In season two of HBO’s The Sex Lives of College Girls, Kimberly Finkle (Pauline Chalamet) finds herself in a financial predicament. She’s lost her scholarship and is in desperate need of money for tuition. She considers her options: Apply for grants, enlist in the military, or wait: what is this pamphlet she spots in the fictional Essex College’s financial aid office? “Did you know you could have $80,000 inside of you?!” it reads. “Looking for students from elite colleges willing to sell their eggs.”
Kimberly explores the idea with a succinct pros and cons list. (Pro: “Help a family,” Con: “Run into future kids at a shopping mall??”) Sex Lives doesn’t water down the intensity of the egg donation process, chronicling Kimberly’s inconveniently timed hormone injections in a frat house bathroom and her post-op discomfort. But it doesn’t exactly paint an accurate picture either, failing to account for the rigorous screening process, the many doctor’s visits, and the growing privacy concerns surrounding anonymous donation—not to mention how highly unlikely it is to walk away at the end of a cycle with that kind of cash.
Like Kimberly, many egg donors are young women in need of money, though most do not come upon it via well-placed informational literature. Potential donors are more likely to resemble Allie Wertheimer, who found herself strapped for cash when she lost her job at the beginning of the COVID-19 pandemic. Days after she was laid off, she was scrolling through Facebook when a string of advertisements caught her eye. Wertheimer, now 25, found that the platform served her ads that implored her to consider “donating” — or rather, selling — her eggs. “Almost every single ad on Facebook was for that,” she says. Some of them promised up to $10,000 (a far cry from the $80,000 payout on Sex Lives), piquing her interest enough that she began filling out an application. “I seriously considered it because I needed money really, really badly at the time,” she says. “I was filling out the form online, and then I was like, ‘Wait, what the fuck am I doing? I don’t want to do this.’”
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Wertheimer had seen these ads before. They became a regular fixture on her feed when she was unemployed following her 2019 graduation from New York University. “I was very actively looking for work, and I was getting ads for donation every single day,” she says. Like Wertheimer, young women often see advertisements for egg donation on Instagram, Facebook, and YouTube — and many report a spike while on the job hunt. “Google ad tracking knows I’m applying for jobs so now I’m getting egg donor ads,” one user tweeted. “Should I do it? Payout is supposedly $48k.”
The Supreme Court’s overturning of Roe v. Wade unleashed a tidal wave of privacy concerns that would have been inconceivable in 1973, from the security of period tracking apps to Meta handing over private messages about abortion. But ethical qualms in the reproductive health arena reach far beyond abortion. Today, the entire process of egg donation is inextricably linked with technology. Advancements in the fertility field are a double-edged sword, and helping people grow their families can come at the expense of donors.
Fertility clinics usually find would-be donors like Wertheimer through their internet activity. Clinics use behavioral data, which monitors digital footprints, from web searches to credit-card purchases. “There are a hundred companies out there that sell third-party data that they’re collecting on users online,” says Marcus Kroon, senior vice president of the advertising firm Deutsch LA. Clinics also find potential donors through demographic targeting, in which a person’s data is bundled with those who share similar traits, such as age, gender, location, education, and political leanings. (Companies like Oracle sell this segmented data to help narrow the scope of who sees the ads.) Finally, geofencing allows companies to narrow targets using location data by placing digital ads within a physical perimeter. The presence of a phone within a geofencing perimeter can cause targeted ads to bleed outside of the boundary, too, making them inescapable. “We can serve an ad on TV because the mobile phone is connected to the WiFi, which is connected to the IP address,” he says. “It’s kind of creepy. We can place them anywhere we want.” This method of advertising is only going to become more ubiquitous. Global digital ad spending reached $491 billion in 2021 and is projected to grow to $500 billion in 2022.
Clinics also use social media for ad targeting, Kroon says. “Twitter sells most of their data. Somebody can be targeted not necessarily just on Twitter, but outside of Twitter, too, because the data gets sold, and then we can reach that person on YouTube or anywhere else, really.” Kroon also acknowledges the use of app data. “If you wanted to target phones with fertility tracking apps, for example, you can do that too,” he says. Employing a combination of demographics, app and social media data, and search retargeting can help narrow campaigns down to a very targeted audience. These techniques allow for people like Wertheimer to see targeted ads without ever so much as Googling “egg donation.”
While the first live birth from a frozen oocyte occurred in 1986, the American Society of Reproductive Medicine didn’t remove the “experimental” label from egg freezing until 2012. Until just a few years ago, most successful IVF cycles came from fresh eggs, which would match a donor to a carrier on the same timeline. But as technology became more sophisticated, allowing for long-term freezing and preservation of eggs (not just frozen embryos, which have seen successful live births since 1984), clinics began to shift the supply and demand balance to mimic that of sperm donation. With more frozen eggs available, potential parents gained autonomy in creating their future offspring and donors were given the opportunity to complete cycles at their convenience.
