The egg donation ad caught her eye when she scrolled through her newsfeed on Facebook: “You can make $36 grand!!” Most of the ads feature diverse groups of smiling women, some holding books to show that they’re smart and maybe attended college, others smiling with thumbs up, or laughing with joy.

My friend, Caitlin, is the target demographic these ads were made to reach: an altruistic 20-something who’s focused on her career and isn’t currently using her eggs—with some college debt to get out from under. Caitlin has a volunteer’s spirit and a special love for any and all dogs, particularly her rescue pitbulls. She’s relatively healthy, and comes from a large Midwest family, one of six siblings. In short, she’s an ideal egg donor.

“They recommend donating no more than six times in your life,” Caitlin says. Each donation has a pricetag of about $5,000-10,000. “I was a good candidate. I have a good family history. I’m young, healthy and willing.”

While, I’ve seen the same ads flit across my newsfeed and never paid attention, Caitlin was intrigued by the prospect of donating her eggs. Watching a friend go through the process piqued my interest, not about becoming a donor myself, but about the way that donors are treated, the fertility industry, and at the heart of it all, the value of a tiny, DNA-containing egg.

So while Caitlin went through the arduous process of changing her diet and learning how to give herself hormone injections, I embarked on my own much easier, shot-free journey toward understanding.

The fertility industry was born because the world is unfair; some people who don’t want children, get them, and others who desperately long for them, don’t. Donors like Cailtin become donors because they want to do something good. They also want to be paid for it. The industry itself is a capitalist venture, centered around the miracle of life, though exactly what egg donors are being paid for is a question with no simple answer. A 2015 article in The Atlantic put the question succinctly: “Are donors being paid for their labor, their property, the risk they undertake, or a mixture of all three?”

The process of egg donation is unlike any other kind of donation. It’s certainly not like sperm donation: “No one ever wants to do interviews with sperm donors,” Caitlin snorts. It requires 10 days of hormone shots, lifestyle changes and eventually, elective surgery.

As far as the FDA goes, donated eggs (oocytes) are classified as human reproductive tissue. Some of their regulations have to do with the donor’s recovery process following the donation, but the majority of their focus is on handling the oocytes—their processing, storage, labeling, packaging and eventually, their use.

Different local centers provide different information on what exactly they require from their donors, first to even be accepted as donors, and then, much later, to actually be selected by a hopeful couple. Dallas Fort Worth Fertility experts want donors between 21 and 30 years old. Egg Donation Center of Dallas asks for donors between 18 and 27. Most agree on the basics: donors must be non-smokers with no history of substance abuse who have a healthy BMI, who have no significant history of chronic medical conditions or genetic diseases, are willing to pass physical and psychological examinations, have regular menstrual cycles and are in monogamous relationships.

Some get a little more stringent. Egg Donation Center of Dallas has 30 requirements, including that donors agree to send three photographs, an enclosed copy of your SAT or ACT scores or at least meet a minimum college GPA requirement (3.0 or higher).

At other centers, some of the requirements were a little more surprising: “You must not have had any sexual contact with homosexual or bisexual men at this time, or at any time in the past,” one center says. They also add that, “It serves you well to be extremely polite to the nursing staff and to be on-time for your appointments.”

As far as the perfect donor goes, some people are more “highly desired” than others, and get paid more because of it.

“Me, being half black and half white isn’t highly desired,” Caitlin puts in. “Others that are, are 100 percent Chinese, or a 5’10” woman with blond hair and blue eyes, or someone went to an Ivy League school … it depends on what the intended parents want. If the woman in the couple has blond hair and blue eyes, they might want a donor that looks like her and some people will spend insane amounts of money to get it.”

The for-profit nature of the industry has even given rise to boutique agencies, like Elevate Egg Donor Agency, which markets themselves as a premier experience providing “the gold standard of egg donors.” To ensure their prospective donors are “most intelligent, beautiful, altruistic, and highly-vetted” in the world, they ask them beauty-pageant-style questions about themselves as individuals: their talents, the changes they wish they would see in the world, their favorite foods and best-loved books.

“I’d always had an altruistic spirit. The idea of helping someone who can’t have babies, a same sex couple—that was attractive to me,” Caitlin explains. “And they really want people doing it for the right reasons, not for the money. They want you to understand the gravity of it. You’re creating a person.”

Caitlin donated through Circle Surrogacy, one of the oldest in the business, and was matched within a few months with an LGBTQ+ couple from Manhattan. They met on Skype and after that, it was only a matter of timing.

“They’re the kindest, cutest people,” she says. “They’re better than what I imagined.” She went with her father up North to meet them, which she described as a surreal experience. Both men took off work to act as their tour guides. Under ordinary circumstances, their paths never would have crossed. They certainly never would have ended up raising a child with half of Caitlin’s DNA.

