Uncertain Commodities: Egg Banking and Value in Ukraine

BioSocieties Uncertain Commodities: Egg Banking and Value in Ukraine --Manuscript Draft-- Manuscript Number: BIOJ-D-23-00015 Full Title: Uncertain Commodities: Egg Banking and Value in Ukraine Article Type: Original Article Funding Information: Eesti Teadusagentuur (MOBJD1077) 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 - the 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 for the development of quality control in vitrification techniques and donor selection, as well as classification and accounting schemes related to oocyte quality. Corresponding Author: Polina Vlasenko, PhD Tallinn University: Tallinna Ulikool ESTONIA Not applicable Corresponding Author Secondary Information: Corresponding Author's Institution: Tallinn University: Tallinna Ulikool Corresponding Author's Secondary Institution: First Author: Polina Vlasenko First Author Secondary Information: Order of Authors: Polina Vlasenko Order of Authors Secondary Information: Author Comments: Suggested Reviewers: Vincenzo Pavone, PhD Director, Instituto de Politicas y Bienes Publicos vincenzo.pavone@csic.es Dr. Pavone has expertise in reproductive bioeconomy and egg donation. Nicky Hudson, PhD Professor, De Montfort University nhudson@dmu.ac.uk Dr. Hudson has expertise in egg donation in Europe Powered by Edit orial Manager® and ProduXion Manager® from Aries Syst em s Corporat ion Author(s) details/biography, short title etc. Title: Uncertain Commodities: Egg Banking and Value in Ukraine Author: Polina Vlasenko PhD in Medical Anthropology, Indiana University Bloomington Research Fellow, Tallinn University Mailing Address: 809 S West Pointe Ct, Bloomington IN, US Email: polina.vlasenko@gmail.com Phone: +15134407035 Bio: Polina Vlasenko is a postdoctoral fellow at Tallinn University. She received her Ph.D. degree in medical anthropology from Indiana University, Bloomington. Her dissertation explored the functioning of the egg banks and IVF clinics in Ukraine, donor eggs as racialized commodities, and egg donors' experiences of work and motherhood under postsocialism. Word count: 9336 words (including endnotes, but excluding references) 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. On behalf of all authors, the corresponding author states that there is no conflict of interest. Blinded Manuscript, excl. authors' name(s) and affilication(s) Click here to access/download;Blinded Manuscript, excl. authors' name(s) and affilication(s);Uncertainties of egg Click here to view linked References 1 2 3 4 5 Uncertain Commodities: Egg Banking and Value in Ukraine 6 7 8 9 10 11 Abstract 12 13 14 The development of vitrification techniques has increased the use of donor ova by allowing for 15 16 their cryopreservation, storage, and international transportation. However, the implications of egg 17 18 19 banking for the valuation of eggs remain little studied. Building on ethnographic fieldwork in a 20 21 Ukrainian egg bank, in this article I examine different mechanisms and calculations that allow the 22 23 24 bank to transform vitrified ova - the products with volatile outcomes - into valuable but uncertain 25 26 commodities. This article reveals how the bank staff can never completely secure their profits 27 28 because of the variability of the egg quality assessment and unpredictability of their expenses. I 29 30 31 demonstrate how the dilemmas that arise when the egg banking industry tries to turn oocytes into 32 33 commodities trigger certain efforts for the development of quality control in vitrification 34 35 36 techniques and donor selection, as well as classification and accounting schemes related to oocyte 37 38 quality. 39 40 41 Keywords: egg banking, vitrification, donor ova, uncertainty, value, Ukraine 42 43 44 Introduction 45 46 47 The banking and shipping of frozen oocytes has become a novel method of supplying ova 48 49 50 worldwide (Hudson et al. 2020; Waldby 2019).i This innovation boasts the added benefit of 51 52 allowing couples to receive their treatments at home and use donor eggs independently of the time 53 54 and place of their retrieval. Many scholars have raised concerns about whether the egg banking 55 56 57 transforms the way eggs are managed globally, which leads to increased commercialization of 58 59 eggs and disrupts assumptions about donation as a “gift” (Baldwin, Gray and Hudson 2019; 60 61 62 63 1 64 65 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 Hudson et al. 2020). However, the implications of the egg vitrification for the valuation of eggs remain little studied. On the other hand, scholars have debated what stands at the core of generation of “biovalue” of material tissues such as vitrified eggs: their intrinsic properties or “life itself” (Rose 2007), “clinical labour” of the donors’ bodies (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 act 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, 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 unpredictability of egg “quality”–their 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 co-production 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 2 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 Europe and North American purchasers has emerged in Ukraine. As a supply side in the global reproductive bioeconomy, Ukraine is a key nodal point for understanding the process of valuation of human reproductive materials (Vlasenko 2021). This article is based on the research carried out in the commercial egg bank in Ukraine during the years 2015-2018. It not only served IPs who traveled to Ukraine for