The Future of Making Babies
Assistive reproductive technologies such as in vitro fertilization have helped many people have children. Behind many of these births are egg donors, whose experiences remain largely invisible in public narratives and scholarship. As reproductive technologies change—along with the ethical and policy challenges they raise—the role of egg donors will too.
On this episode, host Jason Lloyd is joined by Emily Packard Dawson, a postdoctoral research fellow at the University of Michigan Medical School whose work focuses on the ethics of emerging reproductive technologies. In our Winter 2026 issue, Dawson reviewed a book by Diane M. Tober called Eggonomics: The Global Market in Human Eggs and the Donors Who Supply Them. Dawson discusses egg donors and the donation process, and what advances in reproductive technologies might mean for them.
Resources
- Read Emily Packard Dawson’s review of Eggonomics: The Global Market in Human Eggs and the Donors Who Supply Them.
- Check out the National Academies workshop report, “In Vitro–Derived Human Gametes as a Reproductive Technology: Scientific, Ethical, and Regulatory Implications: Proceedings of a Workshop” to learn more about in vitro gametogenesis.
Transcript
Jason Lloyd: Welcome to The Ongoing Transformation, a podcast from Issues in Science and Technology. Issues is a quarterly journal published by the National Academy of Sciences and Arizona State University.
Where do babies come from? That’s a question that might have some very complicated answers by the time my young children are old enough to ask it. Assisted reproductive technologies are changing rapidly along with the ethical and policy challenges they raise.
I’m Jason Lloyd, managing editor of Issues. On this episode, I’m joined by Emily Packard Dawson, a postdoctoral research fellow at the University of Michigan Medical School. Her work focuses on the ethics of emerging reproductive technologies. In our Winter 2026 issue, Emily reviewed a new book by Diane Tober called Eggonomics: The Global Market in Human Eggs and the Donors Who Supply Them. So we’re going to start our discussion there. Emily, thank you so much for joining us.
Emily Packard Dawson: It’s a pleasure.
Lloyd: So since the first successful birth from in vitro fertilization in 1978, egg donors have been an essential part of assisted reproductive technologies that help people have children. So I’d like to start with the donors who are the subject of a book that you reviewed for Issues, Eggonomics by Diane M. Tober, and who, as you note in the review, are at the center of a sprawling, ethically thorny and economically complex system. So who are the egg donors and how are they recruited?
Most donors do describe a real genuine desire to help someone have a child.
Dawson: Egg donors demographics and motivations vary, but certain patterns do emerge from the research. So at the time of their first donation cycle, most donors in the United States are in their 20s. They tend to be single. They’re often students or recent college graduates. And financial motivations play a real role. So Diane Tober’s work and others point to student debt as a significant driver of participation in egg donation. But it’s rarely the whole story. Most donors do describe a real genuine desire to help someone have a child. Donors are often recruited through social media, campus flyers, college newspapers, and the advertising can be quite specific. So. some will say they’re seeking donors with very particular characteristics of certain ethnicity or race, Ivy League education, physical appearance, and compensation reflects that. So donors with traits considered to be more in demand will command higher pay.
Lloyd: What kind of reimbursement is involved?
Dawson: So donors can make and do make thousands of dollars. Diane Tober indicates one case in which a donor with a specific set of traits and criteria was compensated $200,000. That is far, far, far outside the norm. Most are making somewhere between $5,000 to $10,000, but that does really vary. But you can get a sense of where specific traits can command different payment.
Lloyd: What is the donation process like? And what are some of the potential complications that can occur?
Dawson: So normally, each month a woman ovulates one egg, but just like patients going through in vitro fertilization, egg donors go through a process to stimulate their ovaries to mature and release many eggs at once. So donors give themselves daily hormone injections for a few weeks and then undergo a surgical retrieval for the eggs under sedation. So a doctor uses a transvaginal ultrasound-guided needle and collects the eggs and from start to finish, a single cycle can take three to six weeks. And many donors will experience mild symptoms like bloating, cramping, fatigue, mood swings, but the complications can be much more serious.
We just don’t have very robust follow-up data on egg donors.
