Posts by author: sgcarney

Sometimes certain information can propel itself forward regardless of its factual accuracy. In this case, one single sliver of hearsay printed four years ago sparked an entire body of academic literature that on closer inspection has no basis in reality.

In 2006 the Observer ran an article titled “The Cruel Cost of Human Eggs” about the growth of the Cypriot egg donation industry and the fear that certain clinics were endangering donors’ lives. As I found in my own research, the Observer had a difficult time getting directly in touch with egg donors, but was able to speak with women through intermediaries. One of those intermediaries seemed to make a connection between Cyprus’s brothels and fertility clinics, saying, “They work the cabarets, they’ll sleep with men, they’ll sell their eggs, and then they go back again.”

To its credit, the Observer article does not make the connection explicitly between sex work and egg donation, however that did not stop academics from connecting the dots on their own initiative. References to this quote and article appear liberally in almost a dozen academic texts including Heather Widdow’s “Border Disputes Across Bodies: Exploitation in Trafficking for Prostitution and Egg Sales for Stem Cell Research,” which builds its argument based on “the trafficked Eastern European prostitutes in Cyprus who also sell their eggs to the flourishing private network of in vitro fertilization (IVF) clinics there.”

An anthropologist I spoke to in New York had made her career deconstructing the connections between commerce and tissue donations and said that Cyprus was the smoking gun for human exploitation. In fact, she had just given a talk on the subject at Columbia.

I came to Cyprus almost positive that there was a direct link between sex trafficking and the fertility industry. The beach road in Limassol is dotted with cabarets and brothels where trafficked women are sold by the hour. The country is a repeat offender on the UN Department of State’s anti-trafficking TIPPS report that shows how the government here directly supports the trade in women. The government issues more than 300 special “artist” visas to cabaret workers and the local press is full of accounts of women tricked into working in brothels. The women are forced to pay back their plane tickets to brothel owners and have few rights in the eyes of the law. Along the way into the country they are first screened by doctors at the government hospitals, given a clean chit of health and set to work—a perfect opportunity for a fertility clinic to convince them to sell their eggs. After all, the profile of egg donors and prostitutes is fairly similar—young, beautiful women, mainly eastern European with an aura of fertility.

The facts on the ground, however, did not match the hype. After canvassing three brothels and speaking to sex workers and brothel owners, as well as the top ten anti-trafficking experts in Cyprus as well as two different sources who house and rescue trafficked women, no one had ever heard of anyone in a brothel selling their eggs. Father Savvas Michaelides, a Russian Orthodox priest, with a long flowing beard that is reminiscent of Santa Claus, has spent the better part of the last decade rescuing Russians from the brothels and says that more than 300 have come under his care.

After hearing about possible connections between egg donation and prostitution he frowns. “It seems like it could be possible, but I have never heard such a thing,” he says. His colleague Eleni Pissaridou who runs a shelter for trafficked women said that a study she had conducted last year with more than 100 interviews with sex workers never came across a single case of egg donation.

I asked David Sher, who runs Elite IVF, an egg donation agency, if it was even feasible to harvest eggs from Cypriot Cabarets. “It just wouldn’t make sense,” he said, “To undergo the procedure we need to be sure that the women aren’t having sex while undergoing hormone therapy. They’re very fertile at that time and might get pregnant. Neither the sex worker nor the IVF lab want that.”

For a journalist or academic working on the ethics of tissue donation and sales, a connection between prostitution and medical commerce is something of a holy grail. After all, if sex work is dangerous and exploitative by its very nature, then any related industry that depends on the same pool of workers is similarly corrupt. An academic can apply the same tools of analysis against egg selling as they do sex work.

In an e-mail to the sex industry magazine Spread, editor Will Rockwell said “it all sounds very seedy, as if as decent people we must believe that evil like this takes place, when you put the words “trafficking” and “eggs” together,” he wrote, but there are other reasons that might compel people to sell their flesh. “Young people in need of high-paid, mobile, and mostly unregulated work often turn to sex work the same as they turn to medical studies or egg-selling.”

