiliate reported that the number of egg donors had increased, noting that one Las Vegas clinic in particular had reported as much as a 30 percent increase in the number of donors.
But even as egg donation becomes something young women want to do, the questions of its long-term effects on donors remain unanswered. The first donor baby was born in 1984 in Los Angeles. It’s a relatively new science and has yet to be thoroughly studied. At present, there is no registry to track the donors once the procedure is done and, therefore, no way to learn about what happens to the women after the donation.
Dr. Jennifer Schneider, a physician certified in internal medicine, addiction medicine and pain management, is at the forefront of the campaign to create such a registry.
Schneider met Shield after becoming good friends with her mother. But the Shield family wasn’t the first introduction Schneider had to the egg donor world. Schneider’s own Jewish daughter — Jessica Grace Wing — decided to become an egg donor while a student at Stanford University.
“She had read the ads all over campus, which there still are,” Schneider said of Jessica’s decision to become an egg donor. “What I remember specifically is that I said to her, ‘You know, you don’t have to do this for the money.’ She wanted to do it to assert her independence, and I said, ‘Well, it’s fine with me, the only thing I’m concerned with is, is it safe?’”
By the time Jessica, a tall, bubbly girl with an interest in modeling, entered graduate school at Columbia University to study film, she had donated her eggs three times.
Soon after, Schneider received a call from Jessica’s doctor.
“It’s interesting that he called me rather than calling her,” Schneider said. “He called me to tell me that he just got the results of the CAT scan, and the CAT scan showed she had cancer all over her abdomen.”
“He didn’t know how to tell her; he just didn’t know how to tell her, that’s why he called me,” Schneider said. “He knew I was a doctor, he didn’t want to just call her up and tell her, because he knew what it meant, just like I did, which was that she [was] going to die.”
In 2003, at the age of 31, Jessica Grace Wing died of colon cancer. DNA testing later revealed that Jessica had no genetic predisposition to the disease. Soon, Schneider learned of another young egg donor who had died from the same kind of cancer. Studies she read also seemed to confirm her suspicion that a link between the hormones egg donors use and cancer may exist.
“There are studies done on the cells that line the colon. And they find out that they are affected by estrogen,” she said. “The reason this is important is that ... we know that taking female hormones ... causes a somewhat increased risk of breast cancer. This has already been shown ... but the question is, does it affect the colon?”
“The studies ... show that, in fact, estrogen does stimulate the colon cancer cells to divide and grow,” she continued.
But Schneider also makes clear that she can’t be sure her daughter’s use of hormones had anything to do with her colon cancer, since studies on the long-term effects of egg donation are scant.
In fact, a new study in the December 2008 issue of Fertility and Sterility is believed to be the first of such studies. According to an article on Medical News Today, a health Web site, researcher Nancy Kenney, associate professor of psychology and women’s studies at the University of Washington in Seattle, administered questionnaires to 80 women who had donated eggs at least once, two to 15 years before filling out the questionnaire, and found that two-thirds of women reported satisfaction with the egg donation process.
Women who did report physical problems complained of bloating, pain and cramping, ovarian hyper stimulation — a complication resulting from fertility medication — and other common symptoms associated with egg donation. A few also contended that they had suffered infertility, decreased fertility or damage to their ovaries. But researches note that there is no direct evidence at present linking these problems to the egg donation process.
Kenney believes more studies about the long-term effects of egg donation are needed; studies that are unlikely to happen because the process isn’t tightly regulated in the United States and is, by and large, a medical procedure administered with the anonymity of donors in mind. No cap on the number of times a woman can donate her eggs exists in the United States, and there is no regulation about compensation, though in both instances the suggestion by the American Society of Reproductive Medicine is that the number should remain low.
Other countries have stricter policies regarding egg donation. In Britain and Sweden, for example, anonymous egg and sperm donation are against the law. Once children reach the age of 18, they, like those who are adopted, are free to learn about their genetic parents and inheritance. England also forbids financial compensation for egg donation, though that has led some British donors to travel elsewhere.
Studies have been done on the long-term effects on women who have used drugs to induce ovulation and have, as a result, given birth. The Jerusalem Perinatal Study followed 15,030 women in Israel who gave birth between 1974-1976, through 2004. The study, recently published in the American Journal of Epidemiology, found that “women who used drugs to induce ovulation had increased risks of cancer at any site,” especially uterine, malignant melanoma and non-Hodgkin lymphoma, and notes that the scientific literature on the association between infertility treatments and cancer had previously been inconsistent.
It is findings like these that alarm Schneider and have led her and other doctors to conclude that more studies in this realm are needed. On two occasions, Schneider has traveled to Washington, D.C., with members of an organization called Hands Off Our Ovaries to brief members of Congress on the need for follow-up studies on egg donors and the creation of a national donor registry.
“If you keep track of the egg donors, that provides the possibility of doing follow-up studies,” she said. “Right now the reason there are no follow-up studies of long-term effects of egg donors is nobody knows who they are.”
Schneider believes that a registry could also help children learn about their genetic inheritance, especially when it concerns parental diseases offspring might want to know about.
Bioethicist Rabbi Dorff agreed and noted that information about the health, tastes and interests of the mother should be passed along to the offspring.
“One of the things we do as we grow up is we figure out who we are on the basis of our parents,” he said.
While some, like the American Society of Reproductive Medicine, have cited privacy as a concern, some fertility clinics, like the California Cyrobank, have pushed for a registry, as long as it is done on a volunteer basis, according to a recent article in the Chicago Tribune.
Dorff believes that, as matters stand now, there is not enough evidence of an increased risk of cancer to warrant warning women not to participate in egg donation.
“Men and women both have the duty to preserve their own health,” he said. Right now, women have to “balance between not taking the risk and, on the other hand, not helping people have children.”
When asked about whether or not she worried about the future after learning of Jessica’s story, Shield said she would never again donate eggs, though she made it clear her reasoning has little to do with a fear of getting cancer.
“I don’t know what happened to Jessica,” Shield said, fighting back the tears. “I feel awful about it.”
“But I don’t know that I tie it necessarily to this; there’s no evidence of that,” she continued. “That said, it’s really early days in egg donation.”
“I don’t think it’s unlikely, necessarily, that the two are linked. I just have no idea,” she said.
She said that despite the death of a family friend, she will continue to look back at her egg donation experience fondly.
Just this month, Shield’s donor child is celebrating his second birthday. A few days ago, she received an invitation to his birthday party in the mail from the fathers.
“It was really rewarding. Beyond what I could have hoped for,” she said.