Indirect Financial Inducement

The disparities in the regulatory frameworks governing egg donation and its remuneration—and the concomitant differences in the availability of donor eggs—play a key role in motivating TWEB’s US-UK egg trade. In contrast with the relatively unregulated US fertility industry, the HFEA, which licenses all UK fertility clinics, sets limits on the payments for egg procurement.¹³ These limits have risen steadily over the last two decades—in part in response to the increasing popularity of purchasing eggs abroad to circumvent UK waiting lists. The HFEA has increased maximum payments from £15 per cycle in 1998 to £250 in 2005 and £750 in 2011.¹⁴ The maximum payment for donors of imported eggs was, however, maintained at £250 in loss of earnings per cycle.¹⁵ Testifying to the influence of financial compensation in motivating egg donors, the number of egg donors increased by 35% in the two years after 2011.¹⁶ Although around half of the UK clinics reported an increase in egg donations after 2011, donor shortages remained—particularly for Black and minority ethnic intended parents seeking eggs from “phenotypically similar” donors—and British patients continued to travel abroad to seek treatment with overseas donor eggs.¹⁷

Notably, the HFEA regulations only seek to avoid the financial inducement of potential egg donors. Meanwhile, other parties, such as TWEB, international courier companies, and the recipient’s clinic, may operate on a commercial basis—i.e., be financially induced to engage women in egg procurement. This disparity suggests a regulatory emphasis on egg freezing and egg donation as an individual’s consideration, rather than a focus on the socio-institutional contexts that frame and promote egg donation. In other words, it governs direct but not indirect financial inducement.

When the business models and profit margins of fertility companies are not governed by regulatory limits, they may provide an indirect financial inducement to promote specific treatment choices or patient recruitment practices. One example of such financial inducement comes from the Australian market leader Virtus Health, the world’s first publicly listed fertility business, which owns—among many other clinics across the world—the Queensland Fertility Group, a partnership clinic of TWEB.¹⁸ Virtus Health directly financially induces its clinicians to deliver high numbers of IVF cycles through its High Performer Share Incentive Scheme. This scheme financially rewards fertility specialists who “consistently deliver more than 400 cycles per annum for a consecutive three year period” because “the Board recognises those fertility specialists that achieve a high level of fresh cycles over a defined period acknowledging the value they generate for shareholders.”¹⁹ Situated within a regime of financialized capitalism, which Nancy Fraser describes as authorizing finance capital to discipline publics in the immediate interests of investors, the fertility company here becomes beholden not only—or even primarily—to its patients but also to its shareholders.²⁰ While regulations governing individual patients’ and donors’ reproductive decision making abound, the business practices that affect patients and their treatment choices by financially inducing their doctors to “deliver” more cycles are not subject to similar regulatory scrutiny.

In the case of frozen egg donation and TWEB, the modes of indirect financial inducement differ from those governing the Virtus example—or, for that matter, fresh egg donation. In UK and US fresh egg donation, intended parents typically pay for the donor to undergo a cycle, irrespective of the number of eggs produced. This arrangement reflects the ethical justification upheld by both the HFEA and the ASRM—if with different monetary standards—that women are compensated for their time, inconvenience, and expenses, rather than for their bodily tissue.²¹ However, in frozen egg-donation practices, such as TWEB’s, the recipients order a specific number of eggs at a fixed price, instead of linking payment directly to the donor’s cycle. Consequently, the number of tradeable eggs a woman produces per cycle directly affects her profitability for the organization.

TWEB’s egg donors receive $3,000 to $6,000 compensation per cycle, and on average the company “retrieve[s] 12–18 mature eggs per donor.”²² Frozen eggs are sold in batches of six for $16,500, plus $1,600 for international shipping and, where applicable, a $3,000 “Asian fee” for eggs from Asian donors. Provided the eggs are selected by intended parents, the average donor cycle could therefore generate between $36,200 and $54,300 revenue. The difference between retrieving 12 or 18 eggs from a donor can thus translate to an $18,100 difference in revenue for the Egg Bank. By charging for a specific number of eggs rather than a cycle, TWEB’s sales model commodifies the individual eggs rather than the egg donor’s labor and expenses.²³ This model links capital accumulation directly to the outcome of the donor’s cycle and thereby creates a financial incentive that favors donors and stimulation protocols that produce more eggs per cycle.

This is not unique to TWEB; frozen eggs are typically not sold by cycle, but as a particular number of eggs. Major US egg banks such as Donor Egg Bank USA (part of Generate Life Sciences) and Fairfax Egg Bank sell “lots” or “cohorts” of five to eight eggs. Cryos, the world’s largest sperm bank, known for its Danish “Viking sperm,” also has an egg bank in Florida, which sells individual eggs for $2,300–$2,500 each. My Egg Bank, part of the Prelude Network, similarly ships lots of six to eight eggs to affiliate clinics and offers guarantee programs for the creation of one or more embryos after a partner or donor ships sperm to the egg bank. These embryos can then be shipped to the intended mother’s clinic.²⁴ When the remuneration of donors is organized per cycle, and the resultant eggs are sold in a set quantity, donors producing more eggs per cycle become more profitable for the egg bank. While egg banks may or may not adjust their practices accordingly, it is nonetheless important to note that this particular business model sets up financial incentives that reward exactly that. So while regulations and bioethical discussions focus on limiting remuneration to limit egg donors’ financial inducement, the indirect financial inducement resulting from the financial incentives in for-profit egg banks remains unchecked.²⁵

Deterritorializing Egg Donation

The question of financial inducement takes on a different character when the donor eggs are intended to be shipped from the United States to the United Kingdom. Taking up the UK’s donor egg shortage as a business opportunity, TWEB’s home page includes a prominent “Welcome UK” section, which links to a page explaining that a selection of TWEB egg donors complies with the UK’s HFEA’s Code of Practice.²⁶ Accordingly, each TWEB donor has to decide whether to become an international donor, which entails agreeing to the release of identifying information when the child turns 18 and receiving less financial compensation—a consideration situated in a US cultural context that favors altruistic donations and encourages donors to downplay financial motivations.²⁷ While the compensation to so-called international egg donors is curtailed, the price of the frozen eggs remains the same for UK patients. By catering to the HFEA requirements, TWEB demonstrates how the international movement of eggs affects local egg-donation practices, thereby extending UK regulations to new territories—along the pathway of the eggs’ cold chain. Emerging with the transnational cryo-egg flows is, then, a deterritorialization of egg donation, pertaining to the regulations, remunerations, and specific donation practices they engender.

