Title: Money, morals and medical risks: conflicting notions underlying the recruitment of egg donors
Authors: KK Ahuja, EG Simons and RG Edwards
Journal: Human Reproduction, 14 (2): 279-284, 1999
Title: An assessment of the motives and morals of egg share donors: policy of `payments' to egg donors requires a fair review
Authors: KK Ahuja, EG Simons, BJ Mostyn and P Bowen-Simpkins
Journal: Human Reproduction, 13 (10): 2671-2678, 1998
Title: A survey of anonymous oocyte donors: demographics
Authors: AKS Kan, HI Abdalla, BO Ogunyemi, L Korea and E Latarche
Journal: Human Reproduction, 13 (10): 2762-2766, 1998
This is a questionnaire based study of 501 women enquiring about anonymous oocyte donation at a private in-vitro fertilization (IVF) unit, investigating the demographic characteristics and logistic issues involved in ovum donation. The 501 women were made up of 356 women who did not donate (`non-donors') and 145 women who eventually donated their oocytes (`donors'). Although there was a majority of housewives among the enquirers, women in full-time employment were the majority of actual donors. Logistic factors such as the travel and time commitment involved were major reasons for non-donation as well as concerns about complications. There was a paucity of ethnic donors. Recruitment strategies must focus on retaining potential donors and ensuring a higher proportion become actual donors. These strategies must address the logistic difficulties associated with non-donation including transport problems and social commitments by assisting with childcare provision and travel. Improving donor education and the access to more personal and non-threatening information were other areas that needed attention which were highlighted in the survey.
Key words: anonymous oocyte donation/demographic/IVF/survey
Title: Recruitment and screening policies and procedures used to establish a paid donor oocyte registry
Authors: SR Lindheim, M Frumovitz and MV Sauer
Journal: Human Reproduction, 13 (7): 2020-2024, 1998
We have reviewed the demographic characteristics of, and report abnormalities noted in, the de-novo growth and development of a paid oocyte donation programme. The personal profiles of all prospective oocyte donors were reviewed. Acceptance or rejection of candidates was based upon screening the results of medical, genetic and psychological testing. A total of 603 candidates initially responded to our advertisement. From this pool, 313 individuals were considered suitable and contacted by telephone. Following further conversation, 176 women were scheduled an entry interview. On completion of the formal screening process, 17.6% (n = 31) of those actually interviewed were denied entry. Thus, from the initial interested parties, only 23% of women wishing to participate in oocyte donation were considered suitable candidates. Given the high attrition rate, we concluded that the need for rigorous and thorough medical, psychological and genetic testing is mandatory for the establishment of a donor registry. Furthermore, professional counselling of prospective donors with respect to the results of tests and the implications of test results with respect to their future medical and reproductive health, are important parts of providing comprehensive care.
Key words: donor registry/oocyte donation/pathology/screening
Title: Statutory information for the children born of oocyte donation in the UK: what will they be told in 2008? Authors: H Abdalla, F Shenfield and E Latarche
Journal: Human Reproduction, 13 (4): 1106-1109, 1998
In the UK, non-identifying information on the donor is recorded by statute in assisted reproduction with gamete donation. This may be made available eventually to the resulting children. Prospective parents are counselled about openness, and often wish to know what may be available if the child has access to this information. We analysed forms from the Human Fertilisation and Embryology Authority completed by all donors at the Lister in-vitro fertilization unit. We found that 94% of oocyte donors did not respond to the last question asking for a brief description of themselves, leaving only profession and interests as information to be given in the future. There was a significant difference between the known and anonymous responders. This has important implications for the future parents who want to tell their child of his/her origins.
Key words: child/information/oocyte donation/origins/statute
Title: Cancer of the colon in an egg donor: policy repercussions for donor recruitment
Authors: KK Ahuja and EG Simons
Journal: Human Reproduction, 13 (1): 227-231, 1998
This paper describes the tragic case of a young woman who died of cancer of the colon after successfully donating eggs to her younger sister. Although there is no direct link between her operation and the subsequent development of bowel carcinoma, this case imparts a feeling of unease when seen in conjunction with other cases reported during the last few years. It is a reminder that little is known of the long-term consequences of some aspects of assisted conception. Women undergoing ovarian stimulation for themselves or a matched recipient have the right to be advised, in an agreed format, that there is some concern about unproven potential risks from the stimulatory drugs. The safety of egg donors must assume priority over all other considerations, including lack of donors or any moral position. The recent decision by the Human Fertilisation and Embryology Authority (HFEA) to withdraw any form of payment or recompense to egg donors does not seem to us to be based on a balance of scientific advances, patient needs and the ethics of gamete supply. They state that the intention to withdraw payments was implicit in the 1990 Human Fertilisation and Embryology (HFE) Act. However the act was based on the Warnock report made 6 years earlier. Even in 1990 ovum donation was uncommon and fertility drugs had not yet caused any unease. The Act provided the HFEA with discretionary powers to issue directions so that the future policies would be consistent with any emerging new medical evidence. It is imperative that the HFEA provide convincing evidence on how the current policy of payment to donors harms society, donors or recipients, and how in the UK the new policy will improve medical practice in assisted conception. Successful pilot studies must precede the implementation of any new policy. Failure to do this could cause irreversible harm to the practice of assisted conception using donor gametes, which will ultimately be against the basic aims of the 1990 HFE Act.
