Like a Virgin (34 page)

The free movement of people across the European Union makes it difficult to crack down on the trade in eggs, all the more so since the demographic changes over the past few decades mean that
some countries have a shortage of eggs and others have a youthful supply. Jacques Testart, the research director at INSERM, a medical institute in Paris, was not particularly surprised by the
stories coming out of Romania and Cyprus. ‘There are rumours circulating about trafficking
in Europe, although they are difficult to prove,’ he told the news
agency AFP. ‘There will always be a need for the “hens” and there will always be women who do that to earn a bit of money… especially in the current economic crisis.’
One gynaecologist, who spoke to AFP on condition of anonymity, claimed that egg trafficking is common in Cyprus. ‘Everyone knows that, but we don’t do anything [about it],’ the
doctor alleged.

Eric Blyth, a professor in the Department of Human and Health Sciences at the University of Huddersfield, has identified three key characteristics of the countries that have become popular
destinations for fertility tourism: ‘First, the lack of regulation affording adequate protection for the parties most directly affected, i.e., donors, surrogates, patients, and children;
second, the operation of a commercial market in human gametes – especially eggs – and women’s gestational services; and third, a level of secrecy that helps to conceal
unprofessional, unethical, and illegal practices.’ Because of these issues, the UK’s Human Fertilisation and Embryology Authority (HFEA) has called the use of foreign egg donors a
‘profoundly exploitative and unethical trade’.

There have also been shenanigans involving sperm acquired by ill-gotten means. In the past decade, a number of internet businesses have cropped up that claim to be able to put people desperate
to become parents in touch with potential sperm or egg donors, or to supply donations directly, serving as a middle man. The online services may appear to be an easier, cheaper, and less
bureaucratic option than going through a government-licensed clinic; they also rarely advertise, say, the sperm shortages that characterize the market, which makes them seem more likely to deliver
the goods. But such sites may pose a risk to people trying to find help. In fact, since April 2007, it has been unlawful to ‘procure, test or distribute’ human eggs or sperm for human
reproductive use in the UK without a licence
from the British government authority that regulates fertility work. Regulated clinics in both the UK and the US are required to
freeze and store sperm for six months before it is used by a woman, during which time the clinics test it for HIV and other diseases, but internet traders selling ‘fresh sperm’ had not
been required to do such checks. The law, called the Human Fertilization and Embryology Act, was brought in to regulate the use of fresh sperm, with a view to ensuring it is safe. In addition, via
the internet there is generally no way to confirm that the donor is who he says he is, and, as a result, the safeguards that UK and European law offers to parents and any resulting children may not
apply. And given the internet’s ability to cross borders, there is little that can be done to force a site based in another country to follow local law – an issue made even thornier in
the US, where state laws may vary considerably.

In 2009, the UK saw the first prosecution of an internet sperm trader under the new law. The case involved a website called Fertility First, through which fertility patients could select from a
database of anonymous sperm donors and order ‘fresh sperm’ to be delivered, for a fee, direct to their front door. A customer, Melissa Bhalla-Pentley, paid £530 to receive this
convenient sperm supply, a price tag that allegedly included reimbursement of the sperm donor’s expenses as well as a site membership fee, a courier charge, and a per-cycle cost for the sperm
itself. When she failed to get pregnant, she arranged for another donation – an extra £300 charge. She had requested the donor’s medical records, but when they arrived she noticed
that his name was visible, ‘just lined through with a black marker’. Something seemed amiss. At the very least, the company had breached protocols of donor privacy. When her request for
a refund was refused, Bhalla-Pentley went to the police with her complaint.

When the case came to court in 2010, it emerged that the
entrepreneurs behind Fertility First had earned up to £250,000 from about eight hundred customers. Two men
were found guilty of procuring and distributing sperm without a licence, as required by UK law. The sperm donors were reported to have received no payment at all for their services, nor had they
realized, by their account, that Fertility First was unregulated. In the
Daily Mail
, reporter Laura Topham related how the enterprise had been hatched after the men overheard a childless
woman in a pub talking about her desire to get pregnant – ‘she wanted sperm delivered like milk in the morning’.

This is what reproduction looks like when capitalism’s invisible hand has a free rein. Where there is demand, a supply will be found.

In order to give birth, a woman first needs eggs, and then needs sperm. That’s how reproduction works today. If she doesn’t have good quality eggs of her own, and
has no access to safe sperm, there are currently few channels through which she can acquire either, outside of the donor market. But doctors are developing ways to bypass the market –
including a treatment that is already being used successfully.

Eggs develop in ovaries, of course, but what is contained in the ovaries are not strictly eggs but immature ‘follicles’, clumps of cells that contain a single oocyte that grows and
develops into a mature, ready-to-be-fertilized egg. This is why the key hormone in timing of conception and in IVF treatments is called follicle-stimulating hormone (FSH): the hormone stimulates
the follicles to grow and eventually erupt, releasing the egg during ovulation. This means, however, that acquiring a healthy ovary, or even strips of tissue from a healthy ovary,
and transplanting it into a woman is another way of getting around the problem of scarce good eggs. If the tissue has follicles that are still receptive to FSH, a woman would once
again be able to generate eggs, no matter what her age. Take the case of Susanne Butscher, a woman who became infertile at the age of fifteen when her ovaries failed, causing her to experience a
very early menopause. In November 2008, at age thirty-eight, she became the first woman to give birth after receiving a transplanted ovary.

