An article from the July 26, 2015 edition of the Wall Street Journal reports on a federal lawsuit on the subject of paying women for their eggs in the setting of in vitro fertilization (IVF). This suit sheds light on several ethical issues regarding paying for items related to life itself and what is and is not appropriate.
Egg donation has become a nationwide practice and extends globally. It is offered by many fertility clinics to couples for whom there is a female (specifically egg) factor so significant that IVF is simply inappropriate.
IVF relies on an ability to “recruit” several follicles at once in order to mature and then retrieve several eggs at once; those eggs are inseminated with sperm in order to create embryos. If a woman’s “follicle reserve” is low or “depleted”, IVF will not succeed. However, if eggs are “donated” by another woman whose ovaries are normal, IVF can proceed and the embryo (and subsequent child) can be carried by the original female partner.
Early on, in cases of egg donation, sisters were often asked to donate eggs for their siblings; however, the process has evolved and egg donors are now routinely compensated for their eggs. Of course, egg donation requires time, effort, inconvenience and even some risk on the part of the donor. There is both physical and psychological screening. Several different medications are used to stimulate the ovaries in a cycle prior to egg retrieval. Egg retrieval itself is a procedure requiring anesthetic medication. So it may seem appropriate to compensate donors for what they sacrifice. But the higher the dollar figure of compensation climbs, the more ethical boundaries may be crossed.
Ideally, a major motivation for egg donors is to help couples that are unable to carry a child otherwise; that “gift” of eggs can give the donor a sense of satisfaction that they are helping another couple. In fact, in some countries, compensation for egg donation is prohibited.
Initially compensation in the US was in the range of a few thousand dollars. Over time, the figure has climbed to five to ten thousand dollars with some donors requesting more. However, the higher the compensation climbs, the more it is anticipated some women who might not have considered donating before, might be tempted to now. Even worse, some women might be pressured by their spouse, family or friends to donate because of the potential reward. There may also be more temptation to hide relevant health history or dismiss the health risks of procedure.
For these and other reasons, in the year 2000, the American Society of Reproductive Medicine (ASRM), suggested that payments should not go above $5,000 without justification, and that payments greater than $10,000 were inappropriate.
The current suit is brought by two women who claim the price guidelines adopted by fertility clinics nationwide have artificially suppressed the amount they can get for their eggs. The legal basis is a claim of violation of federal antitrust laws; essentially the plaintiffs are contending that the guidelines are anticompetitive and interfere with the free market. The lawsuit, filed in the Northern District of California, could go to trial next year, potentially changing the protocol for egg donation in the US. According to the Society for Assisted Reproductive Technology, more than 9,500 US babies were born from embryos created with donor eggs in 2013.
The market for sperm donation, works differently than that for egg donation. Sperm donors generally contract with a sperm bank to give samples over a period of time, for which they are paid about $100 each. Ethical issues regarding compensation seem to have largely avoided this market. However, controversy abounds when extending further the concept of a market for things related to human life. Recently, planned parenthood clinic has stirred controversy when it was discovered they were selling fetal tissue after termination of pregnancy. Furthermore, in the US, it is illegal to procure organs for donation by compensating the donor. Not so, for other countries, and transplant tourism is a reality in other parts of the world.
The issue of buying and selling viable human tissue remain surrounded by ethical qualms and concerns. Gamete donation has served an important need among fertility patients in the US. It is my sincere hope that a lawsuit doesn’t derail a practice that has been serving these needs over many years and that physicians are allowed to continue a role in guiding their patients and others in these difficult considerations.