use. As vitirication has been developed and improved, with reports of pregnancy rates between 54 percent and 63 percent per transfer, egg banks have become a source of donated eggs. We are hearing of more and more reproductive medicine centers partnering with egg banks and offering patients egg donation at one-third the cost and a much faster process.
Challenges remain—ethical, legal and regulatory concerns
Reproductive technology and egg donation practice are moving at such a rapid pace today that many important social, ethical and legal considerations are lagging behind significantly. Many of us, including leaders in the field of reproductive technology, are unsure what the next steps should be.
Although egg donation has enjoyed widespread acceptance and relatively little scrutiny in the United States, this is not the case throughout the world. In Italy, for instance, a law was passed in 2004 to ban egg donation completely, banning also the use of donor sperm and helping women past childbearing age becoming pregnant via ARTs. The road to this law started in 1994 when Italy made headlines because Dr. Severino Antinori used donor eggs to allow 63-year-old Rosana Della Cortes to become pregnant. Robin Marantz Henig states:
We are learning the wrong lessons from our earlier misadventures. Things got a little out of hand, yes, but that is because governments around the world adopted a hands-off policy towards the whole affair. It was too complicated to reach consensus about what steps were too intrusive, about when human life begins, about what risks were worth taking for the sake of having one’s own biological child. So governments turned their backs on reproductive technology and allowed the field to be taken over by cowboys. (Henig 2004)
Still unable to come to a consensus about exactly what should and should not be accepted with regard to egg donation, countries such as Italy, Austria, Norway, Sweden and Switzerland have also nearly eliminated egg donation. While such strict laws serve to call everyone’s attention to the potential for ethical abuses in egg donation, they also create new social problems. There now exists what has been termed “fertility tourism”—people living in countries that ban egg donation are traveling to other countries to obtain eggs.
Many counties in which IVF and other ARTs are part of national health care plans—such as France, the Netherlands, Spain, the United Kingdom, Canada and Australia—have legislation in place regulating egg donation. These policies especially place restrictions on anonymous donors. The Human Fertilisation and Embryology Authority (HFEA) is a government body in the UK which regulates and inspects all clinics providing IVF and donor conception. Its governing board, which includes people who have had personal experience of donor conception, along with experts in the field of reproductive medicine and bioethics, makes important decisions regarding regulations about the way donor conception is carried out. In January 2003 the UK announced a registry for donor offspring, which was established in 2004 as a pilot project. This voluntary registry enables donor offspring and donors who participated in gamete donation before 1991, when the Human Fertilisation and Embryology Act came into being, to exchange information. Since then more than 18,000 children have been born in the United Kingdom with donated gametes. In 2004 the United Kingdom also announced that, after April 2005, anyone looking to donate eggs or sperm would no longer be given anonymity. Similarly, some Scandinavian countries have always had open sperm donor files, and clinics in New Zealand do not accept anonymous donors.
Another worldwide difference of note is the use of IVF patients as a source of egg donation or egg sharing. This is allowed and even promoted in Canada, Denmark, India, Israel, Spain and the United Kingdom, as well as sometimes in the United States. Many European countries, particularly those that support egg sharing, provide government funding to women attempting anywhere between two and five cycles of IVF. Many feel that this method of engaging egg sharing among government-funded IVF cycles ensures “more bang for the government’s buck.” On the other hand, New Zealand believes that egg donors are only able to give consent without the pressures of financial incentives; as a result, egg donors are not allowed to be paid in any case.
The New York Times has an “Ask the Ethicist” column each Sunday in its magazine section. Evidence of how mainstream egg donation has become came on April 8, 2012, when the column concerned egg donation. Specifically, the writer complains about a “fertility consultant” who took their money and then failed to search for an egg donor with a Hawaiian background. The ethicist chooses to comment more on the intended parents’ desires to find a donor of their ethnicity than on the fact that, in the US, anyone can call themselves a fertility consultant or an egg donor agency and charge large sums of money to find egg donors.
It is seems odd to us that even in the “Ask the Ethicist” column, the ethicist does not address some of the fundamental ethical concerns of egg donation: should women be paid? If so, how much? Should anonymous donation be permitted? How should egg donation be regulated and by whom?
It seems that the most controversial issue worldwide involves financial compensation to donors. There are countries, such as Australia and Canada, that prohibit payment to donors and there are others, such as the UK, that limit payments to a compensation for time spent. By contrast, the United States has allowed an industry to develop in which donors commonly receive between $5000 and $10,000 and, all too often, upwards of $15,000. Although the American Society for Reproductive Medicine (ASRM) stipulates that this payment is for time and effort, women are commonly receiving higher payments when they have donated successfully in previous cycles. One would think that, if anything, a second- or third-time donor would spend less time and effort on the cycle, since she is familiar with the process, but, rather than her fee remaining the same or being reduced, it rises with each successful cycle. Similarly, women who are physically beautiful or have high SAT scores may also command higher fees, again suggesting that the payment is not simply for time and effort.
Major ethical issues range from concern for the offspring, some of whom may be forever separated from their genetic relatives, to concerns for the donors, who may be enticed by the payments to do something they may later regret, to concerns for the recipients, some of whom may be entering into parenthood at advanced age with inadequate understanding of the challenges involved for themselves or their children.
Other questions about egg donation involve who should regulate the practice and how it should it be regulated. Some in the United States feel that this country should follow in the footsteps of nations that have implemented governmental regulations and restrictions. Others in the United States prefer to have professional organizations, such as those in the field of reproductive medicine, responsible for making these types of decisions, rather than government agencies. Still others argue that since egg donation is a multidisciplinary field, it, should be thoughtfully guided by a panel of experts in medicine, science, genetics, psychology, sociology, theology and law. They feel that these professionals can work together for a common goal: to maintain excellent quality of care while considering the effects on greater society.
Regardless of who regulates egg donation, the questions around regulation all involve protecting the best interests of all participants. First, the offspring. The appreciation for the lifelong impact of donation on all participants has come largely from a worldwide movement of donor offspring (although all adult donor offspring were conceived through donated sperm, not egg donation, they do not differentiate themselves from anonymous egg donor offspring). Many donor offspring throughout the world have spoken poignantly and powerfully about their experiences.
Christine Whipp wrote an article entitled “Why I need to find my father” in which she writes:
Luckily through the media and the internet I came into contact with other donor offspring from across the globe… It soon became apparent that we share a commonality in our experiences and have identified many uncomfortable issues with which we must deal as a result of the choices made by our parents. These can include feelings of revulsion at the clinical method by which we were produced; a sense of loss and grief for deliberately severed relationships with unknown biological kinfolk; a fear of accidental incest; anger and
