How Prevalent is It?

Approximately one in 10 couples in the United States faces infertility, defined as the inability to conceive a child after trying for a year or more. In 1995, 12.9% of married couples in the United States reported some form of impaired fertility.¹ There are many causes of infertility, including damage to the fallopian tubes, possibly resulting from a sexually transmitted disease; abnormal or too few sperm; or, any of a host of reasons that may result in the repeated failure of embryos to implant.²

Couples may use in vitro fertilization, in which donor oocytes and sperm from the genetic father are mixed to form embryos, which are then transferred to the uterus of the older woman in the hopes of achieving a pregnancy. The older woman thus becomes the gestational and social mother of the child.

Donors range in age from 18 to 41 years, and may be married or single. Research confirms the risks that donation poses to these women:

Oocyte donation is hazardous. It is invasive, physically demanding and often painful. . . . Donors are required to receive daily injections of drugs that induce ovarian hyperstimulation—the ovaries are caused to produce several eggs at a time. For three weeks, donors must go to the infertility center every morning so that the physician can monitor egg development and take blood samples to ascertain hormone levels indicating egg growth. Approximately 34 hours before egg extraction, donors receive an injection of human chorionic gonadotropin to trigger ovulation and then they begin to take antibiotics to ward off infection.³

Is It Ethical to Seek Egg Doners?

There are additional risks associated with egg donation. There is some risk of unintentional pregnancy, as hormonal contraceptives need to be discontinued for donation to take place.⁴ Ovarian stimulation could result in ovarian hyperstimulation syndrome in which ovulation proceeds rapidly without stopping. There could be prolonged side effects from the oocyte retrieval, such as cramping or hemorrhaging. And the possible long-term effects of drug-induced ovarian stimulation are not known. These possibilities have led some to conclude that it is safer and therefore more ethical to accept donors who have already completed their families, so that any possible adverse effects will not compromise donors’ reproductive plans. The Canadian Royal Commission on New Reproductive Technologies concluded that it is not ethical to permit otherwise healthy women to assume the risks of egg donation for someone else, and it has proposed a ban on payments for gamete donation.⁵ The ethics of egg donation balance the autonomy of women who choose to donate against the harm that may be involved. Are college students and others who agree to donate oocytes because of financial need acting autonomously?

It’s crucial that full information is provided before the donation is made. For instance, the ads that young women read in college newspapers seldom inform them that oocyte donors spend 56 hours in the clinical setting for interviews, counseling, and procedures related to the process.⁴ With this in mind, the National Advisory Board on Ethics in Reproduction developed recommendations including³:

• Before potential donors undergo testing and screening at an infertility center, they should receive detailed information about the oocyte donation procedure.
• Donors should be informed about the purpose for which their eggs will be used, such as for implantation (after fertilization) or research.
• Donors should be advised that, to minimize medical risk to the recipients and the children to be, certain sorts of nonidentifying information will be disclosed to recipients. Informed consent should be solicited from prospective donors after they have successfully completed the screening process, but before they are enrolled as oocyte donors.
• Screening for potential donors should be distinguished from the counseling process. Potential donors who complete predonation screening should receive additional counseling and education before they make a decision to donate oocytes.

It’s important that young women interested in donating oocytes maintain continuity in their primary health care during and after donation. And potential donors should verify that infertility treatment centers have insurance covering any injury incurred during the oocyte retrieval process.³

In a recent report, the Ethics Committee of the American Society for Reproductive Medicine suggests that compensation for oocyte donors should range between $5,000 and $10,000. This range is identified as the amount of money that is most appropriate to compensate donors for their time, trouble, and to some extent, the risks incurred, without representing an undue inducement of donors or suggesting that the payment is for the oocytes themselves.⁴

The Responsibility of Nurses

The variability of advertisements seeking oocyte donors remains troubling. A few years ago, then-director of the National Institutes of Health, Bernadine Healy, MD, recommended that ads seeking egg donors in college newspapers should always be accompanied by a kind of Surgeon General’s warning that enumerates the risks of the procedure.⁶ This proposal has never been widely adopted and college students continue to consider oocyte donation primarily for financial reasons.

Nurses have a responsibility as patient advocates to be fully aware of the clinical dimensions of oocyte donation and to be available to counsel young women in all settings about the physical, emotional and social dimensions of this type of donation. In addition, we can use our collective power to advocate broader public awareness and public notice, similar to what Healy has recommended, to ensure responsible advertising. In our society, we value autonomy and the opportunity to make responsible decisions about the donation of bodily substances, tissues, and cells. Fully informed consent is the most reliable basis for continued autonomy and for continued opportunities to both donate and receive oocytes.

References

1. Abma JC, et al. Fertility, family planning, and women’s health: new data from the 1995 National Survey of Family Growth. Vital Health Stat 23 1997(19):1-114.

2. Congress. Office of Technology Assessment. Infertility: medical and social choices. Washington (DC): Government Printing Office; 1988 May. OTA-BA-358.

3. National Advisory Board on Ethics in Reproduction. Report and recommendations on oocyte donation. In: Cohen CB, editor. New ways of making babies: the case of egg donation. Bloomington: Indiana University Press; 1996.

4. Ethics Committee of the American Society for Reproductive Medicine. Financial incentives in recruitment of oocyte donors. 2000;74(2):216-20.

5. Royal Commission on New Reproductive Technologies. Ottawa: Canadian Government Publishing; 1993.

6. Healy BP. Egg donors for hire: a medical dilemma in search of solutions, not college students. J Womens Health 1995;4(2):107-9.