“If you would have talked to me five years ago it was all about fresh donor cycles. The donor would complete the cycle in real time, and then we do a transfer,” says Dr. Deborah Wachs, a Bay Area-based reproductive endocrinologist. Today it’s the complete opposite. “Now, the vast majority of patients are looking for a donor through an egg bank,” she says. Desperate to fix the deficit, many took to social media to recruit donors, including Wachs, whose practice posted ads on its own Facebook page, as well as in print and on the radio. “Agencies were much more targeted on college campuses,” Wachs explains.
Donating eggs is grueling. Just a fraction of applicants (fewer than 1 percent in some clinics) pass the prerequisite psychological evaluation, extensive genetic and fertility testing, and meet the laundry list of criteria required of donors. If accepted, the donor begins a two-week course of birth control pills starting on the third day of their period. A few days later, they will begin taking daily hormone injections of luteinizing and follicle stimulating hormones to trick the brain into growing multiple follicles — the fluid-filled sacs that house egg cells — as opposed to the singular follicle that matures during a normal menstrual cycle. After 10 or 11 days of injections, the donor takes a “trigger” shot to release the follicles. Thirty-six hours later, they are placed under general anesthesia for the 20- to 30-minute retrieval procedure, in which a doctor uses a transvaginal ultrasound to guide a hollow needle through the vagina to remove the eggs from the follicles.
The trigger shot, called Lupron, is one of the biggest advancements in fertility medicine, according to Wachs. “Lupron allows the eggs to mature and get ready for the day of the egg retrieval so that mature eggs can be collected,” she says. “But then very quickly, it brings all the hormones back down to normal, and it brings the ovaries right back down to their normal size.” Prior to the introduction of Lupron, patients were triggered with an injection of human chorionic gonadotropin, which carried a risk of hyperstimulation. In most cases, hyperstimulation causes sluggishness, nausea, bloating and general discomfort for a week or so after retrieval.
“In its most severe form, hyperstimulation can result in fluid building up in the belly,” Wachs says. “In its very dangerous form, you could get fluid in your lungs, fluid around the heart.” However, Wachs underscores that while donation was once considered risky, it is a very safe procedure. “A lot of that was back in the day where there just wasn’t as good of an understanding of what we did,” she says. “They weren’t able to monitor as closely as we are now in terms of what we have with ultrasound and blood work.”
Thanks to the recent ability to freeze eggs at -321° Fahrenheit for decades, more and more donations are coming from strangers — as opposed to fresh donations from family or friends. But as the process becomes less rooted in emotion, the mindset has become less altruistic. “People say vaguely, ‘I want to help somebody,’” says Dr. Arthur Caplan, a bioethicist and founding head of the ethics division at the NYU School of Medicine. “If they’re not paying, I think they don’t want to help as much.” (Caplan purposely refers to these paid transactions as sales rather than donations.)
While financial compensation is an incentive, potential donors may be surprised to learn that walking out with an $80,000 check is all but impossible. Even the fine print of Kimberly’s brochure on Sex Lives suggests otherwise: “Typically, an egg donor fee will range from $35,000 to $80,000 per cycle. Those egg donors who have previously cycled or who have exceptional qualities may be paid more egg donor compensation,” it reads. But outside of the HBO Cinematic Universe, the average payment is significantly less than even their fictional price floor.
In August 2021, the American Society for Reproductive Medicine’s Ethics Committee released its updated compensatory guidelines for clinics in which it recommended: “Total payments to donors in excess of $5,000 require justification and sums above $10,000 are not appropriate.” The money given to the donor, the ARSM says, is not a sale, but compensation for the time, inconvenience, and demands of the process. Depending on the location, clinic, and experience, donors can expect to make between $5,000 and $10,000 per cycle, and are advised not to complete more than six cycles in their lifetime. Those who complete the maximum cycles are likely to make between $30,000 and $60,000 total — nowhere near the one-time rate of $80,000 that single-handedly pays off nearly two years of Kimberly’s Essex tuition.
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Although the ASRM deems that individual clinics can set their own rates, it cautions that a high payout could cloud informed consent and encourage patients experiencing financial stress to donate purely out of necessity, not altruism. “Compensation should be fair and not become an undue enticement that negatively impacts a donor’s ability to make an informed decision about the donation process,” says the Ethics Committee of the ASRM. Conversely, Caplan worries that donors are getting the short end of the stick, especially those without legal representation. “The woman who’s unemployed and thinking this is a quick way to make money is likely going to settle for less,” he says. “You need a lawyer to sell your house, but apparently you don’t need one to sell your eggs.”
In most cases, the clinics are the big winners. “When the eggs are frozen, they’re divided into batches of six to eight eggs, and then sold for like 20 to 30 grand a batch,” says Sophie Winkel, an IVF patient care coordinator in New York City. At Egg Bank America, donors can expect to be compensated between $5,000 and $10,000, while a “premium donor batch” of five to seven frozen eggs are sold for $20,900. (Of course, prices vary clinic to clinic.) Winkel worries that this method is rife for exploitation, especially when advertising — or a television series — leads donors to expect a more substantial check. “I think it’s really misleading because it makes girls think, ‘I’ll just donate my eggs and make 100k,’” she says. “That’s not how it works.”
