Egg-sharing in assisted conception: ethical and practical considerations

Abstract

The present acute shortage of eggs for donation cannot be overcome unless adequate guidelines are set to alleviate the anxieties regarding payments, in cash or kind, to donors. The current Human Fertilisation and Embryology Authority (HFEA) guidelines do not allow direct payment to donors but accept the provision of lower cost or free in vitro fertilization (IVF) treatment to women in recognition of oocyte donation to anonymous recipients. Egg-sharing achieved in this way enables two infertile couples to benefit from a single surgical procedure. However, the practical guidelines related to this approach are ill-defined at the present time leading to some justifiable uncertainty. A pilot study was therefore undertaken in order to establish the place of egg-sharing in an assisted conception programme. The current HFEA guidelines on medical screening of patients, counselling, age and rigid anonymity between the donor and recipient were followed. The study involved 55 women (25 donors and 30 recipients) in 73 treatment cycles involving fresh and frozen-thawed embryos. Donors were previous IVF patients who, regardless of their ability to pay, shared their eggs equally with matched anonymous recipients. They paid only for their consultations and tests right up to the point of being matched with a recipient. The sole recipient paid the cost applicable in egg donation of a single egg collection, although both received embryo transfers. The results indicate that although the recipients were older than the donors (41.4 +/- 0.9 versus 31.6 +/- 0.5 years), and there was no difference in the mean number of eggs allocated, the percentage fertilization rates, or the mean number of embryos transferred, there were more births per patient amongst recipients than amongst donors (30 versus 20%). We conclude that providing the donors are selected carefully, this scheme whereby a sub-fertile donor helps a sub-fertile recipient is a very constructive way of solving the problem of the shortage of eggs for donation. There are also the advantages of including a group of women who would otherwise be denied treatment. Problems related to 'patient coercion' can, in our view, be fully overcome by the application of strict common-sense safeguards. The ideal of pure altruism is not without its medical and moral risk. The success of egg-sharing depends on shared interests and a degree of altruism between the donor, the recipient and the centre. The current HFEA guidelines should be applauded for enabling a highly effective concept of mutual help to develop.

The relationship of clinical response, oocyte number, and success in oocyte donor cycles

“…This procedure has made childbearing possible in women with age-related infertility and diminished ovarian reserve or lack of functional ovarian tissue (1). The process is unique in several clinical and ethical aspects (2)(3)(4). Management of ovarian stimulation in donors and embryo selection for recipients may require a paradigm distinct from that of standard in vitro fertilization cycles.…”

Egg sharing: a practical and ethical option in IVF?

“…Egg sharing has been reported in Australia [12], Belgium [13][14][15], Canada [16], Greece [12], Spain [12], the UK [12,[17][18][19][20][21][22][23][24][25][26]103,104] and the USA [27][28][29][30][31][32][33][34][35][36][37], and was practiced in Italy until legislation passed in 2004 that prohibited all forms of donor and third-partyassisted-conception procedures [38][39]. It is the sole legally permissible form of egg donation in Denmark [3,105] and Israel [40].…”

“…Sharing their eggs might therefore be seen as being of potential interest to women who are unable to access NHS treatment at all, women who have used up their entitlement to NHS-funded treatment and women eligible for NHS-funded treatment who could have one or more egg-sharing cycles while on the waiting list for NHS treatment. Egg sharing in the UK was developed and promoted in the early 1990s by Ahuja and Simons with three specific objectives: as a means of addressing the supply-demand disparity, by accessing an additional source of donor eggs; to provide treatment opportunities for women who otherwise might be unable to afford treatment at all or who might have to delay treatment while saving up to pay for it; and to reduce reliance on -or avoid completely -the recruitment of nonpatient donors who would be exposed to the risks associated with ovarian stimulation and egg retrieval [17,18,20,25]. The first birth resulting from egg sharing in the UK was reported in 1992 [25].…”

“…Others, while providing outcome data for both donors and recipients, are restricted to pregnancy -or to pregnancy and implantation outcomes only -and provide no information regarding live births [19,28,30,31,35,36,38]. Only five studies provide data regarding live-birth outcomes for donors [14,17,25,26,34]. A single published paper has compared pregnancy and live-birth rates for donors, egg-share recipients and women undergoing nonegg-sharing standard IVF cycles [26].…”

Egg sharing in return for subsidized fertility treatment—ethical challenges and pitfalls

“…Oocyte . Subsidy Egg sharing in return for subsidized fertility treatment is often proposed to be a more ethically acceptable means of procuring donor oocytes, compared to the direct monetary payment of egg donors [1,2]. In recent years, the concept of egg sharing has caught on in popularity; and among the various countries that have permitted egg sharing in clinical assisted reproduction includes the United Kingdom [3], Belgium [4] and the People's Republic of China [5].…”