The EDNA study which looked at the social, political, economic and moral constitution of egg donation in Europe, ended recently, after 4.5 years of research. This large-scale comparative project was designed to provide a holistic overview of the changing landscape of egg donation. Here, I outline some of the main findings from the project.
Egg donation was first carried out in the early 1980s; making it almost as old as IVF itself. In the early days, egg providers were usually women undergoing treatment themselves and recipients tended to be heterosexual couples. The number of cycles carried out per year was very small and the profile of the practice – ie, one woman donating (fresh) eggs to another medically infertile woman – was how we imagine egg donation to work today. Fast forward to 2022, and the fertility treatment landscape has shifted considerably, as have the wider social norms around the use of donor eggs. One striking shift is the growth in the numbers of egg donation cycles – now over seven percent of all IVF cycles in Europe, as reported in Human Reproduction Open. Use has also expanded to include a wider range of groups: eg, gay couples using surrogacy or women experiencing age-related fertility decline.
Much of what we currently know about egg donation comes from scholarship based out of the USA, where egg donation, and fertility treatment in general, has historically been shaped by commercially-driven practices. We therefore set out to explore the changing landscape of egg donation in Europe. Specifically, we focused on countries within the EU (at the time of our data collection the UK was still part of the EU) because a common regulatory framework – the EU tissue and cells directive – bans the outright commercialisation of human eggs (as well as other tissue), but leaves individual countries freedom to determine whether or not to provide egg donation, and if they do, how to define the specificities of its regulation. While Europe is sometimes referenced as being regionally homogenous in policy and welfare terms, in fact there are significant differences and local specificities which shape the practice of fertility treatment in different jurisdictions. A key question for us was also about whether tensions arise if growing commercialisation in the fertility sector emerges in the context of broadly anti-commercial regulation.
To answer these questions, we selected three countries as our cases studies: the UK, Spain and Belgium, and systematically compared them across a number of key dimensions. These countries each share a place as leaders in the development of fertility treatment techniques, have a long history of provision and liberal laws around access, but have differing approaches to the regulation of egg donation – for example on whether donors can be anonymous (Spain and Belgium) or must be identifiable (as in the UK and Belgium), how much compensation they can receive, or how many families can be created from one egg provider's eggs.
Our comparative approach allowed us to bring into sharp relief how local regulations, cultural and economic contexts interact to give rise to what we refer to what refer to as differing egg donation 'regimes', as we outlined in our most recent paper in Social Science and Medicine. This led us to our first conclusion, that egg donation is 'multiple'. By that I mean that there are different versions of egg donation – it is not one homogenous phenomenon. Differing national regimes produce and reinforce a multiplicity of practices, varying moral frames and distinct economic models in which egg donation takes place. This left us asking whether there is in fact, any singular phenomenon which could be referred to as 'egg donation'. Neither is this simply a matter of national differences, instead our data illuminate numerous versions of egg donation within national settings.
One of the key technological shifts we were interested in at the outset was how the emergence and impact of vitrification on egg donation. We found access to egg freezing to be especially transformative; allowing donated eggs to be stored for later use or shipped to clinics within and between countries. While much of the media focus of this technology recently has been on egg freezing for personal use, or on its impact on the ability to ship eggs internationally, our work shows that egg freezing is having a significant impact on the business models that operate within countries.
Our analysis shows how in Europe, egg donation tends to be framed as an altruistic practice between women, with the work of clinics, egg banks and other agencies often hidden. This representation may in fact obscure a range of motivations, practices and narratives, which is important to consider as this may affect which people come forward for egg donation.
While egg donation 'agencies' originally arose in the USA, the past decade has shown that an increasing number of agencies and other intermediaries have now emerged in Europe. Spain, for example, has a large number of egg banks and this shift has been made possible due to increased access to egg freezing. Our work shows how intermediaries might introduce additional complexity to the regulation of egg donation. These intermediaries are uniquely entwined with local regulations, cultures, history of fertility treatment culture and importantly the way in which health care is organised; and are directly contributing to the reshaping of fertility treatment business models. This points to an increasingly commercialised landscape for fertility treatment across Europe, giving rise to important policy blind spots, something we discussed in our paper in Health Policy and Technology.
Finally, our work demonstrates how the perceptions and experiences of egg providers are affected by regulatory, moral and economic contexts. What egg providers were told about the number and use of their eggs within each country, for example, was linked to local regulations and cultural and moral framings. Our study shows how women's perceptions about profit-making practices around eggs (eg, shipping them abroad for a fee) raise questions about whether such practices may be increasingly out-of-step with existing policy.
If you would like to follow the project for updates, please visit the study blog or follow the project on Twitter @edna_project. For a recording of our recent end of project webinar, visit our website. We are busy preparing a number of publications and other outputs and look forward to engaging in on-going debate about the outcomes of our work.