In January 2020, LaFemme Healthcare Clinic in Nairobi ran an advert to recruit voluntary human egg donors to increase its pool as clients sought more options. Previously, egg donors were picked by word-of-mouth and this narrowed the options presented to clients.
“We got 4,700 responses,” says Dr George Thuo, the founder of LaFemme. “And a lot of backlash from Kenyans.”
A few years ago, ‘buying and selling’ human eggs and sperms were unheard of in Kenya. But the business is taking off fast as more couples unable to get pregnant, same-sex couples and single women seek to get children through in vitro fertilisation (IVF), where a baby is created in a laboratory and implanted in a uterus.
According to Dr Thuo, several reasons necessitate gamete (eggs and sperms) donation.
“There are couples unable to produce their own gametes due to primary or secondary infertility problems. Others are single and want to have children. Both will need someone to donate for them,” he says.
In Kenya, egg donation is especially more lucrative, under-regulated and understudied. Eligible female donors have to be aged between 18 and 25 years because the quality and the quantity of eggs they produce are very high.
Dr Wanjiru Ndegwa-Njuguna, an obstetrics and gynaecologist at Footsteps to Fertility in Nairobi for the past six years, says that normally egg donations are done on demand.
“A client will come and look through the profiles in our database. Should they see a woman who matches what they’re looking for, the process of egg harvesting begins.”
However, there are cases where clinics need not wait until a client comes looking. If a donor walks in with a requirement that is missing in a clinic’s database, for instance, someone who is “exceptionally handsome or beautiful or kind-hearted”, with unique skills or exceptionally high IQ, their gametes will be harvested and stored in anticipation of a buying client.
In Kenya, women are compensated between KSh30,000 and Sh50,000 per donation cycle. In developed countries, women donating eggs are paid KSh268,000 per cycle. Buyers then pay about KSh535,250 for the eggs.
But egg donation is not as easy as ABC. The women are first injected drugs to stimulate their ovaries before doctors can retrieve the eggs.
The information donors give out is extensive. The clinics have donors’ portfolios that contain religion, ethnic group, height, weight, eye colour, hair colour, hair texture, blood type, occupation and level of education. Some contain coloured photos. There is an option of requesting an audiotape, for an additional KSh2,000 fee, in case a couple wants to hear a donor answer questions about herself or himself.
In Kenyan clinics, men have the final say when picking a sperm donor from the portfolio and women choose the egg donor. A clinician once joked that “this avoids the chances of a woman picking a sperm donor who resembles her ex-boyfriend or a secret admirer.”
Per one vial of semen, Kenyan men are compensated between KSh3,000 to KSh10,000. Men from around the region, for instance, Tanzania get KSh10,000 as compensation. Should the male donor have striking characteristics, the compensation is between KSh25,000 and KSh30,000.
The rarer the characteristics a donor possess, such as green or amber eye colour, lighter or biracial skin colour, model-like features and hair, and a higher IQ, the more there are sought-after and paid.
A couple can opt to import frozen semen or eggs and it is delivered at an IVF centre of choice. The most favoured countries are the US and Denmark because of the donor confidentiality laws.
According to Ayieta Lumbasyo, a lawyer and bioethicist at the Nairobi IVF Centre, the work of fertility centres is not to buy and sell gametes.
“IVF centres exists to solve fertility problems. The money paid to donors is compensation for time taken out,” she says.
During donation, it is impossible to extract only one egg or sperm from the donor. To increase chances of success in IVF treatments, more than one egg is fertilised but not all of them are implanted. An IVF centre is thereby morally and ethically obligated to store the gametes and embryos.
This has led to the rise of fertility preservation — an arm of IVF that deals with the preservation of gametes and embryos used in assisted reproduction through cryopreservation.
Cryopreservation is the process of rapidly freezing eggs and embryos at a temperature of -196°C in liquid nitrogen. This provides flexibility in their use because frozen tissue can be stored indefinitely. Currently, IVF centres in Nairobi have thousands of donated gametes and remaining embryos preserved.
