Sat, May 06, 2006 page9

• The murky trail of the fertility trade

  British women who desperately want to have babies are going to eastern Europe and Cyprus. There, clinics are thriving on the profits of fertility tourism. But donors in this egg harvest run hidden health risks.

  • By Antony Barnett and Helena Smith / THE OBSERVER
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  Svetlana has a big family secret: she sold her eggs for US dollars. Svetlana did not tell her husband what she was doing because she knew he would be furious. Nor did she tell her mother or her two young children. Every day after lunch this 27-year-old unemployed cook would sneak out of her cramped, Soviet-era tower block on the outskirts of the Ukrainian capital, Kiev, to go for hormone injections that would stimulate her ovaries into producing dozens of eggs. Each one of these had the potential of becoming a relative that her family would never know about.

  Desperate for money after the birth of her second child, Svetlana had applied for work in the canteen of one of Kiev's growing number of fertility clinics that charge infertile women from Britain thousands of pounds for help in getting them pregnant.

  Svetlana didn't get the job, but was told that if she needed cash she could sell her eggs. She was told that the process was straightforward and that she would be given US$300 -- more if she was a good donor and produced lots of eggs.

  

  For Svetlana, like a growing number of Eastern European women, it was too good an opportunity to pass up. Since the birth of her second child she had been surviving on less than US$15 a month. She turned out to be an excellent donor. By the time of her fifth donation, her ovaries, stimulated by the injection of a hormone, produced a batch of 40 healthy eggs. This is four times more eggs than a woman undergoing IVF treatment would produce.

  The medical staff gave Svetlana an extra US$200 as a reward. For the clinic, Svetlana was a cash cow, a woman whose eggs could be sold for profit. Older women from Britain, the US and other Western countries whose ovaries can no longer produce healthy eggs are happy to pay more than ?3,000 (US$5,550) for donor eggs that could be fertilized into an embryo. The hope is that, once implanted back into the woman, they will conceive the "miracle" baby that has so far eluded them.

  Yet what Svetlana didn't know is that donating eggs is not a straightforward matter like donating sperm. It can be a lengthy, painful and potentially dangerous procedure involving the injection of a powerful drug known as follicle stimulating hormone (FSH).

  Medical experts believe 1 percent of women undergoing this can suffer serious side-effects know as ovarian hyper-stimulation syndrome (OHSS) that in extreme cases can prove fatal.

  One leading British fertility expert, Adam Balen, Professor of Reproductive Medicine at Leeds General Hospital in England believes the fact that Svetlana produced 40 eggs is evidence that she was being hyper-stimulated by the clinic and her health was being put at risk. At no time did the medical staff at the Kiev clinic explain anything to Svetlana or give her any counselling on the psychological impact of donating eggs. Svetlana found out she was being injected with hormones only when, on the fourth time, she had to be put on a drip. She was told the injections were to "clean her blood." Other complications included missing her period for two months and stomach pains.

  A year after her last donation, Svetlana meets at a secret location to tell her story. She is scared of being seen speaking to a journalist near her home. She has had no physical problems, but is affected psychologically. "I feel like I sold part of my body," she explains.

  What did she think about the possibility that she may have children in London and her son may have a half-brother? "They will be two now, but I try not to think about it. Hopefully they don't look like me. My two children look like their father, so I hope that is the case."

  She has kept her egg donation a secret from most people: "I don't want anybody to know; for me it's unpleasant that I have sold a part of myself. That I have sold myself for money. Many people wouldn't understand it."

  An investigation by the London-based Observer newspaper has revealed a burgeoning global trade in women's eggs where infertile British women who cannot find a donor in the UK will pay thousands of pounds for the chance of finding one overseas.

  Svetlana is typical of dozens of young Ukrainian women desperate for cash having to sell their eggs to make ends meet. While most sell them in Kiev, others are sent by Ukrainian clinics to Cyprus or even Belize. Their Caucasian appearance is turning young East European women into a source for one of the continent's most prized commodities: human eggs.

  It is a trade conducted in the utmost secrecy, with donors' identity strictly protected. Yet the Observer tracked down several other egg donors in Kiev who, like Svetlana, have sold eggs to clinics that helped British women to conceive. Some of the girls are unemployed or working in low-paid menial jobs, others are former graduates now earning good salaries; some are blonde, while others are brown-haired with dark eyes. But all the donors we spoke to have one thing in common: they all sold their eggs for the money, all have regrets about what they did, and none would do it again.

  "We only did it for the money," says Erena, who donated four times and knows more than 20 donors who gave eggs to one of the city's clinics.

  She claims that one young girl she knew donated nearly 20 times and none of the girls was given any psychological counselling. She says they are given more money the more eggs they produce.