This deterritorialization of egg donation works in both directions and is propelled by the cross-border movement of eggs. Besides the introduction of UK remuneration practices into the US clinic, the movement of cryo-eggs into the United Kingdom also imports at least two important aspects of US egg-donation practices. Firstly, frozen egg banking changes the temporal dynamic of international egg procurement; whereas fresh egg donation is characterized by a degree of uncertainty about the outcome of the donor’s treatment, which may take up to three months, cryopreserved eggs are available for immediate shipment and do not require synchronization between the two women’s cycles. Because there is no need to await a match between recipient and donor to start a stimulation cycle, egg banks can accommodate both a continuous supply of eggs by donors and a continuous demand for “high-quality” eggs in anticipation of a diverse group of future intended parents not limited to the local population. If there are enough donors and recipients available, egg banks can thus speed up the egg-donation process by stalling the eggs’ cellular time. TWEB’s specific transatlantic egg flows likewise may speed up egg-donation procedures by making the more abundant bioavailability and variety of donor eggs in the United States accessible for local treatment of UK intended parents. For those patients seeking to avoid waiting lists, this speeding up of the reproductive process may be a key motivator for purchasing eggs abroad.

The second key element that frozen US oocytes import into the United Kingdom is the particular discursive framing of the eggs by TWEB and the concomitant choice for a specific donor by the intended parents. In the United Kingdom, the choice for an egg donor is anonymized and typically made by the fertility clinic, rather than by the intended parent. The clinic normally controls “all aspects of the matching process,” including the classification of donors, the range of preferences recipients can specify, and the allocation of donors to intended parents.²⁸ Priya Davda’s research into matching in UK egg donation highlights some of the issues that may arise with this practice. She found that the matching process “singled out ‘race’ as a primary indicator of kinship and ‘racial difference’ as a primary ‘kinship risk.’” She describes how “clinicians sought to curtail BME [Black and minority ethnic] recipients’ reproduction of racialised white features whilst maintaining the reproduction of racialised white features of white British recipients.”²⁹ Instead of clinicians allocating donors to recipients, the London Egg Bank allows intended parents to do their own matching through an online catalogue.³⁰ This catalogue includes donor characteristics such as weight, height, eye, hair, and skin color, and categorizations of “race” and “religion” along with medical test results and keywords on “personality” and “hobbies.” The London Egg Bank explicitly foregrounds its use of individualized—if anonymized—donor presentation in its marketing with slogans like, “The choice is yours. You are in control.”

TWEB nevertheless introduces a much more specific donor choice in the United Kingdom through its detailed online catalogue. While the frozen donor eggs cross a greater spatial distance for UK egg recipients, TWEB offers a closer encounter with the donor through profiles that include photographs as well as donor statements about their talents, reasons for donating, favorite books, future goals, and exercise habits. The profiles also feature a detailed medical history, including birth control method, abortions, plastic surgery, and diagnosed conditions—from dwarfism to near-sightedness—of the donor and her (biogenetically related) family members. TWEB’s profiles are carefully constructed to meet widespread preferences for healthy donors who physically resemble the intended parents, but they also invite selection based on traits like beauty, intelligence, and athleticism through photographs of graduation ceremonies, beauty pageants, and cheerleading. Similarly, the textual descriptions of the donors convey gender-specific positive traits that intended parents are expected to be looking for, such as caring qualities, altruism, or maternal solidarity with infertile people. The profiles thereby attest to the importance of not only the eggs’ bioavailability but also their “biodesirability” in cross-border reproductive care.³¹ By extension, the introduction of these biodesirability markers to people receiving donor-egg IVF treatment in the United Kingdom may be a driving factor for transnational egg movements.

TWEB website’s interface is organized around this more detailed type of reproductive decision making for the most biodesirable egg donor. Rival international egg and sperm bank Cryos has designed its website with donor profiles specifically “to resemble Match.com, a dating site,” because, according to its founder, “finding a donor should be as close to finding a natural partner as possible.”³² TWEB’s website similarly facilitates such a search by offering the option of arranging profiles in “ascending” or “descending” order based on organizing categories like “weight” and “height,” thereby inviting a comparison between the donors. Likewise, filters allow recipients to only show blue-eyed or French-ancestry donors, thereby presenting racialized categorizations as key considerations to potential egg recipients.

The interface and metrics of these online platforms demonstrate how transnational egg donation is embedded in systems of social organization based on race, class, and nationality. There is a prevalent preference among intended parents for egg donors who look like themselves, in order to invisibilize the donation process. This leads to a demand for egg donors who reflect the racial and class disparities in the take-up of these technologies; in the United States, the vast majority of patients are middle- or upper-middle-class, and white women are more than twice as likely to access fertility services as Hispanic or Black women.³³ In keeping with this, Catherine Waldby notes that the availability of donors of “Caucasian” appearance, “which matches that of [the majority of] the North European purchasers,” explains the popularity of Spanish and Eastern European clinics in transnational egg donation.³⁴

Beyond resemblance, Carolin Schurr emphasizes the importance of (post)colonial imaginaries of white desirability in her study of transnational assisted reproduction in Mexico, where higher value is ascribed to white eggs and egg donors, while the differential selection of egg donors and surrogates reflects how the genetic traits of nonwhite women are devalued.³⁵ In her study of US egg donation, Anne Pollock similarly writes that “most of those with the means to use the technology are seeking white eggs, and it is likely that even among those Black egg consumers dark skin is undesirable.”³⁶ Daniels and Heidt-Forsythe found that dominant cultural norms of white femininity were overrepresented in gamete databases, as “egg donors [we]re racially whiter, taller, thinner, and more highly educated than the national average of women their age.”³⁷ While Rene Almeling’s research into the egg-donation industry found that clinics have trouble “recruiting diverse donors” and therefore may pay African American women more for their eggs, Diane Tober’s study of hundreds of US egg donors found that Black egg donors were paid significantly less for their eggs than white or Asian donors.³⁸ At TWEB, intended parents pay an additional “Asian fee” for eggs from donors with an Asian background, probably reflecting the increased demand for donor eggs following China’s shift to a two-child policy.³⁹ Through these varying dynamics of supply and demand in egg-donation practices such as TWEB’s, “race/ethnicity is genetically reified to the degree that it serves as the basis for program filing systems.”⁴⁰ The mobility of frozen eggs moreover accommodates a wider range of nationally specific and racialized origin stories for eggs that may be accessed from the comfort of one’s home.

