By CRG staff - interview with Debora Spar

Debora Spar, PhD, is president of Barnard College and author of The Baby Business: How Money, Science, and Politics Drive the Commerce of Conception.

GeneWatch:  The big question is: how did we end up with an essentially unregulated multi-billion dollar industry?

Debora Spar: I think that we wound up with this unregulated industry for reasons that are actually quite understandable, if not good. We wound up here because, to begin with, the United States has a deep aversion to regulation of any sort. Compared to many other countries, particularly Western Europe, we don't like regulation. Virtually all of our markets, whether it is banking or Internet or education, are less regulated than they are in many other places. So right off the bat, it's not surprising that we also have a lack of regulation in this sphere. What makes it so pronounced in this particular area, though, is that we also have a deep aversion to having any kind of political conversation around reproduction, and particularly around the status of the embryo. It's almost impossible to have those conversations without getting deeply involved in the abortion debate, which is essentially political suicide in this country. So I find it not in any way surprising that there is virtually no politician out there that wants to tackle this issue. 

GW: From either side of the aisle ...

DS: Absolutely. It's poison on both sides. Poison across the spectrum.

GW: That explains why it's not being addressed in a legislative way, but does it seem to carry over into agency rules and state and local policies?

DS: Yes, because these are not regulations that would ever sneak under the radar. This is too politically charged. It's politically charged across the political spectrum in ways that can create very strange bedfellows, so you also don't want as many folks who tend to cluster on the left, particularly people in favor of same sex marriage or same sex relationships. They don't want the government touching the arena of assisted reproductive technologies because they understandably fear that it allows for government intervention in the question of who can have children. You have those on the far left who don't want to touch this, and then those on the right who don't want to touch it because of their concerns about abortion, so there is no political constituency in favor of reform.­

I would add one more piece. There are also the parents who become involved in this area; they don't want regulation because when they're in the reproductive center, all they want is babies. They don't see the government as a way to get there. So if the parents in the process don't want regulation, the industry doesn't want regulation, and there is no political constituency pushing for regulation, there's really no voice for regulation ... with one exception. We are starting to see flickers of a movement made up of the grown children of assisted reproduction, and I suspect that it will grow much, much louder. In particular, we're seeing that children who were born of sperm donors are increasingly fighting to have some sort of way of identifying their genetic fathers. And I think that's just the first wave: this is the first generation of grown-ups who were born through assisted reproduction. 

GW:  As you've pointed out, this is a multi-billion dollar industry. What sort of sense do you get about where the money is ending up? Who is getting rich off of this, if anyone?

DS: Reproductive doctors. The doctors and their intermediaries. There is an utterly unregulated group of egg donors, egg brokers, surrogacy brokers; they are truly a new sector of the market. They're making money, the clinics are making money, and the companies that make the drugs are making money. None of which, let me underscore, are necessarily bad. People make money doing all kinds of things, like creating cancer drugs. I don't think the fact that people are making money is bad at all. I do think it is bad that there is less regulation in this area than in other fields of medicine where people also make money. 

GW: The Baby Business came out in 2006. Do you have a sense of how much has changed since then?

DS: My sense is that there have been two major trends. When we hit the economic downturn, it appears that there were fewer people who could afford or were willing to pay the expenses to go into the assisted reproductive market, although I suspect that may be ending now. By the same token, though, there were also reportedly increased numbers of women interested in donating their eggs for the same reason. And then the other main trend, of course, is as same sex marriage becomes more socially and legally accepted, I think that we're going to start seeing the same sex part of this market steadily increasing. It's already increasing very very rapidly, but obviously, for gay men, if they want to have a child together, they almost certainly have to go into the reproductive market to some extent-especially since it's become harder and harder for them to adopt children.

GW:  So would surrogacy be the most common way to go about this?

DS: It's really the only way. And adoption, but as I said, that's being cut off. And surrogacy is almost most certainly the most expensive way to acquire a child. 

GW: In terms of cost, how does surrogacy compare to other options, like egg donation or adoption?