fertility treatment, but also delivered cryopreserved donor material (such as ova, sperm, and embryos) to individual patients and IVF clinics in various countries.ii During the time 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 bought 17 frozen eggs through the bank’s official distributor in Canada, complained about low egg survival rate. The vitrified eggs were from 3 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 fertilized and cultivated into embryos. The couple argued that even the ones that did survive were of poor quality, and asked the bank 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. The distributors were very interested to know if the bank was seeing the same outcomes in other partner clinics, and what was at issue - the vitrification and the donor selection and stimulation at the bank, or the thawing technique at the clinic receiving the material. 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 unpredictability of their nature. 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 3 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 egg quality to their partner clinics while outsourcing responsibility for the 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. To commodify eggs efficiently, the bank came up with embryological training; donor efficiency reports; and subdivision of vitrified oocytes into different quality categories. As the factors that affect ova “quality” are volatile, the staff tried to classify vitrified eggs in a way that allowed to sell more of them and yield “higher” quality. As the staff could not predict how many oocytes will be “fertile” and/or sold, they were unable to calculate their expenses and price the goods accordingly, which further exacerbated the uncertainties of value. So, finally, I discuss how the bank came up with different accounting schemes to negotiate the uncertainty of their expenses and account for unsellable eggs. Methods and the Overview of the Bank 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), located in Western Ukraine’s major city L’viv (which had a population of 721,301 in 2017). I attended it daily as a part-time employee (4 hours per day) and observed weekly staff meetings, business meetings with clients, medical and embryological procedures, including initial consultations with egg donors, subsequent medical examinations, egg retrievals, oocyte vitrification, and fertilization, and shipment of vitrified biomaterials. I also examined financial and statistical data produced by the bank. At the bank, I fulfilled the responsibilities of the international coordinator: communicating with partner clinics and individual couples, as well as completing other occasional tasks, where my knowledge of English was needed, such as preparing marketing 4 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 materials, writing and translating emails and contracts, doing research, writing reports, and assisting in the organization of international meetings, seminars, and conferences. 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—the case study of the bank exposes how the demands of the global export of eggs shape the process of valuation of eggs. Cryova provided all kinds of ARTs services, conducting around 1,000 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. It was the first clinic in Ukraine to apply 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 “frozen” eggs 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 launched the first bank of vitrified donor oocytes in Ukraine. The egg bank Cryova 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 eggs in-house—it conducted 80 egg retrievals per month on average in 2016-2017 (around 5–6 egg retrievals per day). Cryova positioned itself as a bank that mostly exports vitrified oocytes. However, when this is not possible due to legislative or other restrictions, the bank offered a variety of other methods to expand its global reach. As a result, there were two main medical and business models of international cooperation enacted by Cryova—two practices in which eggs were handled and which resulted in their different classification: “fresh” and “frozen” oocytes, iii and in different enactments of eggs as commodities. The first, the cycle with “fresh” donor oocytes involved the 5 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 bank conducting embryo cultivation in Ukraine. In this process, the bank received frozen sperm from its partner clinic, fertilized “fresh” oocytes (immediately after retrieval from the donor), cultivated and cryopreserved the embryos, and finally sent the frozen embryos back to the partner clinic. The second model, with vitrified donor oocytes, entailed carrying out stimulation protocol, oocyte retrieval, and vitrification in the bank, delivering the ova to the partner clinic or individual couple abroad, where it is thawed, fertilized, and used in recipients’ IVF procedures. “Fresh” and “frozen” donor oocytes were two different commodities involving different value and different production and circulation processes.iv The difference between fresh or frozen oocytes influenced donor recruitment, selection, and ovarian stimulation. If the eggs were to be frozen, stimulation and egg retrieval begun immediately after the donors had been recruited. This process was easier and faster than cycles with “fresh” eggs because 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, allowing couples to avoid travel and access purchased eggs at a clinic convenient for them. 