At the time, donating her eggs to an infertile couple seemed like the perfect solution for Marilyn Drake's money troubles. A single donation helped her finance her divorce. Then she did it four more times over the course of two years, as she struggled to raise two children on her own.
In 2004, having remarried, Drake began trying for baby No. 3. She tried for three years, with no luck. At 30, she was diagnosed with premature menopause and, in an odd twist of fate, had to undergo fertility treatment to have her third child. It struck her as particularly curious, since her identical twin sister never had any fertility problems. (See the top 10 medical breakthroughs of 2008.)
"At the time, I was told it wouldn't affect my health or fertility," says Drake, 32, of Lebanon, Ore., referring to her egg donation.
Doctors say there is no biological reason that donating eggs would cause infertility, but they also cannot say for sure that it doesn't. The long-term health effects of egg donation have never actually been studied, in large part because the high cost of studies doesn't "seem justified in terms of what the possible risks [of the procedure] might be," according to Sean Tipton, spokesman for the American Society for Reproductive Medicine (ASRM). He points out that egg donors undergo the same drug treatment as IVF patients hormone injections and other drugs that stimulate follicles, promote egg maturation and prevent the release of eggs before they can be retrieved and that studies of the latter population show it is safe.
But some women's health advocates say that evidence isn't strong enough, calling for further study and a national, trackable registry of egg donors. While the Centers for Disease Control and Prevention (CDC) logs the number of donated eggs transferred to infertile women each year there were some 15,500 in 2006, the most recent year for which data are available no one knows how many individual donors those eggs came from, who they were or whether they were exceeding industry guidelines of six donations in a lifetime. (The guidelines are intended to limit the number of offspring from a particular donor and to prevent overexposure to fertility drugs, but they are not based on scientific data.)
"Right now egg donors are treated like vendors, not as patients. Patients need to be followed up," says internist Jennifer Schneider, who has been advocating for the government to track egg donors since 2007, a few years after her daughter, a three-time egg donor, died of colon cancer at age 31. "After the first few days of being discharged from the IVF clinic and seeing that there were no immediate consequences, they are never contacted again."
The issue has resurfaced recently, with fertility clinics and egg-donation agencies across the country reporting a precipitous increase in applicants seeking to donate eggs as high as 55% over the past four months compared with the same period last year. With college students struggling to pay tuition and young homeowners facing foreclosures, much has been made of the potential economic benefits of donation, a term that belies its lucrativeness: egg donors can earn about $5,000 per donation, with thousands more in premiums for eggs from women with exceptional looks, high SAT scores or an Ivy League diploma, and an in-demand ethnic background, such as Jewish or Asian. Proven donors whose eggs have already succeeded in making a baby are also often paid premiums for subsequent donations. (Read "How Not to Get Misled by Health Statistics.")
The surge in interest hasn't yet translated into an uptick in donations, since the majority of applicants are weeded out in a rigorous screening process. But it still prompts the question: What are the long-term risks of donating?
So far, there have been no long-term medical studies of donors. But fertility doctors agree that a lot can be gleaned from the smattering of studies of long-term risks for infertility patients, who receive the same protocol for ovarian stimulation and retrieval as donors. The primary health concern is cancer, and studies assessing cancer rates among infertility patients have drawn conflicting results. Many such studies are hobbled by small sample groups, or are too short term. The most extensive study to date, published in February in the American Journal of Epidemiology, used historical data from women who gave birth in Jerusalem in the early 1970s. It found a significant 30-year increase in various cancers among women who underwent fertility treatments, with the highest risk being for uterine cancer.
But studies like this establish only an association, not a cause; fertility doctors note that infertility itself is associated with elevated risks of uterine cancer. "It's hard to say if the cancer was caused by the disease, the treatment of the disease or some combination of the two," says Elizabeth Ginsburg, a fertility doctor and president of the Society for Assisted Reproductive Technology.
Reproductive-health advocates respond by calling for a study of egg donors, who could also serve as a natural control group for a study of cancer in women who are treated for infertility. Another long-standing question among doctors and donors is whether egg donation affects future fertility, says Schneider, who has conducted a survey of 155 egg donors and heard several reports of fertility problems among women post-donation. Schneider concedes that her poll was too informal and small to lead to any conclusions and suggests that a larger, national study be undertaken.