SUMMER REPLAY: "Emotional choreography" and the cross-border egg trade

How do all these women end up donating eggs around the world, you wonder? The egg donation business is a sophisticated marketing and emotion-management machine.

This item was originally published in HeyReprotech on 08 Jun 2021.

I've written a fair amount about egg donation over the years and have interviewed donors who travelled places to do it. There is a lot to think about when you consider that droves of young women are crossing borders to have medical procedures performed upon them for the benefit of other people.

The paper "Emotion, embodiment, and reproductive colonialism in the global human egg trade" tackles many different parts of this picture — too many for a brief newsletter. So, drawing on both the paper and a conversation I had with one of the authors, Diane Tober, an anthropologist at the University of California San Francisco [now at the University of Alabama], I concentrate below on their findings regarding emotion and emotion management in the egg donation process.

7 minute read

Young women are recruited into the global egg trade through shrewd emotional marketing techniques and a skillful manipulation of their emotions during the process, according to research published in the journal Gender, Work and Organization. Coauthors Diane Tober, at the University of California San Francisco, and Charlotte Krolokke, at the University of Southern Denmark, in Odense, describe an addictive formula that combines an appeal to altruism with the lure of money and foreign adventure, while playing down the realities of egg donation.

The two academics examined differing but overlapping pieces of cross border egg donation. Krolokke did fieldwork in Spanish fertility clinics and interviewed patient coordinators about their work, as well as analyzing online depictions of international egg donation. Tober surveyed 657 egg donors and interviewed 130, many of whom donated across borders. Combining their work revealed an elaborate "emotional choreography" designed to draw women in and keep them donating as needed.

There are several steps in using emotion to recruit and retain egg donors, Tober told me via Zoom.

Step one: frame egg donation in just the right way.

Very often, that first impression takes place online. Instagram, Facebook, Spotify, Twitter and other platforms serve up ads targeted specifically to young women, especially those with financial stresses like student debt. Sometimes women find themselves reading egg donation websites after searching phrases like "easy ways to make money."

A key recruitment feature both in ads and on websites is the donor testimonial. This is where one donor speaks directly to another about her experience:

The most inspiring of it all was the feeling that I was able to give a couple the opportunity to be one step closer to their dream of having a baby. It is amazing the joy it generates inside when you are able to give a gift so priceless and important. It was not only a wonderful holiday experience but an uplifting journey.

Egg donation is portrayed, first and foremost, as an act that helps someone achieve "their dream of having a baby." Only the potential donor can give this priceless gift. This marketing strategy taps into the young woman's feelings of empathy, says Tober.

But at the same time, egg donation is an adventure — a "wonderful holiday experience" — and she will have fun, the ads tell her. Krolokke notes that on some websites the coordinators are even dressed to resemble flight attendants. Egg donors, meanwhile, are presented as beautiful, carefree young holidaymakers.

"The first level of recruitment is right there," says Tober, "when they see that messaging, that targeted marketing, that plays on both financial need and emotion."

Egg donation is not only exciting, but meaningful, she's being told. And, incidentally, she will get paid.

Step two: reinforce that what she's doing is amazing.

After the donor expresses interest, she gets a response. What she's doing, she's told, is a really amazing thing. Egg donors are so badly needed! Fill out the paperwork, go through the preliminary screenings, and let's get started.

The testimonial:

I saw egg donation as an opportunity to travel and see beautiful places, but I soon realized it offered a greater opportunity to make a difference in someone's life.

She's doing this huge, enormous thing, for another person, says Tober, and "that makes you this amazing, altruistic individual — even if you're getting paid." It may have started out as an "easy way to make money," but it's not about the money anymore, or about the thrill of travel, but rather, it's about making "a difference in someone's life."

It feels good. It feels virtuous. It feels important. She must be an awesome person.

Step three: flattery.

The donor is so pretty. The donor is so smart. And now somebody has chosen her — and so quickly! It never happens this fast!