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.v As a result, cryopreserved oocytes can be monetized and rationalized more efficiently, with one donor oocytes stored, divided, and allocated between several couples and delivered to any destination worldwide (Waldby 2019). Moreover, the bank could recruit more donors, and accumulate more eggs, than the “fresh” model allowed. Cryova’s most significant and oldest international partnerships were with clinics in Ireland and Israel that followed the “fresh” donor oocyte model, which has been established before egg vitrification started to be extensively used in the bank. Israel and Ireland were “bulk” partnerships, 6 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 which have constant needs for donor material, and which received deliveries monthly. vi After “Cryova” joined “Medi Group”, the Poland-based healthcare and diagnostic services provider in Central and Eastern Europe with Swedish ownership, it started to supply vitrified donor eggs to clinics—which was part of the concern—including “MedIVF” in Poland and “GRH” in the UK. The rest of its “stock” was for sale to clinics and individual couples not in the network. The case of Cryova illustrates how scientific and technological developments such as vitrification have facilitated the commodification of eggs and have been conditioned by capital’s logic of growth. The second product of the bank—vitrified ova—allowed the bank to expand into international markets. At the time of my observations in 2017, the bank had around 500 egg donors in the database, and the coordinators mentioned that they had 10–15 international patients at work and around the same number of new patients each month. The total number of vitrified oocytes in the bank was around 9,000, of which around 3,000 were of a first premiere quality level, and 6,000 of a second quality level. The bank was shipping around 400 vitrified oocytes per month to its partner clinics. There had been 150 international shipments and the bank sold 565 sets of vitrified ova (7,400 oocytes) to different countries around the world (EU countries, North and South American countries).vii These numbers kept growing until the full-scale invasion of Ukraine by Russia. For example, only in 2021 the bank shipped around 11 000 vitrified oocytes abroad. Uncertain Commodities A vast body of scholarship within more-than-human geography (Whatmore, 1999, 2002), actor network theory (Castree 2002; Latour 1993; 2005) posthumanism (Haraway 1991, 2008), and new materialisms (Alaimo and Hekman 2008; Barad 2007; Bennett 2010) focuses on the constitutive agency of things in social and political life and emphasizes the co-productive relationship between 7 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 the economy and nature. However, these currents often do not consider questions of political economy (Castree, 2002). Marxist scholars of “lively” labor, commodities, and mobilities have examined the distinctiveness of capitalist appropriation and commodification of “nature” (Castree 2003). 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 materialities of nature (whether water, tree growth, seeds, or animals) might be “sources of unpredictability, unruliness”, which muddle human efforts to produce nature in particular ways (Bakker and Bridge, 2006, 6, 18; Bakker 2012; Bridge 2011; Braun 2015; Ellis et al. 2020; Prudham 2003).viii By tracing how ova value is created, transformed, and included into circulation, and how the result is often uncertain, this article accounts for the uneven forces through which life is commodified and turned into mobile “lively capital” (Haraway 2012; Sunder Rajan 2012), as well as the effects of materiality of lively commodities on the processes of valorization, consumption, and flow (Collard and Dempsey 2013; Colombino and Giaccaria, 2016; Shukin, 2009). 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 controlled and predicted. Having a particular quality–their rate of survival and fertilization–they co-produce together with the industry and science a particular kind of commodification process. Their agency can be understood as “an emergent property of network associations rather than a property inherent in discrete entities” (Bakker and Bridge, 2006, 19). By decentering 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 relative effect of a combination of socionatural factors— 8 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 the uneven structure of the global economy, international regulations and standards, the variability of rates of survival and fertilization and their assessment, the unpredictability of a donor’s fertility, coordination between different sites (clinics) along value chains, measurements of quality and accounting schemes. From one point of view, commodification of eggs is “real”, because eggs become separate entities with their specific qualities, which can be bought and sold (Castree 2003).ix 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, 281). 