Oocyte markets: women's reproductive work in embryonic stem cell research

Abstract

Somatic cell nuclear transfer (SCNT) research, otherwise known as therapeutic cloning, requires large numbers of research oocytes, placing pressure on an already limited supply. In the UK, Canada, Australia, Singapore and most of Western Europe, oocytes are made available through modestly reimbursed donation, and, owing to the onerous nature of donation, the existing demand for reproductive oocytes far outstrips availability. SCNT research will place this system under even greater pressure. This paper investigates the growth in a global market for oocytes, where transnational IVF clinics broker sales between generally poor, female vendors and wealthy purchasers, beyond the borders of national regulation, and with little in the way of clinical or bioethical scrutiny. It considers the possible impact that SCNT research will have on this global market. It argues that oocyte vending could be understood as a kind of reproductive labor in the bioeconomy, and suggests some ways to improve the protection, security and power of vendors.

Keywords:

• Somatic cell nuclear transfer
• oocytes
• women's health
• globalization
• reproductive labor

Ian Wilmut, creator of Dolly the sheep, recently called for young British women to donate oocytes to assist with stem cell research into motor neurone disease. British scientists believe that somatic cell nuclear transfer (SCNT)1 research, sometimes called therapeutic cloning research, is being hampered by a shortage of good quality oocytes, and a reliance on those rejected as non-viable for IVF. In an interview with the Guardian, Professor Wilmut said,

I have never doubted that women would donate if they thought we were helping people to have treatment. Our hope and belief is that women who have seen the devastating effect of this disease will be prepared to make such a donation. (Sample and MacLeod 2005)

Meanwhile, the Human Fertilisation and Embryology Authority (HFEA), the statutory body that regulates fertility medicine and embryonic research in Britain, has taken a series of measures to improve the availability of oocytes, both for fertility treatment and for SCNT research. Following the SEED report (HFEA 2005), which reviewed gamete and embryo donation in Britain, the HFEA has both increased the levels of reimbursement for reproductive donation and in a separate move, made so-called “research donors” (women who are willing to donate oocytes for SCNT research) eligible for discounted IVF services as well as compensation of up to £250 (HFEA 2007).

These measures have been quite controversial, precisely because they depart from the altruistic ethos to which Professor Wilmut appeals. His call for donation plays on the ethic of the gift relation, articulated by Richard Titmuss in his classic study of blood donation and the role of altruism, The gift relationship: from human blood to social policy. Wilmut follows Titmuss's conviction that donors should act not out of self-interest but out of a sense of collective belonging and duty to the national body politic (Waldby and Mitchell 2006). Titmuss's nation-building, egalitarian proposals, published in the late 1960s, were directly opposed to the marketing of human tissues, their exchange for a price. The commodification of such an intimate part of the person was, for Titmuss, a synecdoche for the reduction of all forms of relationship to the contractual mechanisms of capitalism, and the destruction of any domain of social life outside of market relations. It is, he implies, on a continuum with slavery, the commodification of body parts rather than the body as a whole (Titmuss 1970/1997).

While the HFEA's new policies are couched in the language of reimbursement and in kind support, they are controversial because they involve a restricted form of marketization, where oocytes are put into circulation via an increase in cash and treatment incentives rather than through an act of selfless generosity to the less fortunate. The reason for the HFEA's real politique here is quite simple: the gift relation, in its strict sense, is proving an inadequate framework to meet an ever-expanding, worldwide demand for oocytes.2

This paper examines this rapidly expanding global demand for oocytes and the implications of this demand for female donor populations in several different countries. The increasing resort to assisted reproductive technology (ART)3 and the globalization of the IVF industry, combined with the recent legalization of SCNT research in the UK, Australia, Singapore, Sweden, Spain, Israel, South Korea and India, has rapidly escalated demand for oocytes. In particular, it examines the implications that the new demand for research oocytes may have for impoverished female populations already involved in a somewhat clandestine reproductive global oocyte market, brokered by fertility clinics operating in several different national and regulatory sites. I argue that the existing exploitative procurement networks for reproductive oocytes could readily be used to obtain research oocytes as well, if no measures are taken to prevent this.

