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This miracle, however, depended on more than medicine. It also needed eggs—healthy eggs, to be precise, ideally produced by a young woman whose ovaries were at the peak of their production. The doctors who performed these procedures also liked to have multiple eggs, increasing the likelihood that at least one would be fertilized and implant; and the recipients generally wanted eggs that looked like them—eggs, in other words, that bore particular genetic characteristics: the intended mother’s hair or eyes, for example, or her desired level of educational achievement. Sometimes, suitable donors could be found—the sisters or roommates who volunteered their eggs and were medically able to provide them. In most cases, however, donors simply weren’t available, interested, or able. The demand for donor eggs thus grew steadily during the 1990s, tracking the growth of IVF centers and the increased social acceptance of test-tube kids. But the supply was sharply limited.

The sources of this shortfall were obvious. Unlike sperm donation, which involves at most a fifteen-minute commitment and a small dose of embarrassment, egg donation is an arduous procedure. The donor must agree, first, to a three-week regimen of hormone therapy, involving daily injections that prompt her ovaries to produce an overabundance of eggs. During this time, she makes frequent visits to the doctor’s office, giving blood samples and having ultrasound exams that help the doctor to determine when her eggs are “ripe.” Then, when the eggs are ready to be harvested, the donor undergoes a brief procedure in which the doctor plucks the eggs from the ovaries using a small ultrasound probe connected to a needle. Although the procedure usually entails only the discomforts of mood swings and abdominal swelling, some donors suffer from hyper-stimulation, a painful condition in which the ovaries produce too many eggs and the body swells with fluid. Others develop bleeding or, very rarely, an allergic reaction to the hormones. [32] The long-term implications of egg donation are unknown. [33]

As long as egg donation remained truly altruistic, therefore, it was destined to be plagued by severe shortages. Why would a healthy young woman put herself at any risk to help an infertile stranger? Why would someone undergo surgery just to give away a piece of herself? There was simply no mechanism to push supply anywhere close to the level of demand.