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 value of eggs instead. The doubts in quality of vitrified eggs encountered by the bank illustrate how reproductive biologicals constitute “uncertain commodities”. Markus Becker and Thorbjørn Knudsen (2005) define uncertainty 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. So, how does the industry succeed to create a market for biologicals that were not previously commodified and might resist and redirect human action? In what follows I show how the “quality” of vitrified eggs from Ukraine is uncertain because of the unpredictable results of thawing and 9 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 fertilization; the value of vitrified eggs and their chances of being sold depend on assessment of their “quality” by the costumers; to cope with the uncertainty of quality of vitrified eggs and to turn them into sellable commodities, the Ukrainian bank introduces different techniques to measure and prove their “quality,” and to account for their losses. Uncertainties of Vitrification How many donor oocytes Ukrainian bank can sell, and at what price, largely depends on how their “quality” is assessed by the clinics that purchase and handle them – whether vitrified eggs survive thawing, and result in fertilization and implantation of an embryo. Although vitrification enables accumulation and use of eggs independent of 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. The egg is turned into a glass-like material. Although most studies show similar rates of survival (around 80–90%), fertilization (around 70–80%), good-quality embryo (around 50%), clinical pregnancy, implantation, and clinical results with vitrified and fresh eggs (Arian et al. 2014; Rienzi et al. 2010; Rienzi et al. 2012; Solé et al. 2013; Trokoudes, Pavlides and Zhang 2011), research is not definitive. The bank Cryova promotes cycles with vitrified eggs and claims that their success rate (97% survival rate, 82% fertilization rate, and 64% pregnancy rate) is the same as with fresh eggs.x However, some partner clinics and couples report that cycles with “fresh” oocytes are more efficient than cycles with vitrified oocytes, resulting in better fertilization and pregnancy rates. xi For example, the Polish partners who purchase vitrified eggs are skeptical: 10 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 Their [Polish clinic] overall impression is that our oocytes become worse and worse, they don’t survive and there are no pregnancies. (Solomiia, 2017). 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 “vitrified” cycles; or guarantee that vitrified eggs will survive warming and be successfully fertilized. 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 “efficiency” of the egg donors and their stimulation protocols (medication types and dosage, number of oocytes per retrieval, number of egg retrievals per donor); 3) the embryology at the partner clinics which purchased vitrified oocytes, where thawing (warming), fertilization, embryo cultivation, and implantation happens; 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, because for instance of her level of stress, menstrual cycle, etc. The success of frozen oocytes depends on how the egg donor was stimulated, how the eggs were harvested and frozen, and on the work of the embryologists in the partner clinic in warming and fertilization. Vitrified eggs from the same egg retrieval can survive warming in one partner clinic, but not in another. Since partner clinics have concerns of low quality 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 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 11 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 relate to their embryology—thawing, fertilization, cultivation, and embryo transfer. Polish embryologists, he says, are not doing a good job thawing eggs, which leads to a low survival rate. To prove quality, bank staff often refer to cases of partners with good fertilization rates with vitrified eggs. xii To further provide evidence that vitrified eggs are not properly handled by the laboratories where they are thawed, bank staff are trying to track whether the oocytes from the same donor and the same stimulation and vitrification resulted in different survival rates when thawed in different clinics. Some bank’s 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 out of 19 eggs surviving thawing and no pregnancies.xiii The clinic’s embryologist was concerned that one donor had had “bad” results before—her oocytes shipped to another clinic in Poznan had not survived thawing either. He argued: 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 12 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 the lack of skills and necessary technology of embryologists in Poznan. Solomiia argued that the bank’s donors were not at fault, and clinics in Israel working with “fresh” eggs of the same donors had very good survival and pregnancy rates.xiv In the conversation with the Bulgarian partners, the Israeli doctor Tamar, who is a scientific advisor for Medi Group’s fertility operations in Europe and India and often represents the Ukrainian bank, in its cooperation with other clinics, argued that a certain uncertainty of the results is acceptable. Anatiy’s comments reveal the essential uncertainty implicit in the work of the bank - the eggs come from humans, and their success in fertilization cannot be predicted. Nature does not give any guarantees, as well as the social condition, in which these 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 reveal how economic incentives and the need to commodify eggs efficiently force the bank to come up with ways to negotiate these 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 co-production of material’s and technology’s agency. Frozen eggs are manifested in the process as uncertain commodities, since, according to reports of partners, they consistently result in low fertilization rates, and it is unclear which factors are to blame for that. However, the staff at the bank do not 13 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 exactly know how to find out what causes the low survival rate and how to withdraw from the responsibility 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. For example, because eggs are vitrified in the bank according to the Kitizato protocol, they must be thawed using the same protocol.xv To cope with this 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 the processes to complement the processes in 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. 