Not only is she an awesome person, doing a selfless and meaningful deed, but it turns out she's especially good at being that person. "Somebody actually wants them," says Tober. This appeal to the woman's self esteem, to her self-worth, to her value, to her desirability, can be powerful, says Tober: "That feeling has been described to me as being 'addictive.'"

Step four: portray her egg production as a personal triumph.

Sometimes egg donors are medically stimulated to produce a large number of eggs, then they're congratulated for that. It's almost as though the drugs they'd been injecting had played no role.

Their bounty is celebrated, while their discomfort is minimized. "Donors have told me they've been told, 'Oh, you're a good donor!' — 'You are a super donor!' — 'You have a lot of eggs!' — regardless of the fact that she's sitting there, you know, bloated and in pain."

There's a strong sense of pride in being super-fertile, says Tober.

Step five: forge a sense of community

Many egg donor websites portray a sense of camaraderie and community, as donors travel together, in groups, to exotic places like Thailand or India. Sometimes that sense of community is real.

Ironically, bonding may be partly a result of how difficult overseas donation can be. "Traveling groups of egg providers — regardless of where they come from — leave their homes behind, and spend weeks together, undergoing the shared experiences of injections and heightened emotions in response to fertility drugs. They share rooms, meals, and go to clinic appointments and sightseeing together. They undergo potentially precarious medical procedures under anesthesia," the researchers note in the paper. Some form lasting friendships, and they try to do future donation cycles together. Traveling egg providers sometimes share a dangerous rite of passage, and past research shows that under such conditions, strong bonds can form.

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Despite danger and discomfort, many egg donors keep donating. Tober says that while money is a big factor in why donors continue, it is not the only one: emotion plays a role here too. Many donors say that they'd planned to quit after the next cycle, but when they hear the compelling story of another recipient and know they can help, they agree to do it. Tober knows of several women who've been enticed back 10 times. One woman did 19 donations, she says.

For many women, the clincher is the sibling cycle. "A lot of them think, okay, I was going to quit, but since it's a sibling cycle, I kind of have to," says Tober. This is yet another example of emotional choreography at play, she says: relaying a story that a donor is going to connect to, that will make her feel that she has no choice but to say yes.

Unfortunately, says Tober, that empathy is often not reciprocated. Unlike the paying clients, who have multiple attendants by their side as they go through procedures in foreign countries, Tober has observed that donors are often left to fend for themselves. Or when things go wrong, they are sometimes met with blame rather than sympathy.

The paper describes an episode where a group of women arrived in Mumbai to donate. One had the wrong papers, so was sent home. Others waited for a promised limo that never arrived, then made their way to a hotel that had no reservations for them. When they found another, they were told off by the agency. Worst of all, the women discovered the next day that they weren't even the donors that the intended parents had selected. They had not been chosen after all, and this was devastating.

In another instance, Tober overheard a coordinator tell her assistant about a donor who'd been, in her words, a "drama queen." As it happens, Tober had interviewed that donor, and knew her story. During her sixth donation, the donor had produced 56 eggs. After the retrieval, she had been screaming in pain and asking for help, but the coordinator told her to take Tylenol. Likewise, the doctor who'd performed the retrieval refused to help, according to the paper. The woman flew home to Aruba the next day, and was taken to hospital, where her swollen and twisted ovary was surgically removed.

"The expectation of care was unidirectional," the authors write. Despite all the empathy extracted from the donor, there was none was available to her when it was needed.

Update: Diane Tober's new book, Eggonomics: The Global Market in Human Eggs and the Donors Who Supply Them, will be out in October.

Diane Tober and Charlotte Krolokke. "Emotion, embodiment, and reproductive colonialism in the global human egg trade." Gender, Work and Organization. 2021.

Diane Tober. "Student debt is driving more Americans to donate their eggs — and some suffer lasting complications." Salon. 2021.

HeyReprotech. "Ads that target young women." 2020.

HeyReprotech. "The other reasons egg donors donate." 2018.