3 Things You Should Know About Egg Donation
3 Things You Should Know About Third Party Assisted Reproduction
Our Documentary Films
We have made two documentaries on the topic of egg donation. Maggie’s Story is a 22 minute documentary short on one woman’s egg donation journey. Eggsploitation is a feature length documentary examining the stories of several women and interviewing a number of experts and activists
2017 Journal Article
“Long-Term Breast Cancer Risk Following Ovarian Stimulation in Young Egg Donors: A Call for Follow-up, Research, and Informed Consent” by Jennifer Schneider, Jennifer Lahl, and Wendy Kramer. In Reproductive BioMedicine Online, Vol. 34 (2017) 480-485. Here is an earlier version of the paper and its related table (PDF). We think it’s important to get this out there because we had significant difficulty getting this article published; after an initial outright rejection, we had to go through multiple revisions and requests to eliminate material which we felt was essential to the paper. We had doubts along the way about whether this paper would ever be accepted because it emphasizes the need for egg donor registries. The main take-home messages of both versions are the same: (1)There have been no long-term follow-up of egg donors, with the result that, so many years after the beginning of hormonal stimulation for egg donation, we still do not know if there are any long-term health risks such as various cancers or infertility for the young women who donated eggs. (2) Young women who are told that “there are no known long-term risks” often do not understand that this does NOT mean “There ARE no long-term risks” and do not realize that this is uncharted territory. The solution is (1) To implement egg-donor registries and begin long-term studies of these women and (2) Meanwhile, begin to provide straightforward information to potential donors about the fact that currently we DO NOT KNOW what the risks are. What is different about this early version is that it includes additional perspectives directed at an American audience, in that pages 14-17 speak more to institutions such as the U.S. Centers for Disease Control (CDC) and National Institutes of Health (NIH), and to the need for American organizations such as SART and ASRM to provide more transparent “informed consent” forms to donors. These statements were removed from the final version. I was also asked to remove the last sentence (about informed consent) in case D and also the quote in the description of case E, regarding her experience at the IVF clinic.
Our View on Egg “Donation”
Reproductive technology in the 21st century operates with enormous reliance on ‘donated’ human eggs, meaning dependence on young, fertile women for the eggs their bodies produce (1). The effect of this practice is to commodify women’s bodies. The 2008 Centers for Disease Control & Prevention (CDC) report on Assisted Reproductive Technology (ART) found that 18,121 cycles (the administration of drugs to induce egg production in the ovaries) were performed in the U.S. using “donor” eggs (2). As of 2007, in the U.S. alone, the infertility industry was a $6.5 billion for-profit business, growing exponentially (3).
This summary addresses four issues that demonstrate that the human rights of women who are solicited to provide their eggs are being violated (4). These issues include:
- Coercion of “donors”
- Eugenic commodification of egg providers
- Health risks to suppliers and recipients
- Effects of third party reproduction on the children produced
Egg providers are enticed through ads in online classifieds, social media, and college newspapers, offering anywhere from $5,000 to $100,000 per extraction. Ads invoke language appealing to the altruism of potential providers, calling for their pity on infertile couples desperate to have a child and suggesting that it is their duty to help such people have children. These ads are markedly coercive and manipulative of young college-aged women as they directly appeal to their financial need and so-called “maternal instincts.” Ads generally do not make any mention of the potential health risks involved or reveal the lack of studies conducted—essential information to enable informed decision-making and consent. Setting a further dangerous precedent for exploitation of women and their health and human rights, in June 2009, New York became the first U.S. state to use taxpayer funds to financially compensate (up to $60,000) women for eggs harvested for stem cell research, meaning women’s eggs would be used for research rather than reproductive purposes. Prior to this development, egg seekers targeted young women at elite universities with high SAT scores, good looks, athletic and artistic talents, and preferred ethnic/racial backgrounds. When eggs are sought for stem cell research, the floodgates open to exploitation of low income and poor women, largely from communities of color. Competition for human eggs is a reality while awareness of or concern for the young women supplying them is generally nonexistent.