Supply and demand

This shortage of oocytes is exacerbated by both pressures on demand and constraints on supply. As Sexton (2005) notes, women in Britain, and other developed nations that regulate oocyte donation through gift systems, are generally unwilling to donate oocytes unless they are already themselves within the IVF system. While blood donation systems generally rely on the voluntarism of their donor panels, this method has failed in the case of oocytes, because their donation is so onerous. It is constrained by the recalcitrance of the material, and the difficulty, time, pain and risk associated with giving. Oocytes are difficult to disentangle (Callon 1998, Waldby and Mitchell 2006) from the body. Unlike semen, they are not a self-renewing, copious and accessible tissue. The normal biology of reproduction involves the release of a single oocyte per month. Unlike semen, oocytes are never detached from the body in the normal course of events. Hence, donation involves a complex IVF procedure. In a process termed ovarian stimulation, drugs are administered to shut down the woman's normal reproductive cycle, and then other drugs administered to stimulate the development of multiple follicles. Harvesting requires invasive surgery. The procedure involves,

Daily subcutaneous hormone injections over a period of 7 to 10 days. Mature oocytes are retrieved under ultrasound guidance by the insertion of a needle through the vagina in a brief surgical procedure that requires anesthesia […]. The ethics committee of the American Society for Reproductive Medicine cites an estimate that egg donors spend “56 hours in the medical setting, undergoing interviews, counseling, and medical procedures related to the process”. The injections are uncomfortable and have side effects. The retrieval of oocytes carries risks, such as those of anesthesia and bleeding. (Steinbrook 2006, p. 324)

It also carries the risk of ovarian hyperstimulation syndrome, a usually unpredictable response to ovulation induction (Steinbrook 2006) that involves pain, abdominal inflammation, possible renal failure and infertility, venous thrombo-embolism and cardiac instability. It can be fatal. Up to 5% of women in treatment develop hyperstimulation syndrome (Delavigne and Rozenberg 2002, Magnus and Cho 2005). Moreover, there is little research into the long-term risks of ovarian stimulation; whether there may be implications for later fertility, hormonal health or the general health of reproductive organs (Dickenson 2005). In short, ovarian induction for both fertility treatment and donation is onerous and risky. Dickenson (2005) argues that oocyte donation is more like live kidney donation than sperm donation, in terms of the singularity of the tissue, the risks involved in the process and the possibility of long-term consequences.

A demand for research oocytes for SCNT simply places greater pressure on an already short supply of oocytes and on female reproductive biology more generally. A striking feature of contemporary biotechnical innovation is its ever more ingenious use of aspects of female reproductive biology – particularly embryogenesis and the fetal–maternal blood system – to generate therapeutic tissue. As Brown and Webster (2004) note, female reproductive biology is increasingly used by contemporary biomedicine as a generative site separate from the production of children, “through which biological materials and information is harvested for scientific, medical and commercial purposes” (Brown and Webster 2004, p. 71). Reproductive biology has been redistributed throughout diverse areas of regenerative and diagnostic medicine, and assisted reproduction technology has become central to many biomedical domains unconcerned with the production of children. Like in vitro embryos, in vitro oocytes are point where this reproductive potential bifurcates. Each can be transferred to a recipient and used to produce another human life, a child; and each (at least theoretically)4 can be biotechnically reconfigured in a laboratory, diverting their pluripotency into the production of embryonic stem cell lines. This double capacity, to produce both new offspring and new therapeutic stem cell lines, make oocytes highly desirable, so that demand continues to escalate.

The sheer numbers of oocytes required to mount a serious research effort further drives demand here. The now discredited Professor Hwang's work in South Korea gives an indication of the ratios of oocytes that may be needed to make a viable blastocyst, and of blastocysts needed to strike a viable stem cell line. In one of his studies, 16 donors produced 242 oocytes, which in turn produced 30 blastocysts and finally, one cell line (Hwang et al. 2004). In more recent revelations, the Seoul University inquiry in Hwang's activities found that between November 2002 and November 2005, his laboratory used 2061 oocytes produced by 129 women, an average of 16 oocytes each (Steinbrook 2006). The implications of these kinds of ratios for stem cell research and eventual therapeutic applications of ESC research are quite daunting,5 and have caused disquiet among many bioethical groups. So, for example, the European Group on Ethics in Science and New Technologies (2002), which advises the European Commission, singles out this problem of ratios and the inefficiency of SCNT in its advice that therapeutic cloning should not be pursued.

