Oct. 21, 2007: Miracles for sale

Caitlin Karolczak sees it as a classic case of supply and demand. After all, one of her eggs goes to waste every month, so she might as well share it with a woman who can use it. She thinks the $8,000 she can get is a reasonable price for helping someone create a life. "If you give something away, they won't cherish it," she said.

Much has changed since the first test tube baby was conceived in a laboratory petri dish in 1978. Today, Karolczak, a 24-year-old Minneapolis artist and antique dealer, is a bit player in a $3 billion business, which is thriving on the Internet and being transformed by advances in medical technology and new competition among clinics promising miracles to couples often desperate to have a child.

But as it flourishes, some are warning that the freewheeling marketplace is turning the creation of human life into a commercial enterprise that cries out for consumer protection. And nowhere is this more evident than in the exploding market for human eggs, where there are few laws protecting the rights and health of donors and parents.

Though women like Karol-czak are called egg donors, most are well paid. Couples in parts of the country offer fees as high as $20,000 or more for the eggs of educated, attractive young women.

"The first donations were sister to sister," said Linda Hammer Burns, a psychologist at the University of Minnesota and an expert in infertility. "Now, it's an industry."

She worries that clinics and egg donor agencies are increasingly motivated by money rather than the best interests of patients, donors and the children they create. "Doctors are putting money first," she said. "If you turn someone down, it's a patient walking out the door."

Websites are making finding a donor egg as easy as shopping for a car. Egg brokers are assembling detailed databases of young women -- their hobbies, religion, education -- willing to hand over their eggs. They are marketing package deals to their customers that include medical and psychological screening of egg donors. Some fertility clinics are even offering money-back guarantees if the couple fails to conceive.

And now, scientists are working on freezing eggs -- a technique that, once perfected, promises to propel the industry into even more rapid change.

Donor #8447

Karolczak was donor #8447 on the website created by Egg Donation Inc., one of the largest egg donor agencies in California. The site says it's the place "where dreams come true." It's also a place where the supply and demand for human eggs come together.

This year, Karolczak's picture was one of nearly 1,200 photos that pop up on the site like electronic baseball cards: Sarah, 24, 5'2", blue eyes, blonde hair; Ashley, 21, brown hair, green eyes; Caitlin, 23, blue eyes, brown hair.

The increasing demand for eggs is fueled by the growing numbers of older women who want children but who find, too late, that their ovaries have quietly failed them. "It's a social phenomenon we are seeing worldwide," Burns said. "Women are postponing childbearing."

One in 10 couples are unable to conceive on their own, and many are turning to donor eggs to get pregnant. Minnesota has five clinics specializing in fertilization, all clustered in the Twin Cities and Rochester and attracting patients from across the Upper Midwest. Donor egg prices are lower here than in Boston and Los Angeles, where eggs can go for $20,000 or more.

Lyne Macklin-Fife, program administrator for Egg Donation Inc., said that when she got into the business a dozen years ago, donors primarily wanted to help other women. They were happy getting paid $2,500 or less. But as the prices increased, the motivation changed.

"Donors are becoming savvy," she said. "I think some of that still remains, but in the big scope, girls are doing it because it helps with their finances."

Today, the fees are driven primarily by couples on the coasts who are willing to pay high prices for "our creme de la creme kind of lady," Macklin-Fife said. That's a woman who has successfully donated -- or "cycled" -- three or four times, "has a phenomenal health history, Ivy League academics and is very attractive."

Health plans, which routinely control quality and pricing and set treatment standards in other areas of health care, seldom pay for in-vitro fertilization, commonly known as IVF. That process, in which an egg and sperm meet outside the body in a petri dish, is the only way to get pregnant with a donor egg.

So would-be parents pay the fee to the egg donor themselves, in addition to the $15,000 or more that goes to the agency for insurance, and the donor's medical and legal costs.

Karolczak said she found the Egg Donation Inc. website a few years ago when she was a student at the University of Minnesota. She sent in her profile and waited a year before the agency contacted her, saying that a couple from Los Angeles had chosen her to be the biological mother of their baby. Karolczak flew to Los Angeles for medical, genetic, and psychological screening.

The couple paid her $6,000, an average fee for first-time donors in the Egg Donation Inc. database, and the woman is now pregnant, Karolczak said.

The second couple paid her more -- $8,000 -- because she was a proven donor. After injecting herself with fertility drugs every day for six weeks, Karolczak flew to a Los Angeles IVF clinic, where she produced 16 eggs at once.

The husband's sperm and her eggs were combined in a petri dish and during the next few days grew into embryos. Karolczak said that some were frozen and that some were implanted in a surrogate carrier the couple also hired because the woman was unable to carry a child. She has heard since that the surrogate miscarried and that the couple plans to try again with the frozen embryos. Given the chance, she would donate again, Karolczak said.

"I think it's great," she said. "Men have always been able to spread their genes. Now I can spread my genes."

The broker

Minnesota doesn't have any giant donor agencies like Egg Donation Inc. But it does have Steve Snyder, an attorney who has owned the International Assisted Reproduction Center since 2003.

Snyder is a broker who recruits and screens surrogate mothers and egg donors.