  Erena recalls that once she was injected with five ampoules of FSH. Each capsule contained 75 units of the hormone, so she received 375 units. According to Balen, this is a potentially dangerous amount that could spark OHSS: "For a young woman with healthy ovaries, I would use no more than 150 units of FSH or you run the risk of OHSS. Although serious complications are rare, they can be extremely serious and even fatal."

  Egg farming

  Balen was particularly concerned at the sliding scale of fees paid which would encourage donors to accept more hormones in the hope of more money. "It sounds more like egg farming to me than egg donation," he says.

  Erena says she felt she was treated like a "milking cow."

  In today's global market, a healthy human egg from a young white European woman is more valuable than gold. Under British law any fertility clinic that wants to import or export embryos fertilized by donor eggs must obtain a special license from the UK Human Fertilization and Embryology Authority (HFEA). In January, using the Freedom of Information Act, the Observer asked HFEA for a list of all the special licenses it approved last year.

  The details, revealed here for the first time, give an insight into the role Britain is playing in the growing global trade of babymaking. It shows that more than 400 human embryos were either imported to, or exported from, Britain last year as part of fertility treatment, with the booming trade stretching from London, Kiev and Warsaw to Limassol, Chicago and Sydney. Yet these figures underestimate the scale of the trade. Many women go "freelance," using internet chatrooms to locate clinics across East Europe and elsewhere which promise to find them donors quickly and cheaply.

  These women who have embryos implanted overseas and return home are not covered by UK regulations, so would not be in the HFEA dossier.

  Nor would it catch British clinics sending women overseas to have an embryo implanted.

  In the UK there is an acute shortage of donor eggs and the wait can be more than two years -- if one comes along at all. Fertility doctors believe that last year's change in the law removing anonymity from donors has made the shortage of donors even more acute. Clinics in Britain are forbidden to pay donors anything other than a nominal sum of about ?15, so there is no financial incentive. Any woman who wants to donate eggs must have a psychological assessment and counselling.

  British clinics which send infertile women to Kiev say they have rigorous procedures to ensure that the Ukrainian clinics are operated to the highest standards. Adverts in women's magazines sell the dream to women that a short trip abroad could answer their prayers. They are often charged hundreds of pounds to join lists of hopeful recipients, and it is estimated that the cost of using overseas egg donation could be between ?7,900 and ?11,000 before travel and other costs. Some clinics claim a pregnancy success rate of "almost 50 percent."

  Professor Gedos Grudzinskas, medical director of the Bridge Centre in London which does send people abroad, defends the practice.

  "Would it be preferable if a British woman who needs a donor egg does not need to travel abroad? Yes, of course. But fertility is the Cinderella service in the NHS [the state-funded National Health Service], and for some women it is the best option," he says.

  Grudzinskas stresses that his clinic does thorough "due diligence" on the centers it uses overseas: "We work entirely in accordance with the best practice laid down by the HFEA."

  The Institute of Reproductive Medicine which sits in the grounds of Kiev's main city hospital, is a modern clinic with all the latest technology. Oleg Kucherenko, the institute's marketing manager, confirmed it had treated several British women. He insists the institute operates to the highest international standards.

  "Is it normal for a British woman to travel to Kiev, or Russia, or Poland to have a baby? I don't think so, but why are they coming? That is not for me to say. Is it a result of the rules in the UK that force them to come or for other reasons? We are here to help any women, whatever country they come from, who want a child but cannot have one," he says.

  Kucherenko insists the institute "fully respects" the rights of donors: "We don't pay for their eggs, we pay US$300 compensation for their time."

  One of the most popular Kiev clinics used by British women seeking donors is the Isida. Its directors also stressed that it did not exploit donors. Both clinics, however, were unwilling to allow the Observer to contact any donors even if we guaranteed confidentiality.

  As the Observer now reveals, a trade that can fulfil the dream of a British couple can be a hidden nightmare for the donor. While there is no denying the joy of an infertile woman who has been able to have a baby using an overseas donor, there is an unsavory underside to the process where poor young women are exploited, injected with potentially dangerous hormones and treated like "battery hens" being farmed for their eggs. These are women who are the secret mothers of British children, parents who will never know their genetic children. It is what the chair of the HFEA, Suzi Leather, has called a "profoundly exploitative and unethical trade."

  Conflicted rights

  Should the rights of a British woman desperate for a family supersede the rights of a poor East European forced to sell her eggs for cash? If the foreign clinics can assure that donors are not exploited, is there a problem? Are the strict British regulations helping to create an unsavory market in human eggs?

