Conflicts of Interest and Effective Oversight of Assisted Reproduction Using Donated Oocytes

Abstract

Oocyte donation raises conflicts of interest and commitment for physicians but little attention has been paid to how to reduce these conflicts in practice. Yet the growing popularity of assisted reproduction has increased the stakes of maintaining an adequate oocyte supply and (where appropriate) minimizing conflicts. A growing body of professional guidelines, legal challenges to professional self-regulation, and empirical research on the practice of oocyte donation all call for renewed attention to the issue. As empirical findings better inform existing conflicts and their potential harms, we can better attempt to reduce these conflicts. To that end, the article first describes the nature of conflicts in oocyte donation and relevant regulations and professional guidelines. We then describe studies on conflicts at four phases of oocyte donation: recruitment, screening, stimulation, and post-stimulation monitoring. Next we consider three models for conflict reduction in medicine generally: improved professional self-regulation, outright restriction like Stark anti-referral laws, or the use of conflict mediators, like in living organ donation. We ultimately conclude that improved professional self-regulation is a reasonable starting place for oocyte donation.

Alignment between expectations and experiences of egg donors: what does it mean to be informed?

“…Potential long-term complications, such as risk for various cancers, are an even greater unknown, as it is difficult to determine cause and effect without long-term, large-scale studies ( Ahuja et al, 2003 ; Beeson and Lippman, 2006 ; Jayaprakasan et al, 2007 ; Sauer et al, 1996 ; Schneider, 2008 ; Schneider et al, 2017 ). The wide range of conflicting data on short- and long-term safety/risks complicates the informed consent process; some have highlighted that potential practitioner conflicts of interest may also complicate informed consent ( Blake et al, 2015 ).…”

Storage, transport, and disposition of gametes and embryos: legal issues and practical considerations

“…So it is not surprising that regulatory guidance regarding the storage, transport, and disposal of gametes and embryos is seen as disparate, vague, overreaching, or (unfortunately, in some jurisdictions) nonexistent. In the United States, for example, the federal government has a relatively small role in regulating technology such as cryopreservation (11). Guidance is often learned as the result of litigated issues rather than through legislative direction-a case of learning from the outcome of someone else's risk event.…”