Buying and selling human eggs is a booming business–one that confronts donors and recipients with unexpected dilemmas

The boy in the picture is smiling. Exuberance shines through his blue eyes. His face is round and the baby fat in his cheeks conveys an innocent sweetness. He wears thin-rimmed glasses and has blond hair. With an outstretched arm, he’s giving the thumbs-up sign. He is 10 years old.

Like most mothers, Lisa Grossman* lights up when she shows off a picture of her son. She extends the picture, her brown eyes beaming. Her short, dark hair complements her delicate features and narrow jaw. She will be the first to point out that she and her son, Josh, look nothing alike. That’s because Josh shares none of her genes. Josh was born through an egg donation from an anonymous woman when Grossman, a psychotherapist, was 41-and too old to get pregnant with her own eggs.

Grossman was one of the first women to receive a donated egg through the NYU School of Medicine’s fertility center, which had started its program shortly before her procedure in 1996. Preferring to get pregnant rather than adopt, Grossman plunged herself into the double unknown of a new medical procedure and of bearing the child of a woman she would never meet.

In the decade since, women who have encountered trouble conceiving have increasingly turned to using eggs from younger women, who donate them for a fee. Even as sperm donation became popular in the 1970s, egg donation remained a futuristic concept hovering out of the reach of science. But the most recent data released by the Centers for Disease Control and Prevention show that infertile women have a growing dependence on this technology. In 2004 alone, 15,175 eggs were transferred from one woman to another, with about 51 percent leading to births. This is close to triple the number performed in 1996, when there were only 5,162 transfers with about a 40 percent birth rate.

At NYU’s center two years ago, medical teams transferred 153 fresh embryos, with 51 percent resulting in births, according to the Society for Assisted Reproductive Technology, a watchdog group. The NYU School of Medicine, which is the one of the components of the NYU Medical Center, was one of the early promoters of egg donor technology. Even though its numbers seem small, the donor program is one of the largest in the country.

Buying a stranger’s eggs is a huge investment. It costs $16,200 at the NYU clinic for a shared donation procedure, meaning that two women share one donor’s eggs. If a woman desires to monopolize the donor’s eggs, she must pay $25,250. Either way, it is prohibitively expensive for some infertile women and a boon to the doctors who have turned it into a specialty. It also can be a much-needed source of income for donors, who are often struggling college students. Savvy to this, the clinic advertises in college newspapers, bulletin boards and online.

The demand for egg donors, however, is much higher than the supply. Recipients, who are usually over 40, often wait between eight and 12 months to acquire that precious capsule of genetic cargo through NYU’s clinic. In light of the demand, the clinic recently hiked the donor’s compensation from $7,500 to $8,000, to entice her to give up about 20 eggs out of her lifetime supply of around 300,000.

The donor and recipient, who never reveal their identities to one another, embark on parallel psychological and physiological journeys that can make them re-evaluate what it means to be a mother. It can also force them to confront–and even re-define–their views of themselves.

To donate her eggs, a woman must go through the unappetizing combination of repeated hormone injections followed by surgery–and then live with the tantalizing possibility of her unknown biological child’s existence.

For Hadar Cohen, an Israeli immigrant, the stringent requirements of her visa that forbade her from legally working, combined with her shrinking bank account, prompted her to respond to a newspaper advertisement looking for Jewish donors. Throw in the sheer kindness of helping out an infertile couple, and Cohen, now 29, was sold on the procedure.

“I thought, ‘This is something I could do to earn money and be proud of, not something I would hate myself for doing afterwards,” said Cohen. “I was convincing myself that the real parent is really the person who is raising the child and the biological link is not really–not nearly–as important as the actual rearing and taking care of, and educating, and all that, so I just went ahead.”

Cohen, a doctoral candidate in psychology at Yeshiva University, had just immigrated to Astoria, Queens, with her husband, when she noticed the ad in an Israeli newspaper in late 2003. After being reassured that the donation would not compromise her own fertility, she filled out the NYU clinic’s 12-page application–the beginning of the rigorous screening process meant to ensure that only the the most qualified women between ages 21 and 32 have the opportunity to pass on their genes. The application asked about her appearance, ethnicity, extended medical history, religion, education, musical and athletic abilities, hobbies, occupation, and sexual health. Among other responses on the questionnaire, she said she did not have acne as a teen, did not wear braces and had a maternal grandmother with blue eyes. Although her husband assured her that any recipients would be lucky to get the Cohen genes, she admits she experienced some test anxiety at the time.

