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June 17, 2013 | Posted By Lisa Campo-Engelstein, PhD

One of the major concerns with human egg donation is that there is no federal or systematic oversight. The UK has the Human Fertilisation and Embryology Authority (HFEA) that regulates the use of gametes and embryos for fertility treatment and research. In contrast, the US is the “Wild West” when it comes to reproductive medicine as we lack any real regulation in this field (there are soft policy guidelines from various medical and scientific organizations but these don’t have teeth). 

Without any oversight, many concerns are raised about the screening of donors. For example, women can donate at multiple centers without any of the other centers knowing. There are no good studies on the effects of donating eggs numerous times, but many believe it could be detrimental to women’s health. Another problem with women donating to multiple centers is that if their eggs are to be used for research purposes, it could lead to less diversity in the research sample. If their eggs are being used for reproductive purposes, then there is a greater chance of creating many half-siblings. 

The lack of oversight means there is no standard screening process for fertility centers. If the screening process is not rigorous at a particular center, it can be easy for donors not be truthful about their personal and medical information. If these eggs are going to research, then incorrect information about the donors could significantly affect the research. In the case of egg donation for assisted reproductive technologies, screening not only affects the donor and the researcher, but it also affects the intended or social parents. If fertility clinics do not adequately screen their donors, then people who purchase an egg may not get what they signed up for. For example, a donor may lie about information (e.g. eye color) or omit certain information (e.g. being a carrier for a particular disease). 

Whether women are “donating” their eggs for research or reproduction, without oversight, the concerns of informed consent, medical and psychological risks, and compensation for donors are likely to be exacerbated. While informed consent is always necessary to perform any type of medical procedure, there is a concern that without oversight some clinics may not ensure that informed consent guidelines are met. One way this could happen is if clinics minimize the medical and psychological risks because they are eager to get more and/or specific types of egg donors (e.g. eggs from certain ethnic groups are in high demand). There isn’t clear or conclusive research on all the medical and psychological risks associated with egg donation (in part because this is a neglected research area) and this may allow clinics to downplay or omit some of the very real risks associated with egg donation. Oversight would ensure that clinics have to share specific information with potential donors. 

One area where oversight would be especially useful is in setting clear compensation guidelines for donors. Right now in the US there is a wide range, from a couple of thousands of dollars to as high as six figures. Some may view the high compensation that can be associated with egg donation as coercive, especially toward economically disadvantaged groups like the poor and college students or recent college graduates with high student debt. Indeed, there is the concern that exploitation is more likely to occur is there is no base minimum payment for egg “donation.”

In sum, the US desperately needs federal oversight of egg donation and of reproductive technologies more broadly. Such oversight will not only protect women who donate their eggs but also those who use their eggs (i.e. scientists or intended parents). 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

1 comments | Topics: Assisted Reproduction, Fertility, Reproductive Medicine, Women's Reproductive Rights

Comments

Tara Bernardino

Tara Bernardino wrote on 07/01/13 9:58 PM

Dr. C-E:

As always, you make incredibly compelling arguments for the need for oversight of egg donation in the US. I would like to add to your essay the additional need for oversight of surrogacy, which often uses donor eggs - whether from the intended parent or an anonymous or non-anonymous source. Many of the arguments you have cited for the need for egg donation regulation also apply to surrogacy governance. Perhaps the issue is even more complex given the often greater number of parties involved.

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.
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