These ratios also suggest that the compliance, generosity, power and agency of female populations will become more central to the development of the regenerative medicine industries, an issue that is beginning to martial significant feminist concern (Dodds 2004, Dickenson 2005, 2007, Cooper 2007). While the HFEA ruling has provoked concern in many quarters about the pressures placed on British donors,6 I would argue that the expanding demand for research oocytes will be most consequential for the female populations of nations that do not regulate oocyte transfer through gift systems. While compensated gifting and regulation along the lines of solid organ donation is the norm in the UK, Australia, New Zealand, Canada, Singapore and most of Western Europe, many other states treat gametes as a separate category, or simply lack a regulatory regime. So, for example, in the USA, gametes do not fall within the purview of the National Organ Transplant Act 1984 (Steinbrook 2006) because they are classified as “self-regenerating tissue”, and hence can be bought and sold. In Spain, oocyte donation does not come under the authority of the organ donation legislation. These countries now have a vigorous and privately controlled internal trade in reproductive oocytes, in each case linked to unregulated transnational trade. Nations that attempt to protect oocyte donation from free market forces find that nationally based regulations are being increasingly undermined by tissue trading between states, facilitated by medical tourism, global medical commerce and the ever-expanding demand for oocytes.7

This global market has serious implications for women not well protected by legal structures, bioethical regulations, adequate income or a feminist-influenced civil society (Dickenson 2004). The Hwang case is telling in this respect. Some of the oocyte donors for his studies were young research staff in his own laboratory, with all the implications of coercion and absence of meaningful informed consent this entails. Hwang's laboratory also used numerous paid oocyte suppliers (Steinbrook 2006). This has also raised issues of informed consent and the problem of full disclosure of risks to donors when demand for tissue is high. At the time of writing, a coalition of 35 women's groups were involved in a suit for compensation against the South Korean government on behalf of some 20% of the women who provided eggs, on the grounds that they had not been informed of the risks of donation. In some cases, the women had required hospitalization owing to the side effects of ovarian hyperstimulation (Chong 2006, Hwa-Young 2006).

In the next section, I will consider the growth of global oocyte markets. I will focus on three different kinds of market – the medical tourism markets in Spain and South Korea, the Romanian export market, and the highly stratified, predominantly internal market in the USA. I will consider the possible effects that the new demand for research oocytes is having on such markets. I will also consider the place that oocyte vendors (i.e. women who sell oocytes rather than donors, who give them) occupy in the global knowledge economies. I will argue that oocyte vending can be usefully understood as reproductive labor in the bioeconomy, and consider what this suggests in terms of improving regulation and protection for such women.

Global oocyte markets

Reproductive tourism

Shortages of gametes and regulatory restrictions on availability have created a market for reproductive oocytes among wealthy North West Europeans. To supply this demand, and to circumvent national regulatory systems, privately run fertility clinics have set up in countries with more permissive regulations on the fringes of Western Europe. Clinics in Spain and Crete offer “IVF holidays” to attract wealthy North European IVF tourists who have not been able to obtain satisfactory treatment at home. Multilingual websites and internet communication have made international partnerships and patient bookings much easier, facilitating the growth of such IVF tourism. So, for example, the fertility company Nordica, with English, Danish and Lithuanian webpages, offers oocytes through a Spanish clinic. Their website states,

At Nordica we offer treatment with egg donation. We have a co-operation [sic] with a fertility clinic in Spain. The clinic has a great experience with egg donation and also offers eggs to women with a Scandinavian look. If you want egg donation abroad, all consultations, preliminary examinations and the medical treatment take place in the Nordica Fertility Clinic. The fertilisation of the egg and the transfer of the fertilised egg take place in Spain. After your homecoming the after-treatment takes place at Nordica.8

Similar arrangements with Spanish clinics have been reported in the Netherlands (Gupta 2006). British IVF tourism to Spain and elsewhere has become so prevalent that in 2006 the Director of the HFEA issued a public statement warning British citizens of the dangers of poorly regulated treatment in overseas clinics (HFEA 2006). British IVF tourists cite the shortage of oocytes in the UK IVF system as a major reason for their trip, particularly since donor identity is no longer anonymous (British Fertility Society 2005). Spain is a particularly attractive destination for European IVF tourists because it combines high medical standards with minimal regulation, a liberal approach that has its origins in the post-Franco government's desire to remove state restrictions on reproduction.9 According to a report about UK IVF tourism in the Observer newspaper (France 2006), clinics recruit through beauty parlors, supermarkets, colleges and by word of mouth, and pay oocyte suppliers about £1000 per procedure, with a premium paid to fair, “northern looking” donors. The Spanish Society for Fertility estimates that approximately 3000 oocytes were traded in this way in 2004 (European Commission 2006, p. 9).

