Abstract
The development of vitrification techniques has increased the use of donor ova by allowing for their cryopreservation, storage, and international transportation. However, the implications of egg banking for the valuation of eggs remain little studied. Building on ethnographic fieldwork in a Ukrainian egg bank, in this article I examine different mechanisms and calculations that allow the bank to transform vitrified ova—products with volatile outcomes—into valuable but uncertain commodities. This article reveals how the bank staff can never completely secure their profits because of the variability of the egg quality assessment and unpredictability of their expenses. I demonstrate how the dilemmas that arise when the egg banking industry tries to turn oocytes into commodities trigger certain efforts to develop quality control in vitrification techniques and donor selection, as well as classification and accounting schemes related to oocyte quality.
Similar content being viewed by others
Avoid common mistakes on your manuscript.
Introduction
The banking and shipping of frozen oocytes have become a novel method of supplying ova worldwide (Hudson et al. 2020; Waldby 2019). This innovation boasts the added benefit of allowing couples to receive treatments at home and use donor eggs independently of the time and place of their retrieval. Many scholars have raised concerns about whether egg banking transforms the way eggs are managed globally, which leads to increased commercialization of eggs and disrupts assumptions about donation as a ‘gift’ (Baldwin et al. 2019; Hudson et al. 2020). However, the implications of egg vitrification for the valuation of eggs remain little studied. Scholars have debated what stands at the core of generating the “biovalue” of material tissues, such as vitrified eggs, their intrinsic vital properties or “life itself” (Rose 2007), embodied biomedical work of donor populations or “clinical labor” (Cooper and Waldby 2014), or immaterial assets, such as fertility specialists’ skills (Birch and Tyfield 2013). This literature, however, pays limited attention to how the egg banking industry navigates the uncertainties of the value of eggs.
While frozen ova function as commodities on the market, their economic value is not produced as something tangible and stable. Rather, eggs are produced as uncertain commodities with value that is often unpredictable. What is being bought and sold is a promise of a pregnancy, but whether vitrified ova result in pregnancy cannot be easily known in advance or guaranteed. Like any “lively” commodities, the vital qualities of vitrified eggs are fundamental to the generation of capitalist value as long as they “remain alive and/or promise future life” (Collard and Dempsey 2013, p. 2684). While research inquires how different actors perceive eggs and their value and how eggs transition in and out of commodity status (Hoeyer 2013; Kroløkke 2018; Waldby 2019), the ways in which the unpredictability of egg quality—the chances of survival and fertilization—affect the logics of accumulation remain little known. This article reveals how the egg banking industry measures value and negotiates the doubts regarding the “quality” of vitrified eggs to turn them into sellable commodities. Building on an example of a commercial egg bank in Ukraine, I show how this newly emerging industry cannot secure profits due to the contingency inherited in the process of coproduction of human eggs and vitrification technology, which often resists or redirects the commodification process (Castree 1995).
With the growing international demand for donor oocytes (European IVF Monitoring Consortium 2022), a booming unregulated ova market oriented specifically toward Western Europe and North American purchasers has emerged in Ukraine. As a supply side in the global reproductive bio-economy, Ukraine is a key nodal point for understanding the process of valuation of human reproductive materials (Vlasenko 2021). This article is based on research carried out in a commercial egg bank in Ukraine during the years 2015–2018. It not only served intended parents (IPs) who traveled to Ukraine for fertility treatment, but also delivered cryopreserved donor material (such as ova, sperm, and embryos) to IVF clinics in various countries, allowing couples to avoid travel and access purchased eggs at a clinic convenient for them.
While I was doing my observations in the bank, I sometimes came across couples who expressed disappointment about the quality of the cryopreserved material. For example, in 2019 a couple who had bought 17 frozen eggs through the bank’s official distributor in Canada complained about the low egg survival rate. The vitrified eggs were from three different donors, and the couple had a suspicion that the bank just got rid of “leftovers.” Only half of the eggs survived thawing and were successfully fertilized and cultivated into embryos. The couple argued that even the ones that did survive were of “poor quality” and asked the bank either to replace free of charge the eggs that were lost or to reimburse their cost. While the bank’s distributors in Canada expected the survival rate to be over 90%, they recorded poor rates (68.9%) across all cycles with vitrified eggs from the bank. Distributors expressed interest in the bank’s outcomes in other partner clinics, hoping to better understand the root of the problem; the vitrification, donor selection, and stimulation at the bank or the thawing technique at the clinic receiving the material were all possible culprits.
This article examines how the staff at the bank negotiated these uncertainties of “quality” in the process of egg commodification, creating the value of vitrified donor oocytes despite the unpredictability of nature’s ‘agency’. To sell more oocytes for a price that yields more profits, the staff aspired to define and control the factors that affected egg “quality” and calculate their costs to the facility. To navigate uncertain value, the bank developed techniques to provide evidence of high egg “quality” to their partner clinics while outsourcing responsibility for negative outcomes. The uncertainties of egg “quality” triggered measures at the bank that would make value more predictable and thus secure profitability, as well as a development of existing techniques to match global techno-scientific standards. As the factors that affect ova “quality” are volatile, the staff tried to classify vitrified eggs in a way that allowed for selling more of them and yielding higher “quality”. As the staff could not predict how many oocytes would be ‘fertile’ and/or sold, they were unable to calculate their expenses and price the goods accordingly, which further exacerbated the uncertainties of value. To commodify eggs efficiently, the bank came up with (1) embryological training; (2) donor efficiency reports; (3) subdivision of vitrified oocytes into different quality categories; and (4) different accounting schemes to negotiate the uncertainty of their expenses and account for unsellable eggs.
Methods
In this article, I draw from 15 months of participant observation and 20 interviews with the staff in the egg bank based in the facilities of the fertility clinic (hereinafter I use a pseudonym Cryova). This data is part of dissertation fieldwork I conducted in Ukraine in 2015–2020. This project was approved by IRB of Indiana University in 2015 (#1502824526), with amendments approved in 2017, 2019, and 2020. I recruited my participants among medical professionals and agents by directly contacting eight clinics, banks, and donor agencies throughout Ukraine. I first met with the director of the bank Cryova in 2015 for an interview, introducing my project to her and inquiring about permission to conduct participant observation at their facilities. The bank’s director agreed, emphasizing the transparency of the bank’s organization and work. She introduced me to the rest of the staff, explaining to them that I am a researcher from a US university who is writing a dissertation and potentially a book about egg donation in Ukraine. Then, I explained my project in greater details to provide enough information for the staff to give informed consent to their participation. In summer 2016, I conducted participant observation at the bank for 3 months and negotiated returning to continue my observations in fall 2017–winter 2018. During this time, I attended the bank daily (four hours per day) and observed weekly staff meetings, business meetings with clients, and medical and embryological procedures, including initial consultations with egg donors, subsequent medical examinations, egg retrievals, oocyte vitrification and fertilization, and shipment of vitrified biomaterials.
The bank’s staff always felt overwhelmed with work. They often asked for my help in communicating with partner clinics and individual couples, as well as completing other occasional tasks where my knowledge of English was needed, such as translating emails, contracts, reports, and marketing materials, doing research, and assisting in the organization of international meetings, seminars, and conferences. I also examined the bank’s financial and statistical data. As I was performing a substantial amount of work, they grew uncomfortable with me lacking an official status at the bank. First, they offered me a position as an intern and then as a part-time employee, mostly to legitimize my daily presence in their work environment and to compensate for my labor. I agreed, but continued emphasizing my role as an independent researcher whose goal is not to promote the bank, but to critically analyze its work and context.
Since I was shifting between my roles as researcher and employee, I treated informed consent as an ongoing process throughout my research engagement. The amount of information provided and the relationship between researcher and subjects is liable to fluctuation, as is their view of consenting. Thus, I made sure to continuously maintain the informed and voluntary nature of the staff’s consent. Usually, I was invited to meetings or offered information by the staff. When the invitation was not clear, I always asked beforehand if my presence at the meeting or access to information was allowed. In every sensitive situation, I inquired if participants prefer to amend, or, if necessary, remove their consent. I have pseudonymized medical professionals and the bank itself to keep the identity of the respondents separate from the information they have provided. Whenever research subjects requested certain information to be treated confidentially, I have respected their desire. I used NVivo software to organize my data. I used open coding to identify common categories and recurrent themes and allowed the coding categories and theoretical conceptualization to emerge from the data as I built a grounded theory (Glaser and Strauss 1967; Corbin and Strauss 1990).