So one of the most significant short-term medical risks is ovarian hyperstimulation syndrome or OHSS. And it’s a reaction to the hormones that are injected where the ovaries swell, and then they can leak fluid into the abdomen. And in severe cases, it can be life-threatening. So clinics and professional societies typically cite the risk of OHSS as about 1 to 2%, but that number is increasingly being called into question. Researchers like Dr. Tober have conducted surveys where patients retrospectively report experiencing OHSS at much, much higher rates. It highlights a deeper problem, which is we just don’t have very robust follow-up data on egg donors.
Lloyd: Interesting. So I think connected with that, egg donation in the United States—along with reproductive medicine more generally—is regulated by the states. So what kind of protections for donors are in place in the US? And I guess are there differences among different states?
Dawson: Sure. So as you mentioned, some countries regulate assisted reproduction through a centralized oversight body, but in the US, public health clinical practice generally are primarily governed by the states. So that means that mainly we rely on guidance from professional societies such as the American Society for Reproductive Medicine to guide clinical norms, but clinicians aren’t legally obligated to follow them. Patients or donors who experience harm, they might seek redress using medical malpractice liability, but again, that’s going to be very retrospective. So in practice, donors’ protections depend a lot on where they are and which clinic they go through. And as you said, there is variability across states. Some states have some laws that regulate what donor conceived children have a right to know about their donors and various other factors. But in general, that’s a pretty fragile system for something that involves real medical risk.
Lloyd: You are interested in a technology that might someday dramatically change how egg donation works. So I was wondering if you could talk about in vitro gametogenesis. Am I saying that right?
Dawson: You are definitely saying that right. And it’s a tricky word and a little bit of a tricky futuristic concept, but it’s not truly speculative anymore. So in vitro gametogenesis, or let’s just call it IVG for the sake of both of ourselves. It’s the idea of creating eggs and sperm in the laboratory from pluripotent stem cells. So for example, you could take an adult person’s skin cell and then convert that back into an induced pluripotent stem cell. That’s a cell that can become any other cell, and then reprogram it into a lab-derived sperm or egg.
So I’ll just tell you that in mice, researchers have made major advances, including generating functional lab-derived sperm and egg that were capable of producing healthy offspring. But in humans, we are very much in the preclinical research stage, and there are substantial scientific barriers to getting all the way from stem cells to safe, functional human eggs or sperm. But what makes IVG so significant, is what it can make possible. So IVG could offer a path to conceiving genetically related children for people dealing with infertility, for women of advanced maternal age, for same-sex couples who want to conceive a child related to both parents, and that helps explain why there’s so much interest in it.
Lloyd: So how could IVG change the process of egg donation?
What makes IVG ethically appealing… is it could reduce reliance on third party reproduction and expand options for people who currently don’t have a path to genetically related children.
Dawson: So how IVG impacts the practice of egg donation will largely depend on which scientific approach to IVG develops. So the long-term vision for IVG, I think the hope that many in the field carry, is that they’ll be able to create eggs or sperm entirely from a patient’s own cells. And in that approach, you wouldn’t need donor eggs or sperm at all. And that’s part of actually what makes IVG ethically appealing in part, is it could reduce reliance on third party reproduction and expand options for people who currently don’t have a path to genetically related children.
But there’s something a little tricky at play here, which is that a study that came out at the end of last year out of Oregon Health and Sciences University, and it’s the first study of its kind to actually produce lab-derived human egg that was functional and able to be fertilized. But in that approach, the donor’s DNA, it still relied on donor eggs. So the donor egg didn’t provide DNA, but the cytoplasm, which is the cellular environment of the egg, reprogrammed the intended parent… In this case, I mean, it was not an intended parent because it didn’t go into a clinical state, but let’s say an intended parent’s DNA to behave like an egg. And while researchers were able to fertilize these eggs and they allowed the embryos to develop to the implantation stage, but most had vast chromosomal abnormalities. So the research is very clearly still preclinical and a long way from being ready to be considered for clinical use, but it does move IVG from a purely speculative place to something more concrete.
Lloyd: So if IVG proceeded through this pathway, how would that change egg donation?
