Binders of Women? Reflections on ASRM Annual Meeting Round 2

by Katie Kraschel

Mitt Romney’s anecdote about the binders of women he relied upon in selecting members of his cabinet when he was Governor has fueled criticism from feminist groups and filled my Facebook feed with a plethora of Halloween pictures featuring costumes depicting his unfortunate choice of words.  People generally have an instinctive aversion to being summarized into a page in a loosely bound, plastic-covered book.  However, this level of summary and (arguably) downright objectification happens every day when individuals peruse  IVF clinic and cryobank catalogs shopping for sperm or eggs.  And while many of us worry that a Romney win next week would result in four years of presidential leadership that is clueless and insensitive to the plight of women in the workforce, the ASRM decision to remove the experimental label from oocyte cryopreservation is likely to literally increase the number of “women in binders,” which presents a different set of concerns.

Oocyte retrieval — the process of harvesting eggs that allows a woman to place her age, weight, height, eye color, S.A.T. score, college major, baby picture and perhaps even celebrity look-a-like into a gamete catalog — has long been a topic of bioethical debate and criticism due to the risks associated with the high level of hormones involved in the process and the accompanying high level of compensation frequently offered for women’s eggs.  The likely increases in demand and number of oocytes produced presents a unique opportunity to revisit these issues and reconsider what regulations may be necessary to keep all parties involved respected and protected.

One of the factors that will drive the growth in the size of the binders of women in clinics and cryobanks is the ability to avoid careful planning required to get a woman supplying oocytes in sync with the person gestating the fetus in order to complete a fresh IVF cycle. Currently, in most IVF procedures involving a different women supplying eggs than gestating the fetus, the oocyte supplier and gestator will simultaneously undergo hormone treatements so that eggs are harvested on a timeline that aligns with optimum timing for implantation in the gestator’s uterus.  Often, this treatment plan results in a relationship between the intended parent(s) and the oocyte provider and means that the oocyte provider is treated by the same physician or in the same clinic as the gestator.

The synchronized arrangement provides some natural safeguards to address objections to selling oocytes.  First, the physician responsible for creating and transferring the embryos is aware of how the oocytes were acquired and often has knowledge of the contract between the oocyte provider and the purchasing individual(s).  A qualified physician can then ensure accordance to ASRM guidelines regarding oocyte retrieval and purchase by refusing to use oocytes that were acquired without compliance.  Second, when  purchaser(s) form a relationship with their provider, arguably, she is more than a mere page in a catalog or set of healthy ovaries and is less objectified. Finally, when purchaser(s) have a relationship with the provider of the eggs, it is probably more likely that there will be an ongoing relationship which may be advantageous for the resulting child(ren).  By sidestepping the need for synchronization by using more frozen eggs, these safeguards and potential benefits are likely to be lost.

Concurrently, it is possible that demand will increase because cost could go down absent the need for immediate fertilization and synchronicity.  Currently, if an egg harvest produces any number of eggs during a synchronized arrangement the purchasers are likely to fertilize all of them because they will have incurred the entire cost of the harvest, and freezing any unfertilized “extras” was a disfavored technique.  However, absent the need for synchronization and immediate fertilization, if a large enough number of eggs are produced, they could be split into two separate vials.  With the help of some facilitation by cryobanks and IVF clinics, intended parent(s) could pay approximately half the price they currently incur if they can purchase half of the eggs produced by a given harvest.

As the catalogs mentioned above show, there are already binders of men and women, but as the contrasting sizes of the sperm and egg catalogs indicate, the binders of men are currently much larger since freezing sperm has long been a relatively inexpensive and well-established technique. The increased feasibility, decreased safeguards, and potential for increased demand of frozen oocytes pose important questions: Do we want the binders of women to grow to resemble the binders of men?  Do we think the current system of sperm selling is a good one?  Are the differences between egg retrieval and collecting sperm significant enough to warrant heightened scrutiny and regulations, and where do we draw the line between paternalism and empowerment in such a consideration?  Are voluntary professional guidelines sufficient safeguards?  Given recent controversies around sperm donors having many children, how should we track gamete sale?  I don’t intend to suggest I have the answers to these questions, but hope that we can carefully consider if  and how we want to maintain these binders of women (and men) in cryobanks and IVF clinics in the face of new potential for their growth.

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