I’m sure you’ve seen them in the media: attractive, well-off, smiling parents holding adorable infants created by third-party reproduction and assisted reproductive technologies (ART). Of course, the narrative goes, this development is a win-win for all. Who could object to children being created for those who through either infertility or biological sex are unable to reproduce?
But this picture hides the highly profitable fertility industry’s dirty secrets. It ignores what is required to create these children: exploitation, health endangerment, and the commodification of human life. An honest look at the facts and circumstances surrounding third-party reproduction and ART should give any thinking person pause.
The Exploitative Consequences of Egg Harvesting and Surrogacy
Third-party reproduction first of all requires the procurement of gametes, a man’s sperm and a woman’s egg. The egg is artificially inseminated, and a woman must gestate and give birth to the resulting embryo or embryos. What, in terms of chemicals and technology, is involved in obtaining the necessary human gametes? Here, biology is not exactly fair. While sperm is obtainable through the straightforward process of male ejaculation, it’s a radically different situation to obtain eggs. The egg provider must undergo weeks of painful self-injections of carcinogenic synthetic hormones and other drugs followed by surgery for egg retrieval.
Normally, a woman produces one or two eggs per month, but third-party reproduction calls for more. The object of eggsploitation is to generate as many eggs as possible at once. What is eggsploitation? Eggsploitation is the artificial procurement of an unnaturally large number of eggs—sometimes dozens—from healthy young women.
But acquiring eggs isn’t enough. You also need a womb. The surrogate mother, the woman who will gestate and give birth to the resultant embryo, must undergo a similar regimen of dangerous and painful procedures to prepare her body for implantation and gestation.
All of these procedures to which the egg provider and surrogate are subjected pose devastating short- and long-term health risks. The short-term risks include ovarian hyperstimulation syndrome (OHSS), characterized by difficulty breathing, excruciating pelvic pain, swelling of the hands and legs, severe abdominal pain and swelling, nausea, vomiting, weight gain, low urine output, and diarrhea. OHSS can be fatal. Other short-term risks are ruptured cysts, ovarian torsion, blood clots, chronic pelvic pain, premature menopause, infection, difficulty breathing, allergic reaction, bleeding, kidney failure, stroke, and even death.
The long-term risks include cancer, especially reproductive—ovarian, breast, or endometrial—cancers, and (in a sad irony) future infertility. Both surrogates and egg providers are typically given Lupron, a drug that is notapproved by the FDA for fertility use (it is used to treat men with advanced prostate cancer) to produce the onset of menopause with potentially incapacitating and long-lasting effects. Lupron and Synarel are used off-label and are Category X drugs, meaning that if a woman gets pregnant while taking the drug, the fetus will be harmed. Lupron also puts women at risk for intracranial pressure.
Real People, Real Lives at Risk
It is important in any discussion of these issues not to get lost in abstraction. The new documentary Eggsploitation: Maggie’s Story, produced by the Center for Bioethics and Culture, provides a very up-close-and-personal view of what actual women are subjected to by fertility clinics and the tragic consequences that can follow egg selling.
A thirty-three-year-old woman who began selling her eggs in college, Maggie was lured by the typical combination of financial need and the desire to help someone have a child. She was paid $1,600 and went on to sell her eggs ten times. After her second or third egg sell, she had, for the first time, an abnormal Pap smear test result. The last time Maggie sold her eggs, she went for the customary physical exam, and a lump was discovered in her breast. The clinic recommended that she see one of their “associates” down the street for consultation. The “associates” dismissed the lump as probably just a cyst. Maggie went through another cycle and felt the lump grow over the next three months.
At that point, at the age of thirty-two, Maggie went to her own Primary Care Physician, who did a biopsy. She was diagnosed with stage IV breast cancer that had spread to her bones and liver. Maggie had no genetic history of cancer. Her doctors informed her that this form of cancer generally only occurs in menopausal women or those who have been pregnant three or more times.
In the film, Maggie recounts the ways in which the fertility industry emotionally manipulates naïve young women by telling them they are special, they are the “chosen” ones, they are part of a team, part of a “family.” The guilt-tripping narrative prevents women from backing out; they are made to feel bad for not wanting to help someone. This emotional blackmail exploits the sexist stereotype of women as altruistic, self-sacrificing givers whose role in life is to be of service—particularly of reproductive service—to others.
Little Oversight or Care
How can this happen? The answer is quite simple: There is virtually no regulation of the fertility industry in the United States. For this reason, it has become a popular destination for international fertility “tourism.” The American Society for Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technologies (SART) issue recommendations that are strictly voluntary and therefore unenforceable. For example, they advise that women undergo no more than six stimulated cycles, yet Maggie underwent ten.
There are no national registries to track the health of the women who sell their eggs or rent their bodies as surrogates. Once the woman has performed her function as an egg provider or “gestational carrier,” she is discarded and forgotten, even though she may suffer serious long-term health consequences.
Most concerning, there are no peer-reviewed medical research studies on the long-term health and safety effects of egg hyperstimulation or surrogacy. This makes it impossible for fertility clinics to provide adequate and accurate information to their recruits and impossible for women to give informed consent.
