Egg-sharing is an arrangement that enables qualifying women to receive subsidised IVF treatment, in return for anonymously donating an agreed proportion of their eggs to paying recipients. In our paper for the Obstetrician and Gynaecologist, published on 19 April 2005, we conclude that egg-sharing is ethically and legally sound, minimises risk and should be the only form of egg donation permitted in the UK, as is the case in some other countries.
The first successful case of egg-sharing was reported by our centre in 1992, and although the treatment was legal, it was viewed as controversial for several reasons:
1) Women who were not paid might be manipulated into giving away eggs needed for their own treatment;
2) The collected eggs might be split in a way that favoured the paying recipient;
3) Unsuccessful donors might be psychologically affected if they believed that their recipients might have succeeded from the donated eggs.
Many of the advantages of egg-sharing - such as the shortening of waiting lists for donor eggs and the avoidance of exposing volunteer egg donors to unnecessary surgery and ovarian stimulation - were often lost in the heated debates that followed our announcement. However, following a painstaking review of the ethics, practicalities and patient attitudes towards egg-sharing, in 1998 the Human Fertilisation and Embryology Authority (HFEA) announced their support for this practice. Clearly defined regulations were made available in 2000, which were comprehensively expanded in the sixth HFEA Code of Practice. IVF treatment with donor eggs has increased over the following years, due largely to the increasing acceptability of egg-sharing.
We believe that past criticisms of egg-sharing are not supported by current evidence. Firstly, the suspected dilution of women's consent due to subsidised or free IVF has been vigorously examined. HFEA regulations require separate contracts between the IVF unit and the donor on one hand and the unit and the recipient on the other. Failure to adhere to this practice could lead to a severe reprimand for the centre, and the possible loss of its HFEA license. Individual counselling ensures that the manipulation of neither party occurs.
Egg-sharing centres are distributed across the country in a way that bears no relation to the overall distributed wealth, and there are no 'ghettos of poverty' in evidence in the UK that provide a bountiful supply of easily exploitable eggs. The suggestion that this could happen is probably an inadvertent criticism of the regulatory system that took ten years to analyse the factors underlying egg-sharing before approving the practice.
Finally, the suggestion that egg-sharing reduces the chances of the donor's success is not borne out by recent live birth results from our IVF programme in Swansea. We have never seen the sharers to be disadvantaged in terms of overall success rates, a finding backed up by numerous other studies.
Sticking to a rigid view of altruistic egg donation accepts that only women who need no treatment must undergo complex procedures designed to treat infertility - a practice that is morally and ethically unacceptable, and one which will never meet the need for donated eggs. Many commentators and practitioners, including ourselves, have expressed concern that the loss of donor anonymity that became effective on 1 April 2005 will lead to a marked decrease in the number of egg donors. It may be too early to judge the possible impact of this development on egg-sharing. However, even if the numbers of patients opting for such treatment drop, this would not constitute a criticism of egg-sharing itself, a practice that provides clear benefits to all participants and to society.