Assisted Reproductive Technologies in Ukraine
The sector of reproductive medicine in Ukraine is completely privatized.Footnote 1 There are around 73 private fertility clinics, some of which have egg banks. There have been 34,646 cycles and 10,717 children born from assisted reproductive technologies (ARTs) in Ukraine in 2022, from which 13% were egg donation cycles with 2632 donor egg retrievals (Center for Health Statistics of the Ministry of Health of Ukraine 2023). However, these statistics might be underreported, which can partly be explained by the fact that many of the eggs retrieved were exported to clinics abroad.
There is no separate law on the use of ARTs. Decree 787 of the Ministry of Health (Ministry of Health 2013) provides medical instructions, and the remaining legal norms are dispersed across different legal documents.Footnote 2 Egg donation and gestational surrogacy are legal and compensated. Preimplantation genetic diagnosis (PGD), sex selection, mitochondrial donation, and transportation of cryopreserved gametes and embryos within and outside the country are allowed (Ministry of Health 2013). The legislation determines that “adult woman and/or man has the right to carry out assisted reproduction treatment programs for medical reasons” (Verkhovna Rada Ukrainy 2003). Thus, in contrast to the legislation in many other European states, the recipients of donor eggs in Ukraine are not legally required to be married, to have a relationship, to be heterosexual, or to be below a certain age.Footnote 3 In cases of egg and sperm donation and surrogacy, IPs are considered the child’s parents (Verkhovna Rada Ukrainy 2002).
The wording of the Decree 787 posits egg donation as anonymous and “voluntary,” with women receiving compensation for their time and expenses (Ministry of Health 2013). However, in practice the process is largely commercialized. There is no fixed compensation; instead it fluctuates according to market prices.Footnote 4 At the time of this research, donors received USD 500–1,200 for one donation cycle, while the average monthly salary in Ukraine was around USD 300. Thus, there was an abundance of women willing to donate. There is a legal restriction on donation attempts of up to eight times per lifetime (Ministry of Health 2013). 60% of the donors at Cryova donated eggs more than four times. Since one can donate no more than once every 3 months, some women donated every 3–6 months and saw their compensation as a stable source of income.
Egg donation cycle usually lasts between 1 and 3 months, depending on how much time medical testsFootnote 5 and the matching process take. The intensive stage is that of hormonal stimulation, which usually takes up to 13 days (short GnRH agonist protocol), during which the egg donor self-administers hormonal injections at home and comes to the clinic 2–3 times for an ultrasound and blood test (to check follicular growth). Fertility clinics are usually located in the capital, Kyiv, but many donors live in small cities and villages throughout the country, so they must commute. After the final injection of ovulation trigger is administered, egg collection is performed. Egg retrieval lasts for 15–20 min under general anesthesia. Most clinics aim at retrieving at least 12 mature eggs.
Overview of the bank
Cryova provided a range of ARTs services, conducting around 1000 cycles annually for both Ukrainian and international patients. At the time of this research, 69% of all cycles were egg donation cycles that often involved international patients. The clinic has applied the technique of oocyte vitrification since 2011. In summer 2015, Solomiia, the future director of the bank told me that the method was still experimental, and the clinic was selling vitrified oocytes more cheaply and only to Ukrainian patients. However, with increasing numbers of international patients and partnerships, improved techniques of vitrification and growing numbers of egg donors, in December 2015 the clinic officially launched the bank of vitrified donor oocytes. As a business model that combined all the crucial components of egg production and circulation—donor recruitment and stimulation, oocyte vitrification and fertilization, storage, and shipment—this case study of the bank exposes how the demands of the global export of eggs shape the process of valuation of eggs.
The egg bank aspired to become a transnational company that supplied frozen donor oocytes or any other donor material for IVF to any destination worldwide. The bank retrieved and vitrified eggs in-house. At the time of my observations in 2017, the bank conducted around 80 egg retrievals per month, or 5–6 egg retrievals per day on average, and had around 500 egg donors in the database. The total number of vitrified oocytes in the bank was around 9000, of which around 3000 were labeled as “highest-quality” level and 6000 as “medium-quality” level. The bank sold 565 sets of vitrified ova (7400 oocytes), shipping around 400 vitrified oocytes per month to its partner clinics in different countries around the world (EU countries and North and South American countries).Footnote 6 These numbers kept growing until the full-scale invasion of Ukraine by Russia. In 2021 alone, the bank shipped around 11, 000 vitrified oocytes abroad.
Cryova positioned itself as a bank that mostly exports vitrified oocytes. However, when this was not possible due to legislative restrictions or partners’ lack of experience in thawing, the bank also shipped vitrified embryos to expand its global reach. “Fresh” and “frozen” donor oocytes were two different commodities with different value and different production and circulation processes. In “fresh” donor oocyte model, the bank received frozen sperm from its partner clinic, fertilized oocytes immediately after retrieval from the donor, cultivated and cryopreserved the embryos, and finally shipped the vitrified embryos back to the partner clinic. Cryova’s oldest international partnerships with clinics in Ireland and Israel followed the “fresh” donor oocyte model, which has been established before egg vitrification’s extensive use in the bank.Footnote 7 The model with “frozen” donor oocytes entailed carrying out stimulation protocol, oocyte retrieval, and vitrification in the bank and delivering vitrified ova to the partner clinic or individual couple abroad, where it is thawed, fertilized, and used in recipients’ IVF procedures. If the eggs were to be frozen, the bank did not have to synchronize donor and recipient cycles, coordinate all parties in space, handle the sperm from the customers, and cultivate embryos. The frozen material could be accumulated for future use and readily available for shipment. Moreover, the bank could recruit more donors and accumulate more eggs, than the “fresh” model allowed. While in “fresh” programs, all eggs from one donor belonged to one couple, vitrified oocytes were kept and sold in sets of 6, 8, and 12.Footnote 8 As a result, cryopreserved oocytes can be monetized and rationalized more efficiently, with one donor’s oocytes stored, divided, and allocated between several couples and delivered to any destination worldwide (Waldby 2019).
Uncertain commodities
A vast body of scholarship within more-than-human geographies (Whatmore, 1999, 2002), actor-network theory (Castree 2002; Latour 1993; 2005), post-humanism (Haraway 1991, 2008), and new materialisms (Alaimo et al. 2008; Barad 2007; Bennett 2010) focuses on the constitutive agency of non-human entities in social and political life and emphasizes the co-productive relationship between society and nature. However, these currents often do not consider questions of political economy (Castree 2002). Marxist scholars at the intersection of economic geography, political ecology, feminism, and science studies have examined the distinctiveness of capitalist appropriation, social construction, and the commodification of nature, including living organisms and non-living things (Castree 2003; Bakker and Bridge 2006). Instead of theorizing nature as an “infinitely malleable” object of human manipulation and positioning capital as the only source of agency, recent scholarship inquires how different animate and inanimate materialities of nature (whether water, tree growth, seeds, or animals) might be “sources of unpredictability, unruliness, and resistance to human intention,” which muddle human efforts to produce nature in particular ways (Bridge 2011, p. 226; Bakker and Bridge 2006; Bakker 2012; Braun 2015; Ellis et al. 2020; Prudham 2003).
By tracing how ova value is created, transformed, and moved into circulation, with an often uncertain result, this article accounts for the uneven forces through which life is commodified and turned into a central source of capital (Cooper 2008; Helmreich 2008; Haraway 2012; Sunder Rajan 2012; Franklin 2007; Waldby and Mitchell 2006), as well as how the materiality of “lively commodities” affects the processes of valorization, consumption, and flow (Collard and Dempsey 2013; Colombino and Giaccaria 2016; Shukin, 2009). Capitalist value of eggs is derived from their “vital and generative qualities” (Parry 2012, p. 217)—a chance of conception through technological manipulation. Like many other “lively commodities,” eggs may present obstacles to capital accumulation and shape the social relations of the measurement and calculation of value by virtue of their biophysical specificities that cannot be fully controlled and predicted.
Their agency should be de-coupled from the subject/object binary and understood as “an emergent property of network associations rather than a property inherent in discrete entities” (Bakker and Bridge 2006, p. 19). By redistribution and de-centering of social agency (Whatmore, 2002), the commodification of eggs and accumulation of value appears not simply as channeled by the bank or sabotaged by the intrinsic agency of biomaterial outside of human control. Instead, it is a relational effect of a combination of socionatural factors: the variability of rates of survival and fertilization, development of vitrification techniques and scientific expertise, coordination between different sites (such as clinics) along value chains, the unpredictability of a donor’s fertility, measurements of quality and accounting schemes, the uneven structure of the global economy, international regulations, and standards.