What about the children produced by third-party reproduction? The women used as breeders have few, if any, rights or protections, but the children have absolutely none. For the sake of donors’ privacy, the children have no right to information about their genetic history, despite obvious life-long ramifications for their health and medical care. In addition to frequently not knowing who their biological parents are, they have no way of knowing about any siblings they may have. A 2001 study in the journal Human Reproduction concluded that “Disclosure to children conceived with donor gametes should not be optional.” The study cites the strongly supportive international response to the UN Convention on the Rights of the Child (1989); it was the most rapidly signed human rights convention in UN history. One of the fundamental rights included in the convention is the right to know one’s parents. In the debate about donor/seller anonymity this has been expressed as the child’s right to know the identity of his or her genetic parents. As the study states: “Increased knowledge and a gradual shift in attitudes have enabled us to acknowledge that in our contemporary culture young people have strong moral claims to know their genetic identities. It is now time for these moral claims to be converted to legal rights.”
Surrogate births intentionally sever the natural maternal bonding that takes place during pregnancy. The Journal of Child Psychology and Psychiatry published a study in June 2013 that found that “the absence of a gestational connection to the mother may be problematic.” The study also noted that children’s problems may be underreported by the procuring parents who wish to “present their children in a positive light.” The biological link between parent and child is undeniably intimate; when severed, there are lasting repercussions for both parties. A 2013 study in Reproductive BioMedicine surveyed 108 parents of children conceived via egg purchase and found that 50 percent regretted using anonymous providers for these very reasons.
Biological Bonds Matter
In her book Origins: How the Nine Months Before Birth Shape the Rest of Our Lives, Annie Murphy Paul documents the emerging field of fetal origins. Over the last twenty years, scientists have improved our understanding of how experiences in utero exert lasting effects from infancy through adulthood. The research reveals that pregnancy is a crucial staging ground for our life-long health, ability, and well-being. For instance, individuals gestated during the Nazi siege of Holland in World War II continued to feel its consequences decades later. As a result of both the siege and a severe winter that resulted in famine, studies demonstrated that people whose mothers were pregnant then have higher rates of diabetes, obesity, and heart disease later in life. Their exposure to insufficient nutrition in the womb appears to have had long-lasting effects on their health. In addition, a study published in the Journal of the American Medical Association in 2005 showed that people born to women during the famine were twice as likely to develop schizophrenia. It has been found that severe maternal malnutrition can be a contributing factor in the development of schizophrenia.
Murphy Paul also learned that pregnant women who experienced the 9/11 attacks passed their trauma on to their offspring in the womb. That’s right, newborn children were born with the effects of PTSD, and these stay with the child as she or he matures. A PTSD expert, Rachel Yehuda, studied thirty-eight women who were pregnant when they were exposed to the World Trade Center attack, measuring their basal cortisol levels and those of their infants at one year of age. The women who developed PTSD following 9/11 had low levels and so did their babies. The further along in their pregnancy, the more pronounced were the effects on the children. According to Yehuda, “The particularly strong effects seen after exposure in the third trimester point to prenatal factors, rather than genetic or parenting factors, in the transmission of PTSD risk.”
The pregnant woman is not merely a source of potential harm to the fetus but a source of influence on the future child more powerful and positive than previously known. As Murphy Paul writes, “Pregnancy is not a nine-month wait for the big event of birth, but a momentous period unto itself, a cradle of individual strength and wellness and a crucible of public health and social equality.”
Knowing this, how can we permit this systematic severance of the inextricable union between a pregnant woman and the developing fetus within her? How has our society come to regard the primordial bond between mother and child as easily and inconsequentially severable? How can we accept the creation of a breeder class of marginalized women for the use of wealthy clients? How do we allow scientists and would-be parents to artificially engineer children with no concern for their innate rights to their biological parents, their identity, their health, or their future? How has it become permissible to subject human beings to painful, health-endangering, and even life-threatening procedures to fulfill the desires of those who feel entitled to a child and are wealthy enough to pay?
In a recent article, lesbian feminist Julie Bindel wrote about the international baby business that’s exploding with the marketing of surrogates to gay men. She observes:
As society becomes ever more divided between haves and have-nots, as people from Greece to India to Mexico to the United States become more financially desperate, as corporations turn all living things—from plants and animals to human beings and the earth itself—into commodities for profit, we must ask ourselves: have we degenerated into a dystopia where the marginalized and most vulnerable are fair game for exploitation and children are products to be designed and engineered in a eugenic manifestation of narcissism?
I don’t believe that this is the kind of world that most people want to live in, at least I hope not. If this is not the kind of world you want to live in, it is incumbent upon you to take action. Join the international Stop Surrogacy Now campaign, educate and organize your local community, write letters to the editor, meet with your state and national elected representatives, picket fertility clinics, generate media attention, develop broad-based coalitions, including with those whom you may strongly disagree on other issues. The train has certainly left the station and is gaining speed but it can be stopped if we are actively committed, organized, and demand that our voices be heard. Take action now and remember—the next Maggie could be your friend, your sister, or your daughter.
Kathleen Sloan is a former member of the Board of Directors of the National Organization for Women (NOW), executive director of Connecticut NOW, a consultant on third-party reproduction issues, and co-author of the book Race and the Genetic Revolution: Science, Myth and Culture. She has a master’s degree in international relations and has traveled the world advocating women’s rights, including at the UN Human Rights Council in Geneva and the UN Commission on the Status of Women in New York. This article was published in Public Discourse and is reprinted here with permission.
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