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 organization of the process. According to Solomiia, even the clinic in Poznan had better results 14 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 the longer cooperation lasted. Over time because, different technologies of vitrification and thawing were adjusted to form one synchronized process, and the staff got to know each other. Hence, in this case the scientific expertise is deployed for economic imperatives – it helps to commodify eggs efficiently and increase their value by addressing thawing (and technology discordance between vitrification/thawing sites) as the main factor that makes their quality uncertain. 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”xvi about every donor in its catalogue based on the data from all conducted egg donation programs. This will allow the bank to identify the causes of every failure—vitrification, donor selection and stimulation protocol, thawing process, or egg morphology. 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 15 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 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) The software developed by the bank is seen as a more efficient procedure to deal with donors, and to commodify eggs. It would allow the bank to control and assess donor’s “efficiency” from recruitment to stimulation protocol, to the embryological manipulations performed on donated eggs, to pregnancy in a partner clinic. By comparing the results of numerous donors, the system allows the bank to increase the value of eggs and cope with uncertainties represented by cases when fertilization fails. 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.xvii 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. 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: 16 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 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. But before we have information about her results, we cannot know if she is blacklisted or not. (Solomiia, 2017) If the staff believe eggs have not resulted in pregnancy because of the donor, the staff aspires to see which factors, like age, average amount of donations per donor, the number of eggs per one egg retrieval (if the retrieval of more eggs leads to worse quality), the number of cycles the donor went through (if the quality of eggs worsens the more the donor donates), 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 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) The discourse of “efficiency” and “automation” at the bank takes natural variation out of the equation. In aspiring to calculate and predict fertilization results and bank profits, and tame eggs as uncertain commodities, staff obscures the inherent uncertainty of conception. Although the staff 17 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 often blame donors, they also realize 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) Egg quality categories: what if egg morphology is to blame? How do the dilemmas that arise when the staff tries to turn eggs into commodities trigger certain scientific problems? 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).xviii The bank used medium quality eggs–eggs with minor remarks–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 US). 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 18 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 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 towards the remaining zero quality eggs.xix This did not allow the bank to analyze which stimulation protocols were successful in producing higher quality eggs and which were not. In the case when the cause of failure was hard to identify, the responsibility for the “not so good quality” was once again outsourced to the donors’ performance.xx 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. Negotiating Uncertain Expenses Bank staff was very uncertain about how much money they spent on each donor’s stimulation, vitrification, fertilization, and transportation of eggs. They were therefore uncertain how much profit they were making from each donor, and whether certain partnerships were profitable. They hoped that Donation Service software would assist them in this: 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 19 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 medical tests. Also, it is impossible to finalize the expenses at the stage of stimulation protocol, when we don’t 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) While for a long period of time the bank counted their costs and established prices based on the overall number of eggs retrieved from one donor, large portion of these eggs they were not able to sell. 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 (referred to as leftovers). 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. 