Having Your Baby Through Egg Donation. Evelina Weidman Sterling

to search for an egg donor with a Hawaiian background. The ethicist chooses to comment more on the intended parents’ desires to find a donor of their ethnicity than on the fact that, in the US, anyone can call themselves a fertility consultant or an egg donor agency and charge large sums of money to find egg donors.

      It is seems odd to us that even in the “Ask the Ethicist” column, the ethicist does not address some of the fundamental ethical concerns of egg donation: should women be paid? If so, how much? Should anonymous donation be permitted? How should egg donation be regulated and by whom?

      It seems that the most controversial issue worldwide involves financial compensation to donors. There are countries, such as Australia and Canada, that prohibit payment to donors and there are others, such as the UK, that limit payments to a compensation for time spent. By contrast, the United States has allowed an industry to develop in which donors commonly receive between $5000 and $10,000 and, all too often, upwards of $15,000. Although the American Society for Reproductive Medicine (ASRM) stipulates that this payment is for time and effort, women are commonly receiving higher payments when they have donated successfully in previous cycles. One would think that, if anything, a second- or third-time donor would spend less time and effort on the cycle, since she is familiar with the process, but, rather than her fee remaining the same or being reduced, it rises with each successful cycle. Similarly, women who are physically beautiful or have high SAT scores may also command higher fees, again suggesting that the payment is not simply for time and effort.

      Major ethical issues range from concern for the offspring, some of whom may be forever separated from their genetic relatives, to concerns for the donors, who may be enticed by the payments to do something they may later regret, to concerns for the recipients, some of whom may be entering into parenthood at advanced age with inadequate understanding of the challenges involved for themselves or their children.

      Other questions about egg donation involve who should regulate the practice and how it should it be regulated. Some in the United States feel that this country should follow in the footsteps of nations that have implemented governmental regulations and restrictions. Others in the United States prefer to have professional organizations, such as those in the field of reproductive medicine, responsible for making these types of decisions, rather than government agencies. Still others argue that since egg donation is a multidisciplinary field, it, should be thoughtfully guided by a panel of experts in medicine, science, genetics, psychology, sociology, theology and law. They feel that these professionals can work together for a common goal: to maintain excellent quality of care while considering the effects on greater society.

      Regardless of who regulates egg donation, the questions around regulation all involve protecting the best interests of all participants. First, the offspring. The appreciation for the lifelong impact of donation on all participants has come largely from a worldwide movement of donor offspring (although all adult donor offspring were conceived through donated sperm, not egg donation, they do not differentiate themselves from anonymous egg donor offspring). Many donor offspring throughout the world have spoken poignantly and powerfully about their experiences.

      Christine Whipp wrote an article entitled “Why I need to find my father” in which she writes:

      Luckily through the media and the internet I came into contact with other donor offspring from across the globe… It soon became apparent that we share a commonality in our experiences and have identified many uncomfortable issues with which we must deal as a result of the choices made by our parents. These can include feelings of revulsion at the clinical method by which we were produced; a sense of loss and grief for deliberately severed relationships with unknown biological kinfolk; a fear of accidental incest; anger and frustration at the lack of respect shown for our missing genetic origins and the indescribable emotional burdens which we carry as part of an inherited compromise. (Whipp 2004)

      Many donor-conceived adults will freely admit that their sense of identity has been damaged and would concur with Cicero that: “To be ignorant of what occurred before you were born is to remain always a child. For what is the worth of human life, unless it is woven into the life of our ancestors by the records of history?” (Cicero, Orator, 46 bc).

      Whipp goes on to talk about the anxiety some donor offspring feel about missing medical information and adds:

      Our dissatisfaction has also been tempered with the knowledge that adoptees in the UK were given the right to access their birth records as long ago as the mid-1970s, yet no official records concerning donor conceptions have been maintained at all until the setting up of the HFEA in 1991. (Whipp 2004)

      Unfortunately, many countries, including the United States, have been slow to react to these concerns. Barbara Sumner Burstyn summarizes these sentiments in her article “The new underclass” by stating:

      …allowing technology to willfully create an underclass of people who are unaware of their genetic background and to support parents in denying their children their biological history is to continue the social, medical, and emotional disadvantages that have been suffered for generations by adopted people. (Burstyn 2004)

      As the Donor Sibling Registry has grown and the need for it been expressed worldwide, founder Wendy Kramer has tried to use the media to familiarize the public with the needs and desires of some donor offspring to know where they came from and to whom they are connected. She has surveyed 751 offspring and found that although the vast majority are happy, well-functioning people, they have a need to know their genetic relatives. For some, it is simple curiosity: “Whom do I look like?” or “Where did this interest or talent come from?” For others, there is a need to know up-to-date medical information. Not surprisingly, many donor offspring become most curious around times of major life events such as marriage and becoming parents themselves.

      Egg donation, together with other assisted reproductive technologies (ARTs), also directly led to the ability to evaluate embryos carefully and eliminate defective ones before they are transferred to the uterus. While this increases the chance that couples will have healthy babies, it has sparked the debate about creating “designer babies.” Just how much say should individuals have about what type of baby should be created or destroyed? This illustrates two central ethical dilemmas: should people be allowed/encouraged to create “designer babies” and how can “fertility tourism” be regulated?

      Questions arise also about the donors: as they prepare to donate, are they being adequately counseled on the potential long-term consequences of their donation? These include possible medical problems. In their 2009 paper “US oocyte donors: a retrospective study of medical and psychosocial issues,” Kramer, Schneider and Schultz raise concerns about the risks of ovarian hyperstimulation, including future infertility and some evidence of increased risk of uterine, breast and other cancers. The 2011 film Eggsploitation sounds a louder alarm bell. It follows three former donors who encountered serious medical problems that they relate to egg donation. A common theme is that prospective donors are not adequately counseled about potential medical risks.

      Another concern for donors is how they will feel about their offspring. Donor agency advertisements appeal to prospective donors by telling them of the happiness they will bring to people who want and deserve to be parents. What the ads do not focus on is what it will mean for these women—and their parents, siblings, children—to have genetic offspring that they do not know. I (Ellen) recently had a phone call from a woman who donated her eggs ten years ago “at a time when I was not thinking at all about having children” and who had recently been found by the recipient couple. The donor spent three “amazing” days with the family but returned home with unexpected feelings “that I can’t begin to explain.” She went on to say that everything seems different now that she is married and thinking about starting a family. More significant, she said she was “unprepared for the intense feelings of love” she has for the child she helped create.

      Finally, the recipients. Egg donation has allowed older women, many of whom have entered menopause, to turn back their biological clocks and give birth. There are reports of women in their late 50s, even 60s, having babies. While this is still not a common occurrence, egg donation allows its possibility. This forces us to ask: is this a good thing? Some argue that if a woman in her 50s is married to a man in his 30s, why shouldn’t