Fertility Fallout : It’s the Latest Controversy in Assisted Reproductive Medicine: The Science of Egg Donation . . . and the Tactic of Soliciting Childless, College-Age Women as Donors
It wasn’t exactly the part-time job Rebecca Weis was looking for last year while scanning the jobs bulletin board at Sacramento City College.
Ovum Donors Needed , read the notice from Pacific Fertility Center in San Francisco.
“I am applying to medical school, so I’m interested in all this stuff,” says Weis, now 23, married and childless. “And I thought it would be nice to help somebody else out.”
Weis is an egg donor, a woman who donates some of her own eggs for infertile couples who are unable to become pregnant.
But she also represents what health experts say is a growing controversy within the practice: More clinics are using childless, college-age women because of the difficulty in recruiting egg donors.
Perhaps second only to surrogacy in its potential to stir controversy in assisted reproductive medicine, egg donation--here and abroad--has become fraught with problems because human eggs are a scarce commodity in high demand, experts say.
“I don’t know precisely how great the shortage is, but there aren’t as many donors as [doctors] would like to have,” says John Robertson, a University of Texas scholar on reproductive health issues. “You sometimes have a family member or friend who volunteers. But that doesn’t take care of most of the demand.”
Controversies regarding the scarcity of human eggs have been compounded because egg donation, like other forms of assisted reproductive medicine, is not subject to regulations. (A bill governing the industry was passed by the California legislature in 1993 but was vetoed by Gov. Pete Wilson.)
There is much disagreement on just how the industry should be regulated. For instance, while many medical professionals abhor the use of childless, college-age women as egg donors, others, such as Dr. Geoffrey Sher of the Pacific Fertility Center, think the practice is acceptable.
“It’s in no way reprehensible,” he says. “If it’s OK for a [college-age, childless] man to donate sperm, it’s OK for a woman.”
Still, he says, “Our field is without any accountability. There are no checks and balances that are enforced. Yet, there is no field in medicine that is more emotionally charged and subject to more fallout than human reproduction.”
Controversies have also raged during the past year on how much to pay egg donors ($2,500 is standard) and whether they should remain anonymous to the recipient or reveal their identities.
Moreover, reproductive health experts are still grappling with how to respond to the scandal at the Center for Reproductive Health at the University of California, Irvine--in which university officials allege that doctors stole eggs from women and implanted them in other women.
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The demand for donor eggs is “considerable,” according to the American Society for Reproductive Medicine (ASRM), a professional organization, which has issued voluntary guidelines for egg donation.
More women in their 40s and even 50s are seeking pregnancy, but the chance of having usable eggs after age 40 is poor. A range of illnesses and congenital anomalies can also cause eggs to be unusable.
“People are finding that, over age 42, their chances are zero to 10% of getting pregnant” without using donor eggs, says Karen Synesiou, co-director of the for-profit Center for Surrogate Parenting and Egg Donation, a donor-recipient matching firm in Beverly Hills.
But unlike sperm donation, egg donation is a difficult process. After an extensive physical and mental exam, an egg donor begins several weeks of hormone injections to stimulate egg production that can cause bloating, weight gain and mood swings. Finally, the donor undergoes outpatient surgery to retrieve the eggs.
Risks are involved, including infection, complications from anesthesia and a suspicion that the hormone injections may increase a woman’s lifelong chance of developing ovarian cancer.
In the past, donors were often women undergoing in vitro fertilization who had extra eggs and agreed to donate them. But because of technological advances, couples undergoing in vitro are now more likely to freeze leftover embryos for their own later use.
Donors can also be friends or relatives recruited by the couple. But even that arrangement has been criticized by ethicists who fear a relative or friend may feel obligated to donate despite having reservations.
Thus, in a quest to attract donors from the general population, many of the 75-odd U.S. clinics that offer egg donations have turned to college campuses for donors because young women are thought to have healthier eggs. And infertile couples think college students are more likely to be intelligent, a genetic characteristic that could be passed to offspring.