One characteristic of vitrified ova that matters most in production of their value is their “quality”—their chances of survival and fertilization. This specific nature of life being commodified is always already shaped by human skills and knowledge in reproductive and cryopreservation technologies and quality assessment. Thus, biovalue or a “yield of both vitality and profitability produced by the biotechnical reformulation of living processes” (Mitchell and Waldby 2010, p. 336) is derived not just from the latent vital properties of biological material, but from the effortful application of knowledge labor aimed at making that fragment into a commodity (Birch and Tyfield 2013). The success of frozen oocytes (and their commodification) depends on how the egg donor was stimulated, how the eggs were harvested and frozen, and on the work of the embryologists in warming and fertilization. While scholars have argued that vitrification allows for better capitalization than cycles with fresh donor oocytes because it allows for developing a more industrialized, flexible, predictable, and readily packaged oocyte distribution model for egg banks (Waldby 2019), I examine how vitrification contributes to uncertainties about the “quality” of eggs.
I suggest the term uncertain commodities to describe vitrified eggs and emphasize how the doubts around their “quality” shape the process of their commodification. I borrow the meaning of uncertainty from Becker and Knudsen (2005), who define it as a state when a known event could happen with unknown probability. They differentiate it from risk (where both the event and the related probability are known) and pervasive uncertainty (where neither the events nor probabilities are known). They argue that firms deal with uncertainty by managing all available information and coming up with organizational routines. How does the industry successfully co-produce a market for reproductive biologicals that were not previously commodified and might resist and redirect human action? In what follows I show how the value of vitrified eggs and their chances of being sold depend on an assessment of their “quality”; the “quality” of vitrified eggs from Ukraine is uncertain because of the unpredictable results of thawing and fertilization. To cope with the uncertain quality of vitrified eggs and to turn them into sellable commodities, the Ukrainian bank introduces different techniques to measure and prove the “quality” of eggs and to account for their losses.
Uncertainties of vitrification
How many donor oocytes the Ukrainian bank can sell and at what price largely depends on how their “quality” is assessed by the clinics that purchase and handle them, a question that assesses the likelihood of vitrified eggs surviving thawing and resulting in fertilization and implantation of an embryo. Although vitrification enables the accumulation and use of eggs independent of the time and place of their retrieval, it is not completely clear whether this process indeed leads to more efficient monetization, since the technique can negatively affect egg “quality” by undermining the chances of fertilization. During vitrification all fluid is taken out of the egg so that there are no crystals which could later tear the cell apart during warming. A reduction in temperature (typically at rates of more than − 2500 C/min, before storage in liquid nitrogen at − 196 C) results in the “formation of an amorphous solid or glass-like state (noncrystalline)” (Practice Committees of ASRM and SRBT 2021). Although most studies show similar rates of survival (around 80–90%), fertilization (around 70–80%), good-quality embryos (around 50%), clinical pregnancy, implantation, and clinical results with vitrified and fresh eggs (Arian et al. 2014; Rienzi et al. 2010, 2012; Solé et al. 2013; Trokoudes et al. 2011), the research is not definitive.
Cryova claims that their success rates in the cycles with vitrified eggs are the same as with fresh eggs (97% survival rate, 82% fertilization rate, and 64% pregnancy rate). However, some partner clinics and couples report that cycles with vitrified embryos (with fertilization of “fresh” oocytes) are more efficient than cycles with vitrified oocytes, resulting in better fertilization and pregnancy rates.Footnote 9 For example, the Polish partners who purchase vitrified eggs remain skeptical:
Their [the Polish clinic’s] overall impression is that our oocytes become worse and worse, they do not survive and there are no pregnancies (Solomiia 2017).
Although ova nature is produced in the process of its commodification, it is not a passive or inert backdrop to human actions, a thing to be known and controlled. Rejecting the anthropocentric understanding of agency as rooted solely in human intention and the associated nature–society dualism (Bakker 2012; Haraway 1991; Latour 1993; Swyngedouw 1999), I illustrate how ova nature poses obstacles, opportunities, and surprises to capital accumulation in ways that enable and shape its dynamics (Boyd et al. 2001; Bakker 2003; Henderson 1999; Prudham 2003; 2005; Robertson 2004). Since partners’ doubts about the quality of vitrified eggs diminishes their economic value, the bank must prove the “quality” of vitrified eggs to customers to increase their sales. However, they cannot provide a decisive answer to the difference in fertilization rates between “fresh” and “frozen” eggs or guarantee that vitrified eggs will survive warming and be successfully fertilized. Ova biophysical processes and features resist or confound their “incorporation into particular political-economic and spatial forms” (Braun 2008, p. 668). However, this does not mean that agency of ova can be attributed to intrinsic qualities of an external nature (Bakker and Bridge 2006).
Instead, generative capacities of ova are derived from association with the technology and quality assessment across the sites of their production and consumption. According to the bank, rates of oocyte survival and fertilization depend on a number of factors that the staff cannot always control: (1) the process of vitrification; (2) the embryology at the partner clinics which purchased vitrified oocytes, where thawing (warming), fertilization, embryo cultivation, and implantation happens; (3) the “efficiency” of the egg donors and their stimulation protocols (medication types and dosage, number of oocytes per retrieval, number of egg retrievals per donor); and (4) the morphology of an egg. The same donor can produce eggs that result in fertilization in one cycle, but not in the next one, for myriad reasons, including stress levels and menstrual cycle. Vitrified eggs from the same egg retrieval can survive warming in one partner clinic but not in another.
Thus, in case of vital “quality” of ova, humans and non-humans participate in the “coproduction of socionature” (Bakker and Bridge 2006; Bridge 2011), which results in a model of value generation riddled with uncertainty, disrupting, and shaping the industry’s efforts to commodify ova efficiently. Since partner clinics are concerned that low quality is caused by the bank’s internal procedures, the bank must persuade them that donor selection, stimulation, egg retrieval, and vitrification accord with international standards and do not impede the chances of survival and fertilization of the eggs. The bank increases the value of eggs and negotiates their uncertainty as commodities by outsourcing responsibility for their quality to the partner clinics and blaming “failure” on thawing in the partner clinic. The bank’s embryologist Alex believes that bad fertilization results in Poland relate to their embryology skills—thawing, fertilization, cultivation, and embryo transfer. Polish embryologists, he says, are not doing a good job thawing eggs, which yields a low survival rate. To prove quality, bank staff often refer to cases of partners with good fertilization rates with vitrified eggs.
Some bank partners who are also not happy with the quality of the vitrified eggs blame bad quality on the donor’s “performance.” For example, in 2018 I was present during a Skype call with a Bulgarian clinic that had ordered sets of oocytes from different donors and had four shipments so far. During the conversation, the clinic staff mentioned that they were “slightly disappointed” with the results of the most recent oocyte sets. From the first shipment of sets of ova, all five patients became pregnant, but in the last shipment two donors out of four were “bad,” with only around 8 of 19 eggs surviving thawing, but with no pregnancies. The clinic’s embryologist was concerned that one donor had “bad” results before—her oocytes shipped to another clinic in Poznan had not survived thawing either. He emphasized that the bank must disclose such information in future, to improve cooperation with his clinic:
We would like to have information about the egg donor—how many eggs she donated in this cycle and what the results with her eggs were previously. If we know that this donor already had a bad performance, we don’t want this donor! Solomiia, can you go over those donors already selected and make sure that there is no one who might cause us any trouble? (Philip 2018)
The bank’s director explained that they did not inform Philip about the donor’s previous “bad performance” because her oocytes were thawed in the Poznan clinic, and they saw this as reflecting the lack of skills and necessary technology of Poznan embryologists. Solomiia argued that the bank’s donors were not at fault and that clinics in Israel working with “fresh” eggs of the same donors had very good survival and pregnancy rates.Footnote 10
In the conversation with the Bulgarian partners, the Israeli doctor Tamar, who is a scientific advisor of the international healthcare and diagnostic services concern Medi Group to which the Ukrainian bank belongs argued that a certain uncertainty of the results is acceptable. Tamar’s comments reveal the rationales of socionatural coproduction (Bakker and Bridge 2006) of eggs as uncertain commodities implicit in the work of the bank—the eggs come from human biology and social context and their success in fertilization cannot be predicted. Nature does not give any guarantees, and the social condition in which humans live cannot be controlled in their totality:
This is not like a supermarket where you go and buy oocytes. Human beings have different performances, and there might be some bad donors. Having a high enough rate of survival is considered ok, and the quality of embryos can be also related to the quality of sperm or whatever. I think we have too little info to make a general assumption that something is wrong with oocyte quality, it is too early. There is a limit to what information an egg bank can provide, I think that generally the bank is doing everything in their power to provide good donors and to remove bad donors. (Tamar 2018)
These two cases expose how economic incentives and the need to commodify eggs efficiently force the bank to come up with ways to negotiate the uncertainties of egg quality. Although the bank tries to add value to vitrified eggs and sell them, the process of their commodification is interrupted and their value is undermined by the unpredictability of the coproduction of material’s and technology’s agency (Barad 2007; Haraway 2003; 2008). Frozen eggs are manifested in the process as uncertain commodities, since, according to the reports of partners, they consistently result in low fertilization rates, and it is unclear which factors are to blame for that. The staff at the bank do not exactly know how to find out what causes the low survival rate and how to reject being responsible for it. I examine how when commercializing the uncontrollable and unpredictable natural phenomenon of vitrified eggs, the bank negotiates uncertainty through 1) training embryologists of other clinics; 2) compiling donor efficiency reports; 3) developing different quality categories; and 4) accounting for unsellable eggs.