Otherwise unavailable to British intended parents, these particular presentations of the egg through visual and textual representations of donors introduce new dimensions of consumer choice to the recipients. As a result, the intended parents choose not whether they would like to receive a donor egg preselected by a medical team but which donor egg would suit them best. This choice introduces a higher degree of patient agency over the reproductive process that may reposition conventional anonymous egg donation as lacking in comparison. From the UK perspective, frozen egg imports thus enable a move from a system in which the clinic is trusted to match intended parents to egg donors to one in which patients adopt a more agentic role in the donor-selection process. The TWEB donor catalogue, in turn, functions as an instrument of fostering trust in spite of its distance from intended parents by means of its detailed disclosure of donor characteristics. And in doing so, the online donor-selection system enables choices that at once reify, reflect, and reproduce the very social hierarchies of race, class, and cultural privilege that shape the direction of the transnational egg flows in the first place.

Cryo-egg Cold Chains and the Stratification of Reproductive Aging

While the speedy bioavailability and the choice for biodesirability drive these US-UK egg movements, the underlying demand for egg donation—both for donors and recipients—emerges from age-specific social realities. In a majority of cases, eggs move from fertile younger women to older women with age-related infertility. TWEB donors only qualify if they are between 18 and 29 years old, while UK women seeking donor eggs abroad are on average around 40 years old.⁴¹ Furthermore, reproductive youth tends to have an inverse relation with financial means, and many young women—especially those who bear the expenses associated with their own “proven fertility”—are attracted to egg donation for the financial compensation.⁴² As described on their Eggs without Borders blog, TWEB specifically focuses on recruiting students—targeting campus newspapers and handing out TWEB flip-flops and sunglasses—given that they are typically young and their education levels are a selling point. One blogpost announces that “ASU’s [Arizona State University] Spring Semester will soon be underway…. With thousands upon thousands of qualified young women moving back into the area, The World Egg Bank is giving them the resources they need to learn more about egg donation.”⁴³ Such recruitment drives coincide with a time in which US students are in an increasingly precarious financial situation as university tuition and living costs rise and available grants and scholarships fall.⁴⁴ Moreover, at times of financial recession, young American women who are not students are particularly vulnerable to unemployment, making the option of donating eggs financially attractive.⁴⁵

On the other side of the ocean, and the other side of the donor-recipient relation, British women approaching 40 are relatively well-to-do compared to younger age groups.⁴⁶ Women who turn to overseas egg donation as a second option after failed treatments with their own eggs are typically older than women who try IVF for the first time—averaging around 40 years compared to 35.⁴⁷ As reproductive youth becomes a transferable quality that may be “outsourced” to women across the world, these intersections of age, gender, fertility, and economic means drive the international movements of eggs.

A variation on the distribution of reproductive aging between bodies and eggs in OC, transnational egg flows likewise distribute reproductive aging in a heterologous fashion between bodies and eggs across the globe. Now spanning a much larger spatial scale, it intersects the physicality of cellular and physical reproductive age with broader political-economic structures. As a form of distributed reproductive aging, the reproductive youth materialized in the egg gains a transferable quality, and its production may be outsourced to women across the world.

While cross-border egg donation was previously geographically limited by the distances intended parents and donors were willing to travel, the mobility of frozen eggs allows the extension of international egg-donation networks across the globe. Although TWEB’s egg transfer discussed above occurs between two relatively privileged national contexts, future flows of eggs—following the logic of the existing cross-border trade of fresh eggs—may follow a trajectory from poorer donors to wealthier intended parents, from less regulated national contexts to more restrictive health systems, as well as from younger to older women. These cross-border egg flows emerge in the context of global patterns of inequality in which re/productive labor moves along “transnational hierarchies that are the legacy of colonial, imperial and diasporic ‘non-flat world’ routes.”⁴⁸ Situated in systems of oppression, Dorothy Roberts argues, global ART markets tend to reproduce racial hierarchies, as they are prone to benefit people who have higher social status and exploit those who do not.⁴⁹ Research on specific routes of more established forms of third-party cross-border reproduction, such as fresh egg donation and surrogacy, highlights how they reproduce global inequalities organized around gender, capital, and race.⁵⁰ The conditions are in place for global cryo-egg flows to recreate these patterns in which the reproductive choices of privileged global biocitizens require the “clinical labor” and reproductive substances of those who become implicated through structural economic, racialized, and gendered stratification.⁵¹ Because eggs, rather than people, move in this practice, it is more subject to the logic of outsourcing, whether through price differentials between the eggs’ origin and destination countries, through regulatory discrepancies, or through “racialised notions of the world” that guide intended parents’ choices in global reproductive trajectories.⁵²

As the fertility industry has expanded beyond Europe, North America, and Oceania to the Middle East, Asia, Africa, and Latin America, institutional infrastructures are in place that could be employed to further extend transnational transfers of cryopreserved eggs. Numerous Asian and Latin American countries, including India, Malaysia, Thailand, and Cuba, have actively encouraged—and, in some cases, subsequently discouraged—medical and reproductive tourism; they illustrate that government policies can play a key role in further encouraging the growth of a more globalized ART circuit for egg donation.⁵³ Meanwhile, contemporary global IVF is experiencing a significant merger and acquisition cycle, resulting in the creation of ever larger transnational fertility corporations spanning several continents. For example, the abovementioned Virtus Health operates 46 IVF clinics in Australia, Ireland, Denmark, and Singapore; Spanish IVI and US RMANJ have merged to create the world’s largest fertility network; and Korean CHA Fertility (see below), which owns local and US clinics, has recently bought majority stakes in large Australian and Singaporean fertility groups, thereby aiming to jointly create the largest Asian-Pacific reproductive healthcare network in order to “address the rapidly growing demand” for IVF amid “trends of diminishing fertility.”⁵⁴ The investments required for these global fertility corporations are in part motivated by demographic trends towards later reproduction, while the emergence of transnational fertility companies creates the infrastructures for streamlining egg flows between countries and across borders. Both market developments and government regulations provide the infrastructures for the distribution of global egg flows. The stratified nature of these distributions according to the age-specificity of both the demand and provision of donor eggs highlights how Shellee Colen’s classic notion of stratified reproduction is also organized by a global biopolitics of aging.