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 additional uncertainty of eggs as commodities. As the bank was freezing while unable to sell zero quality eggs, their accumulation in storage undermined value of those eggs that the bank was able to sell and distribute. Since according to internal research in 20 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 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.xxi In cases when a partner clinic or individual couple complains 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.xxii 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 it will 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 don’t 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, 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) Another category of eggs that constituted bank’s losses were the “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.xxiii 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. 21 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 Because zero quality, compensation, and “leftover” eggs could not be sold, while the bank has been spending money on their production, vitrification, and storage, it became less and less clear what the price of the oocyte should be, exacerbating the position 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 towards 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) She 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 22 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 actual situation in the warehouse. Ivan also emphasized that it would make sense to indicate in the balance sheets only those eggs that are sellable and in stock, so accounting only for good quality vitrified eggs.xxiv The bank has decided to write off (depreciate over time) unsellable eggs of lower quality and include them as capital rather than operational expenses. Conclusions This article examined how 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. The value of eggs as commodities is produced not just in one place, but it 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 it. 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. It is monetarily critical for the bank to ensure the “quality” of frozen ova and control the factors that affect it. However, it is unclear which factors influence the outcomes of treatments and to what extent. As a result, the staff at the bank are concerned with the question of the “efficiency” of vitrification and thawing, investigate the relationship between the quality of eggs and donors’ “performance,” and come up with different scientific categorization of eggs (make efforts to predict eggs quality based on their morphology and other factors). As 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 23 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 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 economic value is affected by different factors, including the uncertain chances of survival and fertilization of vitrified eggs, all the losses and expenses that result from these uncertainties cannot be completely calculated in advance to ensure profitability. 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 is doing quite a pioneering job in 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. Notes “Vitrification” commonly refers to “a reduction in temperature, typically at rates of more than -2,500 C/min, before storage in liquid nitrogen at -196 C.” It results in the “formation of an amorphous solid or glass-like state (noncrystalline).” (Practice Committees of the American Society for Reproductive Medicine and Society of Reproductive Biologists and Technologists 2021). ii Such destinations include Ireland, the UK, Israel, Macedonia, Albania, Bulgaria, Slovakia, Poland, Spain, Germany, Austria, Italy, Hungary, Belgium, Cyprus, Georgia, Nepal, Cambodia, the USA, Canada, Argentina, Brazil, Mexico, Argentina, Russia, and Ghana. iii Also called “vitrified embryos” and “vitrified oocytes.” iv In case IPs desire an IVF cycle with “fresh” ova, they can also choose the third option of the “travelling donor”, in which the bank arranges the trip of the egg donor to any destination, where her ova are retrieved and used in the IVF procedures of the clinic’s patients (very rarely performed because of its high cost and inconvenience). v More than 8 vitrified oocytes are required to achieve a delivery rate of 46% (Rienzi et al. 2012). vi 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. vii 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. viii 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, 275) and that “different natures have different types and degrees of “agency”, which may assist or interfere with commodification (Castree 2003, 289). Karen Bakker (2003), for example, shows how water is “uncooperative” in its i 24 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 commodification and Boyde, Prudham and Schurmann (2001) call these contradictions “the problem of nature”, being a source of surprise, always unpredictable and emergent. ix According to Castree, commodification presupposes physical privatization (eggs belonging to different parties who are free to alienate them), alienation and individuation (they can be physically separated from the seller and from their context), valuation and displacement (they take on exchange value, occluding the relations of their production) (Castree 2003). x During internal business meetings in the bank, different estimates are mentioned. The bank promises 64% efficiency if the couple comes to its clinic and does one cycle of IVF with fresh eggs, 59% - with vitrified eggs, and 96% - if the couple uses all the embryos created from one egg retrieval. xi The blastocysts resulting from “fresh” oocytes are still cryopreserved to be delivered to clinics abroad. “Vitrified embryo” transfers also result in similar clinical pregnancy rates as “fresh” transfer cycles (when the embryo is not frozen) (Cambiaghi et al. 2014; Feng et al., 2012) xii For example, the bank’s partner clinic in Macedonia claims a 49% fertilization rate from vitrified eggs. However, while Poland had bought around 793 sets from the beginning of its cooperation in 2016, all other partners together had bought only 71 sets (business meeting, observations, 2016), making comparison difficult. xiii In the shipment before that, they received five sets of ova for five patients and all five were pregnant at the moment of this conversation. xiv 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. After transferring one or two third day embryos in one embryo transfer, 51% of couples had clinical pregnancies. 