Once a donor and prospective couple have been matched, however, the donation becomes personal. On the subject of an open donation—or known donation, where the child is raised knowing they were donor-conceived—Caitlin shrugs. “They’re a same sex couple. Obviously the kid will know.” She belongs to a closed Facebook group made up of donors, surrogates and donor-conceived people; because egg and sperm donation aren’t exactly new processes, there are plenty of adults now who were born through one of them, and willing to share their perspectives. “From an ethical standpoint, donor-conceived people sometimes struggle.” she admits. “Especially if they didn’t know, and found out later.”

Hers will be a known donation. “Donors describe [the relationship with the child] like one with a niece or nephew,” she says. “They’re related to you, you’re fond of them, but they’re not yours. I have eight nieces and nephews. I Facetime them, see pictures and see them once or twice a year. A niece or nephew is my favorite kind of kid. That sounds awesome.”

Caitlin learned a lot about herself during the process. Her fertility clinic told her that each cycle, though only one egg ovulates, other eggs had grown too. “Each month ovaries have a certain number of eggs that start to grow. One egg grows to be big enough and ovulates. The rest are reabsorbed into the body. The hormones get both ovaries acting at once, so that all the eggs grow.” As they explained to her, she wasn’t using the eggs anyway; in fact, she was losing them anyway. “Now they’re going to someone who otherwise wouldn’t have a chance.”

This summer, after her 10 days of hormones, Caitlin went to Connecticut for her elective surgery. By that time, she says she felt like there were tennis balls in her stomach. Most procedures aim to collect 20 eggs; more than 30 becomes dangerous for the donor. The process is full of unknowability and risk from a donor’s perspective. Some donors consider it dangerous, simply because there isn’t much research into the effect the hormones and process have on the donors. Some have gone into menopause early, some have lost own fertility after donating, but the actual cause is inconclusive.

“One has to think, if I’m 45 and get ovarian cancer, is that because of this? Would I have gotten it anyway?” she says. “The main call in the community right now is for more research.” She lets on that there seems to be a lot of concern among donors that there’s more risk than the agencies tell them. Some donors only participate in the groups to warn people not to do it, most because they have had problems later in life that they suspect are tied to their donation. “They’re part of our community and their stories are important,” Caitlin explains. “It’s hard to know how my body will react five or ten years from now. It’s a risk.”

A 2016 Washington Post article chronicled the lives and feelings of donors, and the things they wished they’d known. One donor, who later developed breast cancer, recalled asking her doctor if it could be related to the hormones she took for her donation, but he told her it was impossible to know.

Egg donation has been a practice for more than 30 years. Fertility specialists say that egg donation is safe and involves the same process as in vitro fertilization, which uses drugs to stimulate and regulate egg production, and a 2013 meta-analysis of 25 studies found that there was “no convincing evidence” that the use of fertility drugs increased the risk of invasive ovarian cancer. But the fact remains that there is a lot that we don’t know.

Donors and other women have led the charge on asking for more information on the possible health hazards of egg donation, an expensive enterprise. Dr. Diane Tober, a medical anthropologist at UCSF who researches egg donation has been working on a documentary on the subject for more than five years. She’s spoken to donors, both who regret their choice and don’t, doctors and even donor-conceived people searching for their donors. It’s a complex situation only now beginning to be explored.

For someone like Caitlin, who has always seen herself adopting, rather than having her own biological children, the risks are acceptable. But when the time came for her procedure, she was glad to have her father beside her.

Luckily, Caitlin’s surgery went well; they retrieved 28 eggs total. Some women have severe pain or bloating, even ovarian hyperstimulation syndrome (OHSS), which causes fluid to leak in the abdomen, but the worst it got for Caitlin was a little bit of nausea.

Of the 28 eggs, she learned, generally, only two thirds of these are even able to be fertilized and to create an embryo. After five or six days of growing in the lab, only 50 percent will still be viable. At that point, they’re tested for abnormalities, which usually excludes about 50 percent more. Out of 28 eggs, Caitlin expects only four to six to be useable. Hopefully the first one, given to a surrogate, is successful. Simply put, as one of the Circle representatives says, “We’re asking a lot of these eggs to survive in a lab.”

The others can be frozen in case the couple wants a bio-sibling later on. If not, the couple who chose Caitlin has four to six chances of a successful pregnancy and live birth. Sometimes, none of them are successful. There are so many reasons why an embryo doesn’t take, the agencies tell donors and hopeful parents. If all the stars align, they may get one, maybe two.

“Hopefully if there’s a child that exists, they’ll know my intentions, who I am as a person, never any questionable feelings about it. That kid’s parents will be awesome. They’re excited. They’re the cutest, nicest people,” Cailtin says in the wake of her successful procedure. “If you think about it, the child that hopefully comes from this would never have existed. Never would I have met a couple who lived across the country, and never would I have had a child with them, unless it was through this process. It wasn’t made to be mine. And this baby is so wanted, they’re going to be created.”

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