n the spring of 2006, Heather Cox got an unexpected phone call from a Toronto fertility clinic. Three years earlier, she had donated eggs anonymously to a gay couple through the clinic. Now the same couple wanted a full sibling for their child. Would she consider providing eggs again?She hesitated. Her first experience had been extremely unpleasant. A few days after the eggs were retrieved, her abdomen had filled with fluid. “I looked nine months pregnant,” she says. After fainting in the shower, she called the clinic, and they advised her to come back in to have the fluid drained. She did, but it took a full week before she felt better.
The clinic, CReATe Fertility Centre, called her during her recovery. They wanted to know if she had a telephone number for her cousin, who had also been a donor, and whom they wanted to ask to donate again. Cox couldn’t help them. “Well, would you be interested in donating again?” she recalls them asking. She said no.
This latest request, however, felt different. There was a child out there who had resulted from her egg, and she alone could help that child have a full genetic brother or sister. “I sympathized,” she says. “I only have one full-blooded sibling.” She agreed to do it, but with conditions: the eggs were to be used only by this one couple, and the clinic was to take extra care so she didn’t end up producing so many eggs that she got sick again. She also made it clear that this would be her last time donating.
At the time, Cox was twenty-five years old, a massage therapy student and competitive kick-boxer with strawberry blond curls and enormous green eyes. She wasn’t in a relationship and hadn’t had any children of her own. She had first learned about donation when her cousin had given eggs to a friend of her mother’s in 2000. Her cousin had gone on to donate several more times over the years. Even her mom had donated eggs once, when a cycle of in vitro fertilization produced more than she could use.
For her first donation, Cox had requested $5,000, but this time she asked for $7,000. For one thing, she was now what’s known as a “proven” donor, because a healthy child had resulted from her egg. She had also heard from her mother’s friend, who had received her cousin’s eggs, that $7,000 was a fair rate.
The following year, on a summer break between her coursework and her certification exam, she began injecting herself with fertility drugs in preparation for the second donation. Stimulating her ovaries to produce many more than the usual single egg per month would give the couple plenty of eggs, increasing the odds that a pregnancy would result. The first drug she took was to shut down her reproductive system; the second stimulated egg growth. She was given the final drug, the “trigger shot,” about thirty-six hours before the retrieval, prompting the eggs to ripen fully.
On the morning of August 17, 2007, she went in to have the eggs retrieved. She was lightly sedated, and the physician used an ultrasound-guided aspiration needle to pierce through the vaginal wall and up into her ovary. The needle was inserted into the follicles and the contents — some fluid and, with luck, an egg — gently sucked out into a test tube. Her ovaries were extremely swollen, however, and one had come to rest below the other, blocking the needle’s path, so only about half of the thirty-odd eggs that had ripened could be harvested. The procedure lasted less than half an hour. Shortly after, while she recuperated in a lounge chair in the recovery room, a staff member came by with the cheque.
The logistics of donating were much the same as they’d been years earlier. But since Cox’s first retrieval, the legal landscape for egg donation in Canada had changed dramatically. A long-awaited law, the Assisted Human Reproduction Act, had come into force in April 2004, expressly outlawing the purchase of human eggs. Technically, anyone involved in such a transaction, including doctors and parents, could now be fined $500,000 and be jailed for up to ten years.
In reality, however, the law had done little to stop Canadians from buying human eggs. If anything, with women waiting longer than ever to start their families and gay men increasingly interested in having children, demand had gone up and the market had grown. The law, such as it was, simply forced the activity underground, with unintended and undesirable consequences. Fertility specialists, lacking official guidance from the government, began drawing their own boundaries. Patients had only doctors to rely on for advice. Worst of all, donors became part of a shadow economy, aware they were part of something vaguely illicit and therefore reluctant to come forward when something went wrong. The rare woman who did speak up risked being made the scapegoat of the whole under-the-table arrangement — as Heather Cox was to learn.
he Assisted Human Reproduction Act was supposed to make fertility medicine safer. In 1989, Canada convened the Royal Commission on New Reproductive Technologies, which spent four years and $28 million investigating how best to harness developments like in vitro fertilization, prenatal genetic diagnosis, and research on embryos. Its report, Proceed with Care, was released in November 1993. Regarding payment for eggs, the commission was unequivocal: it was “never acceptable.”The recommendation was in keeping with Canadian practices for other body products, such as blood and organs, and followed from an ethical position that offering money for a kidney or a lobe of a liver — or an egg — might persuade some people to offer them up without thinking through the consequences. The potential for exploitation, it was felt, was too great.
More than a decade went by between the royal commission report and the passing of the legislation, and the process was in some ways atypical. Usually, a law-in-progress is scrutinized by a Commons committee only after it has been fully drafted, but because reproductive technology was so controversial, then minister of health Allan Rock simply handed the Commons health committee some draft proposals and asked it to take the pulse of the nation.