Understanding that there is no clean link between human trafficking for sex work and egg trafficking makes this research all the more relevant. Egg selling, it turns out, has its own problems and origins that raise difficult questions about the motivations of egg sellers to approach fertility clinics.

Originally posted at the Pulitzer Center on Crisis Reporting.

Although Cyprus may have the highest percentage of egg donors in the world with almost one in 50 eligible women donating their eggs, most people are afraid to come forward and speak about their experiences with a journalist. Over the course of ten days I located fifteen women—all Russians and Romanians—who had either sold their eggs at Cypriot medical clinics, or were flown in from foreign countries to donate eggs. None of the women would speak on or off the record. Through intermediaries several women told me that they were scared to speak with the press because “Cyprus is a small island,” and that if word got out that they spoke against clinics that they would be in danger of losing their children. What I do know about their lives was relayed to me second hand—often from a friend that they had confided in for advice. One commonality that linked all the women was that they had sold their eggs for money alone on the recommendations of a friend or by responding to one of the many ads that appear in the classified sections of Russian language newspapers.

While I was not able to speak directly with donors in Cyprus where the market is largely unregulated, I was able to locate numerous women in Spain. While in Barcelona, I contacted two women and one clinic worker who gave me an inside look at how clinics recruit and cultivate donor pools of primarily immigrant students who have few other opportunities to earn money legally in Spain.

“I was an immigrant working illegally. I had just arrived. I didn’t have permission to work from the government yet,” said Nicole Rodriguez who had emigrated from Chile. “It seemed like easy money.” But she had to learn the clinic’s language in order to receive the payment she was after. She said that she called the clinic and said “How much do you pay for eggs? So the woman corrected me saying ‘you mean for the donation of eggs,’ I said “excuse me excuse me, the donation of eggs’ Of course you are not supposed to call and ask how much they pay you. You are supposed to understand that this is only a detail.” The payment of 1000 euros fell within Spanish guidelines.

She signed a contract with the clinic renouncing her right to know about the children born to her eggs and went through two weeks of hormone injections to prepare the eggs for extraction. She went under general anesthesia for the actual procedure and woke up alone in a room with an envelope of cash next to her. “It was like they had thrown cash on a bed stand after seeing a prostitute,” she said.

A second woman, Kika, an immigrant from Argentina said that when she gave her eggs she was surprised to see a room full of other south Americans waiting to sell their eggs “They weren’t Spanish. They were immigrants for sure because I have a memory of thinking about this as an immigrant thing to do, like looking for a salida (a way out), a way to survive for money and this kind of thing.” But when she went through with the injections something went wrong. “All of the eggs they harvested were too big, the doctors called them super-eggs, and they decided to stop the treatment. They only paid me half the money they promised because they weren’t able to get the full batch.”

Claudia Sisti, a former patient assistant and international coordinator at the clinic Dexeus in Barcelona, said that these women’s experiences match what she saw after working in a clinic for two years. “Most of the donors were from Latin America, it was easy money for them,” she said. In the course of her every day interactions she knew of donors who tried to sell their eggs professionally “One Brazilian woman I knew sold her eggs four or five times in the course of a year and got sick. She was very thin, but they always accepted her into the programs.”

Spain performs well over 20,000 IVF cycles a year, and though regulations are far more strict here than in Cyprus, donors are almost universally recruited on the basis of the financial compensation, and are a necessary crutch for immigrant women who have few other options to legally make money.

As the global market for human eggs grows more international each year, the future of fertility markets may be in the hands of people like David Sher, the founder and CEO of Elite IVF a fertility services company that connects international clinics and donors with paying patients in Western countries. The sales pitch is simple; it all comes down to money. The introductory message on Elite IVF’s website boasts, “Egg donors from across the globe are coming to a clinic near you.” Or, if patients are willing to jump a plane to another country, they could save 30% on egg donation. Depending on the type of services they want, costs range from 14,000 to 24,000 dollars.

