What’s in a Gene?
By Alexis Wolff
“The geneticist is going to look at this and freak,” a woman who introduced herself as Veronica told me as we sat across from one another in her Manhattan office. On the coffee table between us sat my application, which I had been instructed to complete at a desk by the receptionist, even though I’d mailed in an identical one several weeks before. This new application sat opened to a grid where I’d filled in information such as the height, weight, hair color, and eye color of my sister, parents, and maternal grandparents. I left blank the boxes devoted to my paternal grandparents. I’d never met them.
“Let’s try to fill some of this in,” Veronica said, “or else the geneticist is going to have some trouble doing her job.”
“Well,” I apologized, “I’m not sure I know any more than what I put.”
“We can just estimate.”
“So your dad’s mom,” Veronica continued. “Would you say she was small, average, or large?”
“I have no idea.”
“What would you guess?”
“And her hair color?”
And on we went. When we finished, Veronica flipped through the rest of my application, in which I documented my interests and talents, my ethnic heritage, and my personal and family medical histories.
“You’ve got a great profile,” she said, glancing up to look me in the eye. “I could match you in a day.” I supposed that was a compliment.
Veronica put down my application and shifted back a bit on the couch. “So,” she asked, “what made you interested in egg donation?” I hesitated. I knew that I couldn’t tell Veronica the whole truth. My interest dated back a few years to when I was a junior in college and the writer Gay Talese spoke to my English seminar class. The week before, we’d read Talese’s classic profile of Frank Sinatra, which Esquire had recently dubbed “The Greatest Story Ever Told.” We’d sat around the circular oak table discussing specific passages and techniques like peewee league football players watching Super Bowl clips.
A week later, Talese stood before us, wanting to hear about the pieces we intended to write. A sophomore named Lily spoke about the frequent ads in the Yale Daily News promising five-digit payments to egg donors. She said she didn’t understand why a woman would subject herself to such an invasive medical procedure, even for so much money. Talese nodded intently as Lily explained that she planned to interview donors and recipients to understand the process better. When she finished, Talese offered his advice: donate your eggs.
We knew that this kind of first-person participation was a central tenet of New Journalism, yet we chuckled. We were merely students, after all, just toying with the idea of being writers. We loved to read about Talese stalking a sick Sinatra after the singer refused an interview, or abouthim tagging along with members of the notorious Bonanno crime family for his 1971 bestseller, Honor Thy Father, but we wouldn’t have dared try either ourselves, and the thought of donating eggs just to get a good story was preposterous.
Two years later, I’d graduated from college and committed myself to being a writer. I was living in New York City—the same city as Talese, but in a far different world. I’d published a few essays for twenty five or fifty dollars, but professional success was nowhere in sight. As a graduate student with over sixty thousand dollars in debt, and more coming, money was a problem. So when I saw an ad online offering $8,000 for my eggs, I was tempted. I thought of Talese. I could use the money, but more importantly, I could use the story. But I knew I couldn’t tell that to Veronica.
“In college, I always saw ads offering tons of money for egg donors, and I told myself I’d never be a part of that,” I began. “It seemed like they were trying to genetically engineer a perfect child. But I noticed in your ad that recipients know nothing about donors except that they’re healthy and have similar ethnic backgrounds, which makes me think they’re seeking egg donors because they really need them.”
I didn’t say explicitly that I wanted to help such couples, but that’s what Veronica heard.
She nodded excitedly. As she expounded on the rewards of knowing you helped an infertile couple start a family, I felt a little dirty. I admired people with such motives, but for me, at least at this point, donating was about what I’d get rather than what I’d give.
I studied Veronica as she spoke. She was probably ten years older than me, wearing a mauve button-up shirt with shoulder pads. Her lips were painted a shade lighter than her shirt, and her eyelids a shade lighter than her lips. I thought of the advice I read once in a fashion magazine—makeup should match your coloring rather than your clothing. I wondered whether Veronica was judging me too. “So what I’m going to do now is tell you a little about the process,” Veronica said. I nodded as she recited, confidently and precisely, the evolution of in vitro fertilization from a procedure performed with a woman’s own eggs to one that frequently employs eggs from donors. As a donor coordinator, she’d surely given the speech dozens, or maybe hundreds, of times before, but her warm smile made me feel that she was truly excited to tell me.
The American Society for Reproductive Medicine (ASRM) estimates that donating my eggs would take approximately fifty-six hours over about two months, Veronica told me. It would begin with a series of physical, gynecological, and psychological examinations to determine my eligibility. Once I passed and was matched with a recipient couple, I would receive an injection to halt the normal function of my ovaries. This would help control my response to the fertility hormones I’d have to inject for ten days, and allow my cycle to be coordinated with that of the recipient.
