Standing 5-foot-8-inches, and weighing in at 130 pounds, Santa Cruz resident Raquel Cool hardly stands out in a crowd—but she’s a hot commodity if you’re in the market for human ova. The 27-year-old, college-educated, trilingual triathlete of Chinese-American descent, who was born and raised in Panama, is currently making a living by donating her eggs to couples that cannot conceive by natural means.
Considered by some to be an altruist and by others to be little more than a pawn in a multi-billion dollar industry—the projected gross revenue of the U.S. fertility industry in 2013 is $4.26 billion according to Harper’s Index—Cool is one of thousands of women across the country that put the human egg trade in motion. But her reasons for doing so are much more pragmatic than you might guess.
Having grown up in a tri-cultural military household, which moved around every few years, Cool’s understanding of what a family is has always gone beyond genetic makeup. “[A child] doesn’t necessarily have to be born of me to be my family,” says Cool, who has dreamt of adopting since her youth. “At the same time, I do harbor this biological urge to pass on my genes.”
“When you first go through the [egg donation] cycle, you’re very hormonal, and for me, it was very much about being maternal, wanting to delay my own motherhood,” she goes on. “I thought about this concept of deconstructing motherhood. For example, if you want to carry a child, you can become a surrogate carrier and rent out your womb; or, if you wanted to raise a child full time, but temporarily, you can become a foster parent; and if you want to pass on your genes, you can become an egg donor. Whereas now, my attitude about it has sort of shifted into this more masculine, almost desire to impregnate as many people as possible. And I’m fascinated by technology and the ability to let a woman do that.”
Cool’s experience as an egg donor and fascination with the idea of family, motherhood, the human egg trade, the marketability of personhood, making a living as an egg donor, and the use of the body as economy is the subject of a new art installation, entitled “Live Nude Eggs,” which debuts this month at the opening of Vapr Labs, the first commercial gallery in Downtown Santa Cruz that is focused on the economies of contemporary art, founded by Mark Shunney and Rob Maigret.
When she was first introduced to the idea of donating her eggs, Cool was 20 years old and attending college in Miami, Fla. “My friend was thinking about doing it, so I remember the four of us, these 20-year-old women, hovering over this computer looking at all of the pieces of the puzzle and getting more and more turned off,” she remembers.
Her initial apprehension stemmed from the idea of an invasive surgery, weeks of self-administered hormone injections, and lack of studies on the effects of egg donation, on donors in particular. In extreme cases, women have died from the procedure, however, the biggest risk is ovarian hyperstimulation syndrome (OHSS), a temporary complication caused by fertility medication which can cause the ovaries to become very swollen, and fluid to leak into the belly and chest area.
While none of her college friends ended up going through with it, Cool continued her research on the topic, and eventually decided to become a registered egg donor. Her eggs were first harvested in September 2011. And despite coming down with a moderate case of OHSS—“My ovaries went from the size of walnuts to grapefruits pretty much—they felt like overfilled water balloons,” she says with a laugh—10 months later, she was hooked.
The Road To Conception
For Cool, the process to become an egg donor was lengthy, intensive, and at times painful and humiliating, but ultimately rewarding.
It began with a Craigslist search. There, she found an agency advertising for donors, and, once she applied, the screening process began—first a phone screening, then an in-person interview. At the meeting she was given a thick packet, “that asks you everything from extensive reporting on your genetic history, to what your favorite book was when you were a kid, to your favorite color, to your favorite TV show, to what countries you’ve visited,” she says. All of that personal information, as well as a photographic history of the potential donor’s life, is then compiled into a profile and added to a donor database for recipient parents from around the world—Assisted Reproductive Technology is banned in many countries—to review. “Your personality is basically relegated to ad copy,” she says.
Though Cool has now been fully registered with three different egg donor agencies, she says the intrusive screening process hasn’t gotten much easier. “All I know about [the recipient parents] is their first names,” she says. “I can’t express how lopsided it feels. You truly feel like you’re on the observed side of a one-way mirror.”
Once a couple is interested in a particular donor’s eggs, the agency will ask her if she is willing and available to proceed with an egg donation. Next comes a screening with a psychologist who specializes in reproductive services. He or she asks the donor to take an assessment (Cool’s was about 500 questions), featuring yes/no or true/false questions, like “Sometimes I think about killing myself” or “Sometimes I feel like people are out to get me,” plus more benign statements like, “I believe the world is a just place,” or “I have people I can turn to when I need it,” says Cool.
If the donor passes the test, she meets with a genetic counselor that reviews her family health history. Donors then have the option of reviewing the egg donation contract with a lawyer who specializes in reproductive law.
“Basically it’s a thick contract that says once the eggs are harvested from your body, they become the property of the recipient parents and they can choose to do whatever they want with those eggs,” explains Cool. “They can put them on ice, they can donate them to other families if they want to, they can discard them, they can donate them to stem cell research, or they can use them.”
Another part of the contract is also interesting.
“It states very clearly that eggs are not being sold as part of a transaction,” Cool adds, “that they are being donated, and that any compensation is considered an honorarium in exchange for the time and effort and discomfort involved with the procedure.”
