Informed Consent, Payment Are Ethical Concerns with Egg Donation
In a survey of 375 current and former egg donors, 55.2% said they believed they were poorly informed on potential long-term risks.1 In contrast, 64.8% believed they had been well-informed on possible short-term risks.
“With lack of longitudinal research, it’s impossible to know potential long-term consequences, both emotionally and physically,” says Diane Tober, PhD, the study’s lead author and an associate professor in the University of Alabama department of anthropology.
Most donors said the clinic indicated there was no evidence of long-term risk. Donors took that to mean egg donation has been studied and found to be safe. In reality, there is no evidence because the studies have not been conducted. “It’s misleading. Informed consent discussion should make it clear that the impact of the egg donation process on women’s health has not been studied, so risks are unknown,” says Tober, adding that more needs to happen to track donor health over time.
Undue inducement caused by high compensation is another concern. A total of 86.1% of the egg donor survey respondents received compensation beyond direct reimbursement. The consensus is egg donor fees should be enough to provide reasonable compensation, but not so high it leads to “undue inducement.”
“The thinking here is that financial precarity and promise of large sums of money could lead a person to make a medical decision they would not otherwise make,” Tober explains. Financial compensation of women donating oocytes is ethically justified and should “acknowledge the time, inconvenience, and discomfort associated with screening, ovarian stimulation, oocyte retrieval, and postretrieval recovery and not vary according to the planned use of the oocytes or the number or quality of oocytes retrieved,” according to an updated policy statement from the American Society for Reproductive Medicine (ASRM).2
The other ethical challenge concerns the fact some people are compensated far more than others. “There is a tiered market in human eggs that breaks down by race, class, and education,” Tober notes.3 In the United States, there is no system to track donor cycles, making it possible for donors to undergo more than the number (six) recommended by ASRM.4 “Those who do so are highly motivated by increased compensation on subsequent cycles. Knowing another $10,000 to $15,000 or more could be just a few weeks away is hard for many people to say no to,” Tober observes.
Efforts also are underway to enable donors and donor-conceived people to find each other down the road if they so choose. As donor-conceived people are reaching adulthood, some have voiced their own desires to be connected with their biological donors.5 “Many intended parents also want contact with donors. Things are definitely opening up on this front,” Tober says.
- Tober D, Garibaldi C, Blair A, Baltzell K. Alignment between expectations and experiences of egg donors: What does it mean to be informed? Reprod Biomed Soc Online 2020;12:1-13.
- Ethics Committee of the American Society for Reproductive Medicine. Financial compensation of oocyte donors: An ethics committee opinion. Fertil Steril 2021;116:319-325.
- Tober D, Kroløkke C. Emotion, embodiment, and reproductive colonialism in the global human egg trade. Gender, Work & Organization 2021.
- Practice Committee of the American Society for Reproductive Medicine and Practice Committee of the Society for Assisted Reproductive Technology. Repetitive oocyte donation: A committee opinion. Fertil Steril 2020;113:1150-1153.
- Scholars Strategy Network. The case for ending the anonymity of egg and sperm donations in the United States. May 17, 2018.
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