Women donate eggs for two reasons. Firstly for other women to conceive
and, secondly, for research. Both are dogged
by controversy on medical,
societal and financial grounds. The US and the UK are currently trying
to create guidelines and legislation that will allow workers in
assisted reproduction and laboratory research to operate without fear
of prosecution.
Infertile women undergoing IVF are usually
given some form of gonadotropin-releasing hormone to stimulate multiple
oocyte production. This hyperstimulation and harvesting results in more
oocytes than can be used in fertilisation and embryo transfer in any
given cycle, so there are spare oocytes for later use by the woman, or
for donation. Whether the stimulation should be with GnRH
agonists or antagonists is one debate and another is whether one or two
embryos should be transferred. What is not in question is that the
demand for oocytes far exceeds supply. Women below the age of 35 years
have significantly higher IVF success rates than older women, precisely
the group who are now more often seeking reproductive assistance. The
result is that the donation or sale of oocytes has become a big issue. Clearly
the unauthorised harvesting of oocytes is illegal as an Israeli doctor
has found to his cost (BMJ 2007;334:557), but what about consented
donations to infertile women? The free donation of “extra ova” from
women to their infertile fellow patients seems straight-forward enough,
but already the problem of incentives has arisen. In private clinics,
can these spare oocytes be bought or can the woman be given a discount
for her
treatment if she donates? This discount for donation occurs in
the UK where 75% of all IVF procedures are funded by the patients
themselves despite decrees that all infertile couples are entitled to
four IVF cycles within the NHS (Ledger Lancet 2007;369:717-8). Moving
further along the continuum, is it acceptable for a woman who has no
fertility problems to supply oocytes for payment? In the US it is,
where thousands of babies are born annually from oocytes acquired from
women who receive an average of $5 000 per harvest (Spar NEJM
2007;356:1289-91). The UK has the Human Fertilisation and
Embryology Authority which is the regulator of IVF treatment. It has
now ruled that altruistic oocyte donation, in conjunction with
fertility treatment or not, is acceptable. The report by Mayor (BMJ
2007;334:445) made no mention of discounts for donations in the private
sector - also known as “egg sharing” - so compensation for co-operation
remains a grey area. Other places such as Singapore, Israel and South
Korea allow donations but without payment or personal benefit. The
role of oocytes in research is more complex, despite the fact they may
not be bought for study purposes. Research falls into two categories -
infertility or stem cell research. The former is not as contentious,
despite using human reproductive material, but the latter is highly
controversial using somatic-cell nuclear transfer (SCNT) to create
lines of stem cells from which the US administration has withheld
federal funding. The arguments go that without payment women will not
donate oocytes for research but, attracted by pay, women could be
tempted to “sell their eggs” in a competitive market to their own
potential detriment.