Negotiating uncertain quality
Embryological training: what if thawing is to blame?
The survival and fertilization rate of oocytes depends not only on the internal process within a bank, but also on the operation of the partner clinic that thaws oocytes, which presents a major uncertainty in the process of egg commodification. Often it is not just one factor at certain clinic that causes the “failure” of a cycle with vitrified eggs, but rather the overall discordance of the process. The uncertain nature of ova quality is produced and affected through coordination of vitrification techniques at different sites, while also shaping and requiring their cooperation for biology’s and technology’s success. For example, because eggs are vitrified in the bank according to the Kitazato protocol, they must be thawed using the same protocol.Footnote 11 To cope with this uncertainty and still make profit, the bank sends every partner clinic instructions on thawing the vitrified eggs. The bank can also send its embryologist to the partner clinic to share experience and skills and tailor their processes to complement those of the bank. It also markets vitrification training (embryological school) as a separate service.
Cryova ensures that any new partner has the technology and experience to thaw oocytes. The bank’s director Solomiia argues that only in this case will thawing and fertilization be successful, which illustrates agency as a “capacity to act with the coming together of things that is a necessary and prior condition for any action to occur,” both human and non-human (Braun 2008, p. 671). When the bank signs a contract with a new partner, it does not guarantee any survival rate until its embryologist visits the clinic facilities and determines the qualification and skills of embryologists and the organization of the process. According to Solomiia, even the clinic in Poznan had better results the longer cooperation lasted. Over time, different technologies of vitrification and thawing were adjusted to form one synchronized process and the staff got to know each other. The biotic qualities of ova—uncertainty and unpredictability of human fertility, tamed but also exacerbated by technology of vitrification—instigate egg banking to take a distinctive organizational form: extensive cooperation between private firms to ensure research and coordination of technological practices at different sites. Similarly, Scott Prudham (2003) reveals how biological constraints of forest trees reproduction present a challenge to proprietary, private forms of capital investment, inspiring co-operative institutional tree improvement strategies (although in this case assisted by state-supported science).
Moreover, biotechnological knowledge that the bank shares with its partners has asset-like properties. Writing from the context where the biological resources themselves are not necessarily turned into commodities, Birch and Tyfield (2013, p. 315) emphasize that bio-economy is an asset-based market where the value is derived “from the knowledge labor protected by laws that create and enforce intellectual property rights.” Even though Ukrainian egg market follows the logic of commodification, the asset-based economic processes, nevertheless, maintain significant importance. Scientific expertise is therefore deployed for economic imperatives—it helps to commodify eggs efficiently and increase their value by addressing thawing (and technology discordance between vitrification and thawing sites) as one of the factors that makes them uncertain commodities.
Donor efficiency reports: what if donors are to blame?
Since many other factors can affect the “quality” of the material, the bank developed a “Donation Service” software to generate “donor efficiency reports” about every donor in its catalogue based on the data from all conducted egg donation programs. This allows the bank to identify the causes of every “failure”—vitrification, donor selection and stimulation protocol, thawing process, or egg morphology, chasing the effects of human/non-human difference and distributed agency (Whatmore 2002). The developer of the software, Dmitrii, works on collecting information from partner clinics on fertilization and pregnancy rates:
Why do we need this automatization? We have more and more work. It is about everything that we produce—what happens to it next. It is difficult because the full cycle of work of the biological material is completed not only at our place—it goes to the partners, and we need to get the information from them. In this way we can do everything in one click—efficiency of the donor, efficiency of each cooperation with the partner, the number of donation cycles (fresh and with vitrified eggs), the number of newly retrieved oocytes and vitrified oocytes available in the warehouse [informal name for the storage facility], the number of oocytes and embryos unloaded and sent to partners, their quality level, fertilization, cleavage arrest, implantation, and pregnancy rate. We can automatically see that today we had twelve sets of eggs added and three sets unloaded. We need to have up-to-date data about the number of eggs in stock each morning before the start of the work of distribution. (Dmitrii 2018)
By comparing the results of numerous donors, the software allows the bank to increase the value of eggs and cope with uncertainties represented by cases of failed fertilization. When bank partners blame unsatisfactory egg quality on the “bad performance” of the donor and demand compensation for the “failed” eggs, the staff respond with a practice they call “reclamation.” To avoid compensation, the staff use this software to prove to partners that the oocytes from the same donor and the same stimulation and vitrification have been thawed in other clinics with a good survival rate, resulting in fertilization and pregnancy. It can also demonstrate that the stimulation protocol and the process of vitrification at the bank did not negatively affect egg quality. The bank therefore once again transfers responsibility for quality to partner clinics, arguing that their embryologists have failed at thawing and fertilization of eggs.
Another way to avoid accountability while coping with the uncertainty of egg quality is to blame errors on donors—major contributing factor to the coproduction of uncertain socionature of egg fertilization and survival. Thus, the software is seen as a more efficient procedure to commodify eggs, specifically by dealing with donors. It allows the bank to control and assess donor’s “efficiency” from recruitment to stimulation protocol, the embryological manipulations performed on donated eggs, and pregnancy in a partner clinic. The software allows the bank to know in advance if the donor has “bad or good performance”—to identify donors whose eggs have not survived warming, did not result in fertilization and pregnancy in previous cycles or were categorized as “low quality.” The bank “blacklists” donors who have had “bad performance”—they can no longer offer their eggs to customers. Solomiia explains that the bank is very careful about donor performance:
We invest money into every donor, and we need to see if it is profitable for us to work with them in the last instance. On a weekly basis, we have meetings when we analyze our outcomes and the efficiency of the donors. Based on that meeting we decide—should we stimulate her further and use her oocytes or not? We understand that one donor can ruin the whole picture like a spoonful of acid. Once we know of a bad donor, we take her out from the catalogue—she is blacklisted. (Solomiia 2017)
If the staff believe eggs have not resulted in pregnancy because of the donor, they aspire to see which factors, like age, average amount of donations per donor, the number of eggs per egg retrieval, the number of cycles the donor went through, and the medications used in the protocol (the dosage, as well as the type of hormonal drugs) influence the rate of oocyte survival, fertilization, pregnancy, and childbirth, or the donor is producing “bad” eggs due to her lifestyle, health, or genetics:
The quality of the eggs depends on the planning of stimulation, and which medications we use, in which doses. It depends on the lifestyle of the donor, whether the donor is nervous, under stress, if there are additional factors that could have influenced it. After changing medication, adding additional biological additives, we analyze if quality has improved or if it is just the donor who has bad eggs. (Ira 2017)
While here the agency of human/non-human association is distributed across medical protocols, human biology, behavior and environment, and the discourse of “efficiency” and “automation” at the bank attempts to take natural variation out of this equation, blaming a single actor—egg donor—for the failure. By aiming to calculate and predict fertilization results and bank profits and tame eggs as “uncertain commodities,” the staff obscure the inherent uncertainty of the ontological choreography within an ART clinic—a dynamic coordination and “deftly balanced coming together of things that are generally considered parts of different ontological orders (part of nature, part of the self, part of society)” (Thompson 2005, p. 8). However, staff also realizes that there are uncertainties which cannot be eliminated as life cannot be controlled:
It is offensive that sometimes patients think that the donor is a machine that produces everything at a certain time and ejects it when we want her to. They forget that she is a human being. Yes, we have planned the program according to certain dates, but this is how the body reacts—there can be delays in menstrual cycle for several days or something else. We do everything to control it, but it is not possible. And the patients think it is just a computer that freezes. And there are some patients who complain: “Why did you change the date? You told us there is going to be a good result!” Yes, but there are many unpredictable situations in life, and this donor could be under a lot of stress. And then the stimulation is not as good as we planned or the results are not as good as we expected. This is life, we cannot control it. (Yustyna 2018)
Staff’s comments illustrate how donors’ biology and social context are coproducing eggs as uncertain commodities, posing obstacles to firms as they “seek to subordinate biophysical properties and processes to the dictates of industrial production” (Boyd et al. 2011). When the capital’s inability to fully reproduce, predict, and control nature comes to light, “failure” is blamed on what is perceived as disposable and expandable resource—worker’s body (Wright 2006). The uncertainty of production is outsourced to the reproductive worker, revealing hierarchical structure of political economy in which “dark value” of the women unacknowledged reproductive labor lies in the foundation of the appropriation of surplus by the bank (Clelland 2014).