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As stated, egg “donation” ads commonly specify racial, physical, and intellectual characteristics, seeking women of a particular ethnicity such as Jewish or Asian, 5’9″ or taller, an SAT score of 1500 or higher, physically attractive with “good genes” and a clean bill of health. The wider cultural effect is to view women’s bodies as reproductive goldmines, commodities to be exploited. This degrades not just the women providing their eggs but all women as it selects out “undesirable” traits through artificial reproductive technologies.
Despite the common use of “donated” eggs in ART procedures, little to no peer-reviewed medical research on the effects of egg procurement on women’s health exists. This makes it difficult, if not impossible, for fertility clinics to provide adequate information for informed consent relative to the health risks involved. It also raises the ethical concern of who should be entrusted to provide the information to the women giving their consent, as conflicts of interest are present if those who want the eggs are informing those who supply the eggs. In other words, would the fox inform the hens of the dangers they faced before entering the hen house?
The lack of statistical short and long-term data on egg supplier health, post-extraction surgery, is caused primarily by the lack of regulation of fertility clinics and the industry as a whole. Regulation would require them to maintain and monitor egg supplier data bases; currently, they have no requirement to follow-up with the women who provide their eggs—once the extraction is over, the women are forgotten history (5). Since the infertility industry makes billions in profits, they fight tooth-and-nail against any oversight or regulation. It is no accident that the U.S. is referred to as the “Wild West” of infertility treatment and a major destination of fertility “tourists.” Clearly, the absence of data does not imply absence of risk; when cigarettes were first marketed, no data existed about their health risks.
Stories of former egg suppliers have surfaced over the past several years with increasing frequency. As awareness grows of egg “donation” and ARTs, more women are speaking up about harrowing personal experiences with it and both the short and long-term health conditions they are now suffering. These conditions include ovarian hyperstimulation syndrome (OHSS), loss of fertility, ovarian torsion, blood clots, kidney disease, premature menopause, ovarian cysts, chronic pelvic pain, stroke, reproductive cancers, and in some cases, death (6).
OHSS is caused by the process of superovulation and is well-documented in the medical literature as a risk associated with women who take fertility drugs to stimulate ovulation. It is also documented in the literature that young women are more at risk for OHSS because the ovaries of a younger woman are more responsive to gonadotropins due to a higher density of gonadotropins receptors (or a larger number of follicles able to respond) (7). A recent study has also indicated increased maternal morbidity in women using an egg from someone else, with considerable risk of pregnancy-induced hypertension (8).
Effects on Children Produced
Egg “donation” is largely anonymous. Recently, adult children of gamete provision have begun to advocate for greater transparency about their biological roots (9). This indicates growing awareness of the importance of personal connections to our biological parents and the necessity of genetic information for one’s health and disease susceptibility. Personal dignity and human rights insist on the right of the child to information regarding her or his biological origins and genetic history.
The commodifying and biologically disconnected nature of egg sale and procurement indicate inherent moral and ethical problems with the practice. Finally, the specter of eugenics looms over the widespread use of egg procurement like an ominous cloud. One need only look at the genocide produced by eugenic attempts to create a “master race” during the Nazi regime in Germany of the 20th century to understand the implications of creating “designer” children from “designer” eggs.
The issues of coercion and health risks may be addressed and corrected through policy and legislation. Recommendations for policy and action are as follows:
- Institute an independent regulatory body able to enforce policies enacted on reproductive technology and third party reproduction.
- Regulate egg procurement ad placement and content, to include prominent disclaimers and warnings just as on cigarette packages or alcohol labels directed at pregnant women.
- Eliminate financial compensation (beyond immediately related medical expenses) from the practice of egg procurement.
- Fill the information void for consent purposes through peer-reviewed medical research of short and long-term consequences of egg harvesting and extraction on supplier health.