Dawson: So in this case, donors would still be required, and that would mean that the risks for donors wouldn’t go away. You’d still have hormone stimulation, surgical retrieval, short-term risks, long-term risks, and the long-term data gaps we’ve already talked about remain relevant that we don’t quite understand what the long-term risks of egg donation are. But what could shift is the market logic around who becomes donors.
So right now, donor compensation and recruitment is tied to traits people think are heritable like education, ancestry, appearance. So if DNA is no longer the point of what the egg donor provides, that logic falls apart and the new premium could be on the quality and functionality of the cytoplasm. And so, that could mean that any donor will do, if you will. You just need a donor that can supply a functional egg. And so, that carries some real equity concerns because if the selection criteria move away from wanting someone with Ivy League credentials, recruitment practices might target donors with lower educational attainment, fewer related economic options who may be more willing to undergo egg retrieval for more limited compensation. And we’ve seen that dynamic play out in transnational surrogacy. So it’s a pattern worth taking seriously before the science moves ahead.
Lloyd: So, this starts to touch on some of the ethical issues that I wanted to get to. As an emerging technology, what are some of those ethical issues that IVG might be raising or starting to outpace a little bit?
Dawson: Well, I wanted to take a second and plug a recent workshop that was hosted by the National Academies in 2023, which did a wonderful deep dive on ethical and social implications raised by IVG. But I’m going to go over some of the ones that strike me most here. So one of the first is family and kinship. IVG could genuinely expand reproductive options. So for example, for same-sex couples who want a genetically related child, but there’s a tension because the more we invest in technologies that enable genetic relatedness, the more we may reinforce the idea that genetics are the most important basis for a family, and that can implicitly devalue other forms of kinship, adoption, fostering, non-genetic parenthood that have been central to many communities and many lives.
Another is a factor of scale. If IVG makes it possible to generate large numbers of eggs, which are usually the limiting factor in terms of reproduction. And so, if you have large number of eggs and therefore a larger number of embryos, we may see a greater push toward embryo selection and applications of tools like pre-implantation genetic testing for polygenic traits. Professional bodies right now have urged caution and noted the limited evidence and clinical utility of what’s called PGTP currently, but with many more embryos, the power of those analyses could increase. And that intensifies already familiar questions about disability, enhancement, eugenics, what traits get selected for or against, and what does that signal about whose lives are valued.
Assistive reproduction tends to work through… stratified reproduction where some people gain new reproductive possibilities while others provide the biological labor or absorb the risks that make that possible.
And then, the final one I’ll touch on is equity, which I think is really up through line through all three of these concerns. Assistive reproduction tends to work through what some scholars call reproductive stratification, stratified reproduction, where some people gain new reproductive possibilities while others provide the biological labor or absorb the risks that make that possible. So many are concerned that IVG, for example, could increase demand for gestational surrogacy, which is a practice that like egg donation, is very ethically thorny. So IVG might not really eliminate reliance on other people’s bodies so much as redistribute it.
Lloyd: So you have this with current egg donation processes. You have this soft selection for traits that you find desirable by recruiting Ivy League students or whatever their physical attributes you’re looking for, height or weight or looks or something like that. But in this case, what you’re warning about in terms of the ethical possibilities of IVG is more of a hard selection process where you can actually look at the differences among the eggs, among the embryos, and select for the traits that you want and that’s the concern. Is that right?
Dawson: Sure. Yes, that’s exactly right. That’s the concern. And again, there’s not clinical validity to those tests now, but as you generate an increasing number of embryos, and frankly with technologies like AI and others, we might soon be able to understand with more confidence how to predict some of the more seemingly ephemeral traits or treats even that really do interact with the environment, but to more deeply understand the genetic basis of something like height, strength, intelligence that could permit deeper selection when you have more scale of embryos to choose from.
Lloyd: Interesting. So we touched on this a little bit, but these kinds of novel assisted reproductive technologies are truly global. So techniques such as IVG that are developed in one place might be used nearly anywhere. What does that global mobility of these technologies and the labor that goes into them, what does that mean for regulating them?