Egg quality categories: what if egg morphology is to blame?
To determine which eggs will result in fertilization and which will not, to turn them into commodities whose value can be measured, and to calculate the price that will bring profits, since 2016 the bank subdivided vitrified eggs into three different quality categories based on their morphology: Q1—highest (morphologically perfectly round); Q2—medium (morphologically not perfectly round); and C—zero-quality (with morphological deviations). The bank used “medium-quality” eggs for their cooperation with Poland (where it sells 65–70% of all vitrified eggs), and sold the “highest-quality” eggs to everyone else (the EU, Canada, the USA). Vitrified oocytes all ended up in the bank’s “warehouse” with different price tags attached to them (from less to more expensive, respectively). From one egg retrieval, a certain number of “zero-quality” eggs would be still frozen, even though they did not look viable enough and were unlikely to be sold.
In 2016, the staff at the bank wanted to see the dynamics and proportion of the increase of the number of eggs in each quality category, to find out how many “zero-quality” eggs they produced for each “medium and highest-quality” egg. That would allow them to cut expenses and increase profits by improving the production mechanisms to yield more “higher-quality” eggs. It was difficult, because all “good-quality” eggs (Q1 and Q2) were sold and then the proportion of eggs stored in the bank was skewed toward the remaining “zero-quality” eggs.Footnote 12 This did not allow the bank to analyze which stimulation protocols were successful in producing “good-quality” eggs and which were not. In cases when the cause of “failure” was hard to identify, the responsibility for the “not so good quality” was once again attributed to the “donors’ performance.” However, by 2018 the bank abandoned this type of classification because it concluded that even morphologically imperfect eggs can result in pregnancy, and there are no means to predict this result.
Bank’s efforts to improve ova quality can be regarded as an attempt of the real subsumption of nature, when a firm succeeds to take hold of nature and achieve “systematic increases in or intensification of biological productivity” through application of knowledge and labor (Boyd et al. 2001, p. 564). The fact that biophysical systems can be forced by capital to operate as productive forces reveals how nature might be “an asset rather than a commodity, especially resources that can be intensified” (Birch and Tyfield 2013). However, the case of bank’s unsuccessful attempts to classify eggs in terms of quality and “selectively breed” “higher-quality” ova, illustrate an extent to which real subsumption of nature is limited, as the bank was unable to directly use natural processes as strategies for increasing productivity. Thus, constant manifestation of ova’s uncertainty and unpredictability resisted and shaped commodification process, pushing the bank back into the use of the strategies of formal subsumption.
Negotiating uncertain profits
Commodity status is never intrinsic to material things which have a fixed identity; rather, commodification is the result of socio-economic processes, actions, and circumstances, through which things are assigned certain characteristics as commodities. Specifically, distinct commodity bodies must be rendered commensurable and exchangeable through the medium of money (Castree 2003). From one point of view, the commodification of eggs is “real,” because scientific expertise and economic incentives at the bank transform eggs into separate entities with specific qualities which can be owned, monetized, alienated from their sellers, and separated from their contexts to be bought and sold on the market.Footnote 13 From another point of view, it may be seen as never complete (Krawiec 2016; Margaryan and Wall-Reinius 2017; Prudham 2003), because “nature puts barriers in the way of complete commodification” by producing “ecological, corporeal, and social effects that lead to problems for those selling the commodities in question” (Castree 2003, p. 281).
While the bank formerly counted their costs and established prices based on the overall number of eggs retrieved from one donor, they were unable to sell a large portion of these eggs. Despite the bank spending money on their production, vitrification, and storage, some of these eggs had “zero-quality,” the others had to be disbursed for free as a compensation for the “defective” eggs or were not present in sufficient numbers to produce an embryo, revealing the “problem of nature” for capital—contradiction-ridden and uneven processes of its formal subsumption (Boyd et al. 2001).
First, while the initial purpose of different quality categories was to increase the value of eggs by ensuring the predictability of thawing/fertilization results and increasing “high-quality”/filtering out “low-quality” oocytes, it resulted in increased uncertainty of eggs as commodities. As the bank was freezing “zero-quality” eggs they could not sell, their accumulation in storage undermined the value of those eggs that they were able to sell and distribute. Since according to internal research in the clinic, one in 16–18 “zero-quality” eggs resulted in fertilization, there were attempts to sell these at a lower price and larger quantities (selling as many oocytes as needed to produce one “good-quality” blast): these attempts failed.
Second, in cases when a partner clinic or individual couple complained about the survival rate of the eggs, the bank usually provided an additional batch of eggs (or returned the money) to compensate for “defective” eggs until several embryos are cultivated. For example, that happened when more than two out of eight vitrified eggs had cleavage arrest or less than four embryos were cultivated out of twelve vitrified eggs. Thus, although the frozen cycle had lower expenses and increased the bank’s profits, there were additional expenses connected to the uncertain outcomes of cycles with vitrified eggs, and the bank needed to reserve a certain number of eggs to send away for free. These costs could not always be predicted, which decreased the profits of the bank:
In our budget, we indicate a certain percentage of egg retrievals that are expected to be defective. Some retrievals do not give any good eggs at all. There is a certain percentage in our budget that presumes that it is medicine, it is not the production of cups and bowls, and does it match the reality? No. We need to explain to the patients that we have a good compensation scheme and while embryos are not good and they will not get pregnant, they will be compensated for another cycle and have more embryos to try to conceive. So, we need to have and give more vitrified oocytes than fresh from the beginning. (Solomiia 2016)
A third category of eggs that constituted bank’s losses were referred to as “leftovers”—eggs that did not make it to the sellable full sets of 6, 8, or 12 eggs. For example, when 13 eggs were donated, 8 eggs formed a set that was sold, and 5 remaining eggs could not be sold because they were often insufficient to result in an embryo or two. To make eggs more sellable, the bank divided eggs not in terms of quality, but in terms of quantity, creating a catalogue of eggs referred to as “small batches”—fewer than 6 eggs, which were often used in bank’s compensation schemes. Solomiia explains:
From the point of view of what we can sell, now we have big stocks that are sellable—where we have eight and more oocytes per donor. 6,095 eggs in these stocks. And we also have small batches—those are the leftovers that did not make it into the sets of eight, and we don’t always use them. For example, if we had 13 oocytes in egg retrieval, we sold eight of them and then we have five that are left. These five are not completely sellable, since when we will have to create an embryo from them, we may not have it, it is a risk. We know that to have one embryo, we need at least four oocytes. It is better still to have six, what if it does not work with four? And even better to have eight, because then we can choose a higher-quality embryo from several. (Solomiia 2018)
Noel Castree emphasizes the importance of understanding that “the process of capitalist commodification (or its effects) might operate rather differently depending on which particular natures are being commodified” (Castree 2003, p. 275) and that “different natures have different types and degrees of “agency,” which may assist or interfere with commodification (Castree 2003, p. 289). Similarly to Karen Bakker’s (2003) research on water privatization in the UK, the biophysicality of ova fertilization and embryo cultivation is “uncooperative” in its commodification. Since the number of unsellable items was hard or even impossible to predict, there was no agreement in the bank on the actual cost of the oocyte and the price that would bring profit, exacerbating the coproduction of eggs as uncertain commodities. The bank’s accountant Diana was concerned with financial reports that did not reflect the real expenses and profits of the bank because they were skewed toward unsellable items. She argued during the business meeting:
In our budget we include higher-quality oocytes that we successfully sold, while residues just pile up and stay at our warehouse in huge amounts. Leftover eggs, compensated eggs, and goods of a lower-quality (zero-quality eggs)—all are indicated as our expenses while we get the profit only from higher-quality eggs. So, the price is lower than it really is. For example, one egg retrieval gives us 20 oocytes, from which we sell 6 and 14 go to the warehouse. While we obtained the revenue only from the 6 higher-quality eggs that were sold, we count all these 20 goods as our aggregate expenditures. But we cannot sell zero-quality eggs because it undermines our image. To get rid of this euphoric warehouse that we do not sell, I suggest not to indicate them in the expenses and put all the expenses on those eggs that we are selling. Only in this way can we evaluate the profitability of cooperation with certain international partners. When there will be some decision and we will be able to sell zero-quality, it will be a direct profit for us. (Diana 2016)
Diana suggested including the expenses incurred to produce these unsellable eggs in the cost of the sellable oocytes, so ensuring the profitability of cooperation with partners and eliminating some of the uncertainty. This meant that the cost and the price of the oocyte must increase. When in 2018 the Medi Group purchased the bank, their representative Ivan met with the bank’s accountant Diana and the director Solomiia to ensure that the bank’s balance sheet reflected the actual situation in the warehouse. Ivan also emphasized that it would make sense to indicate on the balance sheets only those eggs that are sellable and in stock, thereby accounting only for “good-quality” vitrified eggs.Footnote 14 The bank has decided to write off (depreciate over time) unsellable eggs of lower quality and include them as capital rather than operational expenses.