“The technology is at a point now where we could basically FedEx you a baby,” he says as we sit at a swanky seaside hotel in Limassol. His network of hospitals connects patients all over the world to clinics in Cyprus, Mexico City, Tel Aviv, Romania and Canada. His staff of 14 oversees the connecting flights for patients and donors negotiating favorable rates with fertility clinics in different countries and locating egg donors and surrogate mothers for patients. “Donors are always in short supply, if someone wants to donate and they are qualified, you don’t want to let that go,” he says, adding that recently Elite has cut down on flying donors in because of logistical difficulties and quality control, where some egg donors were improperly prepared in clinics abroad. “In the past we had an aggressive program for bringing in donors from outside of Cyprus, from Russia and the whole Eastern European bloc. Patients prefer to come here because no one wants to go to Bucharest for IVF. All of the action is here.”

As nations around the world try to regulate fertility markets, Sher plays something of a spoiler, looking for loopholes between international regulations that allow paying customers to gain access to treatments that are too expensive or illegal in their home jurisdictions. According to a report released this year by the European Society of Human Reproduction and Embryology there are almost 25,000 IVF cycles preformed on fertility tourists every year in Europe alone. More than 50 percent of the people travel for fertility treatments in order to circumvent legal regulations in their home countries.

Elite-IVF follows a well established business model to divide labor and production costs across jurisdictions and keep prices low. The same way that a sneaker can be made in a Chinese factory for less, Elite IVF has removed the production of children from a discrete and sweaty encounter to something that takes place in a laboratories and wombs across the world. The results can be bewildering.

Take for example two of Sher’s most recent customers: Dr. Lavi Aron and his partner Omer Shatzky. They are an Israeli gay couple living in Tel Aviv who desperately wanted children but were confined by both biology and legal regulations that outlawed surrogacy. Through Elite-IVF they flew to Mexico City where they used the eggs of an Eastern European woman and created three fertilized embryos with both men’s sperm. They implanted the embryos into the womb of an American surrogate mother and the embryos developed into fraternal twins one girl, one boy—and one from each father. The surrogate then traveled back to the United States where surrogacy contracts are enforceable. The surrogate delivered twins (defacto American citizens) and then the new parents returned to Israel with their child.

When I ask him what he thinks the industry will look like in ten years, he sits back and muses on the possibility. He says that American parents are extremely particular about choosing the types of babies they want, from eye color, to genetic history, college background, attractiveness and SAT scores. “The future is designer babies.” Adding, “A former patient of mine, a man with more than 100 million dollars, said he wanted to start a farm for babies. Surrogates in Asia would carry the eggs of super donors from America—models with high-SAT scores who get paid $100,000 for their eggs. We would charge one million dollars per baby and sell them to his friends. My answer was a flat no. It’s just too strange. But there is a market for that. It is only a matter of time until someone does it.”

Until the summer of 2010 when police raided the Petra Fertility Clinic outside of Limassol, Cyprus, they posted a list of available donors on their website. “No. 17P, Ukrainian, Height 175, Weight 59, Blood type B+, Hair color: chestnut, Eye color: brown, Education: University, Profession: artist, age: 23; date of arrival: Feb-2-10; estimated aspiration date: feb 05-07.”

The website, which appeared in English, Spanish, Italian and Russian, beckoned foreign fertility tourists to buy eggs from women who are flown in specially for egg harvesting. Every month another crop of ten arrived for their stays’ at the clinic. The women were recruited through a network of fertility clinics and newspaper advertisements in the former Soviet bloc and offered about $500 for their eggs. The sum would have dwarfed their monthly income. Neither the donor nor the customer came from Cyprus; the island nation was simply used as a legal haven for an otherwise illegal transaction to take place.

The clinic, which is owned by the Chicago-based Reproductive Genetics Institute, Inc., has come under fire on several occasions for violating even the lax Cypriot medical guidelines. The allegations include operating a fertility clinic without a license, paying donors coercive sums, performing non-medically necessary sex selection, and tax evasion. For several years the Cypriot Ministry of Health has been running an investigation specifically targeting the Petra Clinic, however, ministry officials were unable to provide details.