  Leather says: "The market in babymaking is now global and these problems have to be tackled internationally. This compelling testimony shows the nasty underside of a global market in babymaking and should act as a wake-up call."

  Near the little fishing village of Sygi on Cyprus sits an unassuming stone building surrounded by palm trees and with its own private beach. In the past year, hundreds of women referred by fertility doctors in Britain have checked in here. This is the Petra Health Clinic, an offshoot of the Reproductive Genetics Institute in Chicago. The Observer has been told that its offices in Kiev that Ukrainian girls US$500 to fly to the Chicago clinic and donate eggs.

  In its waiting room, couples are usually met by Galina Ivanovina, the clinic's resident Russian director.

  Treatment for multi-embryo implants involving an egg donor from the clinic costs US$5,000. Ivanovina claims they do not pay donors. "We put them up in flats and give them a free holiday, but now, it seems, they feel they can pay for their own. If you wish, you can pay them too," she says.

  Ivanovina says the waiting list is only two months' long, which gives clients time to think about the ideal "donor match."

  "Do you want a baby that looks like you, a little bit Slavic?" she asks an undercover Observer reporter who inquired about the possibility of donor egg and donor sperm. On request she produces an itemized description of a woman who donated eggs at the clinic.

  "Nationality, Russian; height, 1.69m; weight, 55 kg; blood type, ABIV+; hair color, brown; eye color, brown; education, higher technical college; occupation, engineer," Ivanovina says. "This would be a typical donor. All of our donors are from Eastern Europe, Russia, Ukraine."

  Vasillis Thanos, the Israeli-trained gynecologist who oversees embryo transfers at the clinic, says female donors get "free of charge" gynecological treatment throughout their lives.

  "These ladies are very well selected; they approach doctors who give them all the information about the whole procedure. They do it for altruistic reasons. So far, not one of these ladies has ever had any somatic or psychological problems," he insists. "They are absolutely from good families; they have children. They are checked in Russia for genetic diseases and psychiatric diseases."

  According to information obtained by the Observer under the UK's Freedom of Information Law, one British clinic that has been sending several couples to Cyprus is the fertility center at the private Cromwell Hospital, an exclusive private hospital in central London. Kamal Ahuja, who runs it, says that the Petra Clinic operates to the highest international standards and has an impressive donor-screening programme.

  An estimated 30,000 immigrants from the former Soviet Union live in Cyprus, even if only half are legally registered with the authorities. Local Russian-language newspapers often place advertisements seeking "young healthy girls for egg donation." Women from the community tracked down by the Observer suggested that "one in four" of their peers had, at some point in their twenties, donated eggs. Women from Russia and Ukraine fly in just to donate eggs. Most desperately needed the money for rent and utility bills.

  Like giving blood?

  Larissa Kovoritsa, a nurse who mediates between Russian donors and a fertility clinic in Nicosia, told the Observer that some women viewed egg donation as their main source of income, going through the process of being injected with hormones at least five times a year.

  The going rate, she says, is 350 Cyprus pounds (US$770) for a cycle in which a woman produces 12 eggs; 500 Cyprus pounds if she can produce more.

  "For them it's like giving blood, you give and then you forget," says Tatjana, a 28-year-old tour representative who is from Minsk, Belarus. "They just give their eggs and get the money, it's a pure transaction."

  Although Tatjana says she has never been a donor herself, she came close to being one eight years ago when she moved to the island and knows many girls who have been donors. Two things stopped her: fear of side-effects and "it just felt very strange to think that there would be a piece of me, some little Tatjana, out there in the world."

  Meeting at a secret location for fear her Greek Cypriot husband might discover the nature of our discussion, she says many women come to Cyprus from the states of "new Europe: Poland, Lithuania, Latvia, Estonia."

  "They work the cabarets, they'll sleep with men, they'll sell their eggs, and then they go back again," she says.

  Two of her four friends spoke to the Observer on a confidential basis. They admitted they had never been pregnant before, in contravention of UK regulations. "I was never told I would have to go through psychological tests," says 33-year-old Yelena from Moscow, who was a donor in her mid-20s. "The only paper I was made to sign was one saying I gave up all my rights to the child, which was OK because now I have two of my own and really don't want to think about the past. That was then, when I was hungry and desperate."

  But Tatjana agrees that the fees were still "very attractive ... In Russia you can live off US$1,000 for an entire year."

  And would there be no curiosity about the child? "You know, you can play with your own psychology," she says. "In Russia when they execute somebody there is always one soldier who doesn't have a bullet, so in the end nobody is really sure who shot the man. It's a bit like that here. Not all embryo [implants] are successful. In the end, you can never be guaranteed that it was your egg that was the one that was used."
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