Key words: altruism/cancer/donor payments/egg donation/fertility drugs
Title: Egg sharing and egg donation: attitudes of British egg donors and recipients
Authors: KK Ahuja, BJ Mostyn and EG Simons
Journal: Human Reproduction, 12 (12): 2845-2852, 1997
The question of payment to egg donors has recently focused the attention of both the Human Fertilisation and Embryology Authority (HFEA) and licensed clinics. An acute shortage of egg donors and the rising costs of assisted conception treatment are matters of grave concern to many patients. To understand the emotional and social effects of egg sharing and egg donation, we conducted a survey of attitudes in a group of women who had some knowledge or experience of egg donation. A total of 750 questionnaires were sent out of which 217 were returned within the specified time limit. From these, 107 respondents had experience of egg donation and 110 had made enquiries about donation. The data from these questionnaires were collated and tabulated by the National Opinion Polls (NOP) Research Group. An analysis of the data produced the following key findings: (i) donating or sharing eggs is a social issue, 94% discuss it with partners/family/friends; (ii) altruistic motives are not the prerogative of non-patient volunteers - egg share donors felt that helping the childless was as important as having a chance of in-vitro fertilization (IVF) for themselves; (iii) the treatment procedure causes the most anxiety for egg donors. The recipients were most concerned about delays, donor characteristics and how the eggs were allocated; (iv) most respondents (65%) with prior experience of egg sharing would do it again - 63% of egg share donors, 72% of egg share recipients; (v) cash rewards to egg donors and outright advertising for donors were rejected by 64 and 62% of the sample respectively; and (vi) counselling was highly valued and there were no instances of 'shattered lives' after treatment. The findings do not support the recently announced intentions of the HFEA to disallow payment to gamete donors on the grounds of devalued consent. There is no precedent in modern medicine for egg sharing. The patients surveyed drew a clear distinction between egg sharing and financial rewards. As long as egg donation is not covered by the National Health Service, it is fairer to offer egg sharing than to refuse treatment to those unable to pay.
Keywords: egg donation/egg sharing/payment/regulation/respondents
Title: Oocyte donation. Ethics of oocyte donation is challenged by the health care system
Authors: Y Englert
Journal: Human Reproduction, 11 (11): 2353-2357, 1996.
Title: Oocyte shortage for donation may be overcome in a programme with anonymous permutation of related donors
Authors: Y Englert, C Rodesch, M Van den Bergh and E Bertrand
Journal: Human Reproduction, 11 (11): 2425-2428, 1996
Difficulty in recruiting donors plays a crucial role in oocyte donation programmes. We report here an original strategy to overcome this problem, consisting of sharing out anonymous oocytes between recipients, which has markedly improved treatment efficiency by avoiding freezing or destruction of supernumerary embryos. Each patient received part of the supply of oocytes from several donors in four successive cycles, while each donor underwent oocyte retrieval only once. This strategy led to one pregnancy per treated donor, increased treatment efficacy by 300%, and reduced dramatically the oocyte shortage at our centre. The system avoids wastage of the rare and precious donated oocytes, increases the chance of pregnancy for each related recipient and even permits the inclusion of some recipients without related donors.
Keywords: anonymity/donated oocytes/IVF/related donor
Title: Egg-sharing in assisted conception: ethical and practical considerations
Authors: KK Ahuja, EG Simons, W Fiamanya, M Dalton, NA Armar, P Kirkpatrick, S Sharp, M Arian-Schad, A Seaton and WJ Watters
Journal: Human Reproduction, 11 (5): 1126-1131, 1996
The present acute shortage of eggs for donation cannot be overcome unless adequate guidelines are set to alleviate the anxieties regarding payments, in cash or kind, to donors. The current Human Fertilisation and Embryology Authority (HFEA) guidelines do not allow direct payment to donors but accept the provision of lower cost or free in vitro fertilization (IVF) treatment to women in recognition of oocyte donation to anonymous recipients. Egg-sharing achieved in this way enables two infertile couples to benefit from a single surgical procedure. However, the practical guidelines related to this approach are ill-defined at the present time leading to some justifiable uncertainty. A pilot study was therefore undertaken in order to establish the place of egg-sharing in an assisted conception programme. The current HFEA guidelines on medical screening of patients, counselling, age and rigid anonymity between the donor and recipient were followed. The study involved 55 women (25 donors and 30 recipients) in 73 treatment cycles involving fresh and frozen-thawed embryos. Donors were previous IVF patients who, regardless of their ability to pay, shared their eggs equally with matched anonymous recipients. They paid only for their consultations and tests right up to the point of being matched with a recipient. The sole recipient paid the cost applicable in egg donation of a single egg collection, although both received embryo transfers. The results indicate that although the recipients were older than the donors (41.4 +- 0.9 versus 31.6 +- 0.5 years), and there was no difference in the mean number of eggs allocated, the percentage fertilization rates, or the mean number of embryos transferred, there were more births per patient amongst recipients than amongst donors (30 versus 20%). We conclude that providing the donors are selected carefully, this scheme whereby a sub-fertile donor helps a sub-fertile recipient is a very constructive way of solving the problem of the shortage of eggs for donation. There are also the advantages of including a group of women who would otherwise be denied treatment. Problems related to 'patient coercion' can, in our view, be fully overcome by the application of strict common-sense safeguards. The ideal of pure altruism is not without its medical and moral risk. The success of egg-sharing depends on shared interests and a degree of altruism between the donor, the recipient and the centre. The current HFEA guidelines should be applauded for enabling a highly effective concept of mutual help to develop.
Key words: altruism/egg donation/egg sharing/payment to donors