I first heard about the Petra Health Clinic from local Cypriot doctors who believed that dangerous conditions on its site could lead to stricter regulation of all clinics on the island. An article that appeared in the Observer in 2006 claimed that egg donors were being routinely hyper-stimulated to produce more eggs and that batches of up to 60 were routine and split up between multiple recipients. Most doctors consider more than 14 eggs dangerous territory.

Embryologist Savvas Koundouros who works in a nearby clinic says that he has seen Ukrainian patients from the Petra clinic on death’s door, hospitalized in the capital city of Nicosia. “They get them sick and the ship them home so doctors in the Ukraine can deal with them,” he says.

I put off visiting the Petra Fertility Clinic for several days as I set about discovering more about the clinic’s international links. My first two attempts to arrange a meeting with the clinic’s director were rebuffed, saying that the clinic would not allow journalists after several “negative” interactions. Then, two days before showing up on their doorstep with a recorder and notepad, Oleg Verlinsky, CEO of RGI called me on my cell phone.

He told me that the Cyprus clinic only conducts egg transfers in rare cases of genetic disorders, and that the clinic’s primary focus is to treat the rare genetic blood disorder Thalassemia. When I pointed out that the Cyprus website does not even mention the word thalassemia anywhere in its over 260 pages of text, but devoted almost the entire site to egg donation and surrogacy he said that the website was in the midst of an update.

Eventually admitting that the clinic does conduct egg donations, I asked about the donors flown in from the Ukraine. “We have contracts with different centers in the world that have donors available. And it is easier to fly people from Ukraine to Cyprus than to Chicago. It is cost effective. It is just where the donors are and where they are available,” he said. When I asked if I could visit the clinic he denied my request, saying that donor confidentiality would be at risk if I showed up.

Two days later I drove a rented Toyota down the winding Cyprus coastal roads. As the deep blue Mediterranean sea jumped out behind palm trees and fish restaurants I was able to make out the dilapidated form of a granite house with signs in Greek and English that read “Preimplantation Genetic Diagnostic Centre”. Broken pots, dried leaves and clutter fill up the semi-circular driveway and a guard dog eyed me warily as I approached the wrought iron gate.

I knocked on the office door and was directed to meet Galina Ivanovina, the clinic’s Russian administrator who proceeded to contradict every statement made by her CEO just two days before. The clinic has only preformed 50 thalassemia treatments since its founding in 1996, and offers egg donation to foreign patients, mostly Israelis, Americans, Spaniards and Italians who come here because egg donation is legal and cheap. She said that the Ukrainian and Russian donors who fly in “do it for economic reasons, nothing else.” Indeed, to make extra money, the clinic will routinely splits batches between multiple customers.

Though she bristles against the allegations of over-harvesting “It is a lie about over-harvesting, we would never do that. No doctor would endanger patients’ health [for] that reason.”

The one case she admits about hyper-stimulation she says “was a shock and we sent her directly to a clinic in Nicosia for treatment.”

Flying donors across international boundaries to meet third-party recipients is a new innovation in tissue tourism, as it separates the payments and fallout the medical treatments across three different international jurisdictions. At best, it opens up a hole for questionable ethical practices, at worst it could put people’s lives in danger as doctors have every financial inventive to over-harvest and hyper-stimulate egg sellers.

Six months after I visited the clinic, police intercepted a group of Russian and Ukrainian egg donors at the airport and brought them in for questioning. Within days the Ministry of Health seized all of the frozen embryos at the Petra clinic and took hold of the clinic’s records. While no word on formal charges has yet come up, the clinic immediately took down its website and ceased all operations.

A white streak of scar tissue rips a path across Catalana Pislaru’s face, the undeniable mark of a violent past. “Yes,” she says, “many women sell their eggs here to make ends meet. We’re all vulnerable.”

The incongruity between the $10 cappuccinos we are sipping in the lobby of the Hilton in Cyprus’s capital of Nicosia and her story of being trafficked across borders to work in cabarets and for notorious underworld figures draws occasional furtive glances from the staff. At 15 she began dancing in cabarets in Greece and eventually was forced to move on to the sex clubs of Cyprus where her then-boyfriend beat her mercilessly and slashed deep wounds into her face. And yet with three children to take care of, she felt trapped in the relationship.