Another recent investigation by the UK Observer newspaper (Barnett and Smith 2006) found that fertility clinics in the Ukraine and other parts of the former Soviet Union recruit young East European women and send them to clinics in Spain and other locations – Cyprus and Belize, for example – to provide oocytes for North European couples. East European women are the preferred providers in the European oocyte market because of their fair coloring and “Caucasian” appearance, which matches that of the North European purchasers. As Pollock notes, “in anonymous egg donation, phenotype is privileged above all else. Physical similarity between donor and recipient makes the donation invisible” (Pollock 2003, p. 253). The women interviewed reported being paid between £300 and £600 per procedure, with a higher fee if they produce more oocytes per procedure. They also referred to friends who had donated multiple times. One informant, a nurse working in the industry, “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” (Barnett and Smith 2006). Some also reported combined oocyte vending with a stint of work in the local sex industry.

A similar IVF tourism market was operating between Japan and South Korea at the time of the Hwang scandal, primarily through an oocyte brokerage company called DNA-BANK, based in Seoul and Tokyo. The Korean clinic recruited young Korean oocyte vendors, primarily college students with tuition fees or debts to repay, for Japanese couples who were forbidden by law to find oocyte donors in Japan. The business was set up to entice Japanese couples away from US clinics to a more local and convenient service, with an abundant supply of phenotypically similar donors (Paik 2006). Rather than offering direct fertility services, it acted as a brokerage firm, working with several South Korean fertility clinics and matching purchasers with vendors.

The market structure is quite similar to the European model – wealthy buyers from a nation that closely regulates gamete donation travel to another country, preferably nearby, where regulations are less stringent or poorly enforced, and purchase oocytes from young women with poor incomes. As long as the oocyte purchaser falls pregnant in the second location, any national import and export restrictions on gametes or embryos are inapplicable.

The South Korean case is notable however because it gradually emerged that Professor Hwang used the DNA-BANK to obtain research oocytes for his now discredited SCNT work, and in fact that the brokerage service had taken the initiative, offering oocytes to his laboratory. Paik summarizes the significance of this transition from reproductive to research oocyte procurement.

The network for trafficking ova was first established to trade ova for the IVF purpose [sic], but, then, was utilized for trading ova for the biomedical research. In this sense, at least in the Korean case, for the ova brokers there existed only a very fine, and sometimes arbitrary, distinction between ova for research and ova for infertility treatment. … While people find the trafficking of ova for the IVF purpose harder to oppose, it is the very same network that enables the distribution of ova for research. (Paik 2006, pp. 4–5)

That is, the DNA-BANK case demonstrates the ease with which recruitment networks and vendor populations for reproductive oocytes can be used for research oocytes.

The Romanian export market

The GlobalART clinic in Bucharest presents a different business model of global mobility and oocyte brokerage. The clinic is part of an international chain, linked to GlobalARTusa, a US-based oocyte broker and an Israeli fertility clinic. It is also associated with the International Fertility Medical Center registered in the Virgin Islands (Magureanu 2005), and so forms a collection node in a widespread international distribution network. The clinic was set up precisely to prevent oocyte purchasers from having to travel overseas to find oocyte vendors. Instead, it recruits young Romanian women to provide oocytes and fertilizes them with sperm from the male partner in situ, before transporting them back to the USA or Israel (Nahman 2006). Young women are recruited by word of mouth and are paid about US$200 per procedure.

An ethnographic study of the clinic, involving two weeks of observation and interviews with 20 of the oocyte vendors, as well as staff, found that the fee amounted to between two and four times the women's monthly salary. Some of the women interviewed had sold oocytes several times, or intended to sell again. All the women interviewed stated that they sold their oocytes because of financial necessity.

