One of the tests of a liberal society is whether the state stays out of the bedroom—but more than 3M people alive now were not made in bedrooms. They came into being as a result of in vitro fertilisation (IVF) under the glare of laboratory lights, with the assistance of a team of doctors, nurses and technicians.
IVF was originally intended to allow heterosexual couples to bypass problems with fallopian tubes or sperm by introducing eggs and sperm to each other in a petri dish. But demand has mushroomed among those with other medical problems as well as the single and gay. They need people to supply them with sperm, eggs and sometimes wombs; and the services of clinics who put the lot together.
Since the manufacturing of anything which is regarded as God-given—or at least natural—touches a moral nerve, governments tend to want to regulate the business. And because attitudes to the family vary from country to country, regulations about baby-making do too. Discerning baby-shoppers therefore assemble inputs from around the world—sperm from Denmark, an egg from Russia, a surrogate mother from California—to ensure that biology, for them, need not mean destiny. Some even switch countries midway through treatment, starting in Britain, say, and travelling to Russia, Spain or America at a crucial stage in the proceedings.
Countries known to be permissive soon end up treating lots of foreign patients. Women from all over Europe travel to Denmark for donor insemination because it is well-regulated, quality-checked and guaranteed to be anonymous: more Swedish women conceive every year in Danish than in Swedish clinics. Women travel to Spain for egg donation, since Spanish women can be paid for their eggs. They travel to California from all over the world to sign surrogacy agreements, since there it is the commissioning, rather than the gestating, woman who is legally considered the “real” mother.
The turkey-baster was an icon of 1960s feminism. But do-it-yourself sperm donation has fallen out of favour in an era of AIDS and child-support payments. Nowadays those who need sperm get it frozen, so the donor can be tested six months later for HIV (the virus does not show up in tests until some time after it has been caught), and anonymous, so the donor can neither claim parental rights nor be burdened with parental responsibilities.
Cryos, a Danish sperm bank, is probably the world's largest supplier of sperm. It sells to clinics in nearly 50 countries, has more than 200 donors on its books at any one time and distributes more than 10,000 units of semen each year, resulting in about 1,000 pregnancies. It cannot export to countries where anonymous donation is illegal, including Sweden, Norway, the Netherlands, Britain, Switzerland and Australia, or to Italy, where it is illegal to use donor sperm. Some clinics in these countries now treat patients at home and fly them to Denmark for insemination. In 2001 the company opened an American offshoot, Scandinavian Cryobank (slogan: “Congratulations! It's a Viking”), which, like other American sperm banks, offers sperm direct to customers via an online catalogue. Its eye-catching offers include exclusive worldwide rights to a donor for $75,000.
A major competitor is California Cryobank. It pays donors $75 per specimen—with occasional gift vouchers and movie tickets thrown in. Customers pay $240-400 per specimen, depending on sperm count. Basic information about donors—height, weight, colouring, occupation—comes free, but further information must be paid for. A facial-features report, listing such attributes as “nostril flare” (narrow, average or large), costs $12; an audio interview is another $25. For $65 a customer can buy a package of baby photo, audio tape, full personal profile, psychological profile, essay, description of the clinic staff's impression of him and facial-features report. She can hire a consultant to help her choose a donor, at $80 for 30 minutes. At a cost of thousands, she can store vials from a donor in order to be able to have more children by him in the future. The clinic will buy back unwanted vials for half their original price.
Donating eggs is considerably more taxing than donating sperm, as it means taking super-ovulation drugs for a fortnight or so and then undergoing a minor operation to harvest the eggs. So where it is illegal to pay donors, eggs are scarce, and where it is legal, they are expensive.
In Britain egg donors can be paid only for travel expenses, so most donated eggs are from friends or family, or, until recently, other infertile women, who are permitted to barter half the eggs harvested during their own infertility treatment in return for a richer woman paying for treatment for both of them. This practice has now almost ceased—an unintended consequence of a legal change in May which gave children born of egg or sperm donation the right to be told the identity of the donor once they turned 18. Most potential egg-sharers have been deterred by the fear of remaining childless and later discovering that another woman has conceived a baby by an egg that was given away.
