Eggs for sale

In a small bathroom of an old house, Maki (her name has been changed to protect her privacy) looks closely at her bare hip reflected in a mirror. Her long black hair hangs down her back. With a practiced hand, the 22-year-old art student from Japan injects a needle into a carefully targeted point on her hip.

Every day at the same time for two weeks before her ovulation date, this is her routine. “If I do it timidly, it will hurt,” Maki said coolly. “So I do it quickly.”

Maki is an egg donor. For a fee, she offers her eggs to a Reno fertility clinic, which in turn passes them along to infertile couples, most of whom are sterile because they have waited too long to have children.

In order to ensure healthy ovaries, Maki has periodic examinations, including ultrasound scans. She also has psychological tests to ensure that the stress of the procedure is not too emotionally taxing. She injects herself with ovulation-inducing agents to hyper-ovulate her ovaries, causing about 20 eggs to mature in a brief period of time rather than the single egg that the average woman releases during each menstrual cycle.

After she has completed ovulation and her eggs have grown up to 1.8 millimeters, Maki will have surgery to harvest her eggs. While she is under general anesthesia, a very fine hollow needle will be inserted through her vagina into the cervix. The needle sucks out the eggs.

“I don’t know what is going on during the surgery, but the antibiotics that I have to take after the surgery kill my stomach,” Maki said. One time she couldn’t eat for three days because her stomach was so upset.

After the two-month period of taking hormone pills, the two weeks of ovulation stimulation, the monitoring of her physical and mental health and eventual surgery, Maki receives $5,000.

Maki heard about the Reno-based Japanese egg-donation agency Family Line from a roommate’s friend two years ago. She was looking for a job to clear her credit-card debt.

“The reason I started was for money, so I did not think much of the recipients,” Maki said.

There is a strict wall of anonymity between donors and recipients, and the donors can’t know the recipients’ pregnancy status.

Maki said, however, her reasons for undergoing the procedure have changed slightly through the experience. The paycheck is the major perk, but the fact that she is giving couples the opportunity to conceive has also become important to her.

“I was very pleased to receive a card from a recipient that says, ‘We really appreciate the precious gift you gave us,'” Maki said. “Now, I hope they will have a baby because I know they spent so much money and had a very hard time.”

Hiromi Asahara, in-vitro fertilization coordinator of Family Line, said the motivations of the donors are diverse.

“First, they write their motivations on the forms. Most of them write it’s helping for others,” Asahara said, “but if one wrote it is for money to pay her tuition, who can say that is bad?”

Since the establishment of reproduction technology, such as egg or sperm donation and surrogate birth, academics and government officials have discussed its pros and cons extensively. Many developed countries, such as Germany, France and Sweden, have clearly defined laws that restrict assisted reproduction. Last year, Italy and Korea established similar national policies. But the United States doesn’t outlaw assisted reproduction.

Japan doesn’t have governmental restrictions, either. However, the Japan Society of Obstetrics and Gynecology regulates itself as if there were laws prohibiting egg donation for profit. Such self-imposed regulations force many infertile couples to come to the United States, where states like Nevada and California allow people to receive egg donations and find surrogate mothers legally. Agencies in the United States are the last resort for those who are refused treatment overseas.

Family Line is one of those agencies. It is affiliated with the Nevada Center for Reproductive Medicine, which had the highest fertility success rate in the United States in 2002. The agency connects egg donors with infertile couples living in Japan. Referred by the company’s business office in Tokyo, 50 to 60 infertile Japanese couples fly to Reno each year. The agency has consulted with more than 500 infertile Japanese women.

Japanese couples with fertility problems usually request an egg from a Japanese donor. But, compared to Caucasians, Asian donors are difficult to find. The shortage of Asian donors creates a gap between supply and demand, which increases the recipients’ cost for the eggs as well as the paycheck for a donor like Maki.

Currently, four to five of 20 Japanese egg donors at Family Line are students at the University of Nevada, Reno, and most of them are repeat donors. Japanese females aged 21 to 29, non-smoking with no genetic disease, are qualified for the anonymous-donor list. There is no need to be from a particular family or academic background.

“I hear some agency in California pays $10,000 for a Japanese donor,” Naoko Arai, the Family Line donor coordinator, said. “But because the money comes from the recipients, we try to avoid the ridiculous cost for them.”

In a typical case, Japanese egg recipients spend about $50,000 making use of an egg donation—without a guarantee of pregnancy.

"[The recipients coming from Japan] are very distressed. They failed external fertilization with their own eggs 20 to 30 times before coming here,” Asahara said.

Last year, the Japanese Health, Labor and Welfare Ministry tried to persuade the Japanese legislature to ban surrogate motherhood and egg donations from third parties for profit. Such a ban in Japan likely would increase the number of fertilizations that take place in the United States.

Noel Tiano, director of the Nevada Center for Ethics & Health Policy, pointed out the importance of developing regulations regarding the use of reproductive technologies in the United States.

“These standards can be formulated by regulatory bodies to ensure that potential for abuse is minimized in the sale of sperm or eggs, use of fertility drugs and their long-term effects, harvesting sperm or eggs postmortem,” Tiano said.

Tiano also said there are potentially harmful health effects related to being an egg donor. “Hopefully, [the donors] will be aware of the harmful drugs,” he said. “There are some kinds of risks involved.”

Maki is only partly aware of the risks. “I researched about the risks on the Internet, but I could not understand clearly,” she said. “I assume taking drugs is not good for my body. It might affect me later, but I do not take it seriously now.”

The Human Fertilization and Embryology Authority reports that ovulation-inducing agents cause a small number of women to develop ovarian hyperstimulation syndrome. OHSS, as it’s frequently called, causes severe ovarian hyper-stimulation, which leads to ovarian swelling and side effects such as nausea, vomiting, abdominal pain and swelling, and shortness of breath.

“As far as OHSS, we are monitoring the donors’ health carefully,” Asahara said. “I have never heard [of a] severe case occur[ring] in this clinic.”

There is also a concern that prolonged use of ovulation-inducing agents—especially when not followed by conception and delivery—increases the risk of breast and ovarian cancer.

To minimize health risks, the American Society for Reproductive Medicine recommends that women not donate their eggs more than five times in their lifetimes. But $5,000 is a lot of money, and some women, especially those for whom money is tight, see nothing wrong with stretching those guidelines.

Maki said it’s possible to take egg donations beyond the five-time limit with a doctor’s approval.

“I can’t tell my debt to my parents, so I have to take a risk,” she said. “Hopefully, I will continue [the egg-donation process] several more times before I graduate.”

Maki completes her seventh egg donation procedure this month.