When Karen James* was pregnant, she wondered what her baby would look like. Unlike most expectant mothers, she was positive it wouldn't take after her side of the family, not "my sister, my father, my mother. I would look at this child and wouldn't see my nose." Now, James gazes at her 20-month-old daughter and does indeed wonder about her "cute turned-up nose. I know it's not from my husband's side." The toddler inherited the feature from her "other" mother, an anonymous woman who voluntarily gave up some of her eggs so that Karen James, 36, a New York City physician who went through premature menopause six years ago, could bear a child.
James is one of a growing number of infertile women who are implanted with embryos conceived in a laboratory from their husbands' sperm and ova from other women. The first "donor baby" was born in Australia in 1984, and there are probably fewer than 500 (statistics aren't complete) in the United States. Most donees, like James, have experienced premature menopause. And though the average recipient is under 45, the outer limits of this in vitro fertilization (IVF) procedure are being pushed to 55. According to the American Fertility Society, the success rate is about 20 percent, slightly higher than that of the standard IVF procedure using the mother's own eggs. But at some clinics the chances are one in three, and the Howard and Georgeanna Jones Institute for Reproductive Medicine at the Eastern Virginia Medical School says that its rate has leapt to 50 percent. Still, the cost is steep-about $9,000 per attempt--and so is the emotional price. "The couple has had to come to terms with the definitiveness of their own infertility," says psychologist Linda Applegarth, who screens participants at New York Hospital-Cornell Medical Center. "This third party will always be a factor in their lives."
As more and more American hospitals--almost 50, up from a handful a few years ago-use the procedure, the numbers are rapidly rising. "This is the best treatment for women under 40 who have failed to conceive," says Dr. Maria Bustillo of the Genetics & IVF Institute in Fairfax, Va. It is, she says, "like adopting an embryo" instead of a baby. But families and the courts have barely begun to address the ethical and legal problems that will almost inevitably surface.
Whether she is helping a desperate sister, friend, colleague or a stranger, the average donor acts out of altruism. The procedure she faces is time-consuming, uncomfortable and carries a slight risk of leaving her infertile. She receives daily injections of a variety of drugs, chiefly fertility ones to induce her ovaries to produce more than one egg at a time. For three weeks, she must go to the clinic every morning so that doctors can check her blood and monitor the eggs' maturity. Then, when the eggs are ready for harvesting, she has surgery. An ultrasound-guided needle is inserted into the ovary, where eggs are picked from their protective follicles and sucked out. They are then fertilized in vitro with sperm from the recipient's husband and transferred, by catheter, to the recipient's uterus. The donor's role is over. Or is it?
An egg donor, unlike a surrogate mother, is genetically linked to the child. Though it hasn't happened yet, it is almost inevitable that a donor will eventually sue for parental rights. And there is a precedent: an Oregon man whose sperm was used for artifical insemination recently won visitation rights. "Whenever you have third-party collaboration in the reproductive process," says Susan M. Wolf, a lawyer at the Hastings Center, a medical-ethics research center in BriarCliff Manor, N.Y., "you have the potential for the collaborator to turn around, break the deal and say, 'I want rights to this child.' There is no clear resolution in our society as to who is th& mother. This is all still very much up for grabs."
As many donors see it, they contribute tissue, not a baby. "I gave an egg," says Nancy Schuster, 37, who twice donated eggs anonymously in an Ohio clinic. "That egg gave a couple the means to have a child. They're really the parents." Elizabeth*, a 28-year-old graduate student who is giving an egg to an acquaintance, feels the same way. "I didn't actually make the child, grow the child, produce the child, give it air and life," she says. "I may have given the yeast, but the bread isn't mine."
Doctors do their best to select donors unlikely to cause problems in years ahead, Ideally, they choose women under 35 who are married and already have as many children as they want. Many women participate because motherhood has been important to them. Stacey McCorison, an associate director of financial aid at Duke University in Durham, N.C., has two children. After hearing women at Duke's IVF program discuss what they had gone through to try to conceive, she says, "I was close to tears. I thought if I could do anything to help, I'd be there in a heartbeat." Doctors are cautious about the donors they accept, and look for donors with a stable social situation. "There's no way you can really do this therapy without taking risks," says Dr. Mark V. Sauer of the University of Southern California. "That goes for all parties. I tell our people that we'll do our best to inform and protect you but I can't predict the future."
Some potential donors are turned down on psychological grounds. Patricia Schreiner-Engel, a psychologist at Manhattan's Mount Sinai Medical Center asks questions such as, "Do you expect to be made a guardian of this child in the parents' wills?" or "If five years from now, you cannot get pregnant yourself, will you feel some claim to this child?" During screening, doctors have discovered that women have been coerced into volunteering, or that they may have differing expectations. A donor usually receives about $1,500-which often doesn't compensate for lost work time and is not enough to make money a real incentive.
Not all clinics insist on anonymity. Sisters, regardless of what variety of program they are in, are usually allowed to participate together. Vicki Miceli, 36, a Los Angeles freelance television producer who had lost both ovaries, gave birth last December to Anthony-the product of sperm from her husband, Larry, and an egg from her sister, Bonny de Irueste, 34. "That she volunteered to do this for us was extremely special and selfless of her," says Vicki. "But as she said to us, 'I'm his aunt, that's it.' There was never any blurring of the line."
At least one donor demands not to be anonymous. Sue Scott, 34, who has two children by her husband, has made 11 donations at USC. With Sauer's approval, she meets with prospective parents before she agrees to cooperate and later asks them to accompany her on doctor's appointments. There are now five babies born from her eggs and Scott asks the parents to send her annual photographs. The first grateful recipient invited Scott to the hospital to see her twins. "There was disbelief in her face as she was staring at these two babies," Scott says. "I just fell apart. I knew why I was doing this. I helped to make this situation happen. I get sheer enjoyment out of it." Scott likes knowing the children she helped conceive: "I don't want to walk around Disneyland one day saying, 'Gee, that one looks like me, I wonder if... "' For the parents whom Scott has helped, the mere existence of their children is wonder enough.
*Not her real name.