“I think I was feeling a mixture of pride in my family together with a fear of how we are going to be viewed by others,” she said. “For instance, is it really bad that my father has high blood pressure?”

One question asks applicants whether they would be willing to be contacted by children once they reach the age of maturity, should the laws change to allow this. The U.S. currently forbids children from contacting their genetic mothers, but experts in the field predict this will change. “The laws for adoption did change,” explained Dr. Mindy Schiffman, the NYU program’s psychologist. “So there is a chance [the contact restrictions] could change. We ask that question in case they do change.” The U.K. eliminated donor anonymity in April 2005, so children who were conceived after that time will be able to look up their donors’ contact information once they turn 18.

Three simple boxes follow the parental contact question on NYU’s application: Check yes, no or undecided. Cohen checked “yes,” prompted by a feeling of “some responsibility” for the child who might result. “I think he or she would have a right to know how they were conceived, and if they wished, to contact me as well,” she explained.

In her mind, the urgency of her financial state obscured the full emotional consequences of that tiny mark-for the time being. “I did that because I think I do have some responsibility for that child,” Cohen said in retrospect, “and I think he or she would have a right to know how they were conceived, and, if they wished, to contact me as well.”

Soon after, she went into the clinic for a physical examination, a drug test and a genetic screening to make sure she wasn’t a carrier of recessive diseases like Tay Sachs or cystic fibrosis. She and her husband, Assaf, a graphic designer, also met with Dr. Schiffman, who evaluated their motivations and backgrounds.

It’s part of Schiffman’s job to match donors to recipients. In suggesting possible matches, she looks for the same race, physical type and perceived intellectual ability. With regard to matching for race, Schiffman said, “We do that because we think it’s easier for the child to grow up in a household where they look like their parents.”

Recipients make the final decision knowing the summary of the woman’s medical exams, genetic screenings and psychological consultations. The recipients also have limited profiles of the possible donors, such as where they grew up and if they attended college. They never see a picture. Cohen–a two-time donor–has zero information on who received her eggs and whether pregnancies resulted.

Each time Cohen donated, the procedure was medically identical. When a recipient agreed to be her match, both received shots of Luperone, a hormone that artificially shut down their menstrual cycles for several weeks so they could be synchronized.

Then Cohen injected herself once each night, in the rear end, with shots of the hormone FSH, which stimulated her ovaries to produce more than the usual one egg per month. The 10-day injection regimen prompted her ovaries to swell to the size of oranges and made her feel more than a little bloated. Every other morning, she went to the clinic so doctors could check on the development of her maturing eggs through a vaginal ultrasound examination and a blood test. “I was a little squeamish about giving myself the shots,” she said, “but it was kind of challenging, like when someone gives you a dare.”

Assaf said he felt uncomfortable watching Cohen give herself the shots, but proclaimed proudly, “It’s a messy process, and I think she was a rock. She handled it like a man.” They both say the experience brought them closer together emotionally, if not physically; the hormones made Cohen hyper-fertile, so they had to forgo intimate relations during that period. Although today Cohen says she would like to have kids, she and Assaf did not discuss it during the time of her donations. “We were not ready then,” she said, “and are not entirely ready now.”

Donors run a slight risk of hyper-stimulation of their ovaries, according to Dr. Frederick Licciardi, the director of NYU’s Donor Oocyte Program. Optimally, the ovaries will produce between 10 and 20 eggs during these 10 days, but some women–about 1 in 500–must be hospitalized if their ovaries produce too many, causing fluid to swell in their abdomens.

When a donor starts these injections, her recipient starts injecting herself with estrogen to prepare her uterus to receive the embryo. “Excluding the risks of pregnancy, it is more risky for the donor,” Dr. Licciardi said about the hormone injections. “I would still call it a very low-risk procedure. Certainly having a baby is much more risky than giving your eggs up.”