In these global flows of frozen eggs, the “cold chain” may start to function like the “global care chain.”⁵⁵ The latter references “the international transfer of caretaking” by the commodification of care work through the employment of lower-waged migrant women.⁵⁶ Rather than the migratory displacement of women as a result of the marketization of domestic care work, the marketization of technologically assisted reproduction may result in the displacement of the cryopreserved gametes of relatively lower-paid egg donors. From the example of TWEB, it may be extrapolated that a global cold chain of distributed reproductive aging would flow from sites in which women’s reproductive youth intersects with forms of indirect or direct financial inducement in a national context characterized by high biotechnological development and permissive regulations. This flow would be directed to the places where an increased age of reproduction—or reduced fertility for other reasons—meets relative wealth, high biotechnological development, and limited or expensive supplies of eggs.

While biodesirability plays a key role in shaping these reproflows, as became apparent in the discursive constructions of TWEB’s eggs, the political implications of the irrelevance of biodesirability in egg procurement for research are a central concern of the following section.

Donor Eggs and Hwang’s Legacy

Egg donation is so important to these three SCNT studies because they achieved what was previously falsely claimed by the South Korean scientist Woo-Suk Hwang. Hwang not only fabricated evidence in his two Science publications but also incorrectly reported that his studies used, respectively, only 242 and 185 eggs from donors who received “no financial reimbursement.”⁷² The Korean National Bioethics Committee later found that over 2,000 eggs were sourced from 119 women, of which more than half were commercially obtained. Hwang’s junior colleagues were also among the egg donors, and, according to Jin Sook Myung’s research, IVF patients who agreed to receive discounted treatment in exchange for their “surplus” eggs unwittingly donated their best-quality eggs to research.⁷³ Following the Hwang scandal, a backlash against stem cell research resulted in a stricter Korean regulatory regime on research egg donation.⁷⁴ Significantly, this included specific restrictions that prescribed that only leftover eggs could be used for SCNT research. And because fertilization would typically be attempted with good-quality eggs in IVF treatments, frozen eggs are far more commonly left over than fresh ones are.⁷⁵

The Hwang case highlights two important aspects that inform the relationship between stem cell research and the geopolitics of transnational egg mobility: first, the mobilization of bionationalist discourses in shaping these egg trajectories and, second, the interplay between transnational egg donation for reproduction and research. Hwang’s research, and the local unpaid “altruistic” egg donations that supported it, drew on a highly bionationalist discourse. Hwang’s stem cell research developed in the context of major and concentrated government investments in biotech—$18 billion over the course of 14 years—that sought to make Korea a leading nation in the field. Hwang was bestowed the status of “Supreme Scientist” and the large, $65 million investments in his laboratory were recognized as a way of securing “prestige” and “symbolic and economic capital,” while asserting independence from—if not global scientific leadership over—former Western colonial powers.⁷⁶ Hwang asserted that “science knows no border, but a scientist has his homeland,” and that with his stem cell research, he “stuck the Korean national flag into the heights of biotechnology, America.”⁷⁷ Against the backdrop of international scientific competition, the idea of the nation was thus highly effective in generating government investment for SCNT.

With the research framed in an “ethos of competitive nationalism,” egg donation became “an act of ‘good citizenry.’” Hwang claimed in public media that the egg donors were “not paid and were motivated by a desire to help sick people and national pride.”⁷⁸ In December 2005, hundreds of women supporting Hwang held a ceremony, in which they sang the South Korean national anthem, declared their intention to donate eggs, and left a trail of azalea flowers leading to Hwang’s laboratory.⁷⁹ Egg donors also contributed to www.ilovehwang.net, where some described their motivation for donating as a “sacrifice” to the nation: “I’m very happy that I can add my tiny self to support him…. Please give me a chance to be a patriot.”⁸⁰ A variation on the traditionally politicized relation between women’s reproductivity and the reproduction of the nation, this bionationalist framing of egg donation positions eggs, rather than children, as symbols of the nation’s successful future.⁸¹

Yet alongside the local egg donors, Hwang’s team also sourced a significant proportion of its oocytes from the international for-profit egg broker DNA-Bank. This broker initially focused on reproductive egg donation and procured eggs from Korean women for intended parents from Japan, where commercial egg donation was prohibited. For Hwang’s project, DNA-Bank allegedly recruited not only Korean but also Chinese and Malaysian women to provide eggs for research. According to Gottweis and Kim’s research into the scandal, the Hwang team paid Mr. “K,” DNA-Bank’s CEO, $1,537 per woman.⁸² As Catherine Waldby notes, DNA-Bank’s role in Hwang’s research demonstrates that existing transnational reproductive egg donation networks can be employed to enable a supply of eggs for research purposes.⁸³ If reproductive and research egg donation thus begin to approximate one another, the current establishment of transnational cold chains to move donor eggs to fertility clinics should also be considered in the light of their potential use to supply ova to research labs. In theory, transnational egg donation for research could approximate existing cross-border reproductive egg movements if frozen eggs could be used for this work—and the post-Hwang regulation of SCNT research prescribed exactly that.

Following the Hwang scandal, it took three years before the Korean National Bioethics Committee approved another SCNT study involving human eggs, in 2009; a second was approved in 2016—both were based at CHA Medical Group.⁸⁴ The latter was directed by Dong-Ryul Lee, who also led one of the three SCNT studies, and the project could use 600 leftover eggs, of which the majority (500) were frozen.⁸⁵ This reflects the post-Hwang revisions of the Korean Bioethics and Safety Act, which limited SCNT research to the use of “residual”—typically frozen—eggs to avoid ethical concerns about direct egg donations.⁸⁶ These residual eggs are described as eggs that are left over after fertility treatment and are required to be provided free of charge by “medical institutions for producing embryos.”⁸⁷

Conveniently, the CHA Medical Group is such an institution—and one that is also a major player in egg freezing for age-related infertility. It claims to be responsible for the first birth of a baby conceived from a vitrified egg in 1999, established the world’s first publicly accessible egg freezing clinic in Los Angeles in 2002, and now owns the three hospitals that currently store the largest number of cryo-eggs in Korea.⁸⁸ CHA is investing in infertility in Korea, where late pregnancies and age-related infertility are on the rise while the birth rate has hit a record low of 0.98.⁸⁹ But CHA also recently acquired majority shares in major international fertility groups, with numerous clinics and frozen egg banks in Australia and Singapore. It aims to become the world’s largest IVF group, with 50,000 cycles annually by 2022.⁹⁰ Meanwhile, in Korea, CHA’s dual focus on stem cell research and fertility treatments creates the institutional infrastructure required to access residual eggs for research.

