A German translation of this interview will be published in May 2026 in the German GID MAGAZIN, which focuses on the market for reproductive technologies. For more information, visit: Gen-ethisches Netzwerk
 

Egg donation is currently prohibited in Germany and Switzerland, but both countries have been debating its legalization for years. In Switzerland, a legal framework is currently being developed, with a first draft expected by the end of the year. Yet the debate rarely draws on scientific evidence. Instead, it is often shaped by arguments about “equality”—comparing egg donation to legal sperm donation—and by market-oriented reasoning. 

Against this backdrop, Gabriele Pichlhofer and Tino Plümecke from the NGO biorespect spoke with Diane Tober (pictured at left), professor of anthropology at the University of Alabama. Tober’s work focuses on health, gender and sexuality, commercialization of the body, bioethics, and social and reproductive justice. Her recent book Eggonomics: The Global Market in Human Eggs and the Donors Who Supply Them draws on more than a decade of research. Based in Basel, Switzerland, biorespect provides critical, fact-based analysis of the effects of genetic, biological, and reproductive technologies on humans, animals, and the environment.

biorespect: In your book Eggonomics, published last year, you shift the focus from the usual framing of egg donation as an altruistic act toward its economic and political dimensions. What do you aim to highlight by analyzing it from a political economy perspective?

Diane Tober: The issue is more complex than the usual opposition between altruism and commercialization suggests. Many donors are motivated by a mix of reasons: they may genuinely want to help others while also expecting compensation for their time, effort, and the medical risks involved. In most cases, motivation is not purely altruistic or purely financial—it is mixed. Compensation levels also vary widely. In countries such as Spain or the UK, payments are regulated and relatively modest, around 1,100 euros or pounds. In the United States, however, compensation is much higher, often starting around $10,000 and sometimes rising far beyond that. In my own data, I’ve heard as high as $250,000, but more recently it is not unheard of to hear of over a million dollars per cycle.

What struck me most in my research was not simply that donors are paid, but how the system itself operates. In the United States in particular, you see a highly commercialized, neoliberal market model that differs significantly from more regulated systems such as the one in Spain. At the same time, public debates tend to focus intensely on donor motivation. There is a strong expectation that donors should act out of altruism rather than financial interest. Yet the clinics, agencies, and intermediaries involved operate for profit. On the global market, five frozen eggs may sell for about $15,000—valuing each egg at $3,000 to $5,000. This is a highly commercial structure. At the same time, donors themselves are expected to act altruistically, revealing a clear double standard. So why are donors the only actors expected to be altruistic when the entire system surrounding them operates through financial exchange? Technological developments such as egg freezing have further expanded this market, allowing eggs to be stored, traded, and shipped internationally. My central question, therefore, is how do commercial markets in human eggs intersect with egg donors’ decisions and medical experiences under different regulatory settings?

In Germany and Switzerland, egg donation is often framed as helping people have a biological child. Why do you emphasize the commercialization of bodily materials instead?

My earlier research, particularly in my book Romancing the Sperm, focused on women—mostly single women and lesbian couples—who used sperm donation to create their families. I also interviewed sperm donors and conducted research in clinics and sperm banks. In that context, the medical procedure itself is relatively simple. Nobody is harmed, right? When I began interviewing egg donors, however, I realized how fundamentally different the situation is. Egg donation is far more invasive and medically intensive. Donors undergo weeks of hormone injections to stimulate the production of multiple eggs, followed by a surgical retrieval. Some donors in my study reported between 40 and 90 eggs retrieved in a single stimulation cycle, rather than the usual one egg released per month. This can be very hard on the body. Unlike sperm donation, this process carries real and potentially serious health risks.

What surprised me most was that, although physicians often claim the risks are very low, there are no comprehensive prospective studies tracking egg donor health over time. In other words, we simply do not have reliable long-term data on the physical and psychological consequences for these women. That absence of data became central to my analysis. At the same time, public debates tend to focus almost exclusively on the positive story of helping people create families. That joy is real, but because of the strong emphasis on intended parents, the experiences and possible harms faced by donors are often sidelined. 

Over the years I have collected hundreds of donor narratives and close to 1,000 survey responses. While many donors report positive experiences, others describe medical complications or later fertility problems. We do not know whether egg donation caused these outcomes—and that uncertainty is precisely the issue. By focusing on commercialization, I want to highlight how market dynamics shape whose experiences are prioritized and whose risks remain largely invisible. If egg donation is to continue as a practice, we need robust prospective studies, transparent data collection, and safeguards that reduce harm.

