Women donate eggs for two reasons. Firstly for other women to conceive and, secondly, for research. Both are dogged by controversy on medical, societal and financial grounds. The US and the UK are currently trying to create guidelines and legislation that will allow workers in assisted reproduction and laboratory research to operate without fear of prosecution.
Infertile women undergoing IVF are usually given some form of gonadotropin-releasing hormone to stimulate multiple oocyte production. This hyperstimulation and harvesting results in more oocytes than can be used in fertilisation and embryo transfer in any given cycle, so there are spare oocytes for later use by the woman, or for donation.
Whether the stimulation should be with GnRH agonists or antagonists is one debate and another is whether one or two embryos should be transferred. What is not in question is that the demand for oocytes far exceeds supply. Women below the age of 35 years have significantly higher IVF success rates than older women, precisely the group who are now more often seeking reproductive assistance. The result is that the donation or sale of oocytes has become a big issue.
Clearly the unauthorised harvesting of oocytes is illegal as an Israeli doctor has found to his cost (BMJ 2007;334:557), but what about consented donations to infertile women? The free donation of “extra ova” from women to their infertile fellow patients seems straight-forward enough, but already the problem of incentives has arisen. In private clinics, can these spare oocytes be bought or can the woman be given a discount for her treatment if she donates? This discount for donation occurs in the UK where 75% of all IVF procedures are funded by the patients themselves despite decrees that all infertile couples are entitled to four IVF cycles within the NHS (Ledger Lancet 2007;369:717-8). Moving further along the continuum, is it acceptable for a woman who has no fertility problems to supply oocytes for payment? In the US it is, where thousands of babies are born annually from oocytes acquired from women who receive an average of $5 000 per harvest (Spar NEJM 2007;356:1289-91).
The UK has the Human Fertilisation and Embryology Authority which is the regulator of IVF treatment. It has now ruled that altruistic oocyte donation, in conjunction with fertility treatment or not, is acceptable. The report by Mayor (BMJ 2007;334:445) made no mention of discounts for donations in the private sector - also known as “egg sharing” - so compensation for co-operation remains a grey area. Other places such as Singapore, Israel and South Korea allow donations but without payment or personal benefit.
The role of oocytes in research is more complex, despite the fact they may not be bought for study purposes. Research falls into two categories - infertility or stem cell research. The former is not as contentious, despite using human reproductive material, but the latter is highly controversial using somatic-cell nuclear transfer (SCNT) to create lines of stem cells from which the US administration has withheld federal funding. The arguments go that without payment women will not donate oocytes for research but, attracted by pay, women could be tempted to “sell their eggs” in a competitive market to their own potential detriment.