Storage costs between Sh20,000 and Sh30,000 per year. This earns fertility clinics millions of shillings in revenue, but investment in the technology and machinery required is not cheap. Some clinics have spent up to Sh60 million to install the machines.
While this freezing technology gives people with reproductive diseases and cancer a chance to have a family, its usage is turning social.
The trend of women delaying motherhood until they reach an age in which fertility has reduced, poor quality or quantity sperms due to increased smoking and drinking alcohol have spurred the business.
Dr Wanjiru says she has noted an increase in the number of women freezing their eggs. Whereas men freezing their gametes are undergoing cancer treatments or in long-distance relationships, women are also doing it for personal purposes.
“Women want to advance their careers but knowing that age reduces their chances of conception, they’re opting to freeze their eggs for the future,” she says.
These women belong to the upper echelons of society, are big on women empowerment and financial security, rightly so because the process of harvesting and storing eggs costs Sh300,000 to Sh400,000, an amount that an average Kenyan cannot afford.
According to Dr Wanjiru, women between the ages of 25 to 35 can freeze their eggs.
Fertility preservation is a global phenomenon. Tech companies like Facebook, Google and Apple offer cryopreservation options to their employees.
Nonetheless, before planning to donate, buy or freeze gametes or embryos, one has to make tough decisions.
Ms Lumbasyo says several issues have to be considered. For example, donors must be prepared to live with the knowledge that there is a child with their DNA roaming the world? How often should one donate gametes? How long can the tissues be stored?
There is also the question of when conception begins. The Kenyan Constitution states that life begins at conception. Does that mean the embryos are children and disposing them of is similar to having an abortion?
“All parties involved must undergo counselling and given all required information so that when they sign papers for donation, IVF and storage, they’ve made an informed choice. These procedures require people with a sound mind,” Ms Lumbasyo says.
Do you fit?
Yet most potential donors are unaware of how tedious and overwhelming the process can be. Besides being the ideal age, donors are required to give information about their medical and genetic history.
Additionally, they should have no criminal record, should not be overweight or on antidepressant drugs. They must also submit to medical, psychological, sexually transmitted diseases, drug and alcohol screening as well as vaginal cultures and ultrasound tests.
Dr Thuo advises women to donate thrice in their lifetime.
On storage, gametes and embryos are kept for five years then the application is made for them to be stored for another five years. Conversations on disposal are held once this period lapses.
“Gametes are cells and can be disposed of by the treatment centre or given to the owner. However, doctors have a medical responsibility towards embryos because they are considered live human tissue and the duty of care falls within the medical faculty,” she explains.
“As such, stored embryos are only transferred from one centre to another. You cannot leave a clinic with your embryo if you intend to have it implanted.” Similarly, IVF centres cannot dispose of embryos for a client. There are four ways of disposing of embryos in Kenya: a donation to an anonymous recipient, a donation to a known recipient, self-disposition, or compassionate transfer once the 10 years lapse, Ms Lumbasyo says.
Most religiously-inclined clients or those whose embryo was made from both partners’ genetic material, opt for self-disposal, where they take their embryos home with them or do compassionate transfer, where the embryo is implanted at a time when it is unlikely to develop into a pregnancy.
Use of the eggs, sperms or embryo after the death of a donor or a partner is not an option in Kenya unless authorised through a court order.
This year, an interesting case landed on Ms Lumbasyo’s in-tray. A client whose son is under medication known to affect male fertility visited seeking legal advice. The client is contemplating storing his minor son’s spermatozoa.
“The law is clear. Parents cannot decide on the reproductive health of a child because it’s not considered primary care. The child cannot decide because he’s a minor. The case for male infertility is a reality in this case. What happens?”
Ms Lumbasyo has since written a letter to the medical and legal bodies in Kenya seeking help.
Her advice on assisted reproduction: “Fertility issues are real and IVF technology is being embraced. Nonetheless, we must be alive to the fact that we’re Africans with African values and deep religious beliefs. It’s paramount to domesticate laws to suit the standards of our community.”
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