The recent news that a seminar set up by an American assisted conception clinic to promote its egg donation services in the UK would end with the award of free donor egg IVF treatment worth about £13,000 to a seminar participant has reignited the debate on whether and how much gamete and embryo donors should be paid. Overseas treatment also challenges the legal stipulation in the United Kingdom that donors be identifiable should the donor-conceived adult wish to know more about the donor parent. The debate hinges on the relative effect these two issues have on the shortage of donors in the UK.
It is not difficult to understand why so many couples attended the meeting, held in a London hotel. The demand for donor eggs in the UK far exceeds supply and treatment costs are high. The possibility that their number would be picked out of the hat must have made attendance irresistible for women and men distressed by their fertility problems.
Some fertility tourism is inevitable - there will always be some people denied treatment by the regulations or prevailing ethical opinion in the UK. If we are to protect these vulnerable people, we must keep reviewing the UK law to minimise the flow of patients to other jurisdictions where commercial considerations are paramount, rather than safety and the welfare of children born following treatment.
The clinic in the US promises anonymity to potential donors on the donor recruitment pages of their website. In the UK, since 2005, donors have to agree to identifying details being made available to donor-conceived children after their 18th birthday. This change in the regulations was introduced to bring the Human Fertilisation and Embryology Act 1990 into line with the Human Rights Act 1998. It happened after the High Court confirmed that Article Eight of the European Convention on Human Rights (the right to respect for private and family life), brought into domestic law by the 1998 Act, was a valid legal basis to challenge the Human Fertilisation and Embryology Authority (HFEA)'s support for donor anonymity. Many British women and couples travel overseas to escape our laws because they do not wish their donor-conceived children to know of their origin. These numbers may only be reduced by education and a change of culture so this becomes unacceptable. Other patients may be forced into accepting eggs from an anonymous donor because of the lack of donors in this country. They may then regret being unable to give their donor-conceived children the information they need to establish their identity. We may be able to help this latter group by relaxing the prohibition of payment to donors.
The HFEA allows 'shared egg donation'. Women with a fertility problem requiring privately funded treatment, after appropriate screening and counseling, are superovulated and donate half their eggs to a woman who needs donor eggs and pays for both their treatments. This payment in kind - but payment none the less - induces women to donate who would be otherwise unable to afford treatment and whose eggs may not be top quality. This way of obtaining eggs has kept the donor egg 'business' going for private clinics in the UK. They argue everyone gains from this approach; the donor gets inexpensive or free treatment and the recipient gets the eggs she needs. From the donor's point-of-view, the need for this ethically dubious arrangement is reducing as the UK's National Health Service provides more cycles of treatment for women who don't require donor eggs.
The time has come to look again at offering proportionate payments to women without a fertility problem who donate eggs. Such women would decide to donate without the pressure of needing treatment themselves. With careful donor selection, the results of treatment would increase to the levels obtained in the US. The potential donor would have to be counseled carefully about the risks of the medication to superovulate her ovaries and the procedure required to collect the eggs, but these risks are very small. Licensed clinics should stop using eggs from egg sharing arrangements and be banned from supporting links with overseas clinics that use anonymous donors.