Whenever Katie sees a baby who shares her trademark chestnut-colored hair and blue eyes, she canâÄôt help but wonder âÄî âÄúis it mine?âÄù ThatâÄôs because Katie, a University of Minnesota advertising junior who is not being fully named out of respect for the privacy of her sexual health, has anonymously donated her eggs four times for in vitro fertilization. âÄúA lot of times I just wish I could meet them once or hold them,âÄù the 26-year-old said of the children born from her donated eggs. âÄúBut I realize I wonâÄôt, and thatâÄôs fine.âÄù In recent months, many local and national fertility clinics reported up to 25 percent increases in the number of women applying to be egg donors, a trend some experts attribute to college students looking to make an average of $5,000 in a rough economy. But the spike has also prompted medical professionals and consumers to push for further government regulation of the practice.

Extensive screening process

To combat the probable rise in money-driven donors, clinics perform psychological screenings to learn applicantsâÄô motivations. Linda Hammer Burns, assistant professor of obstetrics, gynecology and womenâÄôs health and a licensed psychologist, performs some of those screenings. She said she believes most donors have altruistic motives, and 90 percent of those who are only in it for the money quit once they learn the requirements. When Katie first donated three years ago, she wanted to return to the University after a hiatus. She said although the money she made allowed her to go back to school, she was also motivated by the prospect of helping someone start a family. âÄúIf itâÄôs just about the money, I donâÄôt think itâÄôs worth it,âÄù she said. This is a serious ethical issue because more women want to donate due to the economy, bioethics professor Mary Faith Marshall said, but the amount of time donors must spend preparing for the egg retrieval âÄî an average of 60 hours âÄî has a gate-keeping effect. âÄúWeâÄôre not co-modifying human beings,âÄù she said. âÄúWeâÄôre compensating people for their trouble and their time.âÄù

The debate

Ever since the first in vitro fertilization baby was born in the United States in 1981, the practice has grown substantially. In 2006, 54,656 infants were born though assisted reproduction in the United States, slightly more than the 52,041 born in 2005 , according to the Centers for Disease Control and Prevention. The federal government limits the practice in the United States only by enforcing donor eligibility criteria created by the Food and Drug Administration, such as ensuring donors donâÄôt have certain diseases. The American Society for Reproductive Medicine sets ethical guidelines that clinics are encouraged to follow, but theyâÄôre not enforced. The ASRM recommends donors be between the ages of 21 and 34 years old, have a good genetic history and do not receive more than $10,000 per cycle. Chris Gooder, administrator for the Reproductive Medicine and Infertility Associates in Woodbury, Minn., said all clinics should follow the ASRM guidelines. âÄúTheyâÄôre guidelines,âÄù he said. âÄúWhen they speak, everybody should listen.âÄù Hammer Burns, former chair of ASRMâÄôs Mental Health Professional Group , said there needs to be more oversight and monitoring of the practice. She said there were several cases in which clinics were clearly not following ASRM guidelines, including the recent octuplets in California that caused a stir in national media. Other ethical concerns deal with potential side effects of the hyper-stimulation drugs âÄî called Gonadotropins âÄî used to make donors produce more eggs. Although the drugs have been tested, results are mixed, occasionally showing an adverse effect on donorsâÄô future fertility. A condition called ovarian hyperstimulation syndrome is another potential side effect of the drugs. Its mild form, occurring in 10 to 20 percent of cases, includes cramping. In severe cases, about 1 percent, OHSS can cause blood clots, kidney dysfunction, a twisted ovary and, rarely, death, according to the ASRM. Faith Marshall said she thinks the drugs need to be studied further. âÄúThese are studies that probably could and should start now,âÄù she said.

The long road to donation

Despite the rise in applicants, only about 10 percent actually donate their eggs. The others donâÄôt make it through the extensive education and preparation required âÄî either because they donâÄôt qualify or decide itâÄôs too time consuming. At the Reproductive Medicine and Infertility Associates, half of the applicants donâÄôt make it past the first visit, Nancy Schaaf, donor coordinator , said. âÄúItâÄôs not just one visit, come in, donate my eggs and IâÄôm outta here, check in hand,âÄù Schaaf said. âÄúItâÄôs a commitment.âÄù Hammer Burns agreed, saying most donor applicants are naïve about whatâÄôs required for egg donation. âÄúA lot of the girls IâÄôve seen have not been aware of what it actually involves,âÄù she said. âÄúItâÄôs like theyâÄôve watched Friends or something.âÄù Before being accepted into a donor program, one must undergo rigorous psychological, physical and medical history screenings. If they pass, prospective donors wait to be chosen by a recipient. Most want a donor who looks like themselves, Schaaf said, but clean medical histories, physical traits and education are popular factors too. If selected, they begin preparing their bodies for egg donation. A month before retrieval, donors are given a drug to stop their ovulation. A couple weeks before retrieval, donors inject themselves with hyper-stimulation medication daily. They must abstain from sex for two weeks after the retrieval to avoid becoming pregnant. Although the actual egg retrieval only takes about fifteen minutes, donors are advised to lay low for the entire day. Katie said she felt tired and had some minor cramps after her procedures, but no real side effects. After one appointment, she even went to a night class. Before donating, Katie said she wasnâÄôt sure how she would react. She said sheâÄôs surprised by the small connection she still feels to her eggs âÄî wherever they are. Regardless, she said she doesnâÄôt regret her decision. âÄúI define a family by the relationship,âÄù she said.