Progress Educational Trust conference - Having a child: How far should you go?

The ethics of cross-border reproductive care was the topic of the third session of the Progress Educational Trust's annual conference 'Passport to Parenthood: The evidence and ethics behind cross-border reproductive care'.

The first speaker, Professor Naomi Pfeffer, was strongly opposed to the international trade in donated eggs. She described the process as a 'rotten trade' and compared it to the importation of cheap frozen chicken from Thailand. To highlight the inequitable nature of the trade, she gave the example of Ukrainian egg donors who are paid much less than Spanish donors or blond Yale University students who donate their eggs in the US.

Professor Pfeffer argued there was now a 'global market in human eggs' and this was an example of a 'rotten trade'. She explained how democratic countries like the UK often limit the negative effects of this 'rotten trade' through tight regulation. Less-developed countries, however, often fail to control the negative impacts because they have corrupt governments and weak regulation.

She argued the trade in donated eggs caused several potential 'bads'. For example, the act of egg donation could not be described as a job and was not a dignified way to earn money. Professor Pfeffer even suggested some women donating eggs could find the process addictive. She also claimed there was evidence that the drugs used to stimulate egg production in women donors could also be potentially harmful.

Professor Pfeffer argued women have low status in Romania, India and other key egg exporting countries and women from poorer backgrounds were particularly vulnerable to being exploited as egg donors. She described India as the 'reproductive tourist industry' equivalent of a supermarket chain often accused of exploiting its employees and suppliers.

Comparing the trade in eggs to the selling of kidneys, she argued kidney donors rarely succeed in lifting themselves out of poverty. They often end up with poor physical and mental health following donation, which she suspected would also be the fate of many egg donors. Finally, Professor Pfeffer was concerned about the potential impact of cross-border egg donation on donor-conceived children.

Stuart Lavery, a consultant gynaecologist and director of IVF Hammersmith - a fertility clinic - took a more utilitarian approach to egg donation than Professor Pfeffer. He was not opposed to the egg donation trade, as long as it was effective, safe and ethical.

He said that his unit had stopped actively recruiting egg donors and IVF Hammersmith had treated around 1,400 NHS patients in 2009, he said, but only 10 of these were egg donation cycles.

His team at IVF Hammersmith had discussed introducing an 'egg-sharing' scheme - whereby women donate 'spare' eggs to others in exchange for free fertility treatment - but staff were 'ethically uncomfortable' with this idea. Instead, IVF Hammersmith had forged close links with carefully-chosen US and Spanish clinics where privately-funded patients requiring donor eggs could be referred.

He argued the clinics were chosen because of their high levels of clinical care and strong ethical standards. In particular, IVF Hammersmith want to be sure the egg donors were: carefully screened; given appropriate compensation for their trouble; and records kept so donors could potentially be contacted at a later date by any donor-conceived children.

IVF Hammersmith are keen to ensure stimulation and collection of donor eggs was as safe as possible, he said. This includes using levels of drugs that minimised the risk of ovarian hyperstimulation syndrome. He said they also discourage multiple embryo transfer and encourage clinics to transfer only a single embryo, as favoured by the UK's fertility regulator the Human Fertilisation and Embryology Authority (HFEA).

However, Mr Lavery conceded IVF Hammersmith had initially sent patients to an Indian clinic. Ten patients had been sent there, but the high number of multiple births which resulted caused IVF Hammersmith to decide to have no further dealings with this clinic.

Mr Lavery spoke about having a 'duty of care to his patients', even when IVF Hammersmith was no longer directly involved in their care. He said all patients they referred to a clinic abroad were offered counselling and had a named nurse (in the UK) they could contact before they embarked on treatment. This was because he felt IVF Hammersmith still had a responsibility to these patients.

During the question and answer session after the speeches, an audience member called IVF Hammersmith's model a 'fair-trade' solution to the problems associated with cross-border reproduction. Mr Lavery also reiterated that transparency in dealing with overseas clinics was important to maintain patients' trust.

The final speaker, feminist philosopher Professor Janet Radcliffe Richards adopted a pragmatic approach to the donor egg trade. She said banning it simply because people felt uneasy would be counterproductive. During her talk, she focused on unpicking whether it was the payment or exploitation of egg donors that some found 'intrinsically unacceptable'.

Professor Radcliffe Richards said she could not understand why payment for egg donation is prohibited in Britain. She argued there was no distinction between egg donation and other forms of exchange of goods or services which people may find unpleasant or would not be prepared to do themselves such as cleaning toilets or working unsociable hours. She argued that - should paid egg donation benefit the donor and recipient - it would be wrong to ban it.

Rushes to judgement based on intuitive responses were not a justification to prohibit something or argue no one should do it, she said. Professor Radcliffe Richards suggested these rushes to judgement were part of a wider 'politics of unease'. The key to making egg donation a success was 'how to stop the bad, without stopping the good' but - for her - egg donation could be a 'good'.

The Progress Educational Trust (PET) would like to thank Gold sponsors Merck-Serono for their support and Lord Naren Patel for chairing this session.