Fuelled by desire and desperation, and considerable hucksterism, the global fertility industry is sometimes seen as having kinship with the sex trade. Its critics are keen to point out that it’s saturated with eugenicist values and geographic exploitation. In a not atypical scenario, a handful of ‘white eggs’ are purchased from a woman in Ukraine and combined with ‘Viking sperm’ from Denmark in a clinic in Georgia or northern Cyprus, the low-cost reproductive hotspots of the moment. The embryo is then transferred into the hormonally primed womb of a woman hailing from, say, Uzbekistan, lured by what for her is a life-altering sum of money (usually around €5,000). If all goes according to plan, the newly made baby will, with a bit of savvy paperwork, be ferried to its new home – perhaps in the UK – where it might be nourished with human milk ferried from the breasts of women in Cambodia. Spy-like couriers shuttle the various perishables, packed in dry ice, across national borders, cleverly parlaying their way through airport checkpoints and avoiding those with too much regulation. 

Baby-making has become ‘a capitalist’s wet dream’, writes journalist Alev Scott in Cash Cow. Although the subject has been much explored by scholars, Scott comes at it a little differently – initially as a new mother who diligently, sometimes painfully, finds herself isolated and competitively expressing milk, first in her home in the Netherlands and later in the UK, tallying her totals via a scale, storing her extra ounces in the freezer, taking notes all the while and anxiously measuring her production against her baby’s growth. In Cash Cow, which is part memoir and part investigative journalism, she portrays herself as a young naïf (she is in her late thirties), an ingenue learning the new technologically mediated ‘facts of life’, riven by maternal anxiety, but also consumed by curiosity about emerging fertility markets.

After several months of ‘self-milking’, as it’s called, Scott has turned herself into such a prime ‘performer’ that she can’t avoid thinking of herself as an ‘expensively maintained Jersey cow’. With far too much milk in her freezer, she seeks to ‘donate’ to babies in need, to then realise that selling milk is a thriving business. She discovers a popular website called Only The Breast, ‘a bamboozling place, somewhere between Tinder and an à la carte dairy farm’. Here, she poses with some trepidation as a seller, but quickly discovers just how entangled are sex and hormones, comfort and pleasure, milk and babies. Freud was not wrong. Lonely men with fetishes for being suckled, or just for images or soundtracks of the breast releasing drops of milk, are the prime buyers. Some others are followers of a health fad that regards human milk – especially colostrum – as ‘liquid gold’. Occasionally that is just a front. Adult wet-nursing can garner $150–400 a day in the USA, Scott discovers. 

From milk, she briskly proceeds to the circulation of eggs and placentas – each the title of one of her three chapters. The fertility industry’s unsavoury truths continue to fascinate and repel her. She interviews long-haul couriers who keep mum about how much they’re paid, evasively telling her that ‘every journey is different’. Scott also talks to IVF agents and brokers as well as physicians who (over)stimulate ovaries and extract eggs, or transfer embryos into wombs, some of whom give her the impression of having a ‘God complex’. She visits fertility fairs where products and services are hawked and hope is sold. 

In northern Cyprus, Scott poses as both egg buyer and prospective donor. This small Mediterranean half-island with a militarised border is where she spent her childhood summers – her mother was born and raised there – but she barely recognises the place. It now thrives not only as a low-cost fertility hub but – hardly coincidentally – as a gambling mecca, both markets having emerged thanks to ‘relaxed’ laws. She counts seventeen IVF clinics in Lefkosa alone, a city with a population of roughly 100,000. She tracks the story of a lesbian couple from the UK in their sixties and seventies who had two surrogates birth their ‘twins’ on the same day via Caesarean section and then were stuck on the island for four years because they had been remiss with their paperwork. 

Gamely trying to price both à la carte services (ever-changing) and package deals for mitigating risk, Scott discovers that clinics incessantly try to better one another. Who is telling the truth is impossible to determine. Euphemisms abound, captured not just in the very word ‘donor’ but also in the ‘gift’ rhetoric of slick brochures. Looking through the donor egg profiles of Ukrainian and Russian women, their blonde hair and provocative poses reminiscent of Tinder photos, Scott notes their implausibly perfect health histories. Appearance accounts for the difference in price – between £450–600 – but some look decidedly cosmetically enhanced. The eggs from Turkish women sell for less. Would she herself choose, she wonders, the Turkish donor whose profile she likes but who isn’t attractive? (The uncomfortable answer seems to be no.) Jewish eggs exact an enormous premium; Chosen Egg Bank is a facility that ensures fertility treatment complies with Jewish law. But for Scott the whole endeavour is an ‘extreme exercise in trust and hope, and perhaps ultimately a doomed one’. 

In the end, having initially abhorred it, she prefers the rank commercialism of the US model. For all its faults and excesses, it is more transparent. Its fifty-page surrogacy contracts are ‘upsetting’ in their details regarding everything that can go wrong (loss of teeth, loss of uterus, death) and in their prohibitions for the surrogate (don’t handle a reptile) and for the surrogate’s partner (don’t hit her), but she thinks it offers the ‘safest, fairest model’. Overall surrogacy costs are high (often $150,000 or more) but this, she writes, is down to safeguards and health insurance in that country. Base pay for a first-time surrogate is $50,000 in the state of Idaho, more than the state’s average income. The Midwest in general is the world’s surrogacy hotspot for the well-heeled. Many of the surrogates here are nurses, schoolteachers or in the social services. Most are evangelical Christians and, to Scott’s astonishment, sometimes happy to carry for gay men. Several surrogates tell her that they see their creation of children as ‘doing good’ in the world (‘God is telling me I need to do my part’), and claim the money is helpful but not why they do it. Some speak of their pride in their clients’ gratitude, which in lucky cases endures after the baby is born. One interviewee carries twelve surrogate children after two of her own, and then has a hysterectomy to stop the compulsion. What shocks Scott most is the callousness of some intended parents and what she calls ‘cost-effective hacks’ – such as transferring two embryos; twins cost only an extra $5,000 in the USA (a bargain!) but dramatically increase the danger to the surrogate, especially if she is small and the donors are not, and to the babies.

Still, in the end, Scott does not argue against the commercialisation of reproduction. Bans only make the fertility industry go underground. She’d like to see the middlemen not profit quite so much and the women profit more since they are risking health and life. She concedes, however, that motherhood has always been bought, sold and shared as long as humans have existed. And it has always been saturated with risk. Her interviews leave her, then, with untidy moral realities, the messiness of human desires and the realisation that what constitutes ‘exploitation’ is sometimes not so easy to parse.