64% of all patients had a pregnancy after several embryo transfers. In programs where all the embryos from one donation cycle have been transferred (up to six transferred embryos in up to three transfers), 96% of patients got pregnant. The couples get 5.3 good and fair quality embryos per cycle. The patients who did from one to three embryos transfers got two to six embryos using eggs from one egg retrieval in the bank. xv The fact that the medium in which the oocytes are thawed was two 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. xvi The reports will include the following information: the bank’s data about the results of vitrification (freezing) and data from partners regarding the results of thawing (survival rate), fertilization and clinical and biochemical pregnancy rates, the age, weight, and height of the donor (this information will be recorded when the donor fills in the profile form), number of programs, results of medical tests, stimulation protocols, dose of medication, number of stimulation days, date of egg retrieval, AMH levels, ovulation trigger, hCG, number of oocytes retrieved and vitrified, and “quality” levels of retrieved and vitrified eggs. xvii A study like that would also help the staff to find out whether poor quality is a problem of the donors stimulation or a problem of vitrification. xviii The bank’s director Solomiia explained to me how this classificatory scheme emerged: “We had an experiment in 2016, when we vitrified everything. We were thinking about the quality, and we were still learning how to vitrify. We vitrified oocytes according to their morphological features—very round, round, and not that round oocytes. Embryologists divided them into Q1, Q2 and C. Q1 were ideally round. If they had some differences that were not pathological, for example, different size, or more oval than a circle, they were identified as Q2. If we saw that there are some morphological deviations, the cell looks unhealthy, then we did not identify the quality group [group C]. But in 2017 we researched which oocytes survive, and which clinical results we have from each category of oocytes, and we saw that there is no difference. So now all our oocytes can be vitrified, those that are ideally round, and those that are not very round, but are morphologically mature and vitrifiable according to their quality. We don’t produce C quality anymore. These oocytes now are in the internal catalogue for Ukrainian patients.” (2018) xix 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.” xx The bank’s director Solomiia explained: “We need to understand the dynamics of monthly production of new sets and their proportion in terms of quality, but to do that, we must make remarks about each donor - what the protocol was, what went wrong in this protocol, what we should change, or if we should just take this donor out of future stimulation programs.” (2016) xxi The bank created a separate catalogue of zero quality eggs and subdivided them not according to donor characteristics but based on RH factor. They were planning to offer these eggs for lower prices to Ukrainian couples or offer couples to create embryos from them. In this case, they could use as many eggs as needed from this catalogue to create two blasts and sell the embryos. The bank can fertilize eggs with donor sperm (embryo adoption). However, 25 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 the staff did not want to have a catalogue of ready-made frozen donor embryos, because they were afraid that it would not be ethical to have a bank of frozen embryos: “then we would have to announce to the whole world that we have a bank of frozen embryos, and they won’t ‘stroke our head’ for that” (business meeting, 2016). All these plans never came to fruition. xxii In ideal conditions, the bank guarantees an 80% survival rate, and if the result is lower - if more than 2 eggs from the set of 8 had cleavage arrest (the arrest of embryo development), it compensates the money spent or provides additional oocytes to the couple. For the cycles with vitrified eggs, it guaranteed the cultivation of 4 embryos out of 12 oocytes. If the bank creates embryos at its facilities, then it guarantees 1 out of 8 embryos for transfer, on the third day. However, during certain periods of time, it had different policies. Solomiia explains: “We understand from the clinic’s point of view that we must satisfy the final expectations of the program, provide the clients with the amount of material that will allow them to produce the number of embryos that we guarantee. (2018) xxiii 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 (residues) that did not make it into the sets of eight. We offer them to our clients, but 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 doesn’t work with four? And even better to have eight, because then we can choose a higher quality embryo from several.” (Solomiia, observations, 2018) xxiv 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. 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