It was not just eggs’ vital matter that contributed to bank’s accounting uncertainties, rather the agency here should be seen as distributed across human/non-human association. Bank staff remained very uncertain about how much money they spent on each donor’s stimulation, vitrification, fertilization, and transportation of eggs and how much profit they were making from each donor. The whole cycle of commodification of donors’ biomaterial spanned long periods of time and different geographical sites and was characterized by the information flows that were not always transparent and readily available. Thus, the staff had doubts whether certain partnerships were profitable. They hoped that “Donation Service” software would assist them in resolving the issue:
We know the general cost of medication for all stimulation protocols during a certain period, but it is very difficult to tell how much we spent for every donor. If we open the stimulation of every donor in Donation Service, we should be able to see the amount of money spent on the medications during her stimulation. Also, we need to know the amount of money spent on her medical tests. Also, it is impossible to finalize the expenses at the stage of stimulation protocol, when we do not know the result yet—how much we will spend on the transportation of eggs and how much money we will have to return as compensation for the defective eggs. Our financial director still cannot calculate these expenses. So, we need to calculate everything before and after the shipment, until the pregnancy is achieved in the partner clinic. We need to include reports from partners about the results of thawing and fertilization. Then, we can calculate the profit from every donor and the profit from every partner. We have a big question with Israel, are they profitable for us or not? Based on the amount of egg retrievals we conduct for them and adding the number of compensated eggs, it is way over the top compared to what we expected to have, so we need to decide to raise the price or to stop this cooperation and work with clinics that pay more. (Solomiia 2018)
Conclusion
This article examined how the egg banking industry produces and navigates the value of eggs as uncertain commodities. While the bank staff try to run their business according to the pragmatic logic of capitalist enterprise that values efficiency and predictability, the unpredictable nature of the eggs might resist or redirect the commodification process. Having a particular quality—their rate of survival and fertilization—ova co-produce together with industry and science a particular kind of commodification process, while also being coproduced in the process. The “quality” of eggs is contingent on whether they result in fertilization and that often depends on whether they are thawed and fertilized successfully in the clinic that purchased them. Thus, the value of eggs as commodities is produced not just in one place, but depends on how the biomaterial is transported and handled at different stages and how its quality is assessed by fertility clinics and individual couples that purchase them. While it is monetarily critical for the bank to ensure the “quality” of frozen ova and control the factors that affect it, it is unclear which factors influence the outcomes of treatments and to what extent, revealing the inherent uncertainty of the coproduction of nature/technology/capital. By revealing the distributed and relational agency of nature and vitrification technology in coproduction of ova as uncertain commodities, and by illustrating how uncertainties of ova “quality” shape value creation and capital accumulation in egg banking, this paper makes important and novel contributions to the field of reproductive technologies, political economy, economic geography, and science and technology studies concerned with the distinctiveness of capital’s production and commodification of nature and life.
The staff at the bank are concerned with the question of the “efficiency” of vitrification and thawing, leading them to investigate the relationship between the quality of eggs and donors’ “performance” and come up with different “scientific” categorizations of eggs (or make an effort to predict eggs “quality” based on their morphology and other factors). Like any business enterprise, the bank develops mechanisms to calculate the cost of production of eggs, decide on a price that will bring revenue, determine how much money they are making, and if their partnerships are profitable. Besides aspiring to calculate costs and prices, the bank also recognizes the vulnerability of the commodity it sells, which is different from just determining its value; it also means determining a classificatory scheme that would allow for greater sellability. However, since the success of ova commodification is a result of an assemblage of things, including the chances of survival and fertilization of vitrified eggs, human skills/knowledge, and quality assessments, all the losses and expenses that result from these uncertainties cannot be completely calculated in advance to ensure profitability. Even though egg commodification is real, it is never complete. Considering that the bank cannot predict in advance which eggs will be sellable, it runs into a variety of accounting issues: the bank staff are constantly concerned about spending too much on the production of eggs, selling too little, and compensating too many of them. While the bank has pioneered accounting for eggs in economic terms, there is no existing algorithm on how to organize profitable production of such biomaterials and, as a result, they cannot make the process of egg banking and distribution completely certain. By exposing these inner workings of international egg banks which has until now remained hidden, this paper adds a valuable empirical insight into the scholarship on the implications of egg banking for the commercialization, management, and valuation of eggs globally.
Data availability
The data that support the findings of this study are available on request from the corresponding author, PV. The data are not publicly available due to their containing information that could compromise the privacy of research participants.
Notes
The state-provided ARTs services or funding are very limited—only four public fertility clinics exist that conduct a small number of cycles funded by the state and only around 1000 Ukrainian couples have received treatment since 2011 (Ministry of Health of Ukraine 2004).
Article 123 in the Family Code of Ukraine (Verkhovna Rada Ukrainy 2002), Article 281 of the Civil Code of Ukraine (Verkhovna Rada Ukrainy 2003), Article 48 of the Law on the Foundations of the Legislation of Ukraine on Health Care (Verkhovna Rada Ukrainy 1993), and Decree 787 of the Ministry of Health of Ukraine (Ministry of Health of Ukraine 2013).
This is different for gestational surrogacy, which is accessible only to married heterosexual couples, since it is defined in the law as the “transfer of an embryo conceived by a married couple (male and female) to another woman’s uterus” (Verkhovna Rada Ukrainy 2003).
Compensation differs among different clinics, with some clinics paying different compensation based on the number of eggs donated and others paying more to donors of a desired phenotype.
Typical donor screenings include a gynecological check-up, vaginal swab, pap smear, pelvic scan, Rh-factor, LH, estradiol and progesterone levels, HIV test, karyotyping, CF, fragile-X and other DNA screenings, Hepatitis B and C tests, cytomegalovirus, IgM, Syphilis screening, and general blood count.
392 sets (4,743 oocytes)—(65%)—were sold to its partner clinics in Poland, 912 to their partner clinics in Macedonia, 166 to Bulgarian partners, 192 to their partner clinic in the UK, 34 oocytes were delivered to Spain, 14 to Mexico, 42 to Canada, 28 to USA, 30 to Ghana, 8 to Argentina, and 92 to Albania. The bank has conducted 244 programs with UK partners since 2015.
Since 2006, when Cryova started its first international partnership with AFC clinic in Dublin, it had been providing around 8 vitrified embryos for 15–17 Irish couples every month and a half. In 2014 the clinic also started to provide materials to 4 large clinics in Israel. In 2017, the total number of cycles with “fresh” oocytes conducted for cooperation with Israeli clinics was 338 and 707 programs were performed since 2014. For example, to the large Israeli clinic Suta the bank sent embryos for 20–25 couples every month, to the clinic Liya—monthly shipment included embryos for 10–12 couples.
More than 8 vitrified oocytes are required to achieve a delivery rate of 46% (Rienzi et al. 2012).
During a meeting, it was mentioned that in one of the Israeli clinics 85% of their eggs were fertilized, with a 96% cleavage rate, and 89% good-quality embryos survived. The couples get 5.3 highest- and medium-quality embryos per cycle.
The fact that the medium in which the oocytes are thawed was 2 days older, or the temperature, or humidity, or adjustment of gases in the incubator were different, could result in a lower survival rate, so all these factors must be controlled on both sides.
Solomiia mentions during a business meeting in 2018: “Now we have 218 sets of eggs: 116—zero quality, 45—medium quality, and 57—highest quality. This is the overall number of eggs in the bank”.