British women are instead looking abroad, to countries where egg donors can be paid. Many travel to Spain, where a sympathetic attitude to infertile women and a payment of £800 mean that donors are
forthcoming. Spanish clinics advertise for fair-skinned and fair-haired donors, and run partnerships with clinics across Europe who treat women at home and fly them to Spain just for embryo transfer. One large London clinic says it sends a woman to Madrid every other week.
Strictly speaking, paying for donated eggs is illegal in America too, since it counts as buying a body part. But it is legal to compensate a donor for her time and effort, and this compensation can be very high. Some women donate via an egg broker. For this they are likely to be paid $5,000-7,500. Others reply directly to personal ads, which are commonplace in campus newspapers, and which can offer up to $100,000 to the right woman. The Stanford Daily has a “Donors Wanted” heading in its classified section; Jewish, Asian and East Indian women are in high demand, as are those who are tall, athletic and clever—with doctorates or SAT scores above 1,350 often specified.
Paying clever and beautiful American women for their eggs doesn't make much sense, though—such fortunates can make money in other ways. So some American clinics have taken the obvious step of sourcing their eggs from poorer countries. GlobalART provides eggs from eastern European women to clinics in America and Israel. The sperm being used is frozen in America, flown out to Romania and the eggs are fertilised there. The resulting embryos are frozen and flown back to America, to be implanted in the host's womb. The company charges $13,650 for all the eggs from a single super-ovulation cycle.
It is also possible to buy direct. Search online for “Russian egg donor” and you will find many aspiring sellers. Some pose holding babies, presumably to show they are fertile. Others, heavily made up and pouting, are clearly re-using portfolio photos taken for modelling agencies.
Give me a child
There's nothing new about surrogacy: in the book of Genesis three women sent their husbands to their maidservants to remedy their own deficiency in producing sons. Presumably those servants were unenthusiastic about handing over their babies. But IVF has made it all easier. A woman who has functioning ovaries but a damaged, or no, womb can create embryos in vitro that are genetically her own. If she cannot produce eggs, she can use those from a donor rather than from the surrogate, meaning that the surrogate is carrying a child not related to her—a child she is less likely to want to keep.
SuperStockStill, the relationship between intending parents and surrogate mother is unavoidably fraught. It lasts longer than the few weeks taken by egg donation, or the few minutes by sperm donation. And the intending parents will also want to monitor the surrogate's behaviour. So there are significant barriers in the way of using poor women from abroad.
What's more, in most countries the woman from whose body the baby exits is the default mother, no matter whose genetic material was used in the conception. The only safe option is to enter into a formal arrangement in one of the few jurisdictions where surrogacy is legal.
In some of these countries, although the practice is legal, the surrogate mother cannot be paid, so again there are problems of supply. In Britain, for example, paying surrogates is illegal, and an infertile couple cannot advertise to find one. If friends and family are unable to help, the couple must pay to join a surrogacy network and wait to see if they seem attractive enough to any of the dozen or so women in the country willing to carry someone else's baby for nothing more than expenses and a warm glow. And even then, after the baby is born the surrogate can back out—even if the child is not genetically hers.
In the book of Genesis three women sent their husbands to their maidservants to remedy their deficiency in producing sons. Some American states ban surrogacy outright. Some rely on case law. Only a few set out clearly who is the parent of a child born of a surrogate mother. California has long been a popular destination for those seeking surrogates: it has reasonably friendly case law, with the commissioning parents granted considerable rights (and responsibilities), and law firms specialising in contracts between intending parents and surrogates. But Illinois may well overtake it as the venue of choice: a 2005 law provides for intending parents to arrange sole custody of the child of a surrogate, even before the child is born. Still, surrogacy will only ever be an option for the rich: the surrogate mother will require a fee of around $20,000 and the total cost, with legal fees, egg donation and medical procedures, will leave little change from $100,000.
Despite its similarities with manufacturing, assisted reproduction is unlike most technologies in one way: as the science advances, the market may shrink. Most women in need of egg donation have left childbearing too late to use their own—but once eggs can be frozen routinely, young women will surely bank them so they can reproduce when it suits them, not when it suited our shorter-lived ancestors. Some women turn to surrogates after miscarrying repeatedly; again, in future science may enable them to carry their children themselves. But as long as there are people who cannot both conceive and gestate their own child, there will be donors and surrogates; and there will be customers, consumed with longing to be parents, willing to pay."