Notwithstanding CHA’s investments in an infrastructure that incorporates both OC and SCNT, the Korean regulations that limit SCNT research primarily to frozen eggs have also attracted criticisms that once again draw on a bionationalist discourse. In the Korea Times, scientists argue that stem cell research could be “one of our future growth engines,” but that strong government support is needed so “our researchers can get ahead of their overseas competitors.” According to the newspaper, “Leaders of stem cell research like the United States, Britain and Japan allow the use of fresh human eggs for therapeutic cloning. By contrast, we have been prohibited from doing so for the past 10 years after the 2005 scandal and that’s why we are lagging behind…. A lot of scientists went abroad, frustrated by the government’s tougher regulation following the Hwang scandal.”⁹¹ Hwang’s case illustrates how, in the face of international research collaborations, the nation may still be mobilized in framing the scientific breakthroughs, the donors’ bodily sacrifices, and the subsequent government regulations restricting embryonic stem cell research primarily to frozen eggs.

US Stem Cell Bionationalism

Notwithstanding Hwang’s ethical transgressions, both aspects of the egg-donation practices—the bionationalist discourses on stem cell research and the close relation between research and reproductive egg procurement—are also at play in the US context of the three SCNT case studies by Mitalipov’s, Lee’s, and Egli’s groups. In the United States, the nation is mobilized both to discourage and to promote egg-based research with reference to, respectively, anti-abortion and pro-innovation agendas, which set the stage for changing research egg-donation practices.

In 2001, President Bush famously restricted federal funding for embryonic stem cell research, including SCNT. Encouraged by future vice president Mike Pence, Bush maintained these restrictions on the use of embryos for research by repeatedly vetoing attempts by Congress to lift them—a decision he celebrated with dramatic White House press conferences in which he surrounded himself with children born from “embryo adoption” programs.⁹² The limitations on stem cell research provoked fears about a “brain drain” of scientists to other, more permissive regulatory contexts—including those that came to be known as the “Asian Tigers,” such as Singapore and South Korea—thereby “fuel[ling] nationalisms” in the United States and elsewhere.⁹³ Although the primary ethical concern lay with the role of the embryo in stem cell research—informed by its controversial status in the politics of abortion—the US stance on paying women for eggs was also relatively restrictive. While the reproductive egg-donation industry flourished and routinely offered donors $2,500–$10,000 per cycle, influential national bodies such as the US National Research Council and National Academy of Sciences advised against paid research egg donation—a position that was also adopted in various state laws, including Massachusetts’s and California’s.⁹⁴

However, later that decade, President Obama removed some of Bush’s restrictions on federal funding for stem cell research, referencing concerns with national competition in statements like, “We will ensure America’s continued global leadership in scientific discoveries and technological breakthroughs.”⁹⁵ Trump subsequently won the 2016 presidential election on an anti-Obama platform that has consistently “opposed federal funding for embryonic stem cell research” as part of its anti-abortion agenda. After entering office, Trump has focused on restricting federal funding for fetal tissue research—rather than stem cell research—in an attempt to show that “promoting the dignity of human life from conception to natural death is one of the very top priorities of [his] administration.”⁹⁶

The ongoing, politicized changes in US federal regulation of stem cell research are complicated by state-based regulations, which may both reinforce and counteract the bionationalist innovation or pro-life federal agendas. For example, when Bush halted new human embryonic stem cell research, California passed the Stem Cell Research and Cures Initiative, which has provided millions of dollars in stem cell research in the state and is understood to have contributed to a recognition of California as “the national leader in stem cell research.”⁹⁷ Differing state regulations of egg procurement opened up a “new stem cell geopolitics where not only other countries, but some individual states … claimed or were feared to have a new competitive edge.”⁹⁸ While paid egg procurement within permissive states functioned as a condition of possibility for research projects like Mitalipov’s, its successes, in turn, increased pressure on other states and research institutes to reconsider their egg-procurement regulations.⁹⁹ For example, in 2013, the year Mitalipov’s study was published, California sought to follow Oregon’s and New York’s precedent with a bill aimed at lifting the prohibition on paid research egg procurement, which passed the Senate but was vetoed by Governor Jerry Brown.¹⁰⁰ The differing state-specific regulations are moreover instrumental in shaping flows of cellular material across the nation and beyond, as is the case in negotiations of “material transfer agreements” for shipping the Oregon stem cell lines between Mitalipov’s and other research labs, which may be governed by conflicting egg-procurement regulations.¹⁰¹ For example, Mitalipov’s stem cells could not be sent to and studied by the California Institute of Regenerative Medicine, because the institute’s funds could not be used for studies that rely on cell lines produced using paid egg donation.¹⁰² International regulatory differences could similarly play a role in directing the global flow of frozen eggs for research purposes.

At this specific historical moment, a series of factors—the geographically specific relaxation of restrictions on financial compensation for egg procurement, the popularization of OC technology, the mushrooming of egg banks within a general trend of bio-banking, and the availability of cryoshipping infrastructures—paves the way for a transnational flow of eggs. Although strict regulations and bioethical guidelines limit the feasibility of such flows for research projects at present, the global movements for reproductive egg donation provide a model for a more transnationalized research egg-procurement practice. The possibility of shipping eggs could fundamentally shift the spatial dynamics of egg procurement for a research sector that is characterized both by intensive cross-border cooperation in what Charis Thompson calls “stem cell internationalism” and strong pressures of scientific competition, commercial research investments, and politicized regulations linked to local and national identity.¹⁰³

Relating Research and Reproductive Egg Donation

In keeping with this, the three SCNT studies also point to the close regulatory, discursive, and clinical relation between research egg procurement and its more transnationalized reproductive counterpart. Firstly, in the US context of the studies under scrutiny, research egg-donation practices are regulated with reference to their reproductive counterpart. As Waldby has noted, egg donation for stem cell research operates “alongside a transactional reproductive market” in which women are routinely paid up to $10,000 per cycle.¹⁰⁴ Although bodies such as the National Research Council advised that egg donors should only be reimbursed for direct expenses, in 2007, the American Society for Reproductive Medicine (ASRM) adopted the position that financial compensation for egg procurement for stem cell research may be acceptable. The ASRM stated that its compensation guidelines applied to all egg donors “regardless of the ultimate use of the oocytes (e.g., fertility therapy or research).”¹⁰⁵ As mentioned above, states such as California do not permit reimbursement beyond direct expenses for research egg donation. Yet where compensation is allowed, the egg-donation practice is modeled on reproductive egg donation.