Building on Castree’s classification, ova commodification presupposes privatization (ova belonging to different parties who are free to alienate them), alienation and individuation (they can be physically separated from their sellers and from their context in order to be sold to others), abstraction (each individual egg treated as one out of a broader class), valuation (they take on exchange value), and displacement (their value form occludes the relations of their production) (Castree 2003).
However, there are a certain number of “fresh” eggs (around 3,500 according to the accounting documents for March 2018) that are fertilized immediately after egg retrieval, so they do not physically exist in the stock, but they have a certain cost and price as well as vitrified ones. Since the Medi Group representative emphasized that the accounting data must reflect the embryologist data (number of retrieved eggs) together with the actual cost of the eggs so that Medi Group management has an idea how much the firm is actually worth, the bank did not know whether fresh eggs that are turned into embryos and then sent to clinics should be reflected in the accounting books.
References
Alaimo, S., S. Hekman, and S. J. Hekman, eds. 2008. Material Feminisms. Bloomington: Indiana University Press.
Arian, S., J. Griffith, C. Witz, and W. Wang. 2014. Comparison of Vitrified Versus Fresh Donor Oocytes. Fertility and Sterility 101 (2): E31.
Bakker, K. J. 2003. An Uncooperative Commodity: Privatizing Water in England and Wales. Oxford: Oxford University Press.
Bakker, K. J. 2012. The ‘Matter of Nature’ in Economic Geography. In The Wiley-Blackwell Companion to Economic Geography, ed. Trevor J. Barnes, Jamie Peck, and Eric S. Sheppard, 104–117. Chichester: Wiley-Blackwell.
Bakker, K. and G. Bridge. 2006. Material Worlds? Resource Geographies and the ‘Matter of Nature.’ Progress in Human Geography 30 (1): 5–27.
Baldwin, K., D. Gray, and N. Hudson. 2019. On Ice: The Impact of Vitrification on the Use of Eggs in Fertility Treatment. Emerging Topics in Life Sciences 3 (6): 713–717. https://doi.org/10.1042/ETLS20190062.
Barad, K. 2007. Meeting the Universe Halfway: Quantum Physics and the Entanglement of Matter and Meaning. Durham, NC: Duke University Press.
Becker, M. C., and T. Knudsen. 2005. The Role of Routines in Reducing Pervasive Uncertainty. Journal of Business Research 58 (6): 746–757.
Bennett, J. 2010. Vibrant Matter: A Political Ecology of Things. Durham and London: Duke University Press.
Birch, K., and D. Tyfield. 2013. Theorizing the Bioeconomy: Biovalue, Biocapital, Bioeconomics or …What? Science, Technology, & Human Values 38 (3): 299–327.
Boyd, W., W.S. Prudham, and R.A. Schurman. 2001. Industrial Dynamics and the Problem of Nature. Society and Natural Resources 14 (7): 555–570.
Braun, B. 2008. Environmental Issues: Inventive Life. Progress in Human Geography 32 (5): 667–679.
Braun, B. 2015. New Materialisms and Neoliberal Natures. Antipode 47: 1–14.
Bridge, G. 2011. The Economy of Nature: From Political Ecology to the Social Construction of Nature. In The SAGE Handbook of Economic Geography, ed. Andrew Leyshon, Roger Lee, and Linda Mcdowell, 217–230. London: Sage.
Castree, N. 1995. The Nature of Produced Nature: Materiality and Knowledge Construction in Marxism. Antipode 27: 12–12.
Castree, N. 2002. False Antitheses? Marxism, Nature and Actor-Networks. Antipode 34 (1): 111–146.
Castree, N. 2003. Commodifying What Nature? Progress in Human Geography 27 (3): 273–297.
Centre For Health Statistics of The Ministry of Health of Ukraine. 2023. Zvit Pro Dopomizhni Reproduktyvni Texnolohiyi za 2022 (Statistics about Assisted Reproductive Technologies in 2022).
Cambiaghi, A. S., B. R. F. Leao, A. V. Alvarez, P. B. Martins, and P. F. Nascimento. 2014. Elective Cryopreservation of All Embryos and Subsequent Cryothaw Embryo Transfer Results in Better Outcomes than Fresh Embryo Transfer in Shared Egg Donor Program. Fertility and Sterility 102 (3): E226–E227.
Clelland, D. A. 2014. Unpaid Labor as Dark Value in Global Commodity Chains. In Gendered Commodity Chains: Seeing Women’s Work and Households in Global Production, ed. Wilma A. Dunaway, 72–90. Stanford, CA: Stanford University Press.
Collard, R.C., and J. Dempsey. 2013. Life for Sale? The Politics of Lively Commodities. Environment and Planning A 45 (11): 2682–2699.
Colombino, A., and P. Giaccaria. 2016. Dead Liveness/Living Deadness: Thresholds of Non-Human Life and Death in Biocapitalism. Environment and Planning D: Society and Space 34 (6): 1044–1062.
Cooper, M. 2008. Life as Surplus: Biotechnology and Capitalism in the Neoliberal Era. Seattle, WA: University of Washington Press.
Cooper, M., and C. Waldby. 2014. Clinical Labor: Tissue Donors and Research Subjects a the Global Bioeconomy. Durham: Duke University Press.
Corbin, J. M., and A. Strauss. 1990. Grounded Theory Research: Procedures, Canons, and Evaluative Criteria. Qualitative Sociology 13 (1): 3–21.
Diana. 2016. Interview. Conducted by Polina Vlasenko.
Dmitrii. 2018. Interview. Conducted by Polina Vlasenko.
Ellis, R. A., T. Weis, S. Suryanarayanan, and K. Beilin. 2020. From A Free Gift of Nature to a Precarious Commodity: Bees, Pollination Services, and Industrial Agriculture. Journal of Agrarian Change 20: 437–459.
European IVF Monitoring Consortium (EIM), for the European Society of Human Reproduction and Embryology (ESHRE); C. Wyns, C. De Geyter, C.Calhaz-Jorge, M.S. Kupka, T. Motrenko, J. Smeenk, C. Bergh, A. Tandler-Schneider, I.A. Rugescu, and V. Goossens. 2022. ART in Europe, 2018: Results Generated from European Registries by ESHRE. Human Reproduction Open 3:22. https://doi.org/10.1093/hropen/hoac022
Feng, G., B. Zhang, H. Zhou, J. Shu, X. Gan, F. Wu, and X. Deng. 2012. Comparable Clinical Outcomes and Live Births after Single Vitrified–Warmed and Fresh Blastocyst Transfer. Reproductive Biomedicine Online 25 (5): 466–473.
Franklin, S. 2007. Dolly Mixtures: The Remaking of Genealogy. Durham, NC: Duke University Press.
Glaser Barney, G., and L. Strauss Anselm. 1967. The Discovery of Grounded Theory: Strategies for Qualitative Research. New York: Adline De Gruyter.
Haraway, D. J. 1991. Simians, Cyborgs, Aand Women: The Reinvention of Nature. London: Free Association Books.
Haraway, D. J. 2003. The Companion Species Manifesto: Dogs, People, and Significant Otherness (Vol. 1, pp. 3–17). Chicago: Prickly Paradigm Press.
Haraway, D. J. 2008. When Species Meet. Minneapolis: University of Minnesota Press.
Haraway, D. J. 2012. Value-Added Dogs and Lively Capital. In Lively Capital: Biotechnologies, Ethics and Governance in Global Markets, ed. Sunder Rajan, Kaushik, 93–120. Durham: Duke University Press.
Helmreich, S. 2008. Species of Biocapital. Science as Culture 17 (4): 463–478.
Henderson, G. 1999. California and the Fictions of Capital. Oxford: Oxford University Press.
Hoeyer, K. 2013. Exchanging Human Bodily Material: Rethinking Bodies and Markets. Berlin: Springer.
Hudson, N., L. Culley, C. Herbrand, V. Pavone, G. Pennings, V. Provoost, C. Coveney, and S. L. Funes. 2020. Reframing Egg Donation in Europe: New Regulatory Challenges for a Shifting Landscape. Health Policy and Technology 9 (3): 308–313.
Ira. 2017. Interview. Conducted by Polina Vlasenko.
Krawiec, K. D. 2016. Lessons from Law about Incomplete Commodification in the Egg Market. Journal of Applied Philosophy 33 (2): 160–177.
Kroløkke, C. H. 2018. Global Fluids: The Cultural Politics of Reproductive Waste and Value. New York: Berghahn Books.
Latour, B. 1993. We Have Never Been Modern. Cambridge, MA: Harvard University Press.
