JACKSONVILLE, Fla. -- In many ways, the US and Canada aren't that different. But there are important distinctions. And one Canadian law has created a cross-border black market that is potentially hazardous to women in the U.S.
Canada's Assisted Human Reproduction Act makes it illegal for anyone to sell biological material -- including sperm and ovarian eggs. Because the prohibition on compensation does not exist in the U.S., infertile Canadian couples often work through online donor egg companies based in this country, where a cycle of eggs can generate anywhere from $3,000 to more than $10,000.
For one young Jacksonville woman, the opportunity to help a childless Canadian couple have a baby seemed like a perfect kind of philanthropy. In exchange for $5,500, Kylee Gilman agreed to inject herself with hormones toprompt multi-egg ovulation, then travel to Toronto to have a doctorretrieve the eggs.
"It was a free trip up [to Toronto] and it's exciting," recalled Gilman. "I get to help somebody and youget paid for it. The whole thing just sounded good, and no risks."
Gilman clarifies: not "no risk." But she said the worst she was toldto expect was some bloating and discomfort.
Reality was far different.
"Saturday night about 10:30 p.m., I got a call from a girl I didn't know,"recalls Gilman's sister, Courtney Harrison. "She said, "'Don't panic. Yoursister is at the Mayo [Clinic]. She had a stroke.'"
While the egg retrieval process is generally simple, it comes with the risk ofsomething called Ovarian HyperStimulation Syndrome, a rare butpotentially very dangerous condition.
Early tests showed Gilman was at risk.
"Laboratory wise they knew she was responding excessively [to the hormones] because of testing they did before the procedure," said her attorney, Rufus Pennington, a Jacksonville lawyer representing Gillman in a rare case of international medical malpractice.
Doctors lowered her dosage, but they didn't cancel the egg retrieval -- even when it became clear that her egg production far exceeded normal levels.
"Normal egg retrieval in that process is 6 to 10 eggs, andthey said 10-20 range is excessive," Gilman noted. "They documented that he hadtaken 45."
"They got 45," agreed Pennington.
"Wow," said Dr. Daniel Duffy, who is unconnected to Gilman's case, but has managed the egg donor program at the FloridaInstitute for Reproductive Medicine in Jacksonville for more than twodecades. "That's a fairly large number of eggs."
Because collecting so many eggs would almost certainly hyperstimulate adonor's ovaries, Dr. Duffy said his practice would never have proceededwith the retrieval. "We would cancel the cycle and we would stop her stimulation."
But Gilman's doctor went ahead with the procedure. And despite the risks, sent her home that same day. [Her doctor did not respond to repeated requests for comment.]
"I started throwing up in the elevator," she recalls. "I threw up thewhole way home on the plane. In the terminal, on my layover. It was bad, very bad."
Gilman tried calling the doctor. But every time, she said, he put her off. "Every time I talked to them it was: 'You're fine, drink Gatorade, you're OK, you're OK, you'll sleep it off.'"
But things only got worse. Gilman recalls waking and reaching for a drink. "I went to grab for a water bottleand I couldn't feel it," she remembers. "I saw me grabbing it, but I couldn't grab it."
One last time, Gilman had a friend try to call the doctor. "The last time we tried to call, when I was really bad, he didn't answer. So that's when I had him call 9-1-1."
On Nov. 11, 2011, Gilman was admitted to the Mayo Clinic, Jacksonville. Five days later, her egg donation check arrived.
"I hated it, hated that money," says her sister Courtney. "I could crythinking about that money. It's just not worth it."
From around the country, Gilman's family gathered at her bedside and gradually learned what happened. Her sister said the hospital summons was just the start of a long journey. Once the threat of the stroke subsided, the risk of Ovarain Hyperstimulation Syndrome began to manifest.
"We were worried about her ovaries flipping, her ovaries bursting,' Harrison recalled. "Bleeding to death -- do we have to take them out?"
For a while, it was unclear if Gilman would even survive. "The doctors were saying we don't know if she's going to make it," her mother Patty recalls.
Today, nearly 2 years after her stroke, Gilman is recovering -- but she's not healed.
The effects of the stroke -- particularly on her right side -- will be with her forever.
"I can't feel textures, can't feel temperature so I burn myself real easy," Gilman said.
In ordinary circumstances, a malpractice case in Canada wouldn't go far.
"There's not much remedy for medical malpractice [in Canada]," says Pennington. But Gilman's case is unique. The doctor who retrieved her eggs flew toFlorida on vacation the same day she returned home toJacksonville.
"He was in Florida when he called his patient in Florida whowas having symptoms in Florida. And he told her not to go to a Floridahospital and she had a stroke in Florida," says Pennington.
Thus far, Gillman's Canadian physician Dr. Edward Ryan has not responded to the lawsuit.
Gilman is clearly an outlier - less than 1 percent of womenexperience the degree of hyperstimulation she did. Dr. Duffyinsists that, if managed properly, that number should be zero.
"With proper prevention and techniques I don't see why a donor should ever hyperstimulate again," Duffy said.
But as long as the unregulated cross-border trade in ovaries continues,Pennington says there is a danger.
"A market has been created where they are brought acrossinternational border, stimulated and sent home the same day and that'swhat creates this substandard medical environment."
And as long as that circumstance exists, Gilman and her family are determined to warn other young women to stayfar away.
"I want to be able to stop anyone from going through that," Gilman says. "It's not worth it. I thought this idea was grand and greatand I think the idea is good, but for someone to take advantage is not OK."