Egg sharing: a practical and ethical option in IVF?

Abstract

Egg sharing is a procedure in which a woman who is herself undergoing assisted-conception treatment receives subsidized treatment in exchange for sharing her eggs with another woman. It has become increasingly prevalent in the UK and is the major source of donor eggs in the UK; however, its practice is controversial. Available evidence concerning the outcomes of egg sharing is limited. To date, while this has failed to provide strong empirical support for concerns that have been raised regarding egg sharing, continuing significant gaps in information regarding clinical and psycho-social outcomes remain, which mean that an informed judgment on empirical grounds cannot yet be made. Ongoing key ethical controversies focus on the impact of egg sharing on the commodification of human gametes and whether women can genuinely consent to donating their eggs under an egg-sharing scheme. KEYWORDS: commodification of gametes • decision making • donors • egg donation • egg sharing • informed consentTechnological developments in reproductive healthcare have increased the options available to people seeking to overcome fertility impairments -including treatments using gametes provided by a third party. In practice, although some jurisdictions prohibit donor remuneration, payment to 'donors' is common. Such payment necessarily confounds the accepted definition of 'donor'. In accordance with common usage in the assisted reproductive technologies (ART) literature, we have employed the terms 'donor' and 'donation' in this paper, but the reader should be aware of this caveat. While insemination of donor sperm has been used as a medicalized procedure for well over a century [1], IVF using donor eggs is a much more recent phenomenon; the first birth from such a procedure was reported in Australia in 1984, using an egg provided by an IVF patient [2]. It is quite possible, although the authors do not provide details of the arrangements under which the donation took place, therefore, that the very first reported birth through egg donation was in fact the result of egg sharing. Use of donor eggs is clinically indicated for women seeking to conceive who have experienced primary or secondary ovarian failure, who have functioning ovaries but for whom standard ovarian stimulation drug regimes have failed or where there is a risk of transmitting a serious genetic disorder to a child [3].Use of donor eggs has become especially prevalent in ART procedures for older women (i.e., women aged over 40 years), for two inter-related reasons; first, because of the significant decline in female fertility once women reach their mid30s [4] and the more rapid decline after the age of 40 years [101], and second, because the likelihood of successful embryo implantation is related to the age of the woman providing the egg rather than to the age of the woman in whom the embryo is implanted [5]. US data show that while fewer than 3% of all women undergoing an ART procedure during 2005 used donor eggs, 22% of women aged 41-42 years, 55% of women aged over 42 yea...

Giving to receive? The right to donate in umbilical cord blood banking for stem cell therapies

“…The findings from this study suggest that altruism and egoism are interwoven with each other as others have noted when discussing donation programmes such as egg sharing [21]. Titmuss [43] argued that the gift of blood should be an act of pure generosity, yet to expect donation to be driven by solely altruistic tendencies, if it ever was, could be considered naïve [44,45], something which is becoming increasingly recognised worldwide [22,26].…”

“…Previous studies have explored a variety of incentives to encourage the donation of body parts, tissue and blood, which have been based upon reciprocity, whereby the donation is mutually beneficial to the donor and recipient, such as egg sharing programmes [21]. In Autumn 2011, the Nuffield Council of Bioethics discussed the use of limited NHS resources to pay the funeral costs of organ donors [22].…”

Implementing an Altruistic Sperm Donation Program in Canada

“…Following regulation of assisted reproductive technology in the United Kingdom in 1990, gamete donation was premised on a model that permitted modest remuneration of sperm donors (£15, or approximately $23) but-with the specific exception of egg sharing 6 -relied on altruistic oocyte donation. Since implementation of the European Tissue and Cells Directive, 7 which applies to donation of all-not only reproductive-human tissues and cells throughout the European Union, gamete donation in the United Kingdom has essentially been "voluntary and unpaid," and advertising the need for, or availability of, human tissue for "financial gain or comparable advantage" has been restricted or prohibited (as in Canada).…”

Egg-share donors’ and recipients’ knowledge, motivations and concerns: clinical and policy implications

“…While supporters of egg-sharing argue that it has distinct advantages over 'non-patient' donation, such as providing 'a balance of therapeutic risk and reward' by removing the need for a healthy woman to undergo 'ovarian stimulation', 4 extending access 5,6 and promoting 'altruistic reciprocity', 5,7 critics have been concerned that such schemes may exploit women who are otherwise unable to afford IVF and compromise consent; 8,9 that benefits in kind may lead to the commodification of human gametes; 10,11 and that egg-share donors whose treatment ends unsuccessfully will be psychologically damaged . 12,13 Despite these debates, such schemes have been regulated in the UK since 1998 14 and, according to figures from the HFEA, since 2002 egg-share donors have constituted the majority of British egg donors, where the principles of cost-neutrality and non-anonymity have attracted few non-patient donors.…”

“…One of the central debates regarding the practice of egg-sharing has pivoted on questions around egg-share donors’ motivations. Although the HFEA's initial decision to regulate egg-sharing was based on their conviction that ‘egg-sharers are not motivated by money, but by the desire for a baby’ 14 critics have remained concerned that the benefit-in-kind could form a financial incentive 8–11 . While it is clear that egg-share donors form a specific subgroup whose motivations, attitudes and experiences cannot be deduced from data on other types of donors (e.g.…”