While many clinics follow the ASRM compensatory recommendations, the advertising guidelines are often neglected. “If compensation is noted in advertisements, the existence of risks and burdens also should be acknowledged therein,” the guidelines say. On Sex Lives, Kimberly’s pamphlet has a “possible risks & complications” subsection. But since people are more likely to see grabby social media ads, the risks are frequently left out. Wertheimer says the Facebook ads she saw were quick to trot out the five-figure payout, without mentioning the physical and emotional demands, or the potential risks. “The website that I looked at the most didn’t really say much about what exactly the process was, unless I really investigated,” she says.
Instead, advertisers know to lead with the most enticing bait: the money. As targeted ads seek to capture young women’s attention with high figures, potential donors are becoming more motivated by money — and often, $5,000 isn’t cutting it. Some even pivot to black market clinics that don’t follow industry safety protocols and donation standards to make as much as 10 times the ASRM recommendation — a much closer figure to Sex Lives’ projected $80,000. Wachs worries that patients who are selling their eggs for an exorbitant fee are being coerced, and therefore, not truly consenting to the process. “Our practice would never work with an agency that was compensating a donor that way,” she says. Wachs has seen cases in her own practice where the donor seemed too highly motivated by finances and she felt uncomfortable working with them. “As a young woman, it’s really important to know: How have you been targeted, and what’s the motivation behind that?” she says.
For Caplan, the changing donation landscape leads to new concerns. While it is common for couples to seek out a donor with a similar ethnic background, he worries that selectivity can become a slippery slope to full-blown eugenics. He cites people who look for donors with elite degrees or highly valued physical features like height or eye color. “It moved over toward a more eugenic focus with people saying, ‘I want an egg seller who’s going to a good school and has certain properties and traits,’” he says. “I always thought that was a little bit duplicitous, because you don’t necessarily get what you’re trying to pay for that way.” Caplan also points out that selecting a highly educated donor with a cornucopia of desirable traits is not a foolproof way of producing an exceptional child.
While Kimberly’s fear of being discovered by potential future offspring at a shopping mall may elicit a laugh, it also points to the growing issue of anonymity — or lack thereof. Legal identification rights are a potential consequence of donating genetic material. Like with adoption cases, Caplan doubts the courts will protect donor anonymity. “If you’re an egg seller, you will get discovered if somebody wants to, and courts will allow children access to your identity because they’ve already done that a lot in the adoption space,” he says. While clinics may try in good faith to protect donors, it is increasingly clear that they may not be able to. Today, thanks to the ubiquity of direct-to-consumer genetic testing services like AncestryDNA and 23andMe, anonymity is no longer a promise that clinics and agencies can make. A person who donated their eggs in their twenties in exchange for a few thousand dollars may end up with a child reaching out later, regardless of whether they want to be found. “We used to call them anonymous donors,” Wachs says. “That term is not used at all anymore, because we just don’t believe that we can tell a donor that she would remain anonymous.”
Thanks to the sophistication and availability of genetic services, a close enough DNA match can lead to discovery—and there is already an established legal precedent to do so. In 2018, Joseph James DeAngelo, better known as the Golden State Killer, was arrested decades after the case went cold when investigators were able to use forensic genetic genealogy to track him down. DeAngelo was discovered in part thanks to for-profit genealogy services (in this specific instance, the website MyHeritage had a relative’s DNA that cracked the case). Many DNA services, like Ancestry, do not cooperate with law enforcement per company policy. But the ability to turn away law enforcement is on unsteady ground. In 2019, a Florida judge allowed law enforcement access to every single profile on GEDmatch, dealing a massive blow to DNA privacy.
Wertheimer isn’t worried. “Whatever the government wants to know, they’re gonna know,” she says. “I don’t want to concern myself with worrying about keeping these things from these scary authoritative agencies. There’s nothing I could do about it.” As most egg donors nowadays have grown up in the digital age, the potential of being discovered by an offspring isn’t as earth-shattering as it once was. “Young women live their lives in a fishbowl,” Wachs says. “We’ve been surprised at how that doesn’t necessarily seem so overwhelming for them. Years ago the idea of potentially being found was a very scary thing.”
Still, as donors may be growing more comfortable with the idea of being discovered, Wachs says it remains a provider’s responsibility to protect a patient as much as possible. “What you may think you want when you’re 25 years old can completely change. When you’re fully grown with a family of your own, you may never want to even acknowledge to your partner or to your children that you did that,” she says. “So, I think that’s something that we’re very clear on is not taking what a young woman says and assuming that’s how she’s going to feel 20 years down.”
Kimberly Finkle awoke from her retrieval procedure content and at peace. After all, she had just done a good deed and solved her tuition woes in one fell swoop. While the plotline may have been open and shut, it’s not that simple in real life. For Wertheimer, her eggs don’t have a price tag. “Enough money to go through all that shit?” she says. “No way.”