Why did you choose to focus your research on Spain and the United States, and how do these two countries illustrate the dynamics of the global egg donation market?

I began my research in the United States around 2014, and around the same time, I started speaking with clinicians in Spain who were involved in egg donation programs. What immediately struck me was the difference in regulation between the two countries. Spain represents a more regulated model: donor compensation is capped at around 1,100 euros and the country has established a national registry. In contrast, the United States is largely unregulated and compensation varies widely. Comparing these two systems allowed me to examine how a regulated model operates alongside a more market-driven one. 

Could Spain serve as a model for doing this “better”? Spain does have certain structural advantages. Its national registry tracks donor gametes through the medical system and allows clinics to report data to the Ministry of Health. If a genetic condition is later identified, it becomes possible to trace affected offspring and notify recipient families. However, I also found limitations, particularly regarding donor information and informed consent. Spanish donors reported that they were not told in detail which medications they were taking, how many eggs were retrieved, or how their eggs would ultimately be used. 

In the United States, the system is more commercialized, but donors often reported receiving more detailed information about their cycles and where their eggs were going. Economically, the differences are also revealing. U.S. donors may receive around $10,000 and often use the money to pay off student loans or other debts, while in Spain the lower compensation tends to go toward everyday expenses. What makes Spain especially interesting is that its registry already collects important data. In principle, this infrastructure could also be used to track donors’ health over time. However, it is currently focused mainly on genetic outcomes for offspring rather than long-term health outcomes for donors.

Over the past 15 years of your research, private equity has entered the fertility sector and reshaped clinical structures. What changes have you observed in the clinical and market landscape?

When I began this research around 2014, the technology of egg vitrification—freezing eggs—was just becoming widely adopted. At that time, many fertility clinics were still owned by groups of physicians rather than large investment firms. Egg freezing fundamentally changed the business model. Previously, the typical arrangement was one donor for one recipient. Once eggs could be frozen and stored, however, a single donor’s eggs could be distributed to multiple recipients around the globe. At the same time, more women began freezing their own eggs for future use, which almost immediately tripled or even quadrupled the business. 

As the profit potential went through the roof, the sector began attracting substantial private-equity investment. Clinics were increasingly purchased by large fertility conglomerates backed by private investors. In California, for example, several clinics became part of corporate networks. I observed a similar shift in Spain. When I first visited clinics there in 2015, most were still run by their founders. When I returned a few years later, several of those founders had sold their clinics to private equity investors. These investors typically operate on short timelines—three to five years—with the goal of increasing profitability before selling again. Egg freezing and the global distribution of eggs have made the sector far more profitable, fundamentally reshaping the clinical and market landscape.

What forms of international structural inequality did you identify in your research, and how do they shape the global reproductive market?

In the United States, most egg donors are young women—often college students or recent graduates—who face significant financial pressure, particularly from high education costs and student loan debt. Clinics frequently advertise high potential earnings, but these figures are misleading. For example, ads might promise $48,000, which would actually require about six donation cycles. Another issue is taxation. Egg donation compensation is treated as taxable income, and some donors only realize this when they face substantial tax bills. One donor I interviewed felt compelled to undergo another two cycles simply to pay down the taxes she owed after her wages were garnisheed by the IRS; she also experienced medical complications, including ovarian hyperstimulation syndrome, and was billed for her treatment. On top of that, she was not even able to deduct the costs of her medical treatment from her tax bill. Cases like this illustrate how financial vulnerability can shape donors’ decisions.

My data also showed disparities in compensation linked to race and education. Donors perceived as highly educated or having “high-demand” phenotypes—often white or Asian—tended to receive higher payments than Black or Hispanic donors, creating a hierarchy of value within the market.

In Spain, compensation is standardized and lower, but many donors come from economically vulnerable backgrounds, including migrants from Latin America or Eastern Europe. Clinics also practice strict phenotypic matching, favoring donors who fit a “European” appearance. In both contexts, economic inequities and racialized preferences shape who becomes a donor and how reproductive labor is valued.

You point out that there are no prospective studies on the long-term health effects for egg donors. Given the lack of research, do you believe it is ethically justifiable to legalize egg donation as a medical practice under these conditions?

