This article by Aaron Levine, Assistant Professor, School of Public Policy article is currently published online in "The Hastings Center Report," a bi-monthly journal exploring bioethics. The article will be published in an upcoming print issue.

Over the last couple of decades, oocyte donation has become common, important, and sometimes lucrative. Women who donate eggs are often offered fees, though ostensibly only to offset their expenses and limited to no more than $10,000, following recommendations adopted by the fertility industry. Is the industry adhering to its recommendations? A study of advertisements published in college newspapers raises questions.

In vitro fertilization, a technique pioneered by Robert Edwards and Patrick Steptoe in the 1970s, first produced a healthy child in 1978. In the three decades since the birth of Louise Brown, the use of IVF has grown rapidly. In 2007, the most recent year for which data on IVF births are available, approximately 1.3 percent of children born in the United States resulted from IVF. In a typical IVF procedure, oocytes are extracted from the intended mother and fertilized by the intended father's sperm in a petri dish. In some cases, however, infertility results from the intended mother's inability to produce viable oocytes. In this situation, one option is for the couple to use oocytes donated by another woman. The first IVF birth using this approach occurred in Australia in 1983. Following this success, the practice spread slowly, with couples typically asking friends or relatives to serve as the oocyte donor.

The nature of oocyte donation in the United States changed in 1987 when the Cleveland Clinic started its Oocyte Donation Program, the first in the country to match anonymous donors with infertile couples and to compensate the anonymous donors. The program built on existing practices with sperm donation and allowed parents to select their donor based on national origins, height, and eye color, among other attributes. Oocyte donors were paid $900 to $1,200 for participation in the program. This compensation was offered to offset participants' direct and indirect costs, not as payment for their oocytes.

The combination of anonymity and compensation for oocyte donors paved the way for rapid growth of this reproductive practice. In 1987, only seventeen U.S. medical centers offered oocyte donation. By 1990, this number had nearly tripled""forty-eight fertility clinics around the country offered the service. Most of these clinics still required women to find their own donors, but following the lead of the Cleveland Clinic program, an increasing number were providing donors for their patients and brokering a financial transaction between the intended parents and the oocyte donors, who received an average of $2,000 per donation.

Oocyte donation continued to grow throughout the 1990s and 2000s. According to reports produced annually by the Centers for Disease Control and Prevention, approximately 4,800 assisted reproductive technology (ART) cycles used donated oocytes by 1995. Ten years later, approximately 16,000 ART cycles used donated oocytes. The percentage of all ART cycles using donated oocytes increased from approximately 8 percent to 12 percent during this ten-year period. The 1992 law that mandates reporting of fertility clinic success rates does not address compensation for oocyte donation, but most of the women who donated eggs were presumably compensated.

For a variety of reasons, the fertility industry in general and the practice of oocyte donation specifically is not heavily regulated in the United States, particularly compared to other developed countries. The result is that the fertility industry in the United States relies heavily on self-regulation, which generally takes the form of guidelines issued by two professional organizations""the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology.

The research I report here aims to gauge the effectiveness of self-regulation in the fertility industry, particularly as it pertains to the recruitment of oocyte donors. In it, I examine a novel data set""a collection of oocyte donor recruitment ads published in college newspapers across the country""to assess the extent to which the ASRM guidelines for compensating oocyte donors are honored in advertisements that recruit donors.

In brief, my analysis identifies several concerns with the self-regulatory approach. Nearly half of the advertisements offered compensation exceeding recommended levels. In addition, analysis indicated that average SAT scores at the college or university where an advertisement was published were a strong predictor of the compensation offered. This effect was strong and significant for advertisements placed by donor agencies and individual couples, but absent for advertisements placed by fertility clinics, which suggests that donor agencies and couples valued specific donor characteristics and based compensation on these preferences""a violation of the guidelines. These findings call into question the notion that the current self-regulatory framework provides appropriate ethical protections for oocyte donors.

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