- Require fertility clinics to collect, maintain and release for analysis specific “donor” files, including 6 month, 1 year, 3 year, 5 year, 10 year, 20 year and 30 year follow-ups with “donors.” Yearly results will be published and made available to the general public.
- Initiate an imposed moratorium on all egg procurement and sale while retrospective data is collected, analyzed and published.
If adopted, such policies would be a first step toward protecting women from the risky and potentially destructive practices of egg procurement. Unfortunately, they offer little compensation or justice to the women who have already been exploited and severely harmed by providing their eggs. The only way to ensure retroactive justice for these women is to remain vigilant in our efforts to prevent the further exploitation of women, commodification of their bodies, and serious risks to their short and long-term health and well-being. Any society that values and protects human rights demands no less.
- Think Again: A Study Guide on the Legal, Medical, and Ethical Questions of Third Party Reproduction is intended for a wide audience as we aim to meet the needs of high school groups, university students, law groups, church groups, and any other group interested in the issues of third party reproduction. Most importantly, the study guide is available for FREE in order to maximize distribution and use. You can download it here.
- Jennifer Lahl Statement on Egg Donation
- How Do Individuals Who Were Conceived Through The Use of Donor Technologies Feel About The Nature of Their Conception?
- 2020 We Are Donor Conceived Survey Report
- Worldwide Human Egg Laws by Comment on Reproductive Ethics
1. The term egg “donation” is, in fact, a misnomer. Most often eggs are sold to contracting buyers for thousands and sometimes tens of thousands of dollars per cycle.
2. Centers for Disease Control & Prevention, “Assisted Reproductive Technology (ART) Annual Report 2008,” http://www.cdc.gov/art/ART2008/section4.htm 18,121 does not represent the actual number of eggs extracted or used, which could be anywhere from 12 to 60 times more.
3. Sigrid Fry-Revere, “Funding Embryonic Stem Cell Research,” Genetic Engineering and Biotechnology News, Vol. 27, No. 6, March 15, 2007.
4. Relevant human rights instruments include the Universal Declaration of Human Rights (1948), International Covenant on Civil and Political Rights (1966), International Covenant on Economic, Social & Cultural Rights (1966), Inter-American Convention on Human Rights (1969) and the Convention on the Elimination of all forms of Discrimination Against Women (CEDAW) (1979). While regional agreements are only binding on those states within the region, the repetition of certain rights from region to region (e.g., human dignity, women’s rights, health rights, anti-discrimination rights, etc.) demonstrates an international consensus on these basic rights and the obligations of states; CEDAW’s preamble states “the role of women in procreation should not be a basis for discrimination,” Article 6 calls on all states to “suppress all forms of traffic in women,” Article 16(e) ensures the equal right of women “to decide freely and responsibly on the number and spacing of their children and to have access to the information, education and means to enable them to exercise these rights.”
5. Jennifer Schneider, “Fatal Colon Cancer in a Young Egg Donor: A Physician Mother’s Call for Follow-Up and Research on the Long-Term Risks of Ovarian Stimulation” Fertility and Sterility, American Society of Reproductive Medicine, January 21, 2008.
6. Linda Giudice, Eileen Santa, and Robert Pool, eds., Assessing the Medical Risks of Human Oocyte Donation for Stem Cell Research (Washington, D.C.: National Academy of Sciences, 2007), 11. http://www.nap.edu/openbook.php?record_id=11832&page=11.
7. E. Zivi, M.D., A. Simon, M.D., and N. Laufer, M.D., (2010). Ovarian Hyperstimulation Syndrome: Definition, Incidence, and Classification. Seminars in Reproductive Medicine, Vol. 28, No. 6, 441-447.
8. Ulrich Pecks, Dr. med., Nicolai Maass, Prof. Dr. med., and Joseph Neulen, Prof. Dr. med., “Oocyte Donation: A Risk Factor for Pregnancy-Induced Hypertension,” Deutsches Arzteblatt International, January 2011; 108(3): 23-31.
9. For instance, http://www.anonymous.org/, http://www.donorsiblingregistry.com/.