When a couple chose to receive Cool’s eggs in 2011, and she consequently underwent her first cycle, she was compensated $7,000, a number calculated by the egg donor agency, based on her profile, to account for her time, effort, reimbursement, risk and pain. Repeat donors who are proven, meaning their cycles have resulted in pregnancies, are considered to be more desirable candidates, and have a higher rate as a result. Since Cool’s first cycle resulted in a pregnancy, her rate went up to $10,000 at one agency. Her eggs are valued at $8,500 at the other two agencies where she is registered.
The contract states that regardless of the number or quality of eggs harvested, the donor is compensated her rate. If the donor has a significant other—whether she is married or not—her partner is also required to sign off on the contract, representing their consent.
Another factor that can impact a donor’s rate is her race. “Jewish and Asian eggs tend to fetch higher values,” says Cool. “And women who are Ivy League-educated or models, or have proven athleticism, like maybe they were on their college team or something, they could get paid $50,000 to $100,000 sometimes.” The American Society for Reproductive Medicine (ASRM) states that donor compensations beyond $10,000 are inappropriate, but legal limits are not enforced, and, particularly in the case of elite genes, higher rates are not unheard of.
Donor compensation is just one of the many costs associated with egg donation. One agency informed Cool that recipient parents can spend $40,000 or more per cycle.
“I used to think that the recipient parents would be wealthy because they’re paying [so much],” says Cool. “But I realized that some people just go broke trying to conceive, [especially since] oftentimes it doesn’t happen the first cycle.”
Dr. Mary Abusief, a board-certified reproductive endocrinologist and infertility specialist at the Fertility Physicians of Northern California, confirmed that while the expense of the egg donation process is high, it can be explained by what’s involved. “You have to consider the detailed medical screening of the donor and intended parents, the technology involved in the IVF process, the coordination involved in aligning the cycle of the donor and recipient and the stipend for the donor. Additionally, egg donation is associated with a high rate of success (conservatively 50 percent per cycle) and if frozen embryos are created, a single cycle can result in the chance for more than one pregnancy and baby,” explains Abusief.
Once the contract is signed, the donor undergoes a series of physical tests to measure her hormone levels, check for STDs and make sure that her blood is healthy. After she has passed the tests, the donor is sent a large box of medication.
“I call it The Human Egg Retrieval Kit,” says Cool. “It was full of all the injections and hormones that you’ll be shooting up for the next few weeks.”
The donor is then required to take a series of injections that stop her from ovulating. After about a week, she starts taking follicle-stimulating hormones. Though some women experience little or no discomfort throughout this process, Cool says she was often uncomfortable and irritable.
The donor then undergoes a series of transvaginal ultrasounds in which doctors monitor the size of her eggs. Once a doctor has determined that it’s time to remove the eggs, the donor receives her last injection of human chlorionic gonadotropin (hCG), which triggers the eggs so that they can be released.
While the goal is to ultimately harvest about 15 eggs, Cool produced twice that number in her first cycle. A total of 30 eggs were extracted during her surgery. Aside from a follow-up appointment to ensure that the donor’s body has returned to normal, Cool says that the only confirmation the donor gets after the surgery is a “yes” or a “no,” either the woman became pregnant or she did not.
It’s Not Personal, It’s Business
The Fertility Physicians of Northern California advertise egg donation as “a very kind and generous act that is deeply appreciated by the people who become parents.” And for Abusief, it’s one of the best parts of her job.
“For many couples who suffer from infertility, the emotional toll can be tremendous,” says Abusief. “Egg donation is not only an option, it’s a wonderful option for couples who can’t conceive. It’s an opportunity to use at least 50 percent of a couple's genetic material and for a woman to carry a pregnancy and give birth to a baby even if her own eggs are no longer usable. Egg donation is such an amazing gift. For many couples, it’s absolutely like receiving a heart transplant.”
Abusief is the first to admit that egg donation is not the right choice for everyone, and is a big proponent of adoption as another alternative, but she says, “It can offer a tremendous amount of hope.”
In Cool’s experience, however, the dividing line between what’s personal and impersonal is blurred in the human egg trade. At the same time that egg donor agencies are striving to keep the entire process as impersonal as possible, distancing the parents from the donor, and using phrases like “You’re strictly donating your genetic material” or “The building blocks of life,” the intrusive screening process and transfer of reproductive matter makes the process inextricably personal.
Meetings between the recipient parents and the donor are often discouraged by egg donor agencies, unless the parents are insistent. “One agency actually told me that they’re afraid of the donors because they don’t want you to get too invested,” says Cool.
In addition to being intentionally separated from the parents, Cool found that the process made her feel isolated. She says she met with a psychologist only once during the screening process, and met with her agency only once. From then on, her only contact with the agency was in the form of appointment reminders.
Her sense of isolation also stemmed from the fact that to this day, Cool has never met another egg donor.
“The fact that I’ve been singularly fascinated by eggs for over a year now, it’s really strange,” she admits. “But it really speaks to how isolated [egg donors] are, and how there aren’t really any resources within this system for us. There’s no real counseling.”