I asked the donors why they donate, what led them to donate their ova. They told me that they donate “out of desperation”. They said they were desperate to get out of constant debt, so they can buy themselves basic “necessities” such as clothes, new bedroom furniture, makeup, cigarettes. One woman was behind on her rent for two months and so decided to sell her eggs rather than borrow money. (Nahman 2005, p. 224)

Most had salaries that barely covered subsistence (rent, food) and selling oocytes was their only means of paying for clothing, study, basic home maintenance or their children's needs. Many stated anxieties about the risks involved in the procedure but felt that they had little option, given debts and other financial pressures. There is evidence that healthcare standards at the clinic are variable or below acceptable benchmarks. The interviewees stated that they received higher fees for greater numbers of oocytes per cycle, or were allowed back frequently to sell oocytes, a practice also reported by the women interviewed by the Observer. Such a practice is clinically ill advised, as it encourages higher levels of ovarian stimulation and the women run a greater risk of hyperstimulation syndrome.10

In 2005, two young women tried to get criminal charges laid against the clinic for neglect and fraud. Both sold oocytes to the clinic over several procedures, yielding 20 each time. Both suffered serious cases of ovarian hyperstimulation syndrome. They claim that the clinic did not adequately describe the risks of the procedures, and took no responsibility for their illness (Magureanu 2005). The case highlights one of the gravest concerns about the unregulated global oocyte market – in the absence of bioethical or clinical regulation, the clinics' duty of care is not enforced, and women who require follow-up care have no recourse. The lawyer prosecuting the case observes,

The contract [signed by the women] … stipulated that the girls [sic] would never go to another doctor to be treated, if they had health problems. Also they had to agree not to divulge to any Romanian authority what had happened in that clinic, to refrain from launching any legal action against the clinic, regardless of the side-effects of the procedures and not to ask for the opinion of another doctor or medical institution in relationship to health problems resulting from the donation procedure … All these provisions are abusive and against the Romanian law. (Magureanu 2005, p. 4; emphasis in the original)

At the time of writing, the case was still under review. In 2004, the UK Human Fertilisation and Embryology Authority placed an embargo on importation of gametes from the Romanian clinic, because of concerns about the consent procedures used in the clinic, followed by a controversial site visit to inspect the facilities (Sexton 2005). In 2005, the European Parliament specifically named the Romanian clinic in its resolution to ban European trade in ova, and to “take measures to prevent the exploitation of women in the application of life science” (European Parliament 2005).

It is evident then that East European women in particular are the most desirable source of oocytes in the European reproductive market. They have fair skin and coloring, and they are an economically dispossessed population, struggling to find a survival niche in the newly deregulated, former Soviet economies. As I discuss further below, the development of a research oocyte market would expand the possible vendor population to women with other ethnic backgrounds, as coloring and class are irrelevant for tissue used in stem cell research. While there appears to be no evidence that this European market is being used to purchase research oocytes yet, the South Korean case confirms that the availability of vendor populations and an established network of recruitment clinics lend themselves to the development of an international research oocyte market.

The US oocyte market: niche markets, stratification and the stem cell industries

The USA has the most well developed and least regulated internal market for oocytes. It also has the greatest number of stem cell companies, and privately funded stem cell research is unregulated at a federal level. Reproductive oocyte trading is routine. The US Centers for Disease Control and Prevention report that in 2002 alone, purchase oocytes were used in 13,183 (11.4%) of the 115,392 procedures involving assisted reproductive technology, for fees of around $4000 to $5000 per cycle (Steinbrook 2006, p. 324). Like the European market, the US reproductive oocyte market is stratified according to the appearance and “racial” characteristics of the vendor. Premiums are paid for vendors with additional desirable characteristics, particularly pretty, athletic women at elite colleges, who are routinely offered very high fees. While it is difficult to get verifiable, up-to-date figures, fees are reportedly between $20,000 and $100,000 per cycle (Karsjens 2002, Pollock 2003).

There are no federal regulatory barriers to prevent the reproductive market in oocytes becoming a market for research oocytes as well. US bioethicist Jeffrey Kahn argues that the general US aversion to public funding for embryonic stem cell research makes oocyte and embryo purchasing on an open market more likely, in that funding agencies provide no funding for embryo collection, even in public funding situations.