By 2007 she was pregnant with her fourth child and she knew that she had no option but to give it up. She arranged for a wealthy Cypriot family to adopt her child through a hospital in Nicosia and within minutes of his birth he was whisked away. She had barely any time to register that he had deep blue eyes. When the doctor returned without a child in hand, she says, that he started to take pity on her.

“He knew I was in a desperate position. No money, and no easy way to support my family.” So he offered her $2000 if she would agree to sell some of her ova once she had recovered from the pregnancy. She reasoned that the doctor knew that she was proven to be fertile, from his perspective she was a perfect candidate for donation.

Outraged by the offer and saddened by the loss of her child, she turned him down and went home to mourn her position. Others, though, she says, have not been so strong.

She takes out a small digital camera from her pocket and scrolls through several images until she settles on a picture of a dark-haired Russian woman holding an infant swaddled in a white cloth. It’s her friend Doylina, who she says is too afraid to speak with me.

The baby is less than a year old. And when he was born the hospital staff offered her 20,000 euros (about $30,000) to give up her child to a local family. Catalana convinced her not to take the offer, but instead she ended up on a regular regime of egg selling to support her family. Paid 1,500 euros every several months, she provides gametes to a variety of wealthy clients. The money, she says, is all that matters now.

Savvas Koundouros can’t answer every question that I ask him. A handsome embryologist with sterling credentials from the top scientific institutions in the world, he has stimulated the ovaries of almost ten thousand women in his career—all in the pursuit of bringing new life into the world. When he walks through the streets of Cyprus women kiss his cheeks and men slap him on the back and greet him with warm smiles. He is the reason that many of them have children and so has cemented his reputation as one of the most loved men on the island. He has impregnated more women than Ghengis Khan.

But when I talk ask him about the motivations of women who donate their eggs in his program he lets out a heavy sigh and takes a break to smoke a cigarette on the roof of his clinic. “What I want to tell you, I cannot tell you,” he says.

Egg donation and invitro-fertilization, or IVF, is one of the fastest growing medical procedures in the world—and one of the most effective—ways to kick start a pregnancy when traditional methods fail. By the time a woman reaches puberty she has approximately 300,000 proto-eggs in her ovaries. These potential eggs are stored in bunches of follicles. Every month a single proto-egg, or oocyte, matures and drops into her uterus where it waits for fertilization by a sperm. Yet as a woman ages the process tends to break down, eggs mature poorly, fallopian tubes get blocked and any other number of complications can make pregnancy impossible.

With IVF, the doctor takes control of the ovulation process, and does the work that a woman’s body should do naturally under the strict controls of a laboratory. Typically this means stimulating individual follicles with hormones, maturing five to fifteen eggs in situ, and then extracting them, selecting the most promising of the batch and implanting sperm in a Petri dish to create an embryo. Presto: life via laboratory.

The clinical intervention can make a women’s own eggs come to life, however in 30%-50% of cases IVF is not enough to achieve pregnancy and the only option is to retrieve eggs from a donor. When this happens, both women synchronize their fertility cycles with hormone treatments and eggs are matured in the ovaries of the donor, fertilized in a lab, and implanted in the woman who wants to get pregnant.

IVF with egg donation is one of the fastest growing medical procedures in the world and the new social relationships that it creates challenges some of our most basic notions about the beginning of life.

Procreation is no longer an intimate act between one man and one woman. It is a heavily mediated enterprise that involves doctors, patients, donors, airlines, insurance companies, ethicists, governments and psychologists.

Pregnancy separated from passion is a strange animal, rather than rely on random chance, every facet of the future child is managed, scrutinized, valued and assessed. If they’re unable to contribute their own genetic material, infertile couples will scour the world for the very best donor sperm and eggs, and many are willing to pay any price to get the right results.

No matter the promise of the procedure, there is a bottleneck in the system that a laboratory cannot cure. It’s a problem that Savvas Koundouros contemplates every day. The demand for donor eggs vastly outstrips the available supply. Most countries have outlawed direct payments to egg donors, but in Cyprus and Spain it is legal to give donors a small amount of money to cover the time that they spend in the clinic as well as whatever lost wages they might have missed.