This is a difficult question, because without reliable long-term studies it is hard to speak of truly informed consent. Egg donors are healthy young women undergoing a medical procedure that offers them no direct medical benefit, yet we still lack systematic data about the long-term risks. Most existing research focuses on fertility patients, who are typically older and already experiencing difficulty conceiving. Egg donors are a very different group: they are younger, highly fertile, and often selected for traits like low BMI that may actually increase the risk of complications such as ovarian hyperstimulation syndrome. For that reason, findings from fertility patients cannot simply be applied to donors. 

I believe we urgently need prospective studies that follow donors over time—ideally starting before their first donation and tracking their health for five or even ten years. My own research already raises important questions. Some donors who were initially healthy when they first entered my study later reported conditions such as severe endometriosis, diminished ovarian reserve at a young age, or even estrogen-positive cancers. I encountered several donors who developed severe endometriosis after one or more donation cycles, who had no symptoms before. Because endometriosis is strongly hormone-dependent, it is possible that the treatments triggered or worsened an undetected, pre-existing condition. In some cases, these women later struggled with infertility themselves. 

I interviewed donors who began donating in their early twenties, developed serious symptoms by their mid-twenties, and eventually required multiple surgeries and IVF treatments—sometimes without ever being able to have their own biological children. Situations like this raise serious ethical questions. We cannot say with certainty whether egg donation caused these outcomes, or if they would have had these conditions anyway, but the possibility highlights how little we actually know. 

For me, the issue is transparency. Clinics should acknowledge that the long-term risks are still unknown. Legislators and funding agencies need to prioritize funding prospective studies that follow donors over time. Egg donors are highly invested in helping other people create their families; they deserve equal attention to making their health and safety a priority and ensuring truly informed consent.

What measures do you consider most important for strengthening the rights and protections of donors and potential donors?

First and foremost, we need much better research so that donors can give truly informed consent. Second, donors should receive much more detailed information about the medical protocols involved. We know that certain stimulation protocols carry higher risks than others, yet donors are rarely given the same level of information about treatment options that patients normally receive. 

Another important step would be to establish limits on the number of eggs retrieved per cycle. With the rise of egg freezing and egg banking, clinics often aim to maximize the number of eggs retrieved per cycle, which can increase health risks for donors. You know, if you're aiming to get 20 eggs, you're usually going to be using lower dosages than if you're aiming to get the 40 or 50 eggs that you can see her body might produce. Establishing safer standards for egg retrieval could help reduce those risks. Tracking and limiting the number of cycles and cycle outcomes is also important.

More broadly, we need systematic follow-up and national registries that track donor health over time. For example, the United States currently has no comprehensive registry, even though it would be technically possible to create one. Countries that are now considering legalizing egg donation—such as Germany or Switzerland—have an opportunity to design systems from the outset that include prospective research and long-term monitoring. 

Finally, the question of financial incentives also needs careful consideration. High payments can strongly influence recruitment. Some alternative models—such as egg-sharing arrangements, in which women who freeze their own eggs share part of the retrieved eggs in exchange for reduced costs—may offer a more balanced approach if carefully regulated to avoid clinics trying to retrieve high quantities of eggs just because the batch is being shared. Overall, the key priorities should be transparency, better data, safer medical standards, and long-term protection of donor health.

In your work, you refer to concepts such as “eugenic forces” and “grassroots eugenics,” particularly in relation to economic interests. Why do you find the concept of eugenics analytically useful for understanding today’s reproductive market?

My interest in this concept goes back to my earlier research on sperm donation. At that time, different sperm banks operated with very different underlying philosophies. Some were explicitly eugenic—for example, the Repository for Germinal Choice, often called the “Nobel Prize sperm bank,” founded by Robert K. Graham to recruit so-called “genius” donors. When I visited the facility to conduct interviews, I noticed that the entire wall of photos showing children conceived through their donors featured almost exclusively white, blond, blue-eyed babies. So, I mean, the eugenic mission was right in my face.

At the same time, other sperm banks emerged to serve groups that mainstream clinics excluded, such as single women and lesbian couples. These exclusions themselves reflected assumptions about who should or should not reproduce. What I found especially interesting was how intended parents themselves often chose donors based on traits they believed could be genetically passed on—height, eye color, musical ability, or education. While height and eye color are genetically influenced, there is no genetic link we know of that determines where one goes to college or political leanings. These personal selection processes are not the same as historical state-led eugenics or Robert Graham's, but they reflect a more informal, everyday form of it—what I describe as “grassroots eugenics.” 