Because of sensitivity over the status of human embryos and federal law that prohibits tax dollars from being used for embryo research, the U.S. National Institutes of Health (NIH) has proposed that it will fund research on stem cells but won't fund the collection of the stem cells themselves. This leaves private companies to act as suppliers of stem cells. Where will the embryos come from, what limits should there be on embryo use, and how close are we to a market in human embryos? … The government is effectively the market maker – a public buyer creating a demand to be filled by private suppliers. (Kahn 2000, pp. 1–2)

It is currently illegal for couples or women to sell their spare IVF embryos however, so private suppliers would be likely to target financial incentives at oocyte providers. While reproductive oocytes provided by fair-skinned college student fetch high prices, phenotype is irrelevant in SCNT research. I would argue that there is considerable scope to extend research oocyte markets to poor, uneducated and dark-skinned women, who would not normally be valued in the reproductive market, except as gestational surrogates (Pollock 2003). In the US, the juxtaposition of poor, ghettoized populations with high technology corridors – for example around Bethesda, Boston, Raleigh-Durham and Southern California – makes these kinds of markets even more feasible. Here we can see an internal version of the extraterritorial oocyte trade already described, with poor female populations within the nation-state acting as potential vendors for national biotechnology industries.

One business model for this kind of enterprise is the Bedford Stem Cell Research Foundation, founded in 1996 in the Boston area. The Foundation claims to be the first organization in the world to solicit women to “donate” oocytes purely for research. Since 2000, it has recruited oocyte vendors from the Boston area via newspaper advertisements, paying them about $4000 per procedure. The Foundation conducts research within its own laboratories, supplies research oocytes to Advanced Cell Technology and is set to supply other Boston area researchers. The website (www.bedfordresearch.org) emphasizes the use of “mild hormone stimulation” to avoid hyperstimulation syndrome, and the generally high level of screening, informed consent and ongoing care provided for oocyte suppliers. The Foundation only accepts women between the ages of 21 to 35, and they must already have at least one child, as a demonstration of viable fertility. According to an interview with the Director, Anne Kiessling, by the end of 2005, 391 women had inquired about the program. After screening, 28 started hormone injections and 23 completed the process. Eight of those 23 donated twice; three donated three times. The donations yielded 274 oocytes, at an average cost of $3673 per egg, once screening costs were factored in (Vogel 2006). No independent assessment of this program was available at the time of writing. However, what is striking about its approach is the evident concern to head off possible objections about the exploitation of its vendors and to underwrite the ethical provenance of the oocytes its supplies, within the terms of the US free market.

Discussion

Davis (2004), Sassen (2002), Ehrenreich and Hochschild (2002) and other analysts observe that the restructuring of the global economy since the 1980s has had a disproportionate effect on women, as public funding for health and welfare is rolled back, formal unskilled work disappears and women are forced to invent new productive niches in the so-called “informal” economy. In particular, women often support themselves and their children by recasting their feminine capacities for nurturance, maternity and sexuality as negotiable assets, able to be traded for money in first world countries where they can find employment as maids and nannies, as cleaners and waitresses, and as sex workers of various kinds (Ehrenreich and Hochschild 2002, Sassen 2002). In Sassen's words, they form the “lower circuits” of globalization, shoring up knowledge worker households, with their high consumption patterns and need for household assistance and “wifely” services no longer performed by educated, professional women.

Through their [feminized] work in survival circuits … women, so often discounted as valueless economic actors, are crucial to building new economies and expanding existing ones. (Sassen 2002, p. 256)

It is women in this kind of circumstance, living at subsistence level, seeking a niche in the expanding areas of the global economy, who can be readily targeted for oocyte purchase. Nahmen notes of her interviewees in the GlobalART clinic that they, and Romania itself, are “in a frenzied rush toward consumption within the flexible global economy” (Nahman 2005, p. 232). Both the South Korean DNA-BANK and the Spanish clinics target college students, who are both educated and poor, again struggling to find positions for themselves in the contemporary economy. Within the United States, as within most other neoliberalized knowledge economies, economically disenfranchised populations live adjacent to, yet excluded from, the laboratories, universities and technology parks that employ the highly trained scientific personnel who figure as the key players in the bio and information economies. This is the situation not only in the Northern post-industrial democracies but also increasingly in China and India, where biotechnology research capacity is expanding rapidly, often in the absence of effective oversight or regulation (Bharadwaj and Glasner 2004, Jayaraman 2005, Salter et al. 2006). Both China and India have large, impoverished populations, extensive networks of fertility clinics (Khanna 1997, Chu 2001) and burgeoning stem cell industries, setting the scene for exploitative forms of oocyte procurement.

