Maggie Eastman considers it the worst decision she ever made.
In 2003, beset by $30,000 in tuition debt and imbued with a burst of altruism, Eastman, a college senior, decided to donate her eggs to help an infertile couple have a baby. Over the next decade she donated nine more times, earning a total of about $20,000 _ money that helped Eastman and her then-husband buy a house.
"When I think back, I think, 'God, how stupid was I?'" said Eastman, now 34, who works as a 911 operator near Seattle. She made her final donation in 2013, months before she was diagnosed with Stage 4 metastatic breast cancer _ a rarity in someone so young who has no family history of the disease.
Eastman said that when she asked her oncologist whether her cancer might be related to her egg donation, which involves the use of hormones to rev up egg production, he replied that he didn't know, adding, "Well, there are risks."
Although Eastman believes that being an egg donor was the cause of her estrogen-fueled cancer, experts say it is impossible to know. Studies of the long-term impact of egg donation on donors have never been done, even though the practice dates back more than 30 years.
Despite sporadic reports of subsequent infertility and a variety of cancers, some fatal, it isn't known whether these problems are linked to the process or are simply the result of chance.
Fertility specialists say that egg donation is safe and involves the same process as in vitro fertilization, which uses drugs to stimulate and regulate egg production. A 2013 meta-analysis of 25 studies seeking to evaluate the risks between ovarian cancer and the use of fertility drugs found "no convincing evidence" of an increase in the risk of invasive ovarian cancer.
"There are no long-term adverse risks of IVF" or egg donation, said Richard J. Paulson, president-elect of the American Society for Reproductive Medicine (ASRM), which represents fertility specialists. Paulson heads the infertility program at the University of Southern California, one of the nation's oldest egg donor programs, which was established in 1986. "All the data we have so far seem to indicate no long-term problems."
But others say the matter remains unsettled because donors haven't been studied.
"There is a total lack of information about the long-term (effects)," said Timothy R.B. Johnson, the longtime chairman of the department of obstetrics and gynecology at the University of Michigan Medical School.
Johnson supports the establishment of a national registry to track the health of egg donors. "No one's collecting the data" on donors, he said, adding that the fertility industry is largely unregulated. Once their eggs are retrieved, donors are sent home with little or no follow-up.
A transaction once shrouded in secrecy, the internet now hosts a thriving and competitive marketplace for donors, largely supplanting leaflets on college bulletin boards and ads in campus newspapers, the traditional methods of recruiting fertile young women. Payment varies, currently starting at about $3,500 per cycle and sometimes exceeding $50,000, depending on the location of the clinic or egg brokerage and the donor's characteristics. An Ivy League education, Asian descent (there is a paucity of donors), exceptional looks and a previous donation that led to a birth command higher reimbursement.
The demand for donor eggs has increased rapidly in the past decade. Nearly every state has at least one fertility clinic, said Judith Daar, a specialist in reproductive law and a professor at Whittier Law School in Costa Mesa, California. A report in JAMA found a significant increase in the use of donor eggs between 2000 and 2010, from 10,801 to 18,306. Daar estimates that about 10,000 babies born in the United States in 2013 were conceived using donor eggs.
But questions about egg donation abound, said veteran women's health advocate Judy Norsigian, a co-founder and former executive director of the Boston-based advocacy group Our Bodies Ourselves. Among the unknowns: How many women have donated eggs? (The number is believed to be in the thousands.) How many times are they donating? (The ASRM recommends a lifetime maximum of six.) Which drugs are they being given, and in what doses? How common is ovarian hyperstimulation syndrome, a painful condition in which the ovaries swell? Severe cases can lead to a stroke or even, rarely, to death.