I thought about that recipient. She’d likely be coming to the clinic the same days as me, maybe even at the same time. I knew I’d be looking around at the clinic’s other patients and wondering who would receive my eggs, and I guessed she’d be searching for me too. I began to feel fond of her, whoever she was.
On the coffee table, Veronica set a glossy black and white paper facing me that showed ten small and seemingly identical slides. The replication made it look looked like Andy Warhol’s version of an ultrasound.
She pointed to six dark blurs in the last slide. “Here we see six mature eggs,” Veronica said. “Look here and here and here and here and here and here.” I looked. Normally, a woman develops and releases only one egg per month, she explained, but under the influence of fertility hormones, multiple follicles develop. I pretended I could see the difference between this slide and the one before it. Pictures like these would be taken of me too, she continued, because after I began taking fertility hormones, I’d come to the clinic early in the morning every few days so ultrasounds could monitor my eggs’ progress.
“Since you’re young, you would probably have even more eggs than this donor,” Veronica said. Most women on fertility hormones produce as many as twenty-five or thirty mature eggs per cycle.
Veronica set another glossy paper before me, this one a color cross-section illustration of the female sex organs. The image looked only vaguely familiar, like something I was supposed to memorize in ninth grade biology. Veronica explained that when the doctor decided the time was right—just before my eggs would have released into my reproductive system—he would inject me with another drug to prepare them for retrieval. After sedating me, he would insert a needle up through my vagina to coax them from their follicles. After I left his office, my eggs would be mixed with sperm and incubated for three to five days before being implanted into the uterus of the recipient.
I’d already read about this process, but hearing it aloud made it more concrete. This was really going to happen. A part of me was going to become a part of someone else—that amorphous woman I had started to feel affection for. I really did want to help her. Still, the thought of giving away a part of myself to a stranger made me feel a little uneasy.
“The procedure can be done in fifteen minutes, and it definitely shouldn’t take longer than an hour,” Veronica said. “And because you’ll be given a sedative to help you relax, we ask that you have someone to accompany you home that day.”
I froze. That was going to be a problem.
I hadn’t told anyone about this meeting, not even my boyfriend, and if I ever told him, I couldn’t imagine doing so until after I completed the procedure. I knew that he, an internal medicine intern at a hospital just down the street, would shake his head in disapproval and tell me that money’s not everything, that a good story’s not everything. Then he’d invoke medical jargon to make his case for what a bad idea this was. He’d remind me that it was possible (albeit extremely unlikely) that the fertility drugs could over-stimulate my ovaries and require me to be hospitalized, and that the retrieval procedure could (in even more rare cases) result in an infection that could affect my future fertility. I suspected that by reiterating the risks, my boyfriend could talk me out of it, and I wasn’t sure I wanted to be.
“Oh, and one other thing,” Veronica said. “The day of the retrieval procedure is when you’ll get your check.”
I’d already done the math. The $8,000 payment I would receive for approximately fifty-six hours of my time worked out to just under $150 per hour—ten times more than any employer seemed to think I was worth. My boyfriend’s objections aside, I’d have to give this some serious thought.
On my subway ride home, I sat across from a woman who looked seven or eight months pregnant. I stared at her swollen belly and then followed its curve up to her glowing cheeks. She noticed me and smiled. I grinned back. Then I tried to imagine if the exchange happened a few months down the road, after I underwent the procedure; I wasn’t sure the moment would have felt so sincere. Would I wonder if it was my baby the woman was carrying? Would I wonder this about every pregnant woman whose path I crossed, and later, about ever baby, every toddler, every child? Was that anxiety worth $8,000?
It was certainly a lot of money for not a lot of work. In Canada, Australia, and parts of Europe, offering money for donor eggs is illegal. In Germany, Norway, Sweden, and Japan, the use of donor eggs in IVF is forbidden. The United States is, in fact, the only major country with no national policy on IVF, even though nearly 41,000 children were conceived via IVF in the United States in 2001—6,000 from donor eggs. The United Kingdom, on the other hand, not only has a policy but a federal agency—the Human Fertilization and Embryology Authority—that, among other things, sets caps on payments to egg donors.
In the U.S., the price for donor eggs has increased tenfold since the mid-1980s, when donors received about $250 to compensate for their time, transportation, and other incidental costs—about $4.46 per hour, a dollar and change above minimum wage. Donating back then didn’t have a significant financial incentive; most early donors acted out of altruism. Most donors still act out of altruism, Veronica led me to believe, but as time passed and the demand grew, donors began to expect compensation not just for practical sacrifices but also for the emotional burden and medical risk associated with donating.