DS: It's purely additive. If you're doing surrogacy as a gay couple, you have to buy eggs because you don't have your own. And you have to go through IVF because you have to put those eggs together with sperm. And you have to hire the surrogate. So you're doing every single piece of it, whereas if it is a heterosexual couple, they don't have to do all of the pieces, depending on what the circumstances are. But gay couples have to basically buy everything-aside from sperm, which is the cheapest part of the equation.

GW:  How much does an egg go for?

DS: Anyone who sits on a college campus as I do will see ads in the back of newspapers that cluster around $25-30,000, particularly at the elite colleges-although the ASRM (American Society for Reproductive Medicine) guidelines are much lower.

GW:  Do you mean that that is how much someone gets paid to donate an egg or how much it costs to give the egg? 

DS: That's how much the donor will get paid per harvest. So the price of that egg to the purchaser will be higher because it will include that cost, obviously, plus whatever the egg broker is making, plus the cost of whatever you do subsequently with that egg, whether it is then frozen, whether it is made into an embryo. That payment to the donor is only your, if you will, input cost. 

GW: You also write about when efforts to get a baby can approach actually selling babies. Is there a place where you draw that line? How does that happen?

DS: I think that this is a semantic distinction, but it is an important one. Adoption isn't baby selling. The laws here are quite good. As compared to assisted reproduction, adoption is very heavily regulated. It is illegal to sell a baby, and if people are caught, they go to jail or they pay huge fines. So people aren't selling babies. What they are doing is they are paying intermediaries to help them acquire a baby. So the great irony here-and I'm not sure if it's a bad thing, but it is somewhat ironic-is that what is illegal is paying the mother for the child. If you are never paying the mother for the child, you are not buying a baby. What you are doing is paying all of the intermediaries in the process.

GW:  Is a lot of that international?

DS: Yes. Adoption is basically regulated at every level. In the United States, it's mostly at the state level if you're adopting domestically, but if you're adopting internationally, one has to go through state level regulations and national regulations, and the regulations of the target country, and The Hague, which is the international overseeing body. 

GW:  Out of all of the different things you looked at, what are some of the most egregious practices that you came across or that are actually happening

DS: Well, I think that the most egregious umbrella, if you will, is that what gets lost in all of this is a consistent focus on the health of the mother and children. There are not, in my mind, sufficient studies of what the long-term implications may be of assisted reproduction on the health of the mothers, the donors, and the children. There may be trust that everybody is fine, but we don't have the data yet to confirm that. And that, in my mind, is really the most egregious set of practices, because it includes things like transferring way too many embryos at once. There is no cap on the number of times women can go through massive hormonal stimulation. And I think that those are the very egregious practices-not the money side.

GW:  How do the customers, so to speak, the couples or the single parents who desperately want a child, but can't have their own... How do they find their way to these sorts of places? 

DS: Like everything else, these days; it's all online. It's online, and then there are support groups, and list servs, and all of these wonderful things we've discovered and created.

GW: What do you think that the government or other actors need to do to address some of these bigger problems? What kinds of regulations would you like to see and what can be done aside from regulation?

DS: I say this with the caveat that I don't think it is particularly realistic, quite frankly, but I think that we could have a minimal set of regulations at either the state or federal level-I think that the state is more likely-that would really bring some of these practices in line with current regulations that we have in the general medical area; in the case of egg donors, bringing it in line with the kind of regulation that we have for other people who donate organs, blood, other body parts, even sperm. Sperm donation is much more heavily regulated than eggs. 

The other thing I would really push for if I had the magic wand would be just to begin a basic process of data collection. There was one piece of legislation some years ago which does collect data from the fertility clinics. That's a good thing, and I think that if we had a similar set of data on the children who were born through these practices and the women who undergo them, I think that would go a long way toward at least giving us the information to start to understand whether or not there are any long-term medical implications. And it would also give us the ability to allow children born from these practices to find their genetic parents if they choose to as they get older.

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