In the New York context of Egli’s SCNT study, for example, the Empire State Stem Cell Board overseeing the $600 million state-funded stem cell research program permitted its funded researchers to compensate its egg donors “in amounts proportional to those allowed by the state for donation of oocytes for in vitro fertilization.”¹⁰⁶ In its 2009 decision, the board referenced the ASRM guidelines for donor payment up to $10,000 and cited principles of “justice” and “equity” to argue that the same terms and conditions should govern egg provision for reproductive purposes and scientific research.¹⁰⁷ Over the course of the subsequent nine years, the Egli research lab in New York procured over 1,500 mature oocytes, the majority of which were used for SCNT studies.¹⁰⁸ In these studies, including the abovementioned 2014 SCNT study, egg donors were screened and paid $8000 per cycle with explicit reference to the ASRM guidelines.¹⁰⁹ The team notes that these egg-donation cycles were made possible through a collaboration with “a large, academic-affiliated reproductive endocrinology clinic.”¹¹⁰ The bioethical consensus, clinical practice, and screening and compensation guidelines for reproductive egg donation were thus of direct influence on egg donation for stem cell research.

Secondly, the employment of reproductive healthcare infrastructures has effects on the discursive framing of research egg donation. For example, the OHSU Women’s Health Research Unit, which “recruited” the egg donors for Mitalipov’s study, frames its research with reference to values of altruism and women’s solidarity: “OHSU research has begun to illuminate some of the vast overlooked difference between the genders that influence a woman’s overall health” and “This research is vital to the women of Oregon and to women everywhere. You can help.”¹¹¹ Its Facebook page juxtaposes announcements of clinical trials with quasi-feminist links to Buzzfeed posts on #doublestandards. Many feminist scholars and activists have objected to paid research egg procurement out of concern for women’s exposure to significant health risks in the stimulation and extraction procedures.¹¹² Ironically, it is precisely an identity politics of female solidarity that is employed when egg donors are mobilized by an appeal to, in Charis Thompson’s words, a “pro-cures” narrative that frames stem cell research as a contribution to women’s health.¹¹³ This discursive framing of egg donation for research thus appeals to notions of “sisterhood” and altruism, which also characterize discourses of reproductive egg donation and surrogacy.¹¹⁴

Notwithstanding their close relation, an important difference between reproductive and research egg donation is the fact that sociocultural biodesirability is irrelevant in donor selection for research. As a result, a different group of women can become potential donors, thereby shifting the dynamics of egg-procurement practices—especially so when frozen eggs can be used for research studies.

A Cytoplasmic Fountain of Youth

Underlying SCNT research, and the commercial investments into this technology, is a reconceptualization of the aging process in which the egg takes center stage. In SCNT, it is the egg that has the potential both to reconfigure the linearity of cellular aging and to develop cell-based therapies for age-related diseases. In an article titled “The Reversibility of Irreversible Ageing,” Galkin and colleagues propose that the egg’s cytoplasm can be used to “set a genome age to zero.” The embryo created from this egg may then “produce embryonic stem cells with the age apparently erased.”¹²⁴ In other words, the egg’s cytoplasm is presented as a cellular fountain of youth.

The potential profitability of this reconceptualization of aging is reflected in the involvement of the Massachusetts biotechnology company Advanced Cell Technology (ACT) in the SCNT study by Dong-ryul Lee’s team. Prior to this study, ACT attracted large multi-million-dollar investments to intensify its research and development activities in order to secure its “intellectual property position in the drive towards commercialization of embryonic stem cell and SCNT technology.”¹²⁵ ACT had grown from a small agricultural cloning research facility into a large corporation using embryonic and adult stem cells for “therapeutic innovations.”¹²⁶ Stem cell research provided a means of gaining “ownership rights to critical technologies in regenerative medicine” through patents, of which ACT alone held over 50 in the field of SCNT technology. Following several mergers and acquisitions, ACT is now the Astellas Institute for Regenerative Medicine (AIRM), a biotechnology company that aims to develop and commercialize new therapies in regenerative medicine, particularly in the field of age-related eye diseases.¹²⁷ A subsidiary of the Japanese Astellas Pharma, AIRM and its investors are motivated by the “potential size of this market and its projected growth rate largely as a consequence of an increasing aged population.”¹²⁸ Irrespective of whether clinical applications will emerge from this research, the financial stakes in stem cell technologies reflect the speculative value ascribed to the potential profitability of age-related pathologies in global biotech industries.

Significantly, in the SCNT approach, the egg is positioned as the key tool for “reset[ting] the clock of aging.” This idea is expressly stated in ACT’s press release on studies with cows that were concerned with

the feasibility of reversing the aging of cells by SCNT and transplanting young cells back into the old animal…. [T]hese studies suggest that medicine may one day be able to reset the clock of aging in aged human cells by SCNT and then use the resulting young cells to regenerate the immune and vascular system of older patients.¹²⁹

This reconceptualization of the hitherto irreversible process of aging as newly plastic at the molecular and cellular level entails a key shift in perspective in which the egg is valued not for its genetic content—as it was in egg freezing and reproductive egg donation—but for its cytoplasm, which interacts with the nucleus of the donated somatic cell. While the somatic cell’s nuclear genome is key to the stem cells’ desired histocompatibility, the egg’s cytoplasm replenishes this genome with embryonic youth. In other words, in SCNT the egg’s cytoplasm is the “biological tool” that holds the potential to return the adult cell to the youngest pluripotent state.¹³³

It is also possible to bypass the egg and create stem cells directly from somatic cells, such as skin cells, with a technique called “induced pluripotency.” The Nobel Prize–winning achievement of inducing pluripotent stem cells (iPSCs) from somatic cells in the mid-2000s initially shifted the research focus away from SCNT because this relatively simple process did not require eggs.¹³⁴ However, the subsequent successes in SCNT research have revived interest in a technique that had been on its “death bed” after repeated failures, the Hwang scandal, and the iPSC discovery. The three SCNT studies represent a “remarkable comeback” of the nuclear transfer technique and have led to renewed interest in these technologies and their potential clinical translation.¹³⁵ While the creation of stem cells through induced pluripotency (iPSC) is technically less complicated and does not rely on donor eggs, the SCNT stem cells may have several advantages, especially for aging potential patients.