Though Cool says she did not receive much support, Abusief notes the FPNC’s Mind-Body Program, which specifically focuses on each donor’s well being, in order to ease the treatment process and relieve any emotional and physical distress she may experience during her cycle.
Feeling alone in the process, Cool once asked an agency if she could speak to another egg donor about the experience. “[The agency] went as far as to make it a three-way phone call, like they didn’t want me to [talk to the other donor alone],” she says. Uncomfortable with someone listening in, Cool says she was unable to glean any valuable information from the other donor.
In the end of her first cycle, the only exchange Cool had with the recipient parents was a gift basket, which she received after her eggs resulted in a pregnancy. In it, there was a typed letter, which she paraphrased, “Thank you so much for this precious gift. Words can’t express, you know … what you’ve done has meant so much to us.” In addition, there was a candle, hand soap, a dish, a hand towel and a loofa. “I think of them every time I wash my hands,” she says with a laugh.
Eggs As Currency
Donating eggs may sound like an odd day job, but for Cool, it’s just one more way that she feeds her addiction to pushing the boundaries.
“It all started with the suicide hotline,” she remembers. “I was 19 years old and someone told me they were looking for volunteers. And I had this distinct moment when I thought to myself, ‘Can I do this?’ I don’t know if I can do this. And so, I did it. And I realized I could. It started this whole attitude toward kind of strange and uncomfortable experiences.”
Since then, Cool has donated blood several times, donated her hair twice, and takes part in random test studies, including a recent sleep study in San Francisco, in which she had to wear a watch during the day to monitor her wrist movement and be hooked up to brain monitoring equipment for three nights.
“I make a habit of looking in the Etc. section on Craigslist’s job postings, because I just love miscellaneous jobs,” she says. “At some point, it became my natural state, where I was just constantly doing these things that are stepping outside of my comfort zone. But I love this idea of completely throwing yourself into a foreign situation and being immersed in it, and then you reemerge changed somehow.”
Cool took a similar approach to her “Live Nude Eggs” installation. In order to give the public a unique perspective of the human egg trade through the eyes of a donor, she found a photographer on Craigslist, by the name of Dustin Hammon, who agreed to accompany Cool on every one of her visits to the clinic and document the process of egg donation from behind the lens.
The multimedia exhibit at Vapr Labs features a performance art Donor Bar—all goods (including breast milk) are free, but the bartender must be compensated for her time and effort exerted in processing the patron’s order, much like an egg donor—a video interview in which the donor is asked a series of personal questions on camera, and art pieces that reflect on the small humiliations involved with putting yourself out there and the fertility industry as a whole.
“It’s called ‘Live Nude Eggs’ for a few reasons, one of which is a reference to the feeling of bareness and exposure one undergoes as a donor,” explains Cool. “The second is the allusion to the ‘live’ eggs that are harvested—they’re best fresh, where they’re immediately inseminated in a Petri dish. ‘Live Nude Eggs’ explores the intersection of science, international business, and the female reproductive system by constructing an experience: an open market for human ova. It raises questions about the transparencies of this transaction.”
While Cool can’t be an egg donor forever—the ASRM has limited the number of egg donations to six times, and agencies like the FPNC limit it to five for safety reasons—she is currently enjoying the perks of being in what she calls “the spring of my fertility.” With the funds garnered from her first cycle, Cool is taking a scuba diving trip to the Galápagos Islands.
“When I say I’m making a living [by donating eggs], it’s part of this larger body of work that ties into my writing as well, in which I’m designing uncomfortable life experiences, and using this very uncomfortable process of egg donation,” she says. “A big part of my work right now is using eggs as currency. It’s really gotten to the point where I’m [thinking], ‘OK, $233.33 per egg.’ And it factors into everyday conversation. I was discussing buying a mountain bike with a friend, and she was giving me a quote, and I was like, ‘Oh god, that’s like three eggs, I don’t know ...’”
That concept of eggs as currency is central to the installation, in which Cool demonstrates the ways in which the donor agencies promote or market their clients to recipient parents—from instructing donors to dress well and wear a lot of makeup to their interview, because they’ll be photographed and/or have their interview videotaped, to going to great lengths to create a palatable, optimistic version of the donor.
“It’s all the things that make you great,” explains Cool. “But then there are all the things about a person that are omitted—like, when my brother and I were kids, we used to tape live ants to walls [laughs] … you wouldn’t put something like that into a donor profile.”
Furthermore, Cool hopes the installation will help to demystify the economies of the egg donation process and shed light on the business aspects of it.
Asked if she feels that donors are somewhat misunderstood, Cool is candid: “I think that there is a perception that egg donors are being completely exploited and completely commodified, but I think the exchange is really a two-way street.
“All the parties benefit, including the donor,” she adds. “I think the language that’s being used in the industry right now is kind of like feel-good market speak, where you’re giving the gift of life, you’re such an altruist. But that, to me, is ultimately marketing, and it really downplays the true transaction at hand, which is that it’s a business. Egg donors are a part of that business. And whether someone is ethically opposed to that, I leave it to them to decide. The installation raises those questions, you know, what are the implications of using your biology as a source of economy.”
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