'Egg sharing' affects validity of a woman's consent

On 7 October, the UK's Human Fertilisation and Embryology Authority (HFEA) published the results of its sperm, egg and embryo donation (SEED) review. The British Medical Association (BMA) welcomes the majority of the conclusions in the report and particularly the principle that donation of gametes should be 'cost neutral' - that is that people should neither lose out nor profit from their donation. This principle underpins the report's conclusions on payment which say that donors should be paid only out of pocket expenses and compensation for loss of earnings. When it comes to benefits in kind - and specifically compensated egg sharing, however, this principle no longer seems to apply. The offer of free or reduced price IVF treatment is clearly a benefit from which donors profit.

It may seem strange to be arguing against a practice in which, in theory at least, all parties win - donors get the treatment they want, recipients get donated eggs and the clinic gets to help twice as many people who need assistance to have children. There are clear compassionate arguments for supporting egg sharing, so why does the BMA believe it should not be permitted?

If IVF treatment were available free of charge to anyone who needed it, we would have no objection to people choosing to donate some of their eggs for the treatment of others. But, it isn't. It is largely available only to those who can afford to pay, and to pay a very considerable sum of money. For those who desperately want children but cannot afford to pay for treatment, egg sharing represents their only option. Where there is such a large inducement to donate eggs, questions must be raised about the validity of the consent and whether it meets the requirement that, in order to be valid, consent must be given voluntarily and free from pressure.

There is a real risk that women who would not, under other circumstances, offer to donate eggs for the treatment of others, sweep aside their concerns in order to achieve their goal of having a child. Although all women enter IVF with the hope it will be successful, not all women will end up with a child. When treatment fails it can be devastating. How much more difficult is it likely to be for a woman who knows that someone else may be pregnant using her eggs? Given the recent changes to the rules on anonymity, she also knows that a child born following her donation may make contact more than 18 years later. This is a decision that can have life-long implications - it is not a decision that should be entered into lightly and nor is it a decision that women should be given an inducement to make.