Tuesday, January 16, 2007

The business logic of made-to-order babies: Buying and Selling Embryos

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Friday morning, an investigator from the Food and Drug Administration spent four hours questioning Jennalee Ryan of San Antonio, Texas, about her new line of business. That business, outlined a week ago by Washington Postdoesn't appear to violate any rules within its purview. Embryo manufacture? Go right ahead. reporter Rob Stein, is making and selling human embryos from handpicked donors. The FDA says this

It's temping to label Ryan a madwoman, as many critics have. But that's exactly wrong. Ryan represents the next wave of industrial rationality. She's bringing the innovations of Costco and Burger King to the business of human flesh.

To understand her line of work, you have to understand how she got into it. "Twenty years ago, as a single parent, I contacted agencies and attorneys in the hopes of adopting a child," she explains on her Web site. Unfortunately, "those that were willing to help me offered me older children with emotional problems or severe physical handicaps." These lousy offers drove her to find ways around the system. "With a background in marketing, I came upon the idea of advertising for potential birthmothers," she recalls. "My enterprise grew so quickly, that I soon quit my career in sales and marketing to go into the field of adoption advertising fulltime. … Within 2 years, we were the largest adoption service in the United States."

Ryan deplores the helplessness of adoptive parents. They can't control the child's race, sex, or health. "There is no guarantee … that the gender is absolutely known," she warns clients. "If you are open to different ethnic backgrounds, drug use during pregnancy, etc., there is a better chance that you will be called." You can't even verify drug abuse unless the birth mother consents to a test.

Worse, you have to suck up to the birth mother. She can pick any adoptive parent she wants. "After years of dealing with birth mothers who decided to take [babies] back ... watching poor families have to kiss these girls' butts when they know they are using drugs and alcohol in the pregnancy," Ryan says she began looking for ways to give clients more power over child acquisition. "It was a control thing for me," she explains.

One way around the drug problem is to adopt a leftover IVF embryo instead of a baby. That way, you control gestation. But these embryos often aren't viable. Like leftover babies, they may carry "genetic mental illnesses." And you still get screened. "The recipient family must be scrutinized by the biological parents as well as the agency which requires a home study," Ryan protests. "This can sometimes add insult to injury to an infertile family, who … must 'prove' that they will be good parents."

A better solution is to customize your embryo. By buying eggs, you can get "more control of the prenatal environment and heath of the child" than you'd get with adoption. Through Ryan, you can select an egg "donor"—in practice, a seller—based on "her complete application, her medical and psychological results, genetic screening," and "copies of all the pictures she sent our program of her children, if any, and siblings." The pictures are crucial. Ryan requires five color photos before she'll offer a donor's eggs to buyers. One advantage of buying eggs, she points out, is that you can "choose a donor with similar characteristics" to yours.

Better yet, donors can't screen you. Unlike the adoption scenario, in which an agency can examine your parental fitness, "there is absolutely no such screening required for either egg donation nor sperm donation," Ryan tellsaccording to Ryan, is "whether or not a pregnancy resulted." buyers. "Nor is the recipient family forced to have to 'sell' themselves to the biological parents in the hopes that they would be chosen as suitable parents." The only thing your donor will be told about the fate of her eggs,

But eggs, sperm, and IVF are expensive. Ryan lays out the costs: $4,800 to find your ideal egg donor; $3,500 to $15,000 to compensate her; $3,500 for her drugs; $9,000 to $13,000 for related medical expenses; $3,000 for her travel expenses; $1,000 for legal fees; $500 for a sperm donor; and $1,000 in additional charges. And that's before you get into "medical fees associated with pregnancy and childbirth."

What if you pooled these expenses? What if you hired two highly fertile and desirable donors, combined their eggs and sperm in one IVF round, made a big batch of embryos, and sold the embryos a pair a time? Why buy retail when you can buy wholesale?

That's Ryan's plan. She charges $2,500 per embryo. Two women split the first batch; a third has signed a contract for two embryos from the second batch. Ryan figures each batch costs about $22,000 to make. The yield from the first round was 26 embryos. With 300 buyers on her waiting list, Ryan is well positioned to sell out each lot. At $2,500 per unit, a batch of 26 viable embryos would gross $65,000 and net $43,000.

It's a good deal for Ryan's clients, too—"much less expensive than the total IVF procedure, with a much greater overall success rate," she points out. One reason for the higher success rate is that you're paying for an embryo, not an attempt. If you buy eggs and sperm separately and don't get an implantable embryo, you take the loss. Ryan, through her package deal, absorbs that risk for you. No embryo, no bill.