“Obviously the donation is described as an altruistic act and that means no contribution. But it sounds strange to all of us that a person would receive so many injections over several weeks and then go under general anesthesia just because they are so kind,” says Koundouros. He presses out the rhetorical response with his tongue pressed firmly against the wall of his cheek.

The distinction, however, is not lost on the British social anthropologist Michal Nahman, who interviewed 20 Romanian women who gave their eggs. In a 2008 article in the European Journal of Women’s Studies she wrote “To call the women I interviewed ‘donors’ would be a great misnomer. They are explicitly there to sell their ova for a specified sum of money…not out of ‘altruism’ or wanting to donate.”

Regulatory bodies perpetuate the confusion over the proper way to recruit donors. “Compensation is allowed. Paying is not allowed” says Catalana Stylianou Chief Inspector of Tissue and Cell Centers for the Cyprus Ministry of Health.

Doctors like Koundouros have to pretend that the transaction to procure eggs is based on altruistic ideals in order to avoid regulatory pressure from the government. Donors who come to his clinic are paid about $1400 to compensate them for their time.

It is an amount that begs the question: Can altruism be bought?

The altruism/payment double speak creates the exact sort of social stratification that regulators wanted to avoid in the first place. An altruistic system is supposed to take the lure of financial reward out of tissue donation programs and draw flesh from across social classes. However by offering low payments, only the most desperate women are going to come forward to sell their eggs. It’s a Catch-22 where people on the fringes of society start to see egg selling as their only option. It can also turn fertility clinics into predators who face out of control demand for their product, but are constrained by low fees. In order to maintain a strong supply of donors they are sometimes forced to recruit only the most desperate women to give their eggs.

The second of eight posts that will appear simultaneously at the Pulitzer Center for Crisis Reporting which helped fund my research.

CENTER, LIMASSOL, CYPRUS
Published on August 13, 2010
Natasha flashes an inviting smile in my direction and bows her head slightly when she shakes my hand. Pretty at thirty-five, she’s the first face that patients see when they get off the plane to receive and egg donation. She ferries customers to and from the airport and helps ease their cultural transition from abroad. As a medical coordinator her skills are in demand, but it’s not just because of her hospitality. For the less public side of her job she locates and recruits egg donors from wherever she can find them.

In country with an influx of legal and illegal Russian immigrants, she says that many women find themselves in a place where they have few other options to earn cash. “They start relationships with Cypriots who they meet on the Internet. They come and think that they are going to have a good life. Two or three months later they are no longer together and the girls find themselves helpless. She has no place to live, she has no job, and she has no visa to get a job.

For Russians now it is hard for them to get papers. She is in trouble. She starts to think where to get money. But she has her health, and she is quite beautiful,” she says to me in an upscale café on the Cypriot coast. These are the people who come to sell their eggs.

Natasha agreed to speak with me on three occasions on the condition that I would change her name and not mention the name of the specific clinic that she recruits for.

She tells me about her friend Doylana who came from Russia and was sleeping on friends floors because she had no way to get home. “She visited me and I told her about how she could make money selling her eggs. She gave them and then used the money to buy a plane ticket home.”

She says that donors earn between $1100-$1400 for their effort and pain, and while she says that the money can be a motivation, she isn’t sure what sort of risk it entails. “You would have to be stupid to do this several times?” she says, “Who knows how dangerous this is down the line?”

Whatever the risks, the money that clinics offer is enough attract an almost endless supply of Eastern European egg sellers. While not every clinic uses scouts, the situation is similar in both Cyprus and Spain. Small amounts of cash are incentive enough to attract only a certain low-income group of donors.

Scott Carney is an investigative journalist, his first book about the international trade in human bodies will appear in Harper Collins in 2011, see his updates at redmarkets.com

For the next week I am presenting a series of posts about the global trade in human eggs which will appear simultaneously at the Pulitzer Center for Crisis Reporting which helped fund my research.