Wolf and colleagues highlight that, over the years, some limitations of iPSCs have become apparent that are especially significant for age-related regenerative medicine. When researchers are working with older somatic cells, induced pluripotency has a distinct disadvantage over SCNT precisely because there is no young egg involved. The main difference between the two stem cell types is concerned with mitochondrial DNA (mtDNA), which is found in the egg’s cytoplasm. While in iPSCs the mtDNA comes from the donor somatic cell, in SCNT stem cells it is derived from the donor egg. Because mtDNA mutates more rapidly over time than nuclear DNA, the frequency of mtDNA mutations in iPSCs increases with the somatic cell donor’s age. In SCNT stem cells, the mtDNA is unaffected by the somatic cell donor’s age because it is determined by the young donor egg.¹³⁶ As a result, the researchers specifically note “the limitations of iPSCs derived from elderly patients destined for clinical applications” and propose SCNT stem cells as an alternative that counteracts these age-related limitations with the aid of younger donor eggs.¹³⁷ Irrespective of the future development of SCNT-derived therapies, the promise of nuclear transfer for regenerative medicine itself provides the rationale for a renewed interest in this type of research, which is reliant on women providing their eggs.

Chimeric Eggs and Recombinant Fertilities

Beyond regenerative medicine for age-related pathologies, nuclear transfer techniques are also used to regenerate fertility. The possibility of nuclear transfer that the SCNT studies demonstrated can also be used for mitochondrial replacement therapy. This treatment fuses the intended mother’s egg nucleus with a donor egg’s cytoplasm and subsequently fertilizes this merged egg with sperm.¹³⁸ The resulting embryo contains nuclear DNA from the intended mother and father (or sperm donor) as well as mitochondrial DNA from the egg donor. While this treatment allows people with severe mitochondrial diseases to have genetically related children without passing on the condition, the technique has also been used in attempts to treat age-related infertility.

The UK Parliament legalized this so-called three-parent technique for carriers of mitochondrial diseases in 2015. In the same year, it was banned in the United States as a result of an anti-abortion Republican congressional amendment forbidding the FDA from reviewing clinical trials that involve the genetic manipulation of embryos.¹³⁹ Circumventing the ban, US doctor John Zhang, founder of the popular New Hope Clinic in New York, decided to fly to Mexico to treat one of his patients there. This was a woman who had already lost two children aged eight months and six years to a mitochondrial disorder called Leigh Syndrome—the same syndrome carried by the skin cell donor in the Oregon team’s aforementioned SCNT study. In 2017, Zhang’s patient gave birth to the world’s first baby following mitochondrial replacement, which ensured that the newborn avoided the risk of inheriting this debilitating condition.¹⁴⁰ The number of women who would be potential candidates for this treatment is relatively small; the estimated number of births per year among women at risk for transmitting mtDNA disease is 152 (out of 680,000) in the United Kingdom and 778 (out of in 3,850,000) in the United States.¹⁴¹ However, this potential patient group would be dramatically expanded if the technique also worked as a means of treating age-related infertility.

The abovementioned Oregon team responsible for the first SCNT stem cells relates its work to the “current trend toward delayed childbearing in the Western world.” They propose that the cytoplasm plays a key role in the egg’s aging and therefore “mitochondrial replacement therapy could be considered [an] ART technique to solve cytoplasmic defects due to aging.”¹⁴² The nuclei of low-quality older eggs, they suggest, could be combined with the cytoplasm of young donor eggs to create an egg with improved chances of fertilizing and developing. Jose Cibelli, a former ACT researcher and current university professor in biotechnology, suggests that this would be an attractive alternative for the many women opting for donor eggs for age-related reasons because then “older women could have children carrying their own DNA thanks to the cytosolic contribution of a healthy, young surrogate egg.”¹⁴³ In other words, this approach reframes reproductive aging as differently distributed between the nucleus and the cytoplasm within the cell. If age-related infertility is understood to be located in the cytoplasm, these researchers suggest that mitochondrial transfer could provide a solution by creating a chimeric egg, which retains the intended mother’s nuclear DNA, but benefits from the reproductive potential of the donor egg’s cytoplasm.¹⁴⁴ In this way, this approach constitutes a recombinant fertility at a cellular level.

This application of mitochondrial transfer has already found its way to the clinic.¹⁴⁵ In 2019, a woman gave birth to a baby in Greece after receiving mitochondrial replacement treatment. She received this treatment not because of any mitochondrial disease but specifically to improve her fertility after repeated IVF failures.¹⁴⁶ The Institute of Life, the Athens clinic where the woman was treated, subsequently stated that it intended to continue using the mitochondrial transfer technique “to help even more couples facing fertility issues to have children with their own DNA, without having recourse to egg donors.”¹⁴⁷ Like Mitalipov’s Oregon group, the researchers working on the development of the Athens mitochondrial transfer protocol suggested that “faulty mitochondria” could be the main culprit in poor egg quality, one of the main reasons why IVF fails. They resolved this by moving the nuclear DNA of the intended mother into a donor egg with healthy mitochondria.¹⁴⁸

Sensing a business opportunity for this extended indication for mitochondrial transfer, John Zhang started a company called Darwin Life to commercialize mitochondrial replacement therapy for infertility in older women, which was branded H.E.R.—Human Egg Reconstitution—IVF. Although the FDA warned Zhang against his practice, the US-Ukrainian team at Darwin Life-Nadiya in Kiev recently claimed the birth of several more babies after mitochondrial transfer.¹⁴⁹ A study by the Nadiya team itself found that the technique offered little benefit to women of “advanced maternal age,” but the clinic’s director does maintain that the technique remains promising for women with failed IVF cycles, and the Darwin Life-Nadiya website states that they “hope in the near future to be able to help many women under the age of 42” achieve “the birth of a healthy native child without donation of eggs.”¹⁵⁰

The suggestion that donor egg cytoplasm could improve IVF outcomes is also the basis for research into a new approach to generating extra eggs through nuclear transfer. When an egg is formed, a small cell forms alongside it called the “polar body,” which, like the egg, only has a single pair of chromosomes (haploid). Normally these cells cannot fertilize, but Mitalipov’s group found that they could if the polar body nuclei were transferred into donor eggs’ cytoplasms. Harnessing nuclear transfer as an “alternative route for oocyte formation,” the researchers have patented this technique as a means to create an additional “source of oocytes for fertility treatment.”¹⁵¹ They suggest that this could be particularly helpful for “patients of advanced maternal age, who have a low oocyte yield or are poor responders, commonly observed in ART cycles.”¹⁵²

