This story was reported by Register staff writers Susan Kelleher, David Parrish, Michelle Nicolosi, Ernie Slone and Kim Christensen. It was written by Christensen.
At least nine women who were anesthetized for what they believed were routine surgeries to diagnose reproductive problems instead had their eggs stolen at the world-famous UCI fertility clinics, records and interviews show.
The stolen eggs were implanted in other women and resulted in at least three births, making the donors mothers without their knowledge.
These new incidents are strikingly different from previous allegations that have engulfed the fertility clinic at the University of California, Irvine, raising the 6-month-old scandal to new levels.
Previously revealed cases involved illicit transfers from women who knew their eggs were being harvested for reproductive purposes. These most recent cases involve the theft of eggs from women who believed they were merely undergoing routine examinations.
Prior to the surgical examinations, known as laparoscopies, records show the women were given fertility drugs to stimulate egg production, drugs so powerful and potentially harmful that medical experts said they should not have been used under those circumstances.
UCI doctors told patients that their eggs could only be used for testing, not to help them achieve pregnancy.
"It is completely and utterly unjustifiable," said Dr. Arthur Caplan, director of biomedical ethics at the University of Pennsylvania.
"It's like picking someone's pocket, except that it's much worse because you're stealing their reproductive material while they're present for the crime."
Dr. Ricardo H. Asch and his partner, Jose P. Balmaceda, have denied wrongdoing.
UCI officials say they have no direct knowledge of the thefts, but stepped up efforts to contact patients after The Orange County Register reported last Saturday that at least 60 women -- nearly double the number the university had acknowledged -- were involved in illicit egg transfers. The nine laparoscopy patients are among those 60.
"If this is true it would appear to fit the pattern of unethical conduct by the doctors," Chancellor Laurel L. Wilkening said Friday.
Interviews and records show that the nine alleged egg thefts occurred during diagnostic laparoscopies -- surgical procedures in which a tiny optical instrument is inserted into the abdomen to examine reproductive organs for conditions that might cause infertility.
The nine women were on a handwritten list of 26 names under the heading "laparoscopy." Three others said they gave consent. The Register was unable to reach the remaining 14 women on the list, which a former clinic biologist said she prepared in 1994 at the doctors' request.
At least two of the nine women who appear to have had eggs stolen said they did not know that any eggs had been harvested during the operations until they were shown records by the Register.
Others did know, but said they were told by doctors that their eggs were removed only to be examined or tested in an effort to solve their infertility problems.
"I never consented to give eggs to anyone -- ever," said Pamella Kaoud, 42, who resides in the Riverside County community of Nuevo.
In January 1989, Kaoud was a patient at the UCI clinic at AMI/Garden Grove Medical Center. She said she knew that Balmaceda harvested eggs during her laparoscopy, but believed they would be used only in "scientific tests" to determine why she wasn't getting pregnant.
However, records show that a total of nine eggs -- including some taken from Kaoud during her laparoscopy and others from a second patient -- were implanted in a third woman. Records indicate no pregnancy resulted.
Kaoud and her husband were trying desperately to have a child at the time and would never have agreed to donate eggs to someone else, she said.
Instead, she said, they ordered the destruction of all eggs not used for her medical diagnosis.
"I would consider it a sin to give a baby away to somebody else," said Kaoud, has two children from a previous marriage and two from her current one.
The UCI clinic closed in June amid state and federal criminal investigations of egg theft, research misconduct, mail fraud and tax evasion.
A second clinic, directed by Balmaceda at Saddleback Memorial Hospital Medical Center, also has closed.
Asch's lawyer, Ronald G. Brower, did not return phone calls Friday.
Patrick Moore, who represents Balamaceda, said he would be unable to fully investigate the allegations because patient records have been seized by authorities.
Dr. Sergio Stone, who joined Asch and Balmaceda's partnership when the clinic moved from Garden Grove to the grounds of the UCI Medical Center in Orange in 1990, also has denied wrongdoing.
His lawyer, Karen L. Taillon, declined comment Friday but has said in previous interviews that Stone's practice did not include egg transfers.
Both Asch and Balmaceda have sold their Orange County homes and left the country in late summer. Asch, a native of Argentina, has been on a lecture tour in Europe and reportedly opened a practice in Mexico. Balmaceda has returned to his native Chile to be with his family, his lawyer has said.
In their absence, the scandal has grown dramatically from the two cases of alleged egg theft first reported by the Register in May.
Records and interviews now show that at least 60 women, including the laparoscopy patients, were unknowingly involved in illicit egg or embryo transfers by UCI fertility doctors.