Dr Krinos Troukudes slaps his hand loudly on my back after I turn off my tape recorder and turn to make my way down the Pedieos Clinic’s dark stairwell. For the last hour we’ve been talking about the biological goldmine inside every woman’s uterus: human oocytes, or in common English, eggs. Clinics like his make a fortune selling eggs to infertile couples who will travel across the globe for a chance to get pregnant. Through a trick of favorable currency exchange and lax laws the island nation of Cyprus is one of the fastest expanding markets for human eggs. Here a full-service egg implantation costs between $8,000 and $14,000, where in the United States the price floats between $20,000 and $30,000. As he sees it, the only roadblock to becoming a baron of the market in human eggs is controlling a steady supply. “If you have the donors, you have everything,” he says. Everything.

When the first baby was born from a scientific IVF embryo transfer in a London hospital on July 25th, 1978, the market for human eggs took off like a jet plane. Birth control coupled with IVF means that women can delay having children until their professional careers are well under-way. In the last 32 years hundreds of thousands of children around the world have been born to donor eggs. While the miracle of assisted reproduction has changed the way the middle-and-upper classes view childbearing, behind the miracle of each birth is a hidden supply chain where eggs are procured by any means necessary.

Crimes in the egg trade are not hard to come by.

Between 1996 and 1999 and Israeli doctor named Zion Ben-Raphael began stealing eggs from his patients by doping them with hormones without their consent. In once case he stole 181 eggs from a single unknown donor and implanted them in 34 of his paying patients. In the course of his tenure 13 women were hospitalized because of the massive doses of hormones that he delivered triggered a dangerous conditions known as hyper-stimulation syndrome (HSS). Once the Israeli newspaper Haaertz reported on his spree he attempted to evade charges by bribing investigators. Shortly after the scandal, Israel banned all paid egg donation procedures.

Over the years similar crimes have been reported in Cyprus, Ukraine, Spain, Russia and most recently in Romania where a 16-year-old factory worker was in critical condition after she sold her eggs to an Israeli- run clinic. A government raid of the clinic last summer led to the arrest of 30 Israeli doctors, nurses and clinical staff who were offering fertility tours to Israeli patients who were unable to buy eggs domestically.

Most doctors and administrators believe that paying for a body part— including human eggs—creates a system that disproportionately draws raw materials from the bodies of the poor to sell them to the rich. In order to cut back on possible negative social consequences the European Union and the United States have laws that restrict commerce in human tissue. The only way to legally acquire a human egg (or kidney, liver, blood or cornea) is to receive it as a donation, so that money does not unduly influence the transaction. To do otherwise is considered tissue trafficking: An allegation that is the modern equivalent of slavery.

The United Kingdom outlawed even minimal compensation for egg donations in 2007, while simultaneously passing a law that made it possible for children born to donor eggs to be able to track down their genetic parents when they reach eighteen. Many egg-donation advocates say that this one-two punch was the knockout blow for British IVF industry. Since the new laws the waiting list for an egg now stretches two years long. For women already cresting the upper limits of even assisted fertility, the restrictions feel a lot like an outright ban. And yet, most of Europe has passed, or is passing similar laws.

But there are a few holdouts in the European union. Cyprus and Spain have looser restrictions on IVF and have turned into destination spots for the reproduction industry.

In Cyprus, a country with fewer than one million people, there are now more fertility clinics per capita than any other place in the world. In the absence of a formal law to regulate egg selling, or even one that offers clear enforcement guidelines for what to do to clinics that violate ethical norms, Cyprus is something of the fertility industry’s wild west. So many people come here for egg donations that it seems to have caught the government by surprise and stretched its donor pool past the breaking point.

There are approximately 76,000 women in Cyprus between the ages of 18-30 who are eligible to become egg donors. Dr. Trokudes estimates that there at least 1,500 egg donations performed each year in the country’s dozen IVF centers. Some back of the envelope math indicates that approximately one in 50 eligible women have donated their eggs. It’s a startingly high number that dwarfs the comparable rates in America where one woman out of every 14,000 elects to donate their eggs.