I’m not trying to stigmatize these choices. People select partners—or donors—for many different reasons. But when I began researching egg donation, these dynamics appeared in a more intensified form. At one conference, for example, I saw a Ukrainian egg bank promoting so-called “VIP donors” by displaying a young woman on a rotating platform, styled like a fashion model so visitors could view her from every angle. 

What struck me was how strongly egg donors were marketed through their appearance. I have never seen sperm donors presented in this way. In sperm donation, current photos are often not shown—sometimes only childhood pictures are provided. Egg donor profiles, by contrast, frequently feature highly stylized images, even bikini shots. The presentation is highly gendered, emphasizing appearance, education, and perceived “elite” qualities. In the United States, donors from prestigious universities or with certain phenotypes can receive significantly higher compensation. These dynamics create an elitist logic in the egg market that is far less visible in sperm donation. When I refer to “eugenic forces,” I mean how market incentives, consumer preferences, and ideas about desirable traits intersect in contemporary reproductive markets, often reproducing hierarchies of value around bodies, traits, and ancestry.

In your view, what mistakes should Switzerland or Germany try to avoid if they move forward with regulating or implementing egg donation?

One argument often used in these debates is the idea of “equal rights”—that if men can donate sperm, women should also be allowed to donate eggs. But if you look at the physical differences between these processes, that argument quickly falls apart. The two procedures are completely different. Sperm donation is simple and non-invasive and carries no physical repercussions, while egg donation requires daily hormone injections to stimulate egg production and a surgical retrieval procedure under anesthesia that carries real medical risks. Treating the two as equivalent ignores those differences. 

Another common argument is that people are already traveling abroad—for example, to Spain—so the practice should simply be allowed domestically. But this is often also an economic argument. Fertility clinics recognize that treatments abroad generate substantial revenue, and they do not want to lose that market. What is often missing from the discussion is a serious focus on donor health and protection. 

If countries such as Switzerland or Germany decide to allow egg donation, the key question should be: how will they ensure that donors are fully informed, medically protected, and able to safeguard their own long-term reproductive health? That conversation should be central to any policy decision.

In Germany and Switzerland, the debate on egg donation is highly polarized—between arguments for reproductive freedom and concerns about gendered, racialized, and class-based inequalities. How can a reproductive justice framework move beyond this binary and address the full complexity of the issue?

That is a big question. If I were a policymaker, I would proceed cautiously and begin with research rather than immediately legalizing the practice. One possible approach would be to introduce a limited pilot program in a small number of clinics for a fixed period of time and carefully study the outcomes. In other words, the research should come first—otherwise it is difficult to make informed policy decisions. Such a program would need clear safeguards: limits on the number of eggs retrieved, standardized compensation, and regulations preventing race-based recruitment or payment differences. In the United States, for example, Black donors are often paid less than white donors. It would also be important that data not be collected solely by clinics themselves but also by independent researchers, and that donors have a direct way to report their own health outcomes, to avoid the problem of clinics under-reporting post-retrieval complications. A system like this would allow policymakers to gather reliable evidence about donor experiences and potential health effects before expanding the practice—to promote evidence-based policy. 

From a reproductive justice perspective, the crucial point is to ensure that the interests of donors—especially their health and autonomy—are taken as seriously as the desires of intended parents, and also that donors and people who do need to use donor eggs to create their families have equal access to care. Ideally, regulation should begin with careful data collection and transparent oversight so that societies can make informed decisions about whether and how egg donation should be integrated into healthcare systems.

What are the next steps in your research? You have also been working on a documentary film, The Perfect Donor. When can we expect its release, and what further projects are you currently pursuing in this field?

The documentary is largely filmed, but I need funding to finish it. I financed most of the production myself, and the only thing still missing is professional editing. I’ve created a shorter 25-minute version that I show to my students, but I’d like to complete a professionally edited full-length version before releasing it publicly. 

On the research side, I recently submitted a grant proposal for a prospective study comparing egg donors, women who freeze their own eggs, and a control group. The idea is to follow participants over time and examine not only survey and interview data but also biological markers that might reveal potential long-term effects of hormonal stimulation—such as changes related to aging or other health indicators. My existing ten-year study raised many important questions, but because it was a retrospective study it is difficult to determine the degree to which the data is representative of donors’ experiences more broadly—especially regarding long-term physical outcomes. This next phase of research aims to investigate those questions more systematically by recruiting participants before they donate and following them over time—assuming the funding comes through.