Sex Cells: The Medical Market for Eggs and Sperm (2 page)

MARKETS FOR BODILY GOODS: FROM SEX TO CELLS

Commodification of the body—a process in which economic value is assigned to bodily services or goods—has long generated heated debates that only grow more intense as the number and kind of goods for sale increase. There is, of course, prostitution, the “oldest profession,” which has undergone enormous changes in the last few decades as evolving transportation and communication technologies have provided new opportunities for people to buy and sell sex. In medicine, eighteenth-century scientists began to evince a ghoulish need for corpses to sustain and nurture their burgeoning knowledge of human anatomy. More recently, the development of surgical techniques and transplant medicine has fostered demand for various body parts, from blood and organs to bone marrow and even faces.
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But it is in the realm of reproduction, where there has been an explosion in the use of medical technologies to have children, that some of the most pointed questions about markets for bodily goods have been raised.

Infertility, a condition barely spoken of at the beginning of the twentieth century, is now defined as a medical problem and routinely discussed on daytime talk shows and in the pages of the
New York Times
.
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Affecting roughly 10% of the population, infertility can often be traced to physical problems such as blocked fallopian tubes or low sperm count. However, demographic trends and changing cultural norms have also contributed to an increased reliance on reproductive technologies. More women than ever are seeking higher education and participating in the labor force, and as a result, some choose to delay childbearing.
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Gays and lesbians, whose reproductive decisions have become more visible as they advocate for rights associated with marriage and parenthood, are
also increasingly turning to the medical profession for help in conceiving children.
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The technologies currently offered are the result of centuries of reproductive experimentation. The first attempts at artificial insemination began in the late 1700s, but it was more than a century before the use of
donated
sperm was reported in the medical literature. Today, insemination involves the use of a syringe to place semen into a woman’s vagina or uterus. Vaginal inseminations are fairly simple, and some women opt to perform this procedure at home; however, intrauterine inseminations are typically performed in medical settings.
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Experiments with IVF began in the 1930s but did not result in a human birth until 1978, and success with
donated
eggs followed just a few years later.
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Today, an IVF cycle involves a woman self-injecting fertility medications for several weeks, which stimulates the ovaries to produce multiple eggs that are then removed in outpatient surgery. Eggs and sperm (also called “gametes”) are mixed together in the lab, and if viable embryos result, a few are placed in the woman’s uterus.
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People who use insemination or IVF to conceive generally prefer to use their own eggs or sperm, but some must turn to egg and/or sperm donors. Those who cannot sustain a pregnancy might opt to engage the gestational services of a surrogate mother.
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In undergoing the first part of an IVF cycle, egg donors face short-term risks associated with both the fertility drugs and the egg retrieval surgery, risks that include ovarian hyperstimulation syndrome, infection, bleeding, and complications from the anesthesia. The American Society for Reproductive Medicine (ASRM) estimates the risk of serious complications to be around 1%, and the few empirical studies that have been conducted find similar rates.
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There is very little research on the long-term effects of undergoing IVF, which has led to calls for an egg donor registry to track young women who are exposed to fertility medications early in life.
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There are no physical risks associated with sperm donation, but men’s activities are restricted for a much longer period of time than egg donors’. Most programs require that men commit to producing samples by masturbating at the sperm bank at least once a week for an entire year,
and each donation must be preceded by two days of abstinence from sexual activity. If the sample meets bank standards for sperm count and semen volume, it will be frozen and stored in the bank’s offices until it is purchased by recipients for use in insemination.

The United States has responded to technological interventions in reproduction with far less regulation than other countries. For example, Britain’s Warnock Report, issued in 1984, resulted in the Human Fertilization and Embryology Authority (HFEA), which monitors and makes policy on all aspects of assisted reproduction.
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The HFEA sets compensation for egg and sperm donors at very low levels, and in 2005, it eliminated anonymous donation, requiring that identifying information about donors be shared with offspring at age eighteen. In contrast, the United States’ laissez-faire approach has permitted the existence of fairly open markets for reproductive goods and services. Starting in 1992, Congress required that fertility clinics report the number of procedures performed each year as well as what proportion are successful. But there are no federal requirements regarding payments to donors, and ethical determinations about other aspects of egg and sperm donation are left to professional societies such as ASRM, which have very little power to enforce the guidelines they issue.
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THEORIZING BODILY COMMODIFICATION

The issue of bodily commodification has drawn sustained attention from scholars in many disciplines, from law, philosophy, and ethics to history, sociology, and anthropology. Despite all this attention, though, there remains a schism in the wide-ranging literature. On one side, scholars conceptualize commodification as uniform; the simple fact that money is exchanged for all or part of a human being is fundamental in shaping the market. On the other side, scholars contend that the exchange of money for bodily goods and services is a variable social process; it can proceed in many different ways and be imbued with many different meanings.