While it remains uncertain whether mitochondrial transfer will in fact clinically aid infertility, research interest in the possibility of combining “genomes from older women with young donor cytoplasts” certainly does require young women to provide gametes in order to create a new kind of egg that combines the reproductive youth ascribed to the cytoplasm and the biogenetic connection to its nucleus.¹⁵³ The interest in this work suggests that “the need for human eggs for research is back. It seems like it never left the stage after all.”¹⁵⁴

This renewed reliance on egg donation to explore the regenerative potential of youthful cytoplasms once more reconfigures the relation between fertility and aging. A postfertile cell par excellence, the chimeric egg, created by merging the intended mother’s and the donor’s eggs, materializes both fertility and infertility in new ways that hold the promise of shifting the temporal limits of reproductive finitude. Yet unlike autologous oocyte cryopreservation, this cytoplasmic regeneration implicates the bodies of egg donors. And because this process mirrors conventional egg donation, but relies only on the egg cytoplasm, it transfers the logic of research egg donation to reproductive egg donation, thereby expanding the group of potential egg donors as well as the risk of a concomitant stratification in donation practices.¹⁵⁵

OC as Ethical Instrument: Direct and Indirect Egg Donation

The three SCNT studies under scrutiny all used “fresh” egg donation. However, if human frozen eggs could also be used for stem cell studies, the effects of the renewed demand for eggs may be felt far away from the lab. Given that a limited egg supply is one of the key practical constraints for SCNT research, the logistical advantages of banking eggs have been recognized by the biomedical research community.¹⁵⁶ Back in 2009, researchers in reproductive and regenerative biomedicine—including those at RBA, the fertility clinic acquired by egg freezing company Prelude—predicted that “in the future, if the efficacy and efficiency of cryopreserved oocytes are comparable to those of fresh oocytes in human therapeutic cloning, the use of cryopreserved oocytes would be invaluable and generate a great impact to regenerative medicine.”¹⁵⁷

These possibilities are coming closer to reality; Dong-Ryul Lee and colleagues write that the “production of cloned embryos using cryopreserved human oocytes and derivation of their SCNT-ESC lines was not achieved until recently.”¹⁵⁸ Cryopreserved eggs have yielded embryonic stem cells (ESCs) after SCNT in various species, and several recent Korean studies have proposed more efficient methods for using frozen eggs to create SCNT-stem cells.¹⁵⁹ In Korea, the tightening of egg-procurement regulations after the Hwang scandal has become a driving force for investing in stem cell research with cryopreserved eggs because they “could provide a steady source of eggs for research, such as SCNT, and its use also reduces ethical concerns.”¹⁶⁰ This is particularly relevant in a context where payments for egg donations are curtailed and regulations prescribe the use of “residual” eggs that are “intended to be discarded”—typically low-quality or frozen eggs.¹⁶¹ In this way, egg freezing functions as an ethical instrument that both shifts the regulatory permissibility of egg donation and drives future research directions in stem cell biology that accommodate cryopreservation.

A similar prospect of broadening egg donation underlies further Korean research by Dong-Ryul Lee’s team into new egg-manipulation protocols that suggest that “low-quality” eggs, which are of limited clinical value in IVF, may also yield nuclear-transfer stem cell lines.¹⁶² In response to these protocols, Mitalipov and his colleagues express that “it is exciting to think that oocyte quality may become a less dramatic factor [in SCNT],” and “fresh or frozen” eggs from IVF programs could become an alternative source for human SCNT. He proposes that “perhaps we are at the stage where all oocyte donors produce functional oocytes and rejected patient oocytes from IVF programs could be recovered, if not for fertility purposes then for the production of NT-ESCs.”¹⁶³ The new protocols suggest that low-quality eggs, which would normally be discarded in IVF procedures, could provide valuable material for creating embryonic stem cells.

In the context of the growing popularity of egg freezing, these new possibilities pave the way for a model of egg donation in which the categories of patient and donor begin to overlap more. If frozen eggs could also be used, the increasingly widespread preservation of eggs could similarly provide the material for stem cell generation and research. Given that the vast majority of women who freeze their eggs never return to use them, and given the fact that the leftover eggs may not be suitable for reproductive donation due to testing protocols required for third-party reproduction, donation to research could become a rational alternative to destroying the cryo-eggs when they are no longer needed. This would then lead to a situation in which those who provide eggs for research studies also pay for the stimulation, extraction, and cryopreservation procedures, thereby becoming self-financed egg donors.¹⁶⁴ This model, in which women freeze eggs for their own future use and indirectly become donors if their eggs are no longer needed, is understood to “reduce ethical concerns” because it circumvents ethical issues pertaining to donor recruitment and financial inducement, while still providing a “steady source” of eggs.¹⁶⁵ Indirect egg donation after egg freezing may thus be upheld as a solution to the ethical concerns surrounding direct egg donation; cryopreservation thereby becomes itself an ethical instrument that renders egg donation more acceptable.

The future potential of using frozen eggs for stem cell research could also shift direct egg-donation practices, given that the mobility of frozen eggs could remove the need for spatial proximity between research labs and egg-procurement sites. As is the case for its reproductive counterpart, the use of frozen eggs allows for research egg donation to become more spatially dispersed. The possibility of shipping eggs could then fundamentally shift the dynamics of global egg procurement in ways that intersect with local gender- and age-specific social realities, as is now happening in transnational reproductive egg procurement. In fact, existing infrastructures of (cross-border) reproductive healthcare could be employed for research purposes; TWEB, and its advanced infrastructure for handling large egg repositories and creating a transatlantic egg flow, give an indication of how similar biomedical and logistic technologies could be used to move eggs for research purposes.

Because the donor’s biodesirability is irrelevant in research egg procurement, Widdows contends that stem cell research may lead to a situation in which “women from lower socioeconomic strata would be more likely to become the providers of eggs … because the genetic content of the enucleated egg … is irrelevant.”¹⁶⁶ This is particularly pertinent if eggs become movable between different national and economic contexts. If this were to become the case for egg procurement for research, the concerns raised in scholarship on CBRC that the “international economic imbalances” that make “underprivileged women in poorer countries an especially vulnerable population” would become newly relevant.¹⁶⁷ As global care chains create “a series of personal links between people across the globe based on the paid or unpaid work of caring” for both children and the elderly, so global cold chains of frozen eggs may develop to redistribute both reproductive youth and regenerative potential across borders and bodies, creating new relations of dependency that shift what it means to age for donors and recipients alike.¹⁶⁸