Today, payments average between $1,500 to $3,000 dollars, depending mostly on the location of the clinic. In major metropolitan areas, payments are higher. Highly desirable donors—Ivy League students, models, athletes, accomplished musicians, and so forth—are frequently promised even more. Offers of tens of thousands of dollars are not uncommon, though some infertility experts maintain that advertisements like the ones Lily noticed in the Yale Daily News are usually not legitimate. Women who respond are often told that the ad has been filled but that other recipients are still seeking donors. These other recipients, however, always seem to offer substantially less money. As an Ivy League graduate living in Manhattan, I would be compensated well above the national average for my eggs. Given my doubtful professional situation, it felt nice to have someone recognize my worth, even if she was a faceless IVF recipient.
Two weeks later I was back at the clinic, this time to meet with a psychologist. Dr. Jones (as I’ll call her) led me to the same office where I’d met with Veronica. She sat down, crossed her legs, and set a white legal pad on her knee. “So, what can I do for you?” she asked.
I was taken aback by her question. I explained that I’d met with Veronica about the possibility of becoming a donor, and, as I understood it, this was the next step. Nodding, Dr. Jones explained that donors usually undergo physical evaluations first, but after looking over my application, she wanted to meet with me.
“Do you have any concerns about being a donor?” she asked as if she already knew I did. I could have easily recited Veronica’s speech about the virtue of egg donation, which I could relate to now more than I expected I ever would, but I remembered my reaction to the pregnant woman on the subway and decided to be honest. I told her I worried that I might suspect every pregnant woman I saw of carrying my baby.
“That’s a very real concern,” Dr. Jones said. Although my future feelings could not be predicted, she said, how I ultimately felt about donating was likely to be related to how I now understood my role in the procedure. Donating was more likely to be a positive experience if I believed I was giving a piece of myself for the possibility of life, and if I believed that my involvement ended there.
“What do you mean by ‘possibility’?”
“Success rates for in vitro fertilization with donor eggs are about fifty percent,” she said.
I was shocked. I knew that success rates for IVF with a woman’s own eggs hovered around thirty percent, and I knew that using a donor’s eggs increased the chances of success, but I assumed the increase would be more significant. To my surprise, I was also relieved. After the procedure, it would be just as likely that someone wasn’t carrying a child conceived from one of my eggs as that someone was.
Donating might be a negative experience for me in the long run, she added, if I believed a child with my genes was my child.
“I wouldn’t want to find the child and claim it,” I clarified. “It’s just that there might always be a latent curiosity.”
Dr. Jones suggested we table this issue and move on to my family history. She asked about the abnormalities in my parents’ histories documented on my application (both of them). I told her the details without much emotion; after all, I’d recited the information at nearly every doctor’s appointment I’d had over the last decade. I told her that my mom had battled cancer twice, first of the breast and then of the cervix. Dr. Jones seemed alarmed, both by the rarity of those two types of cancer afflicting the same person and by my nonchalant recounting of it. But to me it was just an empty fact: I didn’t remember my mom being sick, and now she was completely fine. When Dr. Jones asked if there was anything she should know about my dad, I chronicled, just as flatly, that he’d become addicted to cocaine when I was two, divorced my mom when I was three, lost his law license when I was ten, was homeless for a while, and then, when I was seventeen, became a used car salesman.
“Is he clean now?”
“Well, he’s held the same job for five or six years, so I think he probably is. But you never know, do you?”
Then Dr. Jones wanted to know about my sister. I mentioned her allergies and her attention deficit disorder, for which she’s been treated since third grade. Dr. Jones wondered aloud whether my dad has a learning disability too.
“My mom’s always suspected he does,” I said. “His mind jumps a lot. But maybe that’s because of the drugs.”
“Could he be depressed?” she asked.
“Maybe,” I conceded.
Dr. Jones’s pen stopped moving. She shifted in her seat and sat staring at her legal pad.
“I don’t think …” she began, her voice low, “that you’re going to be able to help us.”
She paused for what felt like minutes. “It’s really too bad,” she continued, now looking me in the eye. “We would have loved to have had you, but if there’s addiction or learning disabilities in two generations, well, it’s a liability issue for us.”
I sat on the couch, stunned.
“If your dad had just dabbled in drugs we could maybe overlook it,” Dr. Jones continued, “but from when you were two years old to five years ago, and maybe still ongoing—that’s a prolonged problem.” Drug abuse is linked with ADD, and if both are heritable.