Buying embryos gives you all the advantages of buying eggs and sperm. You can screen donors—in this case, the embryo's parents—for physical and mental health, education, and looks. Since Ryan is shouldering the risk, she screens donors up front. Her embryos' moms are college-educated. The dads have advanced degrees. All the donors are white, since the clients are white. Ryan is no bigot, but business is business. "There is simply a demand for white babies," she shrugs. In fact, three-quarters of the DNA in her first two batches comes from blue-eyed blonds. This isn't eugenics; it's narcissism. "What I was really looking for was blond hair, blue eyes, so the child would look similar to me," one of Ryan's clients told ABC News.

Ryan argues that by using a manufactured embryo instead of a leftover IVF embryo, you can avoid "the discomfort of involving the biological parents." No need to worry that they're "a family somewhere." They've never met each other, much less the embryo. All they sold were eggs and sperm. "I am not emotionally attached to my eggs," says a donor quoted on Ryan's Web site as a model of suitability. "I am not giving my couple a baby." The easiest child to acquire, like the easiest child to abuse, is one who belongs to nobody.

The trouble with adoption agencies that handle leftover embryos is that they don't see it this way. They treat embryos like babies. That's why they screen you, to make sure the embryo will be in good hands. To evade this scrutiny, Ryan calls her service embryo "donation" instead of "adoption." The linguistic change is morally and legally pivotal. Adoption is what happens to babies. Donation is what happens to eggs and sperm. "Embryo donation" is a declaration that embryos should be treated like eggs and sperm—subject to purchase, screening, sale, and disposal—not like babies.

Ryan is explicit about this. "It is unfair that the 'creator' of the embryos can use an egg donor and donor sperm to create the embryos, and have no criteria or third parties to be 'approved' by; yet the family willing to undergo implantation of those same embryos after freezing must come under third party scrutiny," she protests. In other words, embryos deserve no more oversight than eggs and sperm do. John Robertson, chairman of the ethics committee of the American Society for Reproductive Medicine, agrees: "People are already choosing sperm and egg donors in separate transactions. Combining them doesn't pose any new major ethical problems."

That's the central question Ryan's venture poses. She didn't invent commerce, quality control, or trait selection in human reproduction. Those trends are rampant in the egg and sperm markets. All she did was extend them across the line of conception. Does that line matter?

If it does, you'd better figure out how to square that with your views on abortion and stem-cell research. But if it doesn't, you'd better figure out where to draw the next line. Because the logic of what Ryan is offering—more control, more customization, higher quality, fewer hassles, lower cost, and lower risk—won't end here.

The first thing to go will be the fixed price of embryos. Ryan says "high demand" egg donors can earn up to $15,000 per cycle, more than four times what other women get. "Additional compensation is offered to those donors who have earned a post-graduate degree [or] have a unique skill, characteristic or trait," she tells them. That cost will have to be passed along. Meanwhile, competition will generate a more affordable low-end market. Ph.D. embryos will cost more than B.A. embryos.

Next comes the integration of surrogacy. If packaging eggs and sperm with IVF improves quality control and cuts expenses, why not add gestation? The embryo you're buying is biologically foreign to you, anyway. Why risk it in your infertile, 40-year-old body when Ryan can find a healthy 25-year-old to carry it for you? She already advertises this service for an extra fee: "pre-screened surrogate mothers available." And since her embryo sales pitch relies heavily on the bottom line—a superior "pregnancy success rate"—why not sell the embryo-surrogate package based on its birth-success rate? That's what buyers ultimately care about. With a network of reliable surrogates, Ryan or a competitor might even make payment contingent on the final product. Cash on delivery.

To Ryan, embryos are inventory. "I saw a demand for something and created the product," she told to the San Antonio Current. The doctor who mixed Ryan's first batch of embryos was aghast to discover their fate, but Ryan insists, "If they are my embryos, legally, what I do with those embryos is really none of her business." What if clients aren't satisfied with the embryos? "If they don't think it's right for them, they don't have to take them," she shrugs. With surrogacy, that policy could be extended for weeks. Tested, personalized, affordable, disposable. You've come a long way, baby. Slate

Pray for us O Holy Mother of God!


1 comment:

Anonymous said...

Amen, Holy Mother of God, pray for us!