Oocyte vendors are thus crucial participants in the global bioeconomy, both for the ever-expanding market in reproductive medicine and now for the stem cell industries. They are on the cutting edge of commercial biotechnology's increasing reliance on female reproductive biology, a reliance that is typically cast in terms of gift relations and donation, between fertile and infertile women or between young women and people suffering serious disability, as in the Wilmut quote that opened this paper. However, I would argue that their participation is more aptly thought of as reproductive labor in the lower circuits of the reproductively based biotechnology industries. This labor is not generally recognized as such, because it primarily consists not of the performance of codified tasks, but rather of subjects giving clinics access to the productivity of their in vivo biology, the biological labor of living tissues and reproductive processes. However, it does involve second order tasks – compliance with often-complex medical regimes of dosing, testing, appointments and self-monitoring. A non-compliant population renders reproductive and clinical procedures useless (Nahman 2005, Nguyen 2005). This reproductive labor is crucial for the development of whole sectors of the biotechnology industry.

At the same time, the essential reproductive labor performed by such women goes largely unrecognized, in an area dominated by ethical concerns for the embryo and by a privileging of intellectual property labor over the other kinds of prior, embodied labor. Oocyte vendors are extremely vulnerable, with little in the way of clinical or insurance protection, compensation or negotiating power. Clinics are privately run, with strong financial incentives to maximize their oocyte providers' “productivity” with strong ovarian stimulation regimes, and little or no external control over clinical and bioethical standards.

Conclusion: reproductive labor and global regulation

In March 2005, in response to Europe-wide media coverage of the Romanian clinic, the European Parliament passed a resolution on human oocytes. It states that “the procurement of cells may not be subject to any pressure or incentive, whilst the voluntary and unpaid donation of egg cells must be guaranteed, so that women do not become ‘suppliers of raw material’”.11

Similarly, in the USA the dramatic inflation of prices around reproductive oocytes over the past five years, and the expansion of markets to include research oocytes have sparked concern among many key actors. In 2005, the US National Academies of Science recommended in its “Guidelines for human embryonic stem cell research” that no payments should be provided for donating gametes for research. The chair of the National Academies committee stated that the recommendations were justified by the sensitivity of egg donation for stem cell research and by uncertainties about the actual risk of severe complications in donors (Steinbrook 2006). Some liberal supporters of stem cell research, in assessing the California stem cell initiative, argue for “public sector bodies with the power to establish and enforce comprehensive regulations that apply to both publicly and privately funded research” (Reynolds et al. 2006, p. 17). They advocate adequate reimbursement rather than payment, an institutional separation between oocyte harvesting clinics and stem cell research companies, and an ongoing duty of care to donors, with adequate follow-up and research of long-term consequences.

Each of these approaches has certain merits and plausibility. It may be possible to introduce an EU-wide regulatory system for the control of oocyte sourcing, with uniform compensation regimes and checks on clinical standards and informed consent procedures. As I have already discussed, the non-commodification of the human body is well entrenched as a norm in EU instruments and regulations around human tissues, and most states in Western Europe observe this norm in their national legislation and regulations. Likewise, in the US, while federal level controls seem unlikely,12 individual states may cooperate in the introduction of market regulation, or the public regulation model advocated by the Center for Genetics and Society (Reynolds et al. 2006). Moreover, in the wake of the worldwide scandals over Professor Hwang's questionable methods of oocyte acquisition, US state administrations, stem cell research companies and professional bodies may be newly sensitized to the potentially devastating effects of bioethical issues on research reputation. There is already some evidence for this. The California Institute for Regenerative Medicine, established in response to the 2005 California stem cell initiative, prohibits payment for oocytes, although it permits compensation (Steinbrook 2006), aligning it more closely with the West European and Commonwealth norms, and presumably smoothing the way for international collaboration.

However, none of these approaches will necessarily work in controlling the oocyte trade at these nations' geopolitical margins. The well-established, highly mobile, clandestine and transnational nature of both recruitment clinics and vendor populations suggests that attempts to ban oocyte markets will simply push trade underground, into black markets with more likelihood of criminal involvement and further possibilities of harm to the women. The apparent overlaps with the global sex trade, uncovered by the Observer report, are of particular concern in this regard. In this situation a combination of international human rights agency involvement, along the lines of agencies involved in the global sex industry, development aid and harm minimization approaches (e.g. international guidelines on clinical and bioethical standards, duty of care, etc.) may offer the best approach. Along these lines, the International Society for Stem Cell Research launched a guideline taskforce in early 2006. Involvement of UN agencies, especially the WHO and the UNESCO Bioethics committee may be beneficial. Concerns have already been expressed within the UN about the threat to poor women's health from the global demand for research oocytes.13 Within the boundaries of Western Europe, the USA, Israel and other regulated nations, fertility clinics that depend on the global oocyte trade are probably the best strategic points for enforcement of adequate consent, clinical care and payment beyond these boundaries. That is, like the UK stem cell bank, they can bring pressure to bear on the conditions of their suppliers, and refuse to traffic in oocytes harvested in exploitative ways. This would in turn require uniform oversight of these clinic's operations and bioethical standards.

