Evaluating egg-sharing: new findings on old debates

Egg-sharing refers to a scheme where a woman undergoing fertility treatment donates a portion of her eggs to an anonymously matched recipient in exchange for a reduction in treatment costs.

As a very specific form of egg donation, egg-sharing has generated heated debate since its introduction in the UK in 1998. While proponents argue it provides a win-win solution, allowing two women to help each other conceive, critics talk of the potential ethical and psychological consequences.

Until recently, there has been very little empirical data to inform these discussions. However, new research (1,2), conducted by myself and Professor Susan Golombok at the University of Cambridge Centre for Family Research in collaboration with the London Women's Clinic, hopes to redress this balance. The two-year study provides detailed perspectives from women who have taken part in egg-sharing, offering the first in-depth and comparative insight into the experiences, opinions and attitudes of egg-share donors and recipients.

Over the years, concerns around egg-sharing have included fears that such schemes may exploit women, especially those who are otherwise unable to afford their own treatment; compromise consent; and lead to psychological damage for unsuccessful donors who will be traumatised by thoughts of the recipient conceiving their genetic children (3-7).

We were interested in finding out as much as possible, both in terms of the objective facts that can inform such debates and also about egg-sharers' own reflections on these questions. Our questionnaire covered a broad range of topics - from motivations to anxieties, emotional reactions to retrospective reflections - and was completed by 86 women (48 donors and 38 recipients) who took part in egg-sharing between 2007 and 2009.

Overall, the data paint a reassuring portrait of egg-sharing. They suggest that some commonly held, and even intuitive, concerns about the practice may be unfounded, and highlight the feelings of empathy and reciprocity between donors and recipients. As well as engaging directly with the Human Fertilisation and Embryology Authority (HFEA) in their recent review of donation policies, the findings are reported in various articles being published this year.

Engaging directly with some of the questions surrounding consent and exploitation, our first article provides demographic details of egg-sharers and reports on their circumstances and retrospective reflections (1). We found that, contrary to some expectation, there were few demographic differences between egg-share donors and recipients: women in both groups came from similar ethnic, religious and educational backgrounds, and had similar kinds of occupations, although recipients were on average 11 years older than donors (44 years old versus 33 years old).

However, there were interesting differences regarding their relationship circumstances: although the majority of donors and recipients were in heterosexual relationships at the time of egg-sharing, there were significant minorities of donors in same-sex relationships (27 percent) and single recipients (34 percent). These findings are not particularly surprising considering the changing landscape of assisted reproductive technologies, but serve as a reminder that the tacit assumption of an IVF patient as a heterosexual woman suffering fertility problems is outdated.

In addition to the demographic data, we sought egg-sharers' own opinions on issues of consent and exploitation. Reassuringly, 88 percent of donors and 76 percent of recipients expressed disagreement or strong disagreement with the statement 'Egg-sharing is exploitative'. The large majority of egg-sharers were glad to have taken part in egg-sharing (87 percent), would still do so if they could make the decision again with the benefit of hindsight (83 percent), and believe that egg-sharing is a good response to donor egg shortages (94 percent).

In the second article (2) we focus more on the emotional and relational aspects of egg-sharing. In particular we ask how donors and recipients feel about each other, about each other's treatment outcome and any resultant offspring. Our findings revealed trends towards openness and disclosure among donors and recipients, sentiments of goodwill between the two groups, and a strong sense of reciprocity and empathy.

When women were asked to describe their feelings towards their egg-sharing partner, the two most common responses were curiosity (71 percent of donors, 78 percent of recipients) and the sentiment 'I hoped her treatment would be successful' (79 percent and 86 percent, respectively). Interestingly, unsuccessful egg-share donors were no different to successful donors with regard to how often they thought about any children the recipient may have conceived; on opinions as to whether those children should be told about the circumstances of their conception; or on feelings about potential future contact. Thus, concerns about the psychological harm to donors whose own treatment ends unsuccessfully were not borne out by our data.

In a third article currently under review, we discuss donors' motivations and concerns in depth, highlighting the multiple considerations of egg-sharers, and the feelings of empathy and reciprocity between donors and recipients. No doubt, it will prove interesting to return to some of these questions in time, in particular to find out more about the opinions and experiences of the children conceived through egg-sharing as they reach maturity. However, in the meantime, the findings should serve to ease many of the ethical and psychological concerns about egg-sharing, and to inform clinical practice and broader policy discussions about egg donation.

Currently, egg-sharing accounts for around 60 percent of donated eggs in the UK, but a severe egg shortage remains. It is possible that with greater information provision and awareness, egg-sharing schemes can further assuage the demand for donor eggs in the UK, in a way that is beneficial for both donors and recipients.