Support for recognition and payment options for egg and sperm donation in New Zealand and Australia

Abstract

STUDY QUESTION To what extent do infertility clinic patients, fertility industry professionals and members of the public support different forms of payment and recognition for egg and sperm donation? SUMMARY ANSWER While participants expressed support for reimbursement of expenses for both egg and sperm donation, payment constituting explicit financial advantage was regarded less favourably although potentially necessary to address donor gamete shortages. WHAT IS KNOWN ALREADY In both New Zealand and Australia, commercial inducement for the supply of gametes is prohibited. This prohibition has been argued to contribute to limited availability of donor gametes with the effect of increasing waiting lists and/or the pursuit of potentially unregulated cross-border reproductive care by domestic patients requiring donor gametes. STUDY DESIGN, SIZE, DURATION The study was a mixed methods study drawing on data from a questionnaire completed by 434 participants from across New Zealand and Australia between November 2018 and March 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS Stakeholders involved in donor-assisted conception (past and present infertility patients, gamete recipients and donors), fertility industry professionals and members of the public were recruited following online advertisement of the study. All participants spoke English and primarily identified as Caucasian. Participants anonymously completed an online questionnaire gauging their support for a range of recognition and payment options. Dependent samples t-tests were used to probe for differences in support of recognition and payment options in relation to egg and sperm donation. Linear regression models were used to determine factors predicting support for the different options for both egg and sperm donation. Thematic analysis was used to identify main themes in free text question responses. MAIN RESULTS AND THE ROLE OF CHANCE Broadly, there was agreement that donors be reimbursed for medical expenses, travel time, unpaid time away from work relating to treatments and out-of-pocket expenses directly related to the gamete donation process, with greater support suggested for egg versus sperm donors. Items gauging support for non-material recognition and tokens of thanks for donations were not significantly different between egg and sperm donation programmes (P > 0.05) nor rated as highly as reimbursement alternatives. Lowest ratings of support were indicated for the outright payment or reward of donors for the supply of their gametes, options that would leave donors in better financial positions. Qualitatively, themes valuing gamete donation as ideally relating to gifting were identified, although counterbalanced in opinion by concepts of fairness in reimbursing gamete donors for their costs. Where payment over and above the reimbursement of costs was supported, this was related to pragmatic considerations of limited supply of donor gametes. LIMITATIONS, REASONS FOR CAUTION This study used a cross-sectional design and consequently causal inferences cannot be made. Additionally, participants particularly professional fertility staff, were required to self-report on politically sensitive and legal issues with the potential for social desirability response bias. Snowball sampling may have led to participation of like-minded individuals, thus limiting generalizations of findings. WIDER IMPLICATIONS OF THE FINDINGS In a climate of global commercialization of reproductive medicine, limited donor gamete availability and rising incidences of cross-border reproductive care, the findings of this study can be used as a basis for further discussion between regulators and professional industry stakeholders with respect to shaping ethical policy and practice relating to donor conception. STUDY FUNDING/COMPETING INTEREST(S) No external funds were sought for this work. None of the authors have any competing interests to declare. TRIAL REGISTRATION NUMBER N/A.

Fertility stakeholders’ concerns regarding payment for egg and sperm donation in New Zealand and Australia

“…Valuable consideration is defined as 'includ(ing) an inducement, discount, or priority in the provision of a service' (HART Act, Part 1, 5). This position is similarly replicated across Australian (Goedeke et al, 2020). In this study, support was expressed for reimbursement of costs, including donors' medical expenses, travel time, unpaid time away from work relating to treatments, and out-of-pocket expenses directly related to the gamete donation process.…”

“…This raises the issue that the motivations of altruistic donors may not always be positive, and highlights the need for ongoing oversight of donor conception protocols and clinical practices. However, it is important to acknowledge that in the context of New Zealand and Australia, cultural views and legislative frameworks continue to favour altruism ( Goedeke et al, 2020 ), and that the meanings ascribed to payment may differ across jurisdictions ( Sutton, 2018 ).…”

“…One possible approach would be to explore the concerns held by people in more depth, and to highlight the research which suggests that financial and altruistic motives are not necessarily diametrically opposed ( Gilman, 2018 , Kool et al, 2019 ), and that the concern around the type of donor incentivized by monetary payment may not necessarily hold true. Given, however, that payment per se may not necessarily increase the number of donors who donate ( Daniels, 2000 ), and that research suggests that support for payment constituting financial reward is not strongly endorsed in the New Zealand and Australian context ( Goedeke et al, 2020 ), other ways that address both the need for donors and ways to improve donor recruitment in keeping with the current legislative framework of altruistic donation should also be considered. These include better education and health promotion programmes with respect to age-related fertility decline, thereby reducing the need for donors in some cases, and public awareness campaigns that draw on personal stories and civic duty to attract donors ( Del Valle et al, 2008 , Shaw, 2010 , Moura et al, 2019 ).…”

“…This study represents the second part of an overarching study investigating recognition and payment options in New Zealand and Australia, with the level of support for various options reported in an earlier publication ( Goedeke et al, 2020 ). Participants were recruited from stakeholders involved in assisted reproductive technology (ART) treatment, and included those who had personally experienced infertility [defined as the inability to conceive after attempting for ≥ 1 year ( Fertility Associates, 2021a ) and may include those who have not accessed treatment]; current and past fertility clinic consumers and their associates; donors; recipients; donor offspring; and professionals such as fertility specialists, embryologists, nurses and counsellors.…”

“…https://www.nhmrc.gov.au/about-us/publications/ethical-guidelines-use-assisted-reproductive-technology, 2017 , Prohibition of Human Cloning for Reproduction Act, 2002 (Cth), S21]. On the other hand, reimbursement of reasonable costs associated with donation is permitted in both countries and was supported empirically in recent research ( Goedeke et al, 2020 ). In this study, support was expressed for reimbursement of costs, including donors’ medical expenses, travel time, unpaid time away from work relating to treatments, and out-of-pocket expenses directly related to the gamete donation process.…”