On Wednesday, after repeatedly denying that they had access to an embryologist's records indicating additional cases of egg theft, UCI officials admitted that their lawyers had overlooked the documents since receiving them in early October.
The documents apparently include former clinic biologist Teri Ord's seven-page handwritten list of more than 200 patients referred to in the Register's reports, UCI officials said.
The list tracks donations from 110 women to 93 recipients, reflecting at least 51 pregnancies and an unknown number of births. It does not show whether patient consents were obtained, but at least 28 "donors" have told the Register they did not consent.
Most of the women who said they did not consent were patients whose eggs were being harvested for their own use during assisted-reproduction procedures that cost thousands of dollars and had made Asch and Balmaceda famous and wealthy.
Kaoud and other laparoscopy patients said in interviews that they were told they were given potent fertility drugs to stimulate their ovaries to see if the drugs would work, or so their eggs could be tested.
But prescribing fertility drugs to create eggs not intended for implantation has never been a standard practice, according to pharmaceutical manufacturers and other fertility specialists.
Doctors sometimes give fertility drugs to see if a woman will produce enough eggs to make an in-vitro fertilization or GIFT procedure worthwhile. If the woman produces too few eggs, the doctor may cancel the cycle without ever retrieving the eggs, said Dr. Richard Paulson, who heads the University of Southern California fertility clinic.
But there are no circumstances under which a doctor would take eggs just to look at them, Paulson said, because little can be determined by such an examination. The best way to see if an egg is good is to implant it, he said.
"The proof of the pudding is in the eating. The proof of the egg is whether they implant," Paulson said.
He said fertility doctors retrieve eggs from a patient for one purpose: to try to get the woman pregnant.
Most of the women whose eggs were taken during laparoscopies said they were given Pergonal, a widely prescribed fertility drug with potentially serious side effects.
The pamphlet that accompanies the drug states that after taking Pergonal, some women have suffered acute respiratory distress syndrome, stroke, ovarian cysts, abdominal pain, fever, chills, joint pains, nausea, headaches, malaise, vomiting, diarrhea, bloating, body rashes and heart palpitations.
"In rare cases ... complications ... have resulted in death," the pamphlet states.
While women who are trying to become pregnant are willing to take such risks, fertility specialists and a spokeswoman for the drug's maker, Serono Laboratories, said they have never heard of the drug being used to produce eggs not intended for implantation.
"Perganol would be used in a procedure where you are trying to get a patient pregnant -- period," said Gina Cella, a Serono spokeswoman.
Balmaceda's lawyer, Moore, said he could not comment on the allegations of misuse of fertility drugs without the patient records.
"To evaluate that, you have to determine whether Dr. Balmaceda was the one who prescribed the Perganol," Moore said.
Patients who have since found out that records show their eggs were given away said trying to achieve pregancy with eggs harvested during laparoscopies was not presented as an option.
"We said 'Can we use these for ourselves?' We were told no" by Asch, said the husband of an Orange County nurse who had a diagnostic laparoscopy in 1989. "It was a flat no, period."
The Register has agreed not to publish the names of fertility patients who request anonymity to protect medical confidentiality and familial privacy.
In addition to the nine patients who said they did not consent to donate their eggs, two said they did consent -- but only because doctors misled them.
Ashley MacCarthy of Irvine said that in 1989 Asch persuaded her to donate by saying her 15 eggs would go to women who did not have the money for the expensive fertility procedures. But she said she recently learned from UCI that her eggs were sold to other patients.
Now she wonders if the famed fertility specialist had a profit motive for putting her on the fertility drugs.
"I feel like I was just an egg factory for Dr. Asch," said MacCarthy, 39.
A second woman said she was prescribed Pergonal and consented to donate her eggs because doctors told her that using them herself was not an option. A third consenting donor said she did not recall being given fertility drugs.
Another Orange County woman, who wound up adopting children after her fertility treatments were unsuccessful, said Asch also prescribed Perganol for her and told her it was necessary to check the viability of her eggs.
"This was done as a diagnostic procedure -- period," she said of the 1987 laparoscopy, explaining that she did not consent to donate.
Records show, however, that three of her eggs were given to another Orange County woman, who had a child.
"They put me under just to take my eggs," she said. "That's really scary. "
In many cases, the scandal has deeply shaken not only the women whose eggs were taken, but their spouses as well.
"We have been raped on a genetic level," said the nurse's husband.
'They have literally taken my children from me, or the possibility of those children. We were robbed of that extra chance to have children."