1. Egg donation for research
Prof. Dr. Donna Dickenson
University of London
‘De Maakbare Mens’ 28 September 2006

2. The Hwang case in Korea: abuse and fraud in the stem cell technologies
Hwang Woo Suk claimed to have created ‘tailor-made’ stem cell lines for use in therapy
Initial reports of 250 eggs and 11 cell lines aroused suspicion
True figure now thought to be over 2,200 eggs, and no successful cell lines

3. Events since Hwang in the UK
HFEA consultation Sept.-Nov on whether women not undergoing IVF should be paid for eggs
Licence also granted to Newcastle stem cell research team to obtain eggs
Women already undergoing IVF can be paid upwards of £1,200, or half cost of treatment, for allowing ‘egg sharing’

4. Ethical arguments in favour
1. ‘It won’t put the women at any increased risk because they are going to have exactly the same treatment that they are going to have for IVF anyway’
2. Acute shortage of eggs; possible benefits to stem cell research
3. No money actually changes hands, and more women can be helped

5. Is payment more honest?
Other researchers concentrating on altruistic donation, probably from women whose families have been affected by diseases for which stem cell research is touted as potential cure-all
Therapeutic misconception encouraged, but unlike altruistic organ donation, donated eggs have no known benefit

6. Ethical arguments against
1. Not ‘exactly the same treatment’: possible temptation to increase level of hormonal dosage to increase yield (cf IVF lite, Dutch findings)
2. Pulls clinicians in two different ways
3. Introduces commercialisation, pre-empts HFEA consultation process
4. ‘Egg sharing’ means something else

7. 1. The same treatment? Hopefully this would never happen here, but…
US (2001) article: seventy eggs extracted in one cycle from young women who nearly died
Risk of over-stimulating ovaries, which can result in toxic shock

8. An illicit slide
Asking a woman undergoing IVF to submit to intensive ovarian stimulation for multiple egg extraction does at least lessen the likelihood that she will have to return for treatment again and again.
But multiple egg extraction has also become the norm in the ‘harvesting’ of eggs for the stem cell technologies.

9. 2. Conflict of interest for IVF doctors
Doctor’s main object of attention should be fertility treatment for woman, not eggs for research
Women in this case aren’t taking part in a research experiment; they haven’t volunteered for the extra levels of risk to which research subjects may be put

10. 3. Commercialisation in the UK
Genuinely open consultation process between September-November already biased towards allowing some payment in form of cheaper IVF
UK Human Fertilisation and Embryology Act 1990, first in Europe, actually opposes commercialisation in other forms (commercial surrogacy is a crime)

11. 4. Egg sharing means something else
Women who donate eggs do so to help another woman in their own situation
Or to obtain cheaper treatment, but…
Who would want to sell their ova except less wealthy women?
Language of altruism pre-empted

12. Belgium findings (2006)
Pennings and Devroey reported drop of 75% in Belgian women’s willingness to donate ova for egg sharing when government recommendation of six free cycles was implemented (July 2003)
‘Confirms fear that majority of egg sharers donate because of restricted finances’, although 25% would still do

13. Eggs are already commercialised
Extraction of gametes for IVF already sold for up to $50,000 per cycle in US
Observer 2006 reports of trade in eggs for IVF from Eastern to Western Europe
Could globalised trade in eggs for research be the next development?

14. Ban or regulate?
We could take the line that ‘first do no harm’ requires clinicians not to impose risks with no therapeutic benefit, especially when long-term risks are uncertain (ban)
Or we could allow patients to voluntarily take on risks under conditions approximating those imposed for research (regulate)

15. If we decide to ban egg donation …
We would have to deal with the argument that research would suffer, and that we allow research subjects to choose freely whether to take risks
But there is nothing experimental being tested on women who donate eggs
They only provide raw material for research, they aren’t research subjects

16. If we decide to permit but regulate…
…we would have to be very certain that vulnerable volunteers were not being offered inducements to participate
Certainly arguable that women undergoing IVF are vulnerable, and that inducement of cut-price IVF is unethical

17. Some specific protections for donors
If—a big if-- we wish to allow egg donation, then we must respect the self-sacrifice which ova donors exhibit by not trivialising or commercialising purposes to which the donation is put.
US National Academy of Sciences 2005 recommendations allow donors to limit types of research done with their embryos or eggs and forbid payment

18. Ongoing consent
Donors should have right at the time of donation to refuse particular uses to which they object, and a right to be recontacted at periodic intervals about further downstream uses which were not known at the time of donation.
Not too cumbersome—the least we can do to reward donors’ altruism