Hatching babies: Our black market in human eggs

November 21, 2009

Megan Ogilvie

Health Reporter

The minute hand has just ticked past 11 a.m. Thea glances at her cellphone, then at the door leading into the busy coffee shop. A woman enters, but not the right one.

"She's late," says Thea, dipping a spoon into her latte and giving it a slow stir. "She probably won't come."

Thea is waiting to meet a stranger she met on the Internet, a tall woman with long, brown hair who is selling something Thea desperately wants: fertile human eggs.

At 39, and after four years of failed fertility treatments and false pregnancy tests, Thea, who asked for anonymity, is still trying to have a baby. In May, her doctor told her and her husband that they were running out of options. Their last hope, he said, was to use eggs from another woman's ovaries.

However, finding an egg donor in Canada is fraught with difficulties. Current laws make it illegal to buy human eggs, and the number of couples who are looking for altruistic donors far exceeds the number of women willing to give away their eggs for free. But as with any prohibition, a ban has not halted the trade of human eggs.

A black market is booming in Toronto. Every day, women post want ads for eggs on free Internet classified sites, including Craigslist and Kijiji. Others offer their eggs for cash, listing their facial features and other traits as if they were selling used cars or antique crockery.

And – despite the threat of a $250,000 fine and a five-year jail sentence from the federal governing body, Assisted Human Reproduction Canada – little is being done about it.

Doctors, lawyers, fertility experts and frustrated would-be parents are asking why Canada bans the purchase of eggs if there is no intent to enforce the laws. As they stand, critics say, Canada's assisted human reproduction laws are hurting the same people they are supposed to protect.

Four months into the search, Thea is increasingly bewildered by the process of finding an egg donor. There must, she says, be a better way to find the other half of her baby's DNA.

The Mississauga woman has no friends or family to ask for donated eggs, and she and her husband can't afford the $20,000 it would take to go to the U.S. to buy eggs, where it is legal to pay for them. Thea's fertility doctor said she should look for eggs online. He told her not to offer more than $3,000, an amount he said could be argued as payment for reasonable expenses, which is allowed under the act. He then asked Thea to return to the clinic once an arrangement was made.

"I can't believe I'm doing this," she says. "I don't know what to look for, what questions to ask. It's not like I'm looking for someone to babysit my child. I'm looking for someone to help me create my child."

FIVE YEARS AGO, the Assisted Human Reproduction Act made it illegal to buy eggs, sperm and embryos in Canada. Legislators had hoped an outright ban on the purchase of these human gametes would prevent the commodification and commercialization of human life.

But almost everyone in the fertility community says the legislation, in which altruism is supposed to trump capitalism, is unrealistic.

"The laws are trying to enforce a moral vision on a society that does not share it," says Bernard Dickens, professor emeritus of health law and policy at the University of Toronto. "Of course women are going online to search for ovum. What other choice do they have?"

Dickens draws comparisons between the ban on payment for human eggs and previous prohibitions on reproductive technologies, including abortion.

"We've come out of criminalizing and punishing people who don't want to have children," he says. "Now we are doing the same – criminalizing and punishing people – who do want to have children.

"These are not wicked people who are trying to shake the foundations of society. They are infertile people, usually couples of so-called advanced maternal age, who want to have children."

Doctors, fertility experts and patient advocates are calling for a regulated market for human gametes that would protect both donors and recipients.

Right now, they say, Canada's fertility laws are out of step with the practical care of patients.

Women and couples who have been told egg donation is their only option for infertility are shocked at being forced outside the clinic for part of their care. They call the process of finding an egg donor intimidating and emotionally draining. They are upset they can no longer opt for an anonymous donation through a clinic-run program. And they are afraid they will be duped by sophisticated sellers.

Egg sellers, beguiled by the prospect of easy cash to pay off student loans or to start a business, are also at risk in Canada's underground egg market.