Perhaps even more alarming, is that most of the egg donors in Cyprus come from a relatively small population of poor Eastern European immigrants who are eager to sell their eggs at a pittance. In January and February 2010 I visited a half dozen clinics and doctors in Cyprus, most of whose egg donors were of Ukrainian, Moldovan, Russian or Romanian descent. Several clinic directors told me that these women are favored because of their lighter complexion, eyes and hair color. British, German, Italian and American customers tend to favor children with Caucasian phenotypes. While no clinic gave me direct information on their donor registries, all said that Eastern Europeans represent the bulk of donors. There are approximately 30,000 Russians on the island nation and it’s possible that in this population the frequency of egg donors of eligible women is as high as 1 in 10.

For fertility clinics bent on increasing their market share of international patients, controlling and cultivating donors is the most crucial part of the business. During my research I found that clinics in both Spain and Cyprus have to play a difficult balancing act between meeting almost insatiable demand from abroad and the recruitment of donors. While many doctors strive to keep the industry safe and legal, internal contradictions in the language of cultivating egg donors makes the boom in international IVF a potential flash point for dangerous practices.

Scott Carney is an investigative journalist, his first book about the international trade in human bodies will appear in Harper Collins in 2011, see his updates at redmarkets.com

This is the first post by Scott Carney in a series of dispatches on the human egg trade that will be featured on Untold Stories over the next week. Read his Fast Company article on the global egg trade.

In a strange way, this comic pretty much sums up the problems with Red Markets.

For as long as I can remember Thailand has a been a patch of tranquility in the turbulent waters of South East Asia. In the Vietnam war the country was a resort for American GI’s who took a break from the fighting on its placid beaches. During the era of the Khmer Rouge killing spree Thailand took in refugees and despite sharing a border with Burma it has never visited totalitarianism on its own people. Thai people are surprisingly un-political in conversation, rarely expressing dissent from the party line. Indeed, most Thais hold unbridled respect for the King and wear yellow and blue shirts in his honor every week. His pictures line the highways as a symbol of unbridled affinity.

Which is precisely why the violent political struggle that is engulfing the capital city of Bangkok this month seems so out of character.It is hard to believe that any society can be politically tranquil. What seemed to be a veil of peace and non-confrontation was a thin veil for burning resentment against the status quo. In 2001 there was a similar situation in Nepal where the Royal family was almost universally adored. At the time a disparaging remark about him to an ordinary could start a fight. Then in 2001 a royal heir slaughtered the rest of the Royal family and the country descended into chaos. For centuries the king had been able to quell distrust between the impoverished rural hinterland and comparatively wealthy major cities. Since the 1950s or so Kathmandu and Pokhara had been inundated with development aid, most of which transmuted into graft and only developed the cities, leaving the rest of the country desperately poor. It was fertile ground for Nepali Maoists to organize and grow a rebel movement. When the Royal family died the revolution was unstoppable.  By 2006 the Maoists won and the country abolished all Royal powers.

The protests this month in Bangkok could be Thailand’s Royal massacre. Simmering resentment beneath an a-political facade has broken through in a violent orgy. Unused to dissent police open fire on protesters who magnify the violence by setting fire to the city’s landmark buildings and hurling grenades.  Yesterday I saw a video on Youtube that has since been taken down of a protester being shot in the head by a military sniper. He died in a pool of blood as other protesters surged forward without regard to  the danger. Even as the leaders of the protest surrender to police today, the violence just seems to magnify. As I write this the city hall is still smoldering.

Thailand is the only country in SE Asia that was never under the control of a colonial power. The tradition of self-rule has continued unbroken because of savvy partnerships between the royal family and western powers. Nepal was also never a colonial subject.  While self-rule has helped Thailand become one of the most developed countries in SE Asia, its mode of governing is an anachronism in a modern world.  The protesters demand new elections to oust the sitting government. Most protesters still seem to support the king, but the party that has kept him in power is losing its popularity fast.

I don’t know what is going to happen in the coming months. But I don’t think that Thailand will ever be the same. We may be witnessing a new revolution. Or we might see the protesters quashed into oblivion, only to rise up again years down the line.