Kamal Ahuja, Managing Director of the London Women’s Clinic, makes the argument that egg sharing has greater potential then the existing donor compensation model favored in the countries like the United States. While egg sharing is clearly a viable option and the altruistic component undeniably noble, I do have to disagree with the conclusion that it could serve as a more “durable source of donor eggs than any compensation scheme.” Setting aside the pejorative characterization of compensated egg donation as a scheme, the larger problem with egg sharing involves the logistical issues.
Among the logistical concerns is the apportionment of the eggs. Who receives the extra egg if there is an odd number of eggs retrieved? How do you distribute the eggs given the varied quality? Even more problematic is that each couple is only receiving half (or sometimes a third) of the eggs. With most donor cycles producing on average 12 eggs, that only leaves 6 eggs per couple. Not all of those eggs will be mature or become viable embryos. Assuming we are left with four embryos per patient, that will likely only permit 2 embryo transfers. Then what? If the couple becomes pregnant, odds are given IVF success rates, they will not have any remaining embryos to provide a sibling for their existing child — unless they are able to proceed with another shared cycle with that donor (assuming she is willing and/or able). What if the genetic mother, who so selflessly donated her eggs, does not become pregnant yet the couple she shared those eggs with, does? This can be devastating from an emotional and psychological standpoint.
Again, these are only a few of the issues that Dr. Ahuja has not addressed in his argument. While I am certainly a proponent of egg sharing, I am afraid its viability is far more limited than Dr. Ahuja suggests. Admittedly in countries where compensated egg donation is prohibited, egg sharing is one of the only options available. Perhaps the better solution is to look to either insurance or other ways to subsidize the high cost of IVF and egg donation so that financial constraints never operates as a barrier to becoming a parent.
I am sure I will have more to add as time permits. For now, here is Dr. Ahuja’s provocative article:
In most developed countries women are deferring pregnancy until well into their 30s. In doing so, though, they are raising their risk of infertility.
This trend is reflected in fertility clinics like mine. Almost one in five women having IVF in the UK in 2010 was over 40, according to the UK’s fertility watchdog, the Human Fertilisation and Embryology Authority (HFEA). This proportion has almost doubled over the past 13 years. Global figures are similar, with 19.9 per cent of all women having IVF in 2007 40 or over.
Many of these women have little chance of success. Tests of ovarian function provide clear evidence that as women age their store of eggs declines, and so does their chance of pregnancy. Once it is gone – sometimes by 35 – it can never be replaced.
A woman whose ovarian reserve has declined past the point of no return has no chance of a natural pregnancy; her only chance lies with a donated egg fertilised in the laboratory with her partner’s sperm, and only then if she is willing to accept a baby who carries none of her own genes.
Many women are willing: demand for donor eggs outstrips supply and the latest HFEA figures suggest that the shortfall will only get worse. Where are those eggs to come from?
One option is to pay women to donate eggs. Countries have widely varying policies about this: in the US compensation is unregulated, and egg donors are offered as much as $50,000; in Spain egg donors are offered a flat rate of €900. Most compensation schemes solicit eggs from healthy young women who would otherwise not be patients undergoing fertility treatment.
In the past year, the HFEA has addressed the UK’s shortage of donor eggs and, after much agonising, announced in October that egg donors would receive £750 per cycle of donation. Until then payments had been capped at £250 per cycle. The HFEA clearly believes that money will resolve the crisis.
There is another option that I believe will work better. Tucked away in the small print of the HFEA’s announcement was a brief section on “benefits in kind”, another name for “egg-sharing”. This is something we and other clinics have been offering for more than 20 years. In an egg-sharing scheme, a woman who is already undergoing IVF donates some of her eggs to another who needs them, in return for subsidised or even free IVF. This has the advantage of not making new “patients” out of donors.
Yet despite two decades of problem-free experience – not to mention several official reviews, the support of the British Medical Association and the Nuffield Council on Bioethics, and the formal backing of the HFEA itself in 2000 – in its build-up to the latest consultation the HFEA described egg-sharing as “controversial”.
In the end, the HFEA decided that the practice “should be allowed to continue”, but appeared to ignore its potential as a solution to the donor shortage.
According to HFEA data, 40 per cent of eggs donated in the UK now come from egg-sharing schemes, a proportion that could increase substantially.
Since 1998, more than 30,000 sharers and recipients have taken part in egg-sharing schemes in the UK. There is good evidence that egg sharers and egg recipients are equally likely to have a successful pregnancy (Reproductive BioMedicine Online, vol 22, p 88).
Research also shows that subsidised treatment is not the sole motivation for sharing, and that couples and single women will share their eggs even if they could have received payment for a donation. Only rarely do donors express regret, even when their own treatment did not succeed.
Herein is the basis of the belief that egg-sharing will prove a more durable source of donor eggs than any compensation scheme. If it were taken up and promoted by the HFEA and other fertility bodies as a preferred policy, egg-sharing has the potential to go further than any payment scheme in meeting the rising demand for donor eggs.
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