Egg Donor Solicitation: Problems Exist, But Do Abuses?

In this issue of the American Journal of Bioethics, Andrea D. Gurmankin takes up the question of abuses in the clinical practice of egg retrieval and donation. It is not an area that has been studied before, and her important pilot study calls attention to one among many issues that should be addressed as bioethics and clinical reproductive practice press ahead with the study of outcomes, risks, and beneats of reproductive technologies. Egg donation has a history. Egg donation has been practiced in the United States for over 17 years and has greatly changed during that time (Buster 1998). It began as a research project, approved by an institutional review board at the University of California, Los Angeles (UCLA). Donors, as “human subjects,” were compensated $50 a day for their time and expenses, for a total of $250 per cycle of participation. Advertising was not permitted and was considered unethical. UCLA’s School of Law reviewed and approved the consent forms prior to their use by patients. Today it is common to and highly-stylized solicitations for egg donors in trendy magazines and newspapers. Ads are both attractive and enticing. Often the advertisements are quite expensive, and the message behind them is clear. Physicians and their agents are interested in obtaining the eggs of young, typically white, educated women, and they are willing to pay handsomely for the service. So what happened between 1984 and the present day to so dramatically alter the landscape? I believe the turning point came in 1990. At that time a sudden demand for donors followed the introduction of egg donation for treating age related infertility (Sauer 1998). A ten-fold rise in cases, mostly performed on behalf of recipients over the age of forty, began that year, and has continued ever-since. These older patients were both able and willing to afford expensive services that increasingly focused on the “pedigree” of the participants (Lindheim and Sauer 1998). Competition for donors grew aerce as supply and demand set off a bidding war for donors that has yet to abate. Unlike other countries, the United States chose a laissez faire approach to egg donation. Some practitioners actually embraced the concept of raising compensation to the point of “what the market will bear. ” As a result of inoated expenses, the cost of egg donation rose to nearly $20,000 an attempt. This increase in price reoected the escalation of fees paid to donors, but was also a consequence of inoated proat taking. The overt commercialization of egg donation worries many who witnessed its evolution from the beginning (Sauer 1996). Avarice often creates an environment in which exploitation is considered acceptable. Concerns have been raised at both state and national levels regarding egg-donor payments. General practice guidelines have been suggested. Yet, it remains unclear whether physicians heed such tenets, because policing is nonexistent and sanctions have never been levied against violators. With these concerns in mind, there have been attempts to identify problems with egg donation in the United States (Sauer 1999). The article by Gurmankin argues that infertility practices are negligent in the recruitment of young women from the initial phone call through screening. As compelling as her argument appears, the data from this small series is highly biased and limited to the interview of only 19 programs (less than 10% of all programs in the United States). More important, the author presumes that programs have an obligation to provide a full informed-consent discussion of egg donation over the telephone to callers responding to an advertisement. I do not share this point of view. In fact, I would discourage nonmedical personnel, who are usually the recipients of such calls, from engaging in such discussions, if for no other reason than to lessen the likelihood of misinformation being disseminated. However, I believe Gurmankin correctly identiaes one of the major shortcomings of current practice. Ads that encourage egg donation never portray the real-life activity and its dangers. Instead, smiling young faces of professional models are depicted next to the $5,000 fee that accompanies participation. For many years it was believed egg donors were somehow free of the complications that patients undergoing in-vitro fertilization are known to suffer (Sauer, Paulson, and Lobo 1996). Recently, I reviewed 1,000 consecutive cycles of egg donation and found this not to be true (Sauer 2001). Nearly 1% of attempts at egg donation are accompanied by serious side effects, usually as a direct result of prescribed fertility drugs. An additional 10–20% of donors develop moderately severe ovarian hyperstimulation syndrome, which, although