Latour, B. 2005. Reassembling the Social: An Introduction to Actor-Network-Theory. New York: Oxford University Press.
Margaryan, L., and S. Wall-Reinius. 2017. Commercializing the Unpredictable: Perspectives from Wildlife Watching Tourism Entrepreneurs in Sweden. Human Dimensions of Wildlife 22 (5): 406–421. https://doi.org/10.1080/10871209.2017.1334842.
Ministry of Health of Ukraine. 2004. Nakaz 579 Pro Zatverdzhennia Poriadku Napravlennia Zhinok dlia Provedennia Pershoho Kursu Likuvannia Bezplidnosti Metodamy Dopomizhnykh Reproduktyvnykh Tekhnolohii za Absoliutnymy Pokaznykamy za Biudzhetni Koshty. (A Decree #579 On the Approval of the Procedure of the Referral of Women with Absolute Indications for the First Cycle of Infertility Treatment with the Help of Assisted Reproductive Technologies for Budgetary Funds). https://Zakon.Rada.Gov.Ua/Laws/Show/Z0224-05#Text
Ministry of Health of Ukraine. 2013. Nakaz 787 Pro Zatverdzhennia Poriadku Zastosuvannia Dopomizhnykh Reproduktyvnykh Tekhnolohij v Ukraini. (The Decree 787 On Instructions on the Use of Assisted Reproductive Technologies in Ukraine). https://Zakon.Rada.Gov.Ua/Laws/Show/Z1697-13#Text
Mitchell, R., and C. Waldby. 2010. National Biobanks: Clinical Labor, Risk Production, and the Creation of Biovalue. Science, Technology, & Human Values 35 (3): 330–355.
Parry, B. 2012. Economies of Bodily Commodification. In The Wiley-Blackwell Companion to Economic Geography, ed. T. Barnes, J. Peck, and E. Sheppard, 213–225. Malden: Blackwell.
Philip. 2018. Interview. Conducted by Polina Vlasenko.
Practice Committees of the American Society for Reproductive Medicine and Society of Reproductive Biologists and Technologists. 2021. A Review of Best Practices of Rapid-Cooling Vitrification for Oocytes and Embryos: A Committee Opinion. Fertility and Sterility 115 (2): 305–309.
Prudham, S. 2003. Taming Trees: Capital, Science, and Nature in Pacific Slope Tree Improvement. Annals of the Association of American Geographers 93 (3): 636–656.
Prudham, W.S. 2005. Knock on Wood: Nature as Commodity in Douglas -Fir Country. New York: Routledge.
Rienzi, L., A. Cobo, A. Paffoni, C. Scarduelli, A. Capalbo, G. Vajta, J. Remohí, G. Ragni, and F. M. Ubaldi. 2012. Consistent and Predictable Delivery Rates after Oocyte Vitrification: An Observational Longitudinal Cohort Multicentric Study. Human Reproduction 27 (6): 1606–1612. https://doi.org/10.1093/Humrep/Des088.
Rienzi, L., S. Romano, L. Albricci, R. Maggiulli, A. Capalbo, E. Baroni, S. Colamaria, F. Sapienza, and F. Ubaldi. 2010. Embryo Development of Fresh ‘Versus’ Vitrified Metaphase II Oocytes After ICSI: A Prospective Randomized Sibling-Oocyte Study. Human Reproduction 25 (1): 66–73. https://doi.org/10.1093/Humrep/Dep346.
Robertson, M. 2004. The Neoliberalization of Ecosystem Services: Wetland Mitigation Banking and Problems in Environmental Governance. Geoforum 35: 361–373.
Rose, N. S. 2007. Politics of Life Itself: Biomedicine, Power, and Subjectivity in the Twenty-First Century. Princeton, NJ: Princeton University Press.
Shukin, N. 2009. Animal Capital: Rendering Life in Biopolitical Times. Minneapolis: University of Minnesota Press.
Solé, M., J. Santaló, M. Boada, E. Clúa, F. I. Rodríguez, B. C. Martínez, P.N. Barri, and A. Veiga. 2013. How Does Vitrification Affect Oocyte Viability in Oocyte Donation Cycles? A Prospective Study to Compare Outcomes Achieved with Fresh Versus Vitrified Sibling Oocytes. Human Reproduction 28 (8): 2087–2092.
Solomiia. 2016. Interview. Conducted by Polina Vlasenko.
Solomiia. 2017. Interview. Conducted by Polina Vlasenko.
Solomiia. 2018. Interview. Conducted by Polina Vlasenko.
Sunder Rajan, K. 2012. Lively Capital: Biotechnologies, Ethics, and Governance in Global Markets. Durham: Duke University Press.
Swyngedouw, E. 1999. Modernity and Hybridity: Nature, Regeneracionismo, and the Production of the Spanish Waterscape, 1890–1930. Annals of the Association of American Geographers 89 (3): 443–465.
Tamar. 2018. Interview. Conducted by Polina Vlasenko.
Thompson, C. 2005. Making Parents: The Ontological Choreography of Reproductive Technologies. Cambridge, MA: MIT Press.
Trokoudes, K. M., C. Pavlides, and X. Zhang. 2011. Comparison Outcome of Fresh and Vitrified Donor Oocytes in an Egg-Sharing Donation Program. Fertility and Sterility 95 (6): 1996–2000.
Verkhovna Rada Ukrainy. 1993. Stattia 48. Shtuchne Zaplidnennya ta Implantaciya Embriona (Article 48. Artificial Fertilization and Embryo Implantation). In Zakon Ukrainy Osnovy Zakonodavstva Ukrainy Pro Oxoronu Zdorov’ya (The Law of Ukraine on The Foundations of the Legislation of Ukraine on Health Care). https://Zakon.Rada.Gov.Ua/Laws/Show/2801-12#Text
Verkhovna Rada Ukrainy. 2002. Stattia 123. Vyznachennia Pokhodzhennia Dytyny, Narodzhenoi v Rezul’tati Zastosuvannia Domozhizhnyh Reproduktyvnykh Tekhnologii. (Article 123. Identification of the Child’s Origin, Born as a Result of the Use of Assisted Reproductive Technologies). Ukrainian Family Code #2947-III. https://Zakon.Rada.Gov.Ua/Laws/Show/2947-14
Verkhovna Rada Ukrainy. 2003. Stattia 281. Pravo na Zhyttya (Article 281. A Right for Life). Civil Code of Ukraine #435-IV. https://Zakon.Rada.Gov.Ua/Laws/Show/435-15
Vlasenko, P. 2021. Global Circuits of Fertility: The Political Economy of the Ukrainian Ova Market. PhD thesis. Indiana University.
Waldby, C. 2019. The Oocyte Economy: The Changing Meaning of Human Eggs. Durham, NC: Duke University Press.
Waldby, C., and R. Mitchell. 2006. Tissue Economies: Blood, Organs, and Cell Lines in Late Capitalism. Durham, NC: Duke University Press.
Whatmore, S. 1999. Hybrid Geographies: Rethinking the ‘Human’ in Human Geography. In Human Geography Today, ed. Doreen B. Massey, John Allen, and Philip Sarre, 22–40. Cambridge: Polity Press.
Whatmore, S. 2002. Hybrid Geographies: Natures Cultures Spaces. Newcastle upon Tyne: Sage.
Wright, M. W. 2006. Disposable Women and Other Myths of Global Capitalism. New York: Routledge.
Yustyna. 2018. Interview. Conducted by Polina Vlasenko.
Acknowledgements
First and foremost, I want to thank the most important contributors to this project – my research participants: egg donors and fertility specialists in Ukraine, who shared with me their aspirations and concerns. I would like to thank the Department of Anthropology, Russian and East European Institute and Russian Studies Workshop at Indiana University, my advisor Sarah D. Phillips, and the members of my Doctoral Committee, Sara L. Friedman, Andrea S. Wiley, and Lessie Jo Frazier, Estonian Research Council, Tallinn University and Eeva Kesküla for supporting this research.
Funding
Funding was provided by Eesti Teadusagentuur (Grant Number MOBJD1077).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Ethical approval
The manuscript is comprised of original material that is not under review elsewhere. The study has been subject to IRB ethical review at Indiana University Bloomington.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
I use the term “quality” (yakist in Ukrainian) throughout this article, as it was the term most commonly used by my informants to discuss eggs survival and fertilization rates.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Vlasenko, P. Uncertain commodities: egg banking and value in Ukraine. BioSocieties (2023). https://doi.org/10.1057/s41292-023-00307-w
Accepted:
Published:
DOI: https://doi.org/10.1057/s41292-023-00307-w