Despite ongoing concerns about the safety of multiple egg extraction techniques, many young women see misleading ads in college newspapers and on the Internet that portray the risks of egg "donation" as quite minor and inconsequential. Most of these ads seek women who would provide eggs for reproductive purposes and often offer a hefty payment that brings the transaction well out of the realm of egg "donation." Some carry rather blatant headlines (for example, "Genius Asian Egg Donor Needed - $35,000 compensation").1
Generally, regulations governing payments to women who provide eggs for research purposes (somatic cell nuclear transfer, or SCNT) have limited the compensation substantially, but that may change in the near future, especially since New York State set a precedent this past year in allowing much larger payments (up to $10,000) to women providing eggs for research purposes.
Elsewhere, we have noted the unresolved safety issues that need greater attention.2 Dr. Jennifer Schneider, whose daughter developed colon cancer and died after several egg extraction procedures conducted during a 2-3 year period, has also written eloquently on the need for more long term safety data.3 Time Magazine noted in its March 31, 2009 issue, "As egg donations mount, so do health concerns." Although a good deal is known about the potentially life-threatening complication of ovarian hyperstimulation syndrome - a rare response to drugs that hyper-stimulate the ovaries to produce multiple follicles - there are no good long term data on the risks of ovulation suppression from drugs such as leuprolide acetate (Lupron). These drugs are typically administered first, in order to allow for more controlled hyperstimulation with the stimulatory drugs.
A recent editorial in Nature magazine unfortunately endorses the decision of New York State to pay women to undergo multiple egg extraction solely for research purposes, even after reporting in August 2006 that "Health effects of egg donation may take decades to emerge":4
"... More states should take New York's lead, and allow researchers to pay for egg donation. The potential for coercion, although real, is manageable. And the technique's move to the clinic would certainly be faster, and arguably more ethical, if donors were paid."5
The editorial glibly asserts that the potential for coercion is "manageable," while there is little evidence to support this claim. Moreover, it fails to mention that the lack of adequate long term safety data continues to make it impossible to secure true informed consent from women undergoing these procedures.
In addition, some ethicists now argue that payments to egg donors for SCNT should parallel payments recognized as acceptable for IVF clinics by the American Society for Reproductive Medicine. Ethicist Nancy Dubler, a member of the Empire State Stem Cell Board, explained her view of the board's role this way: "I think that we are an ethics committee, and I actually think that, if good science demands these oocytes, that we have the obligation to provide them, and I'd like to see language like that. ... I think that this will be a larger national discussion, and this might be an important statement to get out there."6
Prominent ethicist Art Caplan is among those criticizing the New York State's stem cell program for departing from the international consensus against paying women to provide eggs for cloning-based stem cell research:
"The image of women having their eggs harvested in a market is one that the industry is going to find difficult to destigmatize ... That notion of being treated as an object to derive those kinds of materials is not one that will sit well."7
Fortunately, the National Institutes of Health has enhanced access to funding for responsible embryonic stem cell research, while at the same time excluding federal funding for stem cell lines that are created with cloning techniques. This reflects an appropriately cautious stance given what we still need to learn about the potential risks of multiple egg extraction. Also, given that many aspects of this research have thus far failed to produce the hoped-for results, there is even more reason for discouraging other states and institutions from adopting the inappropriate payment incentives now being offered by New York State.
In addition, should scientists be able to demonstrate that cell reprogramming methods may be adequate for producing disease-specific stem cell lines, it may not ultimately be necessary to ask women to undergo the risks of egg extraction solely for research purposes.
Meanwhile, in the absence of well-designed, long term clinical trials, more anecdotal experiences are appearing on the Internet and serve to offset the misleading ads. One woman's lengthy story ends with the following:
"When I decided to sell my eggs, I never thought I'd get cancer... I know that breast cancers are hormone sensitive and can be affected by hormone treatments. During my cancer treatment, two doctors mentioned that anecdotally they see more cancer in women who have had fertility treatments. I'll never know for sure if the egg donation caused my breast cancer, but now I know that it is likely to be a contributing factor. I think often about how much I love my husband, and it breaks my heart that my desperation for a couple thousand bucks has caused him such pain. A bad decision made seven years ago may cost me my life."8
A thoughtful Princeton student writing an article titled "Truth in egg-donor advertising" for the Daily Princetonian noted the following key points:
"Proponents of a free-market egg-donation system may claim that cases of abuse are rare, but the simple reality is that no one knows the true scale of abuse. The Centers for Disease Control is only required to ask fertility clinics how many successful births result from donor eggs. They don't ask important questions like the amount of times a donor has previously donated, reported side effects or long-term medical issues.
With practically no government regulation and increasingly astronomical compensation prices, the blossoming egg donation system is rife for potential abuses. Donors have financial incentives to cover up their medical history, and growing evidence suggests that repeated egg donation may result in decreased fertility for the donor and damaged eggs for the recipient. Without a system to monitor and control egg donations, both donors and recipients could be abused."9
In an effort to improve the quality of informed consent for potential egg donors the California legislature passed AB 1317 in 2009. This bill involves no cost to taxpayers and no new burdens on fertility clinics and brokers already operating in ethical fashion. It would improve both the public oversight of embryo acquisition for stem cell research as well as the quality of informed consent for donors providing eggs for IVF purposes.
The growing number of reproductive technologies offered by an expanding "fertility industry" has posed other challenges dealing with commercial, economic, and ethical aspects of these technologies. For example, abuses related to reproductive "tourism" are appearing more frequently in the news. In 2009, two Israeli doctors were arrested in Romania following allegations that their Sabyc fertility clinic in Bucharest made payments to human egg donors, a practice which is illegal there.10
Internationally, Sama Resource Group for Women and Health (India) is organizing a major consultation in January of 2010 to address these challenges and to explore strategies for responding to the growing phenomenon of poorer women being sought as 'suppliers' of cheap labor (as "gestational" mothers "renting" their wombs) or as providers of eggs used in IVF procedures. India, in particular, has become a "surrogacy" outsourcing capital because of the lower costs involved, the lack of regulation in provision of ARTs, and the highly regulated situation in many European countries. Some estimate that the surrogacy business alone is worth $445 million in India.11
Sama is also involved in action research focusing on social, medical, economic and ethical implications of the ARTs. They are exploring such issues as poverty, religion, caste, gender and state apathy. They note that medical care providers in India often develop their own eligibility criteria for the couples according to which, quite often, single or homosexual women/men fall outside the purview of these services. Their analysis of advertisements seeking surrogates and egg donors identifies stereotypes that reveal an obsession with particular kinds of physical features and an emphasis on eugenics. Because infertility has never been addressed as a public health issue in India, there has been little attention given to the underlying, sometimes preventable, causes of infertility.
Finally, it is also important to remember that SCNT lays the technical groundwork for human reproductive cloning. Until the United States joins the dozens of other countries that have already prohibited reproductive cloning, it is even more critical that we restrict SCNT research in this country.
Judy Norsigian is Executive Director and a founder of Our Bodies Ourselves, also known as the Boston Women's Health Book Collective.
1. See http://www.eggdonorneeded.com.
2. See, for example: http://www.etopiamedia.net/empnn/pdfs/norsigian1.pdf.
11. IANS, (August 25th 2008), 'Surrogacy a $445 mn Business in India', The Economic Times