I would also learn from the medical journals that my dismissal, though not legally necessary, wasn’t unfounded. Research suggesting an influence of genetics on addiction is amassing. In March 2006, for instance, the British Institute of Psychiatry released a study that found that variations in the genetic code for the DAT protein, which controls dopamine levels, can cause a person to become addicted to cocaine more quickly. According to these findings, if the suspect gene were passed from my dad to me, I would be fifty percent more likely than my peers to become dependent on the drug. Other studies have produced similar results. I stared blankly at my computer’s screen. This discovery stung worse than the rejection of my eggs.
Over the next few weeks, that statistic haunted me. A baby born of my genes would be fifty percent more likely than average to abuse cocaine. Though my boyfriend and I were far from thinking about having children of our own, I wondered how he might react to this news. Would he pull out now, knowing he didn’t want to have kids with someone whose DNA was so flawed? He, of course, could have children with someone else, but I would always have these genes. This was my lot. I wondered whether it was irresponsible of me to even consider reproducing.
One day, out of nowhere, it occurred to me that I could have lied. The clinic’s screening process was based on information provided by me. My prior medical records weren’t required, and neither were those of my family. Maybe the clinic’s staff wanted me to lie. Maybe that’s why Veronica had me fill out multiple applications and why Dr. Jones asked me to recite the family history I had already listed twice. Maybe they were waiting for my story to change, and maybe I missed the cue that it was supposed to. After all, Veronica made quite clear in filling the blank boxes of my paternal grandparents that veracity was beside the point.
Maybe Dr. Jones and Veronica knew that heredity isn’t all there is to addiction. Variations in my genetic code related to the DAT protein, if I do indeed have them, might make me more susceptible if I tried cocaine, but I haven’t. I haven’t because addiction isn’t just about an abnormal gene, it’s also about the factors that make drugs tempting. Disorders like ADD and depression can influence a person’s decision to turn to drugs, as can environmental and social factors, which also influence drugs’ availability. If addiction is about nature, it’s just as much about nurture. My dad and I—genetically speaking—were equally susceptible to addiction, but he became entangled with drugs while I didn’t, probably because his parents kicked him out when he was sixteen, and remained estranged from him to their deaths. I, on the other hand, was guided through childhood and adolescence by my mom, a positive role model who offered sound parental guidance. That, it seemed, has made all the difference.
But science is cold, definite. Genetics play a role in drug abuse, period. Nurture is unpredictable. It’s the job of Veronica and Dr. Jones and the clinic’s geneticist to play the scientific odds. It’s the statistic that matters, and a baby born of my genes would be fifty percent more likely than average to abuse cocaine. For weeks, that statistic echoed in my mind every time I passed a child in the park, on the sidewalk, or riding the subway. I thought, too, of how it felt to be rejected for a job that I’d nearly thought I was too good for.
If troublesome genes are to be shunned, a scientist might forever doom the future of the Bonanno crime family based on whatever genetic abnormality makes a person more likely to lead a life of crime. But science doesn’t always have the last word. After publishing Honor Thy Father, Gay Talese allocated some of his royalties to the Bonanno children. One of them used the money to go to medical school and is now a successful physician. His story would be unremarkable, discouraging even, to those who think genes are destiny, but to a writer—or me—he’s a goldmine, because in literature it’s the people who defy the statistics that count. This is the way of thinking I prefer.
Author’s Note: Shortly after writing this piece I stumbled onto a list of thirteen characteristics of adult children of alcoholics; characteristics that also apply to the children of drug addicts. I was skeptical at first. How many people aren’t either extremely responsible or extremely irresponsible from time to time? Who wouldn’t, at some point in his or her life, proclaim that they have difficulty with intimate relationships. But I couldn’t ignore the fact that every characteristic listed seemed to apply to me. Some were more true than others of course, and some might have been true in the way that the intuitions of fortunetellers are. But I saw too much of myself in the list to laugh it off completely, and I realized that my desperate pursuit of experiences about which to write, like donating my eggs, was silly. I already had a story to tell. I’ve read memoirs about families affected by substance abuse, but never about the longer term affects on various family members’ personalities and the life each ultimately chooses to lead. I’m working on a memoir now. Writing this piece helped me get there.
Alexis Wolff holds a BA from Yale University and an MFA from Columbia University. She has previously been published by the New York Times, the Los Angeles Times and in the Best Women’s Travel Writing anthology, among others.
Brain, Child (Winter 2007)