This article is part of Future Tense, a collaboration among Arizona State University, New America, and Slate. On Nov. 20, Future Tense will host “Will the Family Survive the Revolution in Reproductive Technology?” in Washington, D.C. For more information about the event and to RSVP, visit the New America website.
When Dr. Richard Sherbahn founded the Advanced Fertility Center of Chicago in 1997 and launched an egg donation program for women struggling to conceive, he started with a pool of just three donors: “a tall brunette, a short brunette, and a blonde,” all white. Back then, Sherbahn writes in his online guide to navigating the donation process, couples in search of a donor would choose quickly from his small selection. But now, “there are thousands of donors available through agencies over the Internet,” and “couples have become much more particular about what they are looking for in their perfect egg donor. A ‘white girl with dark hair’ will rarely be enough to satisfy recipient couples today.” Sherbahn writes that one couple recently came to him looking for a thin, white woman with green eyes and wavy blond hair who stands between 5-feet-7 and 5-feet-8, has Swedish ancestry, played college-level athletics, holds a master’s degree at the very least, and registers a minimum 120 on an IQ test.
When the first American child conceived via a donated egg was born in Los Angeles in 1984, UCLA doctors deemed the boy “just beautiful.” But 30 years later, some recipients of donated eggs are hoping to bear children who inspire more specific superlatives. Last month, the Journal of Women’s Health published a study tracking the preferences of women seeking ovum donations through the Reproductive Medicine Associates of New York, a fertility clinic on Manhattan’s Upper East Side. Between 2008 and 2012, researchers administered surveys to more than 400 patients, asking them to weigh the importance of certain qualities in prospective egg donors, including their intelligence levels, mental and physical health, athleticism, physical appearance, and ethnicity. In those five years, the study found no shift in preferences for donors “who displayed a physically ‘similar appearance’ or shared a ‘similar gene pool’ ” with the recipients. But the preference for more a broadly desirable résumé skyrocketed: The percentage of couples prioritizing donors in good health increased from 50 percent in 2008 to 72 percent in 2012; those seeking donors with demonstrable “athletic ability” increased from 1 percent to 17 percent; and those stating a preference for high intelligence increased from 18 percent to 55 percent.
An unprecedented demand for smarter, better, faster babies inspires an uncomfortable bioethical image. But Dr. Georgia Witkin, a clinical psychologist who works with donors and recipients at RMA, paints a more empathetic picture of the trend. The study’s results suggest that prospective parents are less interested in creating a “child who looks like an exact clone of themselves” and increasingly invested in priming their offspring for success. That shift could speak to the normalization of racially blended families, gay and lesbian parents, and the role of donated egg and sperm in American conception. (Nearly half of couples surveyed in 2012 said they planned to inform future kiddos of the role of a third party in their origin stories.)
But the increased acceptance of egg donation as an infertility treatment strategy has also inspired intensified demands for the specific genetic instructions that the ovum will provide. Witkin says that it’s often the same couples who come to the clinic requesting donors scoring high marks for health, athleticism, and smarts. As she puts it: “They’re looking for the package.” The expectation for genetic excellence is not specific to eggs—one California sperm bank requires all donors to attend or have graduated from a four-year university, stand more than 5-feet-9, and be “the best”—but with egg donation, the stakes are raised. Banks sell sperm for several hundred dollars, but IVF treatments run in the tens of thousands, so the couples who exercise the option are themselves more likely to have benefited from the privileges of higher education, art programs, and organized sports, and many of these high-standard patients are seeking donors who reflect back their own creative impulses or impressive educational achievements (if not their Swedish ancestry). But some of them are still seeking an outside edge: “The couples who ask about athletic achievements are often not themselves very athletic,” Witkin says. “They just think it would be good for the child.”
And these days, couples who ask for the full package shall receive it. That’s partly because the pool of potential egg donors has increased in the past couple of decades, but it’s also because clinic metrics for evaluating a donor’s genetic fitness have evolved. (Who knows? Maybe the three white ladies in Sherbahn’s initial donor pool were brilliant Olympian models, too.) Now, when a young woman comes to RMA interested in donating her eggs, she submits extensive details about her educational background, job history, and hobbies, as well as those of her immediate family members. (“A donor might be Phi Beta Kappa,” Witkin says, but she could be carrying genes from a relative with less impressive credentials.) The clinic administers basic tests measuring comprehension and reasoning skills—Witkin wouldn’t disclose the specifics of the exams, lest donors get ahold of the questions beforehand—but it also relies on alternate strategies for gauging smarts. A donor, Witkin says, may not have pursued higher education due to her family situation or finances, but perhaps she excels on the stage, or was raised by parents who built a successful restaurant business from the ground up, or has a brother who has risen to a high military rank—all pluses on a donor application. Medical histories and blood tests produce highly specified pictures of the donor’s genetic predisposition to diabetes, mental illness, or heart disease, which can help recipients looking to avoid doubling up on problem genes that run in their own families. Donors are also screened for depression (which could compromise their ability to undergo the hormone-heavy donation process), STIs (which lead to immediate disqualification), and pathological lying (which might cast doubt on the intel provided in their applications). RMA wants a donor who looks good on paper, but Witkin cautions: “You don’t want a donor who tries to make herself look too good.”