The first view has a longer history and more adherents. There are a few in this camp who are unabashedly pro-commodification, arguing
for open markets for sex, children, organs, and the like.
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But the vast majority of scholars in this area have been sharply critical of assigning economic value to bodies, contending that the effects of doing so are uniformly negative. Richard Titmuss’ classic study of blood donation provides just one example. When he was conducting research in the 1960s, the United States relied on a hodgepodge system of paid and voluntary donors, which he compared with the wholly voluntary, centralized blood collection system in the United Kingdom. Titmuss concluded that altruism-based systems like the UK’s produce safer blood and are morally preferable to payment-based systems, writing, “blood as a living tissue may now constitute in Western societies one of the ultimate tests of where the ‘social’ begins and the ‘economic’ ends.”
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Writing about egg donation twenty-five years later, bioethicist Thomas Murray revealed a similarly dichotomous view of society and economy when he asks,

Are children more likely to flourish in a culture where making children is governed by the same rules that govern the making of automobiles or VCRs? Or is their flourishing more assured in a culture where making children . . . is treated as a sphere separate from the marketplace? A sphere governed by the ethics of gift and relationship, not contract and commerce?
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Indeed, deeply embedded in this first view is the assumption that bodily commodification is harmful, both for the society and for the individual. In tracing the stigma associated with earning money through the use of one’s body from the ancient Greeks to the present, philosopher Martha Nussbaum bluntly summarizes the prevailing opinion. “It is widely believed . . . that taking money or entering into contracts in connection with the use of one’s sexual and reproductive capacities is genuinely bad.”
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In the following laundry list, Titmuss specified all the ways in which he believes paying for blood produces negative effects.

The commercialization of blood and donor relationships represses the expression of altruism, erodes the sense of community, lowers scientific standards, limits both personal and professional freedoms, sanctions the making of profits in hospitals and clinical laboratories, legalizes hostility between doctor and patient, subjects critical areas of medicine to the laws of the marketplace, places immense social costs on those least able to bear them—the poor, the sick, and the inept—increases the danger of unethical behavior in various sectors of medical science and practice, and results in situations in which proportionately more and more blood is supplied by the poor, the unskilled, the unemployed. . . .”
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In sum, abstract distinctions—economic/social and commodity/gift—undergird this first view of commodification as uniformly degrading: when the market expands to incorporate bodily goods, social relations are invariably threatened.

On the other side of the schism in this literature is a view based on the opposite assumption, which is that markets and social life are inextricably intertwined. Economic processes are shaped by social factors and vice versa. One leading proponent of this second view is Viviana Zelizer, a sociologist whose research has spanned the emerging market for life insurance, the changing cultural and economic value of children, and the social and legal interpretations of monetary exchanges in intimate relationships.
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Based on this research, she has formulated a sociological model of markets in which economic, cultural, and structural factors interact. Zelizer notes, “As an interactive model, it precludes not only economic absolutism but also cultural determinism or social structural reductionism in the analysis of economic processes.”
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In allowing for the possibility of variation in how markets are configured, this model opens up the theoretical prospect that commodification can have various and multiple effects on those who participate in such markets. In this way, the work of Zelizer and others contests the idea that commodification is inherently or solely detrimental. For example, legal scholar Margaret Jane Radin has endeavored to better understand the “complexities of commodification as we experience it. These complexities include the plurality of meanings of any particular interaction, the dynamic nature of these meanings (their instability), and the possible effects (good or ill) in the world of either promoting or trying to forestall a commodified understanding of something that we have previously valued in a noneconomic way.”
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Likewise, Kieran Healy’s sociological
analyses of blood and organ donation challenge normative assumptions, such as those in Titmuss’ work, about the evils of the marketplace and the benefits of gift exchange. Healy concludes, “The idea that markets inevitably corrupt is not tenable precisely
because
they are embedded within social relations, cultural categories, and institutional routines.”
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Debates about commodification are so extensive because they are so crucial, and thus it is important to directly address this schism.
Is the process of bodily commodification uniform or variable? If there is variation in how markets for bodily goods are organized, to what extent does that variation affect the experience of being paid for bodily goods
? Asking the question in this way builds upon previous research but is innovative in that it clearly delineates two aspects of bodily commodification: the
organization
of the market and the
experience
of the market. Scholars who assume commodification is uniform have not had cause to ask these questions, while those who attend to variation have generally focused on the organization of markets, paying less attention to the embodied experience of commodification. In the next two sections, I develop a theoretical framework to address each of these two levels of analysis.

ORGANIZING THE MARKET: SEX, GENDER,
AND THE VALUE OF BODILY GOODS

In bringing together economic, cultural, and structural factors, Zelizer’s sociological model of a market is a useful starting point, but to analyze the organization of markets for bodily goods, I find it necessary to incorporate biological factors into the framework. Doing so allows for the explicit accounting of different kinds of bodies and different kinds of bodily goods in studies of bodily commodification. In this book, I focus on a particular kind of bodily difference, that of sex. So, in this case, taking biological factors into consideration involves conceptualizing eggs and sperm as cells that are associated with female and male bodies, as well as gendered expectations of women and men.

Here, I am drawing on a long-standing distinction in feminist theory between “sex,” which is defined as biological differences between females
and males, and “gender,” which is defined as the cultural meanings attributed to those biological differences.
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In general, social scientists have paid more attention to gender and downplayed biological sex differences. However, as Sylvia Yanagisako and Jane Collier note, the failure to analyze sex is a mistake because “having conceded sex differences to biology in the interest of establishing our scholarly authority over socially and culturally constituted gender differences, we have limited our project and legitimized assumptions about sexual difference that return to haunt our theories of gender.”
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