Whether an altruistic donor or a seller, women intending to pass along their eggs must first take drugs to stop menstruating and to stimulate their ovaries. In rare cases, those medications cause ovarian hyperstimulation syndrome, a condition that can have life-threatening complications, including blood clots and kidney failure. The long-term health effects of repeated ovarian stimulation are unknown, which has prompted some fertility groups, including the American Fertility Association, to recommend that a woman's eggs be harvested no more than four times in her lifetime – something that cannot be monitored when deals are made outside a regulated system.

And, beyond the immediate risks to egg donors and recipients, some experts wonder how children, whose conception stemmed from online deals, will feel about their origins as they grow up.

"You're talking about 50 per cent of your future child's DNA," says Sherry Levitan, a Toronto lawyer specializing in third-party reproductive law. "Forcing people to shop for each other online does not befit the gravity of what they are doing. Certainly, we need to respect the process a little bit more."

No one in Canada keeps track of the number of women and couples who need egg donors to conceive, but Dr. Ellen Greenblatt, clinical director of the Centre for Fertility and Reproductive Health at Mount Sinai Hospital, says the demand greatly exceeds supply.

"And there will be a need for more and more and more as people delay child-bearing and get into the issue of age-related decline of fertility," she says. According to the Canadian Fertility and Andrology Society, 405 women used donor eggs in 2007 as part of their infertility treatments. But experts say that number represents a fraction of the women seeking donors.

Greenblatt sees at least two such women a week. Yet because so few are able to find an egg donor, Greenblatt can only help about 10 women a year.

"Our program is purely a known-donor program, and that's not easy to come by," she says, noting almost all of her patients ask friends or family members to be donors. From her view inside the clinic, Greenblatt says it is clear Canada's reproductive laws were implemented without proof the concept would work.

"They didn't ask what the supply of donors would be if it was totally altruistic."

THEA PLACED HER ad on Kijiji at the end of June. It was simple, just a few lines, stating that she and her husband were in need of an egg donor to help them build their family. The ideal person, it said, would be Caucasian, 5-foot-6 or taller, and in good health.

Within days, Thea started to get email responses. Few of the replies were worth considering: some women were too short, others the wrong ethnicity, one woman was from California, and several were too weird to take seriously.

The woman Thea has planned to meet at the coffee shop is tall, like her. In their email exchange, the woman described her four children, sent pictures of herself, and said she wants to help other women get pregnant. There was enough in the brief correspondence to spark hope that this stranger could be The One to help Thea have a baby.

But, along with hope, Thea feels disgust that her desire for a baby has brought her to a suburban coffee shop in Burlington.

"This shouldn't be up to me," she says. "They are sending me out for my own body parts. I wouldn't go out looking for a liver if I needed one of those."

At 15 minutes past 11, Thea notices a woman standing in the doorway.

"That's her, I think," she says, and shyly waves the woman over. The two shake hands, smile and sit down next to each other. Their eyes are a similar purplish-blue.

Soon, the woman is chatting about her family and job, and pulling out photographs of her children. Ten minutes later, she smoothly moves the conversation to egg donation.

A two-time donor, the woman, who has a warm smile and easygoing demeanour, is well versed in fertility terminology, reproductive technology and the legal ins-and-outs of exchanging eggs. She wants to help other couples, she says, especially since she is so fertile. Besides, she adds, it would be a waste for those extra cells to be flushed down the toilet every month.

It is a slick, sophisticated sales pitch, complete with a high price tag. She tells Thea that she would expect a "donor gift" of at least $7,900, plus expenses – that's what she got last time – but suggests $9,500 would be more appropriate, since she is a proven donor.

After an hour, the meeting fizzles to an end. Thea says she wants to talk things over with her husband. The woman stands up, shakes Thea's hand and walks to the door.

Thea waits for her to leave. Then sighs.

"I don't think I'm going to find anyone this way," she says.

Levitan, the Toronto lawyer, says women like Thea would have received more guidance and be better educated about the legal, medical and ethical complexities of egg donation under the old system, before assisted human reproduction laws were enacted in 2004.

"Reputable clinics had programs that were run, in their mind, to the highest standard," she says. "Not only were the intended parents well taken care of, but the donor was taken care of. Everyone's needs were considered at every stage of the process."

