Book Review: Eggonomics – The global market in human eggs and the donors who supply them

Eggonomics: The Global Market in Human Eggs and the Donors Who Supply Them
By Dr Diane M Tober
Published by Routledge
ISBN-10: 1032549912, ISBN-13: 978-1032549910
Buy this book from Amazon UK

In her aptly named book Eggonomics, author Dr Diane M Tober uses a combination of interviews and scientific research to analyse the commodification of human eggs in the fertility industry. She focuses on the egg market in the USA and Spain, drawing out similarities and differences in the egg donation process.

The actual medical process is identical in both countries, requiring women to go part-way through an IVF cycle to have their eggs collected and distributed to other patients.

The book extensively details the significant developments in this process, for example, the development of oocyte vitrification, which created new options for banking and then selling eggs. For me, the most poignant part of the book is the discussion of how the process can be distorted due to favouring profit over the patients.

Dr Tober lays out the economic infrastructure of the USA and Spain, detailing how it sustains this intimate medical industry. She makes the compelling point that when bad actors manipulate this infrastructure, the consequences can be unbelievably dire. Specifically, there is a significant threat of donors being treated as products rather than people, resulting in the overvaluing of profit against the respect, health and dignity of patients. Donor women can end up with life-long fertility issues; donor-conceived children can feel incomplete, with a lack of understanding of where they come from, and egg-seeking individuals can be denied wanted or necessary contact with donors.

The book is an interesting balance of positive and negative stories in extremities. Dr Tober uses personal interviews to express the range of experiences faced by women across the industry, which was a welcome addition to a medical process that can feel detached and cold.

Often in the book, there was a feeling that throughout the donor process, clinical metaphors like 'egg machines' dehumanised everyone involved and revealed objectified thinking from the industry.

Although this was a very prominent feature of donor experiences, the motivations and outcomes were mainly regarded as positive. When egg donors were coached through what their donation means, many felt that they have given a gift to a struggling family and felt a strong sense of satisfaction. However, it was evident that when donors are treated as mere instruments to achieve a goal, they faced difficult emotional conundrums – notably how to engage in this disconnected form of parenthood.

There are notable instances where donors had conflicting feelings about egg donation, revealing the often confusing relationship donors have with their eggs. This confusion is sometimes exacerbated into lifelong regret if the clinic does not perform its due diligence in making sure donors are mentally well post-donation. Many donors came to consider the eggs they have given away as a type of child, referring to them as 'egg babies' or simply, their children, intensifying a feeling of abandonment. There was a sense in the many interviews that Dr Tober conducted that a significant number of women felt that they had given up something priceless for an economic incentive.

This points to a wider issue, particularly in the USA, that many donors chose to donate their eggs because they were struggling financially. Therefore, although a large number of donors felt a sense of satisfaction for helping others, many resented the financial position that made them feel they had to sell eggs to relieve financial stress.

This sentiment was shared across both the USA and Spain with certain troubles specifically pointed to as a motivator for egg donation, such as the high cost of living, tuition debt and their own medical bills. It is suggested in the book that this is a type of financial coercion, especially when the marketing and recruitment of egg donors are more closely scrutinised. One of the most troubling aspects of this recruitment was the focus on Ukrainian women, who were highly sought after when they arrived in the USA and Spain during wartime as refugees. For all women, there is a risk that after financial burdens are alleviated because of the large payout, donors can start to feel a much stronger sense of regret. I cannot begin to imagine how this would feel for recent refugees who are facing the harshest circumstances both mentally and economically.

The economic incentive in both Spain and the USA is a complex problem that can reveal racist and eugenics-influenced issues. In the USA, consumers are allowed to pick and choose the donors, while in Spain donor screening is left to the medical professionals. The menu-like nature of the US system is most open to the criticism that there is a eugenic approach to selecting and purchasing eggs, with preference being given to eggs from white and fair-skinned donors of European descent. Even in Spain where this menu-like system does not exist, the selection criteria for donors results in a preference for white donors. Within Spain, this criterion is based upon the degree to which the donor bears phenotypic resemblance to the clinic's intended parent population.

Based on the idea that white eggs are more marketable, black donors are often paid significantly less than their white or Asian counterparts, which has secondary effects on black donor-seeking patients who then have limited options regarding phenotypic resemblance. The Kamakahi vs the American Society for Reproductive Medicine (ASMR) decision is highlighted to further explain the racial inequality that permeates the industry. The decision resulted in white and Asian donors receiving dramatic increases to their compensation rates in the USA, but had little effect for black and Hispanic donors.

Dr Tober highlights how African American donor, Allyn, was told by a white nurse that 'there's just not as much demand for African-American donors. You know, African-Americans and Hispanics don't have infertility problems as much because they have their babies young rather than pursuing education.'

These mass generalisations reveal the racist assumptions that permeate the interactions between medical professionals and donors and ignore the fact that the financial incentive is not comparable for black donors compared to their white and Asian counterparts. This kind of thinking was described in the book as the 'Black Fertility Myth', which outlines the structural obstacles that many physicians create when diagnosing and treating black patients, a situation which is not just limited to the fertility industry but speaks to wider medical mistreatment of black patients in America.

Dr Tober also suggests that the lack of eggs donated by black patients could also be attributed to black egg donors not being recruited with the same intensity, because the clinics have to focus on how these eggs will be marketed and what kind of profit they will receive. Many clinics, especially in the USA, try and circumvent this criticism by placing the onus on the patients who choose their donors.

Overall, this book presents an interesting nuance in the egg-donation industry. The focus on the experiences of actual donors does an excellent job of highlighting the complicated process of egg donation both medically and emotionally. The data from the interviews encapsulates the joy that many women feel knowing they have helped another person on their journey to start a family while also foregrounding the mistreatment that many donors face, whether that be in their over-objectification or harm resulting from racist thinking.

Even in the drastically different systems of the USA and Spain, the same threats to dignity and justice for patients are evident. Although generally considered a happy business because of the often successful creation of families, the side of the fertility industry that prioritises profit over people is rife with patient horror stories. Where medical decisions are far less patient-focused there are a litany of issues: patients may be misinformed or feel as though the negative effects were not explained to them in totality; and medical professionals can be spread too thin, meaning they are unable to provide patients with sufficient exit strategies.

Although the resounding feeling I had from the book was positive, there is room for improvement – in particular, ways that the industry can treat patients better, and do more to avoid devastating and life-ruining consequences.

Buy Eggonomics: The Global Market in Human Eggs and the Donors Who Supply Them from Amazon UK.