Ovary transplants were developed for women, like Butscher, who suffer early menopause, or for those undergoing chemotherapy or radiotherapy to treat cancer. While strips of ovary can be removed
from a woman without ill effects, removing the ovaries themselves can trigger premature menopause, with all of the associated ill health effects. However, Dr Sherman Silber, who performed
Butscher’s transplant surgery, sees the potential for using the procedure as allowing women who have delayed motherhood for any reason to improve their chances of having a baby later in life.
Rather than freezing eggs and undergoing IVF with them, a whole ovary could be frozen; the tissue would be viable for up to a decade. While the extraction and transplant surgeries are invasive,
they could circumvent some of the problems associated with other fertility treatments. Children conceived through ICSI or IVF, even those conceived simply through the use of drugs to induce a
woman’s eggs to be released for harvest, appear more likely to have problems with genetic imprinting, growth, and defects. And, unlike with IVF, a preserved or new ovary gives women the
option of conceiving a child via sexual intercourse with a fertile partner. After her transplant, Butscher started having periods again, for the first time in twenty-three years, and she and her
forty-year-old husband used no other fertility treatments. Indeed, the oestrogen, progesterone, and testosterone produced in the ovaries affect the female body in
many ways,
including protecting the bones from osteoporosis, and Butcher’s bone health improved as well.

Not everyone found good news in Susanne Butscher’s case. Just as happened when Louise Joy Brown entered the world as the first test-tube baby in 1978, the delivery raised moral and social
concerns in many quarters. Chief among them: were surgeons using science as a tool to alter the child-bearing age for women? The UK’s Royal College of Midwives, for instance, stated that it
would be preferable for surgeons to limit ovarian transplants and other reproductive technologies to women who are ‘truly’ infertile – meaning that they have become infertile in
their twenties or earlier – and who are desperate to conceive. This would include Susanne Butscher, of course, but also survivors of childhood cancers who show evidence of normal ovarian
function, but who will require a therapy that would otherwise destroy their ovaries. Right now, women battling cancer at a young age must either become a mother before treating the cancer, or treat
the cancer – hardly a happy choice to make. But is it fair to say that some women, because of a medical condition, ‘deserve’ to benefit from these technologies, while others,
because of societal and economic conditions, do not?

Those working on the frontline with people who are infertile argue that modern lifestyles are altering the child-bearing age for women – making it difficult for women to have children
earlier in life. And then there is the question of how to define a ‘truly’ infertile couple. Yes, a man or a woman may be biologically ill-equipped to have a child together because of
the health of their sperm and eggs, but a lesbian couple could make the case that they fall into this category, too: they don’t have the healthy sperm they need to have a child. In a
statement on why IVF treatments for infertile couples should be a priority for the National Health Service, the British Fertility Society wrote
that those ‘involved in
infertility services are all aware that we are not just dealing with a physical pathology. Infertility is a disease, but it also has fall-out beyond that… causing mental health problems,
depression, stress-related illnesses, and so on.’ These are serious health conditions, and if we have the tools to treat the underlying problem – the inability to have a child, at a
time in life when a child is desired – shouldn’t we do so?

Susanne Butscher, for one, would probably agree with that idea. She and her husband named their baby Maja, for the Roman goddess of rebirth and fertility, and Butscher said Maja gave her
‘a sense of completeness [she] would never have had otherwise’.

Ovary transplants require a supply of compatible ovaries, so the problems that come with the trade in eggs and sperm – replete with misstatements, privacy violations,
skirting regulations across borders, and criminal scandal – may well apply here too. And there are documented reports of a black market in body parts for transplant surgeries, so the
infrastructure is already in place for ovary trafficking if the surgery is allowed to go forward on a larger scale. So scientists are considering how to take the idea behind ovary transplants and
apply it to reproduction, without the demon of a limited supply of organs to meet demand.

Eggs and sperm are collectively called
germ cells
for their potential, somewhat like seeds, for growth to emerge after a period of dormancy. Early in evolution, a process of segregation
must have happened so that germ cells were kept apart from all our other cells, possibly as a way to protect the integrity of their essential genetic material, in case nutrients became scarce
and reproduction had to be delayed. Germ cells, of course, have a special place in our life cycle because they are essentially immortal – they provide the fundamental
link from one generation to another. They must also be able to re-create the entire organism. At the same time, as we have seen, they have a pernicious shelf life, made all the more frustrating to
many people by the fact that each of us has a limited supply. The first question to tackle, then, is whether a woman’s body might somehow be triggered to make eggs on its own, without
resorting to getting follicles from an outside source – in essence, creating a new supply of eggs. In fact, there is a debate around whether a woman is really born with all the eggs that she
will ever have in her life, a debate that has been raging for nearly a hundred years, since the German anatomist Heinrich von Waldeyer-Hartz first proposed, in 1870, that all female mammals stop
producing eggs around the time they are born.