Speaking of looking good: Physical attractiveness is one demand that Witkin says patients rarely raise. “You would think that’s what everyone would be asking for, but it’s actually very unusual,” she says. RMA doesn’t provide current photographs of its donors (though baby photos are made available), but portions of the donor’s files could hint at beauty—this one’s an amateur model, that one works the pageant circuit. Rarely, she’ll get a couple that sheepishly discloses “gorgeous” as a requirement. But most of the time, recipients are happy to read between the lines. After all, they’re making a baby with a mix of genetic material, not picking out a fully formed 20-year-old woman. Says Witkin: “They don’t want someone else’s image in their head.”
Just a fraction of potential donors successfully complete the process—some are disqualified, and others drop out after learning the demands of the job—leaving the RMA with what it touts as a pool of “the highest quality donors” available. In return, RMA donors are paid $8,000 for each cycle. (They can complete up to six.) But women and couples looking for an even more elite breed of donor can pay for the privilege by enlisting the services of a private agency: In 1999, the California-based agency A Perfect Match famously advertised a $50,000 reward in Ivy League student newspapers for an egg donor who had scored more than 1,400 on her SATs and stands more than 5-feet-10. Fifty grand is on the upper end of the agency’s payouts, but many of its donors receive handsome—and controversial—rewards. Though selling human organs is generally illegal in the United States, egg donation is an exception that’s suspended in a kind of scientific-ethical limbo. The ethics committee of the American Society for Reproductive Medicine has decided that it is ethically justifiable to pay egg donors in order to “acknowledge the time, inconvenience, and discomfort” associated with the process (not to mention the risks of complications) but that their compensation should not vary based on the “number or quality” of the eggs removed, the success or failure of previous donated eggs, or the donor’s “ethnic or other personal characteristics.”
In other words, compensation is offered to women who perform the work of donating her eggs, but the eggs themselves don’t carry a price—so the process is simultaneously a selfless charitable donation and a bit of lucrative freelance work. (The Internal Revenue Service, for the record, views egg donation compensation as taxable income.) According to the ASRM, paying a donor more than $5,000 per cycle requires special justification, and sums “above $10,000 are not appropriate.” (In New York state, donors can also now be paid up to $10,000 to donate eggs for the purposes of scientific research.)
Most medical facilities that provide egg donation services voluntarily conform to that upper cap, and outlets affiliated with the ASRM can face sanctions if they don’t comply. (The ASRM won’t disclose the specifics of the penalty.) But many egg donor agencies that facilitate matches between donors and recipients aren’t compelled to follow the rules. For a 2012 study published in Fertility & Sterility, Columbia University clinical psychiatry professor Robert Klitzman scoured 102 websites that recruit egg donors and found that more than one-third of them pay more for donors with certain characteristics, like an elite résumé or a history of previous donations that have successfully produced pregnancies. Sixty-three percent of donor agencies without ASRM affiliation offered more cash, but 26 percent of approved ones did, too. Now, A Perfect Match advertises itself as a member in good standing of the ASRM and emphasizes its work “with many intelligent talented and attractive egg donors who ask for very reasonable compensation.”
In the end, these couples aren’t just looking to stack the deck in favor of their future progeny; they’re also looking out for their own psychological welfare. The Journal of Women’s Health study notes that women in search of an egg donor “often feel vulnerable, powerless, anxious, and insecure due to their infertility, contributing to their anxiety.” Taking a more “active role in donor screening and selection alleviates some of this anxiety, enabling recipients to feel as if they are ‘taking control over their destiny’ ” and granting them “some sense of maternal sovereignty.” Witkin, who also directs the Stress Research Program at the Icahn School of Medicine at Mount Sinai, says that the expansion of choices can grant recipients the peace of mind that they “are loading the dice in the favor for the child, every step of the way.”
But more choices can also amp up the pressure to pick the “best” one. “What is important is that there is a comfort level for the recipient couple,” Sherbahn writes, but it “seems that the comfort level was usually much easier to get to 15 years ago than it is today.” And the illusion of control can drum up false expectations over the outcome. “I tell all of our patients that this is not Match.com,” Witkin says. “You’re getting a mix of genes from the donor’s whole gene pool, so you might get genes from her great, great uncle Harry, or you might get ones from her grandma Sadie, or maybe the man’s genes will override it all anyway,” she says. “The point is: You do not get what you see.”