Now, she adds, many of the women who go online are naive enough to think they'll find an altruistic donor there.

"It's really very sad to watch," she says. "They put their ad out with open hearts and sometimes the responses are quite materialistic. Sometimes the responses are less than what they had hoped for.

"Some of them can see through the inappropriate responses very quickly, while others get led down the garden path."

TAMMY ZUPO POSTED her ad on Kijiji on Sept. 21.

The 32-year-old did not include as many personal details as others who advertise their eggs online. Her message was short, to the point. "I am a proven egg donor," it read. "The couple that I helped out are now on the way to being parents. I am a healthy young Caucasian woman willing to help another couple looking for their little miracle."

Zupo, who has a toddler son of her own, is pretty with long blond hair and light blue eyes. In the U.S., where donors can be paid tens of thousands of dollars for their eggs, these would be desirable – and expensive – features.

The well-spoken Mississauga woman says she goes online to advertise her willingness to donate eggs because she wants others to feel the joy of being a parent. She donated her eggs to a couple in July. When the woman called to tell her she was pregnant, Zupo says she cried. Later, she received a card and necklace from the couple.

"My experience with my son is my life," she says. "To me, nothing is more important. I knew I could help these people."

Zupo says she only asks for the family to pay for her medical care and travel expenses to and from the fertility clinic, as allowed under Canada's fertility laws.

Other egg donors who were in contact with the Star said they were asking between $2,000 and $6,000 for their eggs. Two women wanted money for school. Another, to start a business. And one woman wrote that she needed quick cash; donating eggs seemed an easy way to pay her bills.

"None of this feels quite right, does it?" says Levitan about the online egg trade. In her practice she has seen the damage done by the most mercenary egg donors.

"There are a few who turn this into a lucrative prospect," she says. "They will be the first to respond (to ads). They know so much more about the process than the intended parents, so it is easy for them to take advantage of the intended parents. Some ask for outrageous amounts of money. Some ask for advances, and then don't appear when and where they are supposed to ... This has become very difficult for intended parents."

Those in the fertility community agree that Canadian laws, which were supposed to prevent the commodification of life, have backfired. What, they ask, is more commercial and more disrespectful of the origins of life than an underground Internet trade in human eggs?

Critics say the government, via Assisted Human Reproduction Canada needs to enforce the laws – or amend them.

"You know it's happening, so control it," says Roger Pierson, professor of obstetrics, gynecology and reproductive science at the University of Saskatchewan and spokesperson for the Canadian Fertility and Andrology Society.

In an emailed response to questions, AHRC insisted that it is enforcing the Assisted Human Reproduction Act and its regulations.

"Each (violation of the act) has been fully investigated and appropriate action taken within the authority of the agency. The specifics of any particular file cannot be disclosed, but the agency has acted at all times in accordance with its authority."

But Pierson says no one in Canada has been prosecuted. The agency asserts it conducts website monitoring to "ensure that Canadian websites dealing with assisted human reproduction subject matter are aware of the act and regulations as well as to ensure that any potentially non-compliant findings are addressed appropriately."

But these actions are not stopping online deals from taking place.

Dr. Paul Claman, professor of obstetrics and gynecology at the University of Ottawa and medical director of the Ottawa Fertility Centre, the largest of its kind in Canada, argues there is no inherent moral conflict in paying individuals for an act of kindness.

"A doctor spends his whole life and vocation doing kindness for people, and no one begrudges a doctor for being paid for his time," he says.

Claman and other fertility experts suggest that paying an egg donor a set fee – an amount that would not be considered coercive or payment for eggs, but a recognition of the time, inconvenience and medical risk – would weed out those who are doing it for the wrong reasons.

THEA IS STILL searching for an egg donor.

It has been six months since her doctor told her that she needed eggs from another woman's ovaries to bear a child.

Her ad is still posted online, and she continues to meet with women at coffee shops around southern Ontario.

But, with each meeting and with each passing month, Thea's hope that a stranger can help her with her dream is dwindling.