But the practice of recruiting childless women is one of the most contested in egg donation. The ASRM advises that it’s “preferable” if egg donors are themselves mothers and that fees fairly compensate a donor but are not so large as to cause “undue inducement.”
“In some ways you can look at the practice as exploitative,” says Elaine R. Gordon, a Santa Monica clinical psychologist who specializes in reproductive health issues.
“Women who have children know what they are donating and are clear on why they are doing this,” she says. “But . . . I’ve had [childless] college-age women in my office who claim they know what they are doing.”
The ovarian cancer risk and the chance that a donor may someday have her own infertility problems has led Synesiou to steer away from recruiting childless women.
“Because we don’t know what we’re doing with third-party reproduction, let’s be very careful,” she says. “What if [a childless donor] later decides to become a parent and finds out that she can’t have any children of her own? No one is telling these women that someday the only child she may have is another woman’s baby.”
Stephanie Anderson, 25, who is married and childless, spotted an ad for egg donors in the UCLA Daily Bruin shortly before graduating.
Anderson, who has been told that she now has five biological children whom she has never seen, contends that the criticism that college-age, childless women do not understand the implications of their actions “underestimates our ability to think this through. I thought about it for a year and a half before I did it.”
But the San Mateo woman concedes that she cannot anticipate all the repercussions from donation. For instance, she signed a donor identification consent allowing her offspring to seek her out if they wish once they reach legal age.
“The only thing I’m afraid of is, if something happened to their parents, what if they needed financial help?”
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In the United States, many egg donors prefer to remain anonymous. But increasingly, both egg and sperm donors are being asked to consent to donor identification.
The ASRM recommends that donors be told that the laws regarding parenting rights when third parties are involved in the reproductive process have not been “definitely established.”
Only four states--Oklahoma, Texas, Florida and Virginia--have laws on egg donation, says Robertson, author of “Children of Choice,” (Princeton University Press, 1994). In those states, the law treats egg donation like sperm donation, transferring all parental rights to the recipient couple.
Donor identification is seen as important as advances in genetic medicine make it imperative to know one’s family health history.
But, say Pacific Fertility Center’s Sher and others, an emphasis on full identification may frighten off would-be donors.
“To make an argument that we want children to know who their original or biological parent was is to deny the donor her right to privacy,” he says. “The donor is the one who initiated the entire process and would have preferential rights.”
Sher says his clinic does keep records on anonymous donors but would release them only under court order.
Other experts say the trend in egg donors meeting the recipient couple and, later, the child, is healthy for all parties.
“The trend is for open egg donation,” Gordon says. “There are advantages for the people involved in the process and for the future offspring. It’s psychologically more satisfying. You eliminate the issue of people looking over their shoulder down the line.”
Egg donor Maria Arechiga, 29, says she was a little reluctant to meet one couple who was to receive her eggs. Arechiga, of Thousand Oaks, has four children of her own and has donated eggs three times.
“We met for breakfast and we talked about what we do, what our dreams are,” she says. “They wanted to see me and know who I was. I was nervous but, with the wife, there was part of me that felt sad for her because they had been trying to have a baby for so long.”
Arechiga has agreed to donor identification.
“I don’t want pictures [of the child], and I don’t want contact. But if the child needs me, medically, I’m here,” she says.
Donors can work through issues such as health risks, legal uncertainties and donor identification with the help of legal and psychological counseling, Gordon says. But she and others contend that few infertility clinics offer those services to donors because they add about $1,700 to the bill paid by the recipient couple--which can surpass $10,000 even without the added services provided to the donor.
But counseling all the parties involved, Gordon argues, may help end the secrecy that surrounds egg donation and accelerate the move to industry standards and enforceable laws.
“We keep this whole process under cover, like we have done for so long with sperm donation; like there is something wrong with having babies this way,” she says. “We are getting into a lot of trouble because of this secrecy. If this is a wonderful way to have children, and I do believe it is, then why are we hiding and feeling shame about how we do it?”
