Capital Commentary is the weekly current-affairs publication of CPJ, written to encourage the pursuit of public justice.
The Ethical Pitfalls of Egg Donation
Assisted Reproductive Technologies (ART) offer hope to many infertile couples who would have remained childless in the recent past. Couples facing infertility are walking a painful, emotional journey. But unfortunately, ART has developed more as an industry than a medical procedure, leading some to call it the “commerce of conception.”
The procedure that allows a woman to carry a baby using her own or another woman’s eggs obtained directly from their ovaries is called in vitro fertilization. If a woman is unable to use her own eggs in the procedure of in vitro fertilization, she can use donor eggs instead. Young, fertile women, generally between the ages of 18-30, are recruited to donate their eggs through ads appearing in university newspapers, craigslist and egg donor agencies.
Although the ads appeal to egg donors’ altruistic spirit, they will receive a substantial payment for their “donation.” On average, it ranges from $5,000 to $10,000. Ads can be found, however, offering as much as $35,000 to $100,000. Questions of coercion arise when the donor is young and in debt. Some ethicists have argued that “a female university student in need of financial resources to pay for her education cannot make an autonomous choice to trade her genes for tuition.” The industry has conceded some risk of coercion, suggesting that compensation be limited to $10,000. But these recommendations are voluntary and can be ignored.
Whether a woman harvests her own eggs or a donor is used, the process is arduous and poses real health risks. Young, thin women are more at risk, yet both of these characteristics are donor requirements. Then there are medical hazards associated with each step in the egg retrieval process, from the weeks of self-injected powerful hormones used for ovarian hyperstimulation to the surgical procedure required to harvest the eggs. Long-term risks are unknown because no studies have been done to track the long-term health outcomes of egg donors.
The award-winning documentary Eggsploitation details several young women who had near-death experiences and now suffer ongoing health issues as a result of selling their eggs. At least one is now infertile. Some of them even researched the process and found no information to give them pause in considering their decision.
Fertility clinics are quick to defend themselves, explaining that the application process is thorough and informed consent is obtained. However, for consent to be considered informed, it is crucial to ensure that the donor fully understands the process, including the risks. With the money already on the table, it is questionable if she can really hear and comprehend the risks. And the information supplied is incomplete since the data on long-term outcomes is so sparse. Being told that there are “no known risks”—as one woman described—is not the same as being informed that the risks are still unknown.
Medical ethics have developed on the foundation of “First, do no harm.” Egg donation raises a host of questions regarding all of the basic medical principles: autonomy, justice, beneficence and non-maleficence. How is the dignity of young women respected when they are exposed to coercion, commodification and health risks—not to save a life, but to create one? Perhaps control over our bodies should be considered more of a stewardship than ownership.
The burgeoning fertility industry is largely unregulated, and the standards are voluntary. Federal regulation focuses on reporting the number of successful births that result from donor eggs, lab procedures and testing of the egg and sperm for infectious diseases. Regulation of egg donation occurs largely at the state level and varies widely from state to state.
Two simple steps that would begin to protect potential egg donors would be the establishment of an independent regulatory body and the commissioning of follow-up studies on egg donors. The natural incentives of the industry promote the care of the couple seeking fertility treatment since the fertility center’s future depends on reporting successful, healthy pregnancies. There is, however, little natural incentive for the industry to protect the donor, who has not traditionally been viewed as a patient. Government must provide oversight for the protection of the donors—much in the way that organ donation is regulated.
The market for human eggs is quickly making them, ounce for ounce, the most expensive commodity in the world. And young women are the only source of this lucrative body part. Who is watching out for their health? In our eagerness to fulfill the dreams of some, we must not allow others to be commodified and sold to the highest bidder.
—Elaine Petty is a consultant for leadership development with the Endowment for Community Leadership. She writes and speaks on bioethics issues and is the author of Women for Sale and Eggs Needed: Is the market for Egg Donation Developing without the Oversight that Protects Organ Donors?
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Capital Commentary is a weekly current-affairs publication of the Center for Public Justice. Published since 1996, it is written to encourage the pursuit of justice. Commentaries do not necessarily represent an official position of the Center for Public Justice but are intended to help advance discussion. Articles, with attribution, may be republished according to our publishing guidelines.”