Dawson: Yeah, absolutely. So I’ll take a step back. So to understand the regulatory challenge, I think it helps to start with why certain places become hubs for reproductive medicine in the first place. So for example, since we’ve been talking about egg donation in the US, the US is a huge hub for egg donation for a lot of reasons. It’s broadly permissive in terms of who can access these technologies versus some countries that limit the practice based on marital status, sexual orientation. And the US also permits, as we’ve discussed, the ability to select for a specific donor versus in Spain, it’s actually mediated by the clinics, which will essentially phenotype match based on the intended mother. So that gives a lot of flexibility to people who want to have that kind of ability to do things. So the US has become a hub. So that’s how those hubs emerge.
And then I want to discuss how those hubs can shift. When restrictions are introduced in one place, reproductive services, it’s not that they disappear, they simply relocate. So now let’s use surrogacy as an example. When India and Thailand, they used to be huge hubs for surrogacy, for transnational surrogacy, but when they close their markets to foreign intended parents, clinics moved to Nepal and Cambodia. And then, when those countries followed suit and put in place restrictions, arrangements shifted again to Ukraine, Georgia, Kenya, among other countries. So it’s a rolling pattern of market relocation. And so, it just continues to displace the labor and the burden to people who have fewer and fewer protections generally. And this is an interesting dynamic to consider when we think about emerging technologies. So we’ve seen this before, for example, with mitochondrial replacement therapy. US-based researchers and prospective patients circumvented US regulation, which prohibited clinical practice of MRT, and they traveled to Mexico for the first attempted inhuman use, and that did lead to the delivery of a baby boy in 2016.
Lloyd: So just backing up a bit, what is MRT?
Dawson: So mitochondrial replacement therapy is a reproductive technology designed to prevent the transmission of a mitochondrial disease from mother to child. So mitochondria are inherited through the mother. So essentially, you would replace in the mother’s egg, the mitochondria that would come from a different person. And so then you would enable the resulting child to not carry this mitochondrial disease that the mother has.
Lloyd: Okay, interesting. So getting back to IVG, what does all this mean for regulations?
All of this points the need for more intentionality around building shared international protections.
Dawson: So since the legality of IVG is not straightforward in the US, essentially there’s an appropriations rider that prevents the FDA from reviewing or approving any clinical applications that involve heritable genetic modifications and IVG is a bit wrapped up in that. So in practice, that creates a barrier in which you might see US-based researchers or US-based patients traveling to a different country for IVG research or eventually potentially IVG clinical use. Although I would argue that even optimistic estimates say that’s at least a decade away. All of this points the need for more intentionality around building shared international protections, not perfect agreement, which is probably unrealistic, but meaningful coordination because waiting for highly visible failure to force a response like did, for example, for heritable genome editing is a pattern reproductive medicine has repeated too many times and we need to take a more anticipatory approach for emerging technologies that involves international coordination.
Lloyd: Are you hopeful for that kind of coordination?
Dawson: I think there are a lot of countries and ethical bodies that are taking on some of this work. The National Academies had a workshop. There are bodies in the UK that are really exploring this, but I think in terms of international coordination, it’s still lagging and we probably need to see something for IVG like we saw for heritable genome editing, which involved a lot of cross-international guidance and work where everyone really got on the same page about what they expected and what was needed to move forward.
Lloyd: Interesting, thank you, Emily, so much for this really fascinating discussion. It’s been great learning more about this emerging technology and some of the ethical and technological ramifications of it.
Dawson: I think there’s nothing more interesting or special than germ cells. I’m obviously extremely biased, but I think people’s ability to have children is incredibly special and intimate to them, and I can understand why people would like to see a technology like IVG developed, and I can also understand why and share many concerns about what the implications for such a technology would be.
Lloyd: Visit our show notes to find links to more of Emily Packard Dawson’s work, such as her review of Eggonomics for Issues. Please subscribe to the Ongoing Transformation wherever you get your podcasts and write to us at podcast@issues.org. Thanks to our audio engineer, Shannon Lynch, and producer Kimberly Quach. I’m Jason Lloyd, managing editor of Issues. Thanks for listening.