Donna Carr cried when her name was called. They should have been tears of joy, but Carr felt guilty: Surrounding the Minnesota woman and her husband were dozens of women and couples facing infertility, just like they were.
"It was hard to stand there and know we were the ones when maybe other people needed it more," she said.
It was 2007 and Carr, then 37, had just won one free cycle of in vitro fertilization (IVF), a procedure in which an egg and sperm are joined in a laboratory and later implanted in a woman's uterus.
She was one of a lucky few. Last weekend, two more women won free IVF treatments at an annual Minnesota conference -- the same one that awarded Carr her treatment three years ago -- and, on Wednesday, another woman won a free treatment with donated eggs at an IVF seminar in London.
With scant insurance coverage often available for IVF and each treatment cycle costing some $12,000 or more, IVF advocates and treatment winners call such giveaways nothing short of a miracle.
IVF patients, advocates say, sometimes must make budget-busting choices to pay for the procedure, such as taking out loans, leaning heavily on credit cards or depleting their life savings. Adding to the financial burden: first-time IVF treatments often don't work and many women must undergo -- and pay for -- several IVF cycles before successfully carrying a pregnancy to term, if they get pregnant at all.
"It's very expensive and many people have to make really difficult choices about if they're able to become parents," said Julie Berman, a former IVF patient and the chairwoman of an infertility and adoption conference hosted last weekend by RESOLVE, a national infertility organization. "They're making huge sacrifices to be able to afford it."
At RESOLVE's weekend conference, held in Golden Valley, Minn., the organization awarded IVF treatment cycles from a Canadian clinic and from the Reproductive Medicine Center at the University of Minnesota, which provided Carr's treatment in 2007.
The weekend giveaway came just four days before a similar event in the United Kingdom: the Genetics & IVF Institute of Fairfax, Va., a private infertility center, awarded one free IVF treatment and donor eggs -- for women who can't use their own eggs -- at an IVF seminar in London, where a lack of egg donors has left long waiting lists of would-be moms and dads.
GIVF said it has donated at least seven IVF treatments in the last couple of years, while the Reproductive Medicine Center in Minnesota said it has been donating an IVF cycle to RESOLVE's Minnesota conference each year for the last decade.
Such giveaways aren't the only way to receive free IVF: Through its Partnership for Families program, the Cleveland Clinic in Ohio provides a free, second cycle of IVF treatments to couples who earn less than $100,000 a year and who paid for a first cycle but didn't succeed in conceiving.
University of Minnesota Law School professor Michele Bratcher Goodwin, the editor of the 2009 book "Baby Markets: Money and the New Politics of Creating Families," said IVF giveaways are a relatively recent phenomenon, coming to the fore as the 30-year-old practice of IVF procedures has matured into a full-fledged industry.
Offering free products or services is "a way of advertising," Goodwin said. "What we basically see is an industry unfolding in a way that we've seen other privatized industries unfold before it."
Though infertility treatment advocates are loathe to call IVF an industry, the dollar amounts spent on it suggest otherwise.
At least 142,000 IVF cycles were performed in the United States alone in 2007 -- the most recent year data is available -- according to the division of reproductive health at the Centers for Disease Control and Prevention. Assuming a price of $12,000 for each treatment cycle, that would bring the U.S. IVF industry's domestic revenues to more than $1.7 billion.
Goodwin pegs her estimate of the industry's size to some $5 billion, taking into account the cost of IVF medication, other IVF-related expenses and situations where IVF treatment cycles cost $25,000 or more, such as donor egg IVF treatments.
"The industry is quite significant," she said. "It's blown up in robust ways in the past 10 to 15 years."
Part of that growth, Goodwin said, has come from patients who are willing to cross state lines to obtain treatment -- a trend that has encouraged clinics to promote themselves more heavily, she said.
"Clinics are working on a national model," Goodwin said. "They're no longer working on who in (their) community might be interested" in their services.
Such promotion, particularly giveaways, doesn't sit well with some.
"The capacity of the IVF industry to commodify human life reaches a new low with this latest deplorable initiative," Josephine Quintavalle, the director of the London-based public interest group Comment on Reproductive Ethics, said in a statement released in reaction to GIVF's London event.
"Imagine a child one day finding out that he or she came into being thanks to such a blatantly commercial initiative?" Quintavalle said. "Who won the raffle?"
GIVF Donor Egg Program Director Jennifer Machovina rejected CORE's criticism.
"What we're doing is not a raffle. It's not something we're using as a trick or anything like that," she said. "It's not commercializing anything -- we're just trying to give somebody an option where there otherwise might not be anything."
Goodwin can list other reasons to be wary of IVF giveaways: winners, she said, might rush to pursue free treatment without adequately researching the procedure, including the chance of multiple births, which is higher in IVF pregnancies than traditional pregnancies.
Goodwin noted that babies who are part of sets of multiples are more likely to suffer health problems, as are mothers carrying multiples.
Dr. James Goldfarb, the cofounder of the Cleveland Clinic's Partnership for Families Program and the president of the Society for Assisted Reproductive Technology, said that certain events that offer IVF giveaways, including conferences held by RESOLVE, aren't just promoting IVF services -- they're also educating patients.
Patients might learn how age affects fertility or how female cancer patients can freeze their eggs before chemotherapy causes them ovarian damage.
"It's surprising to me how little people know about some of these things," Goldfarb said.
While IVF watchers may debate the ethics of the industry, giveaway winners like Donna Carr and New York resident Alicia are unequivocal in their support of the practice.
Alicia, 39, who asked that her last name be withheld, won a free IVF donor egg cycle from GIVF after attending on of the institute's seminars last year. She decided to attend the seminar after several unsuccessful tries with IVF cycles using her own eggs.
She and her husband spent "several thousand dollars throughout the years, watching our dreams of a family and our bank accounts diminish," Alicia said.
When she learned of the GIVF seminar and the chance to win a free donor egg cycle, Alicia decided the trip to Maryland, where the seminar was being held, was worth it.
"We went, took a chance and we were the lucky winners," she said.
The following fall, Alicia's husband donated sperm to fertilize the donor's eggs, and by late October, Alicia learned she was pregnant.
She's expecting twins this summer.
Carr, meanwhile, overcame the guilt she initially felt after winning her free IVF treatment in 2007. Today, thanks to the treatment, she and her husband have an 18-month-old daughter, McKenna.
"I'm very, very grateful," she said.