Finally, while it contravenes the European ethos opposing the commodification of the human body, there may be merits in considering oocyte vendors in industrial terms: as essential reproductive workers in the supply chain of the stem cell industries, and as economic actors in their own right. Effectively the stem cell industries, genomics and other areas of the medical bioeconomy rely on the provision of human tissues, and at present, the gift system often means that donors are simply treated as open sources of lucrative biological material that can be profitably privatized by biotechnology companies (Waldby and Mitchell 2006). The asymmetrical reliance on female reproductive biology for regenerative medical research, combined with the growing population of economically disenfranchised women in the developing world, suggests that more and more women may find themselves employed in some kind of clinical or reproductive labor that may be their main means of support. An approach to oocyte supply that combines issues of safety, consent and clinical conditions with those of workers' rights, organized representation for vendors and regulated negotiation of conditions, including follow-up care and insurance, may yield benefits in terms of harm minimization and transparency. Most important of all, vendors themselves should be included in any policy formulation over the global oocyte market, so that their expertise, experience and interests are taken into account.

Acknowledgements

This research is funded by an Economic and Social Research Council Stem Cell Initiative grant “The global biopolitics of human embryonic stem cells” RES-340-25-0001. Versions of this paper were given at the conference, Stem Cells: From Tissue Engineering and Regenerative Medicine to Policy, Cambridge University, 19–21 April 2006 and the Cesagen Seminar, Cardiff University, UK 7 February 2006. The author would like to thank Donna Dickenson, Sarah Sexton, Melinda Cooper and Olivia Harvey for their valuable feedback and assistance with this research.

Notes

1. Therapeutic cloning is based on the technique developed to clone mammals – somatic cell nuclear transfer or SCNT. This involves the creating of an embryo not by the usual fusion of egg and sperm, but through the in vitro insertion of the nucleus of a cell from an adult's tissues into an oocyte. The oocyte has had its own nucleus removed to make way for the introduced nucleus. This creates an embryo with the genome of the adult from whom the nucleus was taken. Such an embryo could be used to develop embryonic stem cell lines with the genetic material of an adult donor, which could in turn be used to produce transplantable tissues genetically compatible with the donor.

2. Strictly speaking, this does not distinguish oocytes from other forms of donated tissue – virtually all tissues are in insufficient supply to meet demand, because demand is ever expanding, driven by new techniques and treatments. For more discussion see Waldby and Mitchell (2006).

3. In Australia and New Zealand for example, the number of both pregnancies and live births involving ART tripled between 1994 and 2003 (Waters et al. 2006).

4. At the time of writing, nobody has succeeded in using an oocyte to make an SCNT line in humans.

5. Sexton (2005), extrapolating from Hwang's figures, claims that almost half the young women in Britain would need to donate oocytes simply to treat those with diabetic conditions.

6. See for example commentary in the Observer (Campbell 2007).

7. Again there is nothing unique about global oocyte trading – it is driven by the same North–South relationship of privilege and poverty that drives the global trade in live kidneys and blood plasma. See Scheper-Hughes (2000) and Starr (1998).

8. www.nordica.org/composite-361.htm (accessed 27 February 2007).

9. Personal communication, 22 January 2007, Donna Dickenson.

10. According to Adam Balen, a British Professor of Reproductive Medicine, interviewed by the Observer (Barnett and Smith 2006).

11. European Parliament (2005).

12. Federal regulations seem unlikely given the US historical preference for decentralized, state-based regulation and professional autonomy and self-regulation. See Waldby and Mitchell (2006) for an extended treatment of the differences between West European and United States approaches to tissue regulation.

13. These can be found at Summaries of the Work of the Sixth Committee, the 58th General Assembly of the United Nations (2003).