In last week's BioNews, Eric Simons and Kamal Ahuja argued that egg sharing should be the only legal solution to donor egg shortages in the UK. This week, Brian Lieberman puts forward his arguments against this practice:
Egg sharing is the euphemism used to describe a form of trade in human eggs. Egg trading (to give the process its correct name) allows financially disadvantaged women the opportunity to trade a proportion of their eggs for IVF treatment. In the UK, the market for human eggs exists because of the shortage of altruistically donated eggs. It is also illegal for a woman to sell her eggs, unlike in other countries, such as the United States. The results of egg trading are cloaked in secrecy. I have, to no avail, requested this information on many occasions, in order to provide independent information when counselling couples in need of treatment with donor eggs. However, the incidence of significant complications such as moderate and severe ovarian hyperstimulation and the live birth rate per trading cycle commenced, for the provider and recipient, remain closely guarded secrets.
It is essential for each trading partner to know the precise outcome for themselves and the other woman. They need to know when they have both had a live birth. This will enable them to inform their children of their half siblings, and the donor-conceived children will, as of the 1 April 2005, have the right to discover the identity of the egg provider. For the same reason, the provider needs to know when she has failed to conceive but the recipient has had a life birth. The provider also needs to know when she alone has had a life birth, as this will free her of any anxiety associated with the loss of donor anonymity. Trading partners need to know when treatment has been unsuccessful for both of them.
The loss of donor anonymity in the UK will go some way to removing some of the secrecy associated with the outcome of egg trading. Hitherto, as a condition of entry onto the programme, at some egg trading centres the women were specifically required to agree to this secrecy.
The trade in human eggs breaches an ethical principle. Human cells, blood, organs and tissues should not be traded in any form whatsoever. It is incorrect to state, as Ahuja and Simons did in their commentary, that 'in 1998 the Human Fertilisation and Embryology Authority (HFEA) announced their support for this practice'. The HFEA did not 'support the practice', but allowed it to continue as many women were unable to obtain IVF treatment on the NHS, and it avoided the risks associated with ovarian stimulation in altruistic donors. The fact that the HFEA allowed the process does not necessarily confer universal ethical approval. The risk of hyperstimulation in egg providers is not published by clinics nor is it known or published by the HFEA.
Egg trading remains the preserve of the proprietors of private IVF clinics and the financially advantaged but infertile. It represents cherry-picking on a grand scale. It does not take place within the NHS, as no woman, however altruistic, is willing to part with a commodity as precious as her eggs until she has had a family. The consent of the egg provider is obviously fettered as she is forced into this arrangement, the only way by which she has access to IVF treatment. Egg trading fails to offer any treatment to the infertile over the age of 35, and to those of any age that are financially disadvantaged and need treatment with donor eggs.
The long term harm or benefits from partaking in an egg trading relationship have also yet to be determined. This information may never be known as long term follow-up studies of this nature are notoriously difficult to organise
The failure of government to provide sufficient IVF on the NHS, rather than an increasing acceptability of egg trading, is likely to have increased IVF treatment with traded eggs. The geographical distribution of egg trading centres simply reflects the site of fee paying IVF units within the UK. It is quite remarkable that egg trading does take place to any extent in Scotland, a part of the UK that is relatively well funded for NHS treatment.
The loss of donor anonymity may well lead to a marked decrease in the number of egg traders. This, in my opinion, is a positive sequel to a practice of dubious ethical merit, but at the same time it has not lead to a decrease in the number of altruistic egg and, may I add, sperm donors in Manchester.
Are the egg providers really getting a square deal by their participation in an egg trading arrangement? They are trading a unique, precious and rare commodity. I would advise them to enter the trading relationship with the same financial vigour as the clinics' proprietors, and insist that all consultations, investigations and treatments including IVF, ICSI, surgical sperm retrieval and the freezing and replacement of embryos are provided totally free of charge. I am aware that there is a wide variation in the provision of these services by different trading centres, and that women have been refused replacement of their cryopreserved embryos until payment is forthcoming.
Finally, the HFEA need to consider a change in nomenclature to reflect the true nature of so-called 'egg sharing' programmes.