Egg sharing and egg donation: attitudes of British egg donors and recipients

Abstract

The question of payment to egg donors has recently focused the attention of both the Human Fertilisation and Embryology Authority (HFEA) and licensed clinics. An acute shortage of egg donors and the rising costs of assisted conception treatment are matters of grave concern to many patients. To understand the emotional and social effects of egg sharing and egg donation, we conducted a survey of attitudes in a group of women who had some knowledge or experience of egg donation. A total of 750 questionnaires were sent out of which 217 were returned within the specified time limit. From these, 107 respondents had experience of egg donation and 110 had made enquiries about donation. The data from these questionnaires were collated and tabulated by the National Opinion Polls (NOP) Research Group. An analysis of the data produced the following key findings: (i) donating or sharing eggs is a social issue, 94% discuss it with partners/family/friends; (ii) altruistic motives are not the prerogative of non-patient volunteers-egg share donors felt that helping the childless was as important as having a chance of in-vitro fertilization (IVF) for themselves; (iii) the treatment procedure causes the most anxiety for egg donors. The recipients were most concerned about delays, donor characteristics and how the eggs were allocated; (iv) most respondents (65%) with prior experience of egg sharing would do it again - 63% of egg share donors, 72% of egg share recipients; (v) cash rewards to egg donors and outright advertising for donors were rejected by 64 and 62% of the sample respectively; and (vi) counselling was highly valued and there were no instances of 'shattered lives' after treatment. The findings do not support the recently announced intentions of the HFEA to disallow payment to gamete donors on the grounds of devalued consent. There is no precedent in modern medicine for egg sharing. The patients surveyed drew a clear distinction between egg sharing and financial rewards. As long as egg donation is not covered by the National Health Service, it is fairer to offer egg sharing than to refuse treatment to those unable to pay.

Egg sharing: a practical and ethical option in IVF?

“…Egg sharing has been reported in Australia [12], Belgium [13][14][15], Canada [16], Greece [12], Spain [12], the UK [12,[17][18][19][20][21][22][23][24][25][26]103,104] and the USA [27][28][29][30][31][32][33][34][35][36][37], and was practiced in Italy until legislation passed in 2004 that prohibited all forms of donor and third-partyassisted-conception procedures [38][39]. It is the sole legally permissible form of egg donation in Denmark [3,105] and Israel [40].…”

“…Sharing their eggs might therefore be seen as being of potential interest to women who are unable to access NHS treatment at all, women who have used up their entitlement to NHS-funded treatment and women eligible for NHS-funded treatment who could have one or more egg-sharing cycles while on the waiting list for NHS treatment. Egg sharing in the UK was developed and promoted in the early 1990s by Ahuja and Simons with three specific objectives: as a means of addressing the supply-demand disparity, by accessing an additional source of donor eggs; to provide treatment opportunities for women who otherwise might be unable to afford treatment at all or who might have to delay treatment while saving up to pay for it; and to reduce reliance on -or avoid completely -the recruitment of nonpatient donors who would be exposed to the risks associated with ovarian stimulation and egg retrieval [17,18,20,25]. The first birth resulting from egg sharing in the UK was reported in 1992 [25].…”

“…To date, empirical studies of views and experiences of participants in egg-sharing programs are confined to surveys undertaken by a single London clinic [17,18] and two small-scale exploratory studies reporting on in-depth interviews with donors [22,24], the latter including the donor's partner. These have investigated donors' motivations and decision-making processes, their perceptions of egg sharing, how they would anticipate dealing with eventual treatment failure and how information regarding egg sharing may be managed within their families.…”

“…On the one hand, it is lauded as extending women's options [17,18]; on the other, it is portrayed as no real choice at all, where a woman's desire to have a child may result in her being manipulated into endorsing any procedure that may hold out the possibility of assisting her to do so [50]. Faced with an option such as egg sharing, a woman may be encouraged to disregard the risks because of the potential prize of a much-wanted baby and may therefore not actually provide valid consent [50,103]: "For those who desperately want children but cannot afford to pay for treatment, egg sharing represents their only option.…”

“…What has clearly been absent from this debate so far has been the views of egg-share donors themselves and whether, at the time of undergoing the procedure and on subsequent reflection, they consider that their consent was properly obtained. The current limited evidence from empirical studies that have asked participants in eggsharing programs indicates that donors themselves feel equipped to make valid choices regarding participating in egg sharing [17][18][19]24] -and some women who contemplated egg sharing decide not to proceed after they have had the opportunity to consider its implications for them [22]. Consequently, egg sharing is not simply perceived as an offer that is 'too good' for potential donors to refuse.…”