These days, his fastest growing service is arranging egg donation. Each month, about 15 or 20 people contact his agency, looking for donors. Most of them either find him on the Internet, or are referred by clinics he works with outside Minnesota.

Clients who choose one of the donors in his pool pay $16,500 to his agency. That covers the donor's fee -- usually about $4,000 to $6,000 -- as well as her medical, genetic and psychological screenings, travel, insurance, drugs, blood tests, ultrasounds and legal fees.

He almost never meets his egg donor clients. All communication is by phone, e-mail, the Internet and electronic fund transfers. The IVF clinics handle the rest.

Snyder dismisses the notion that his clients are shopping for children the same way people shop for mates on dating websites. He has been in the fertility business long enough, he says, to know what drives couples.

"First is healthy," he said. "Then they want a donor who looks like mom. And not all moms look like supermodels."

Thanks to the culture of reproductive freedom here, Snyder has become the beneficiary of a new and growing global trend -- fertility tourism. Some countries outlaw the practice of paying people for their eggs and sperm. Others outlaw such conceptions altogether. So many infertile and gay couples from around the world are quietly flocking to Snyder's agency, housed in an out-of-the-way corner of a Maple Grove office park. There, with confidentiality, they can contract with the donors and surrogates they need to create their children.

Occasionally, Snyder finds himself in the position of ethical gatekeeper.

Not too long ago, a couple in Canada came to him for help: They had lost their only son in an accident, but while he was still on life support they persuaded his doctor to get a sperm sample from him. Would Snyder find them an egg donor, a surrogate mother and an IVF clinic to bring all the pieces together so they could raise their grandchild?

In Canada, all that would be illegal, as it would be in many other countries. But in the U.S. fertility market, where just about anything is game, it's legal.

In the end, Snyder didn't have to decide. The son who died had not had the necessary tests to show he was free of any infectious diseases that could be transmitted to a surrogate or a resulting baby. Such tests are among the few regulations governing egg and sperm donation in the United States.

"But things like this come across my desk every day," Snyder said.

He and many others in the industry say more laws are needed. The U.S. government is unlikely to pass laws that dictate who can be a parent and by what means, he said. But the American Bar Association, physician groups and infertility advocacy groups have lobbied for laws that clearly define who the legal parents are in pregnancies involving donors, recipients and surrogate mothers. They have also pushed for laws that require counseling for donors and recipients.

One of the most important protections that consumers and their children need, they say, is the establishment of a national donor database. That way, if egg donor agencies go out of business or lose their records, children will still be able to find their biological parents, or at least learn their health history.

Egg donation in Minnesota

Bonnie Davig remembers the day she got the letter -- a brief, one-page description of her egg donor. Davig, of Henderson, was 36 when she married for the second time. Her three daughters from her first marriage were grown, but her husband had no children of his own. They wanted a family, but her ovaries no longer produced healthy eggs.

The letter from Davig's IVF clinic in Woodbury said the 24-year-old donor had brown hair, brown eyes and an ethnic background that included Norwegian, French Canadian, Polish, and Italian. She ran a day-care business in her home, was married and had two young kids.

"That's all the information we had on her," said Davig, now 42. "And she sounded great to us."

In fact, that's the only information the Woodbury clinic ever provides on the women who donate their eggs. But what's even more significant about the process is that Davig didn't choose her donor. Her clinic did.

That's how all three of the five Minnesota IVF clinics that run their own egg donor programs choose to match donors and patients. They don't agree with the practice of donor shopping, clinic officials said; they see it as unethical.

Yvonne Kilkelly, a social worker who screens donors for the Center for Reproductive Medicine, a Minneapolis IVF clinic with the largest egg donation program in the state, scoffs at much of what's touted on egg donor websites -- hobbies, religion, advanced degrees.

Such traits are not genetic, she said, and are a false lure. "It creates too much fantasy," she said.

Kilkelly's clinic, Reproductive Medicine and Infertility Associates in Woodbury and the Mayo Clinic all try to match donors and recipients according to a few genetic traits -- hair color, eye color, height, and ethnic background.

"If someone wants a designer egg, they can go online," Kilkelly said.

The three clinics recruit donors through word of mouth and discreet magazines ads. Unlike agencies elsewhere, they don't advertise in college newspapers. College-age women may be too young or too irresponsible to follow the rigid and often uncomfortable medical regimen, clinic officials said.

The clinics want donors who have a healthy blend of altruistic and financial motives -- women who want to help infertile women but who are practical enough not to do it for free.

Burns, the psychologist from the U of M, has counseled many women who used donor eggs, and she warns that women must be certain about the choice before they do it. She has had clients who have looked at the newborn in their arms and said, "I don't feel attached to my child," Burns said. Or years after children are born, divorcing parents use the means of their conception as emotional weapons in bitter legal fights.

IVF doctors say the vast majority of infertile couples who choose egg donation do it with their eyes open and are grateful for the technology that allows them to have children.

"Thank goodness there is such a thing," said Davig, who had thought she could never have children again. She now has two by eggs donated by women she's never met.

She will always wonder, she said, what they looked like. "I'm so curious," she said. "It's good that we don't know. But I wonder."

Josephine Marcotty • marcotty@startribune.com

Chen May Yee • mychen@startribune.com