BioNews recently reported on the Daily Mail investigation of a so-called 'cash for eggs' scandal which suggested women on low incomes are induced to provide eggs for use in the fertility treatment of others. The coverage (see BioNews 899), which prompting swift responses from the field, may shock some readers, and it is beyond question that the welfare of women who provide eggs under any circumstances is of paramount concern. However, the story somewhat belies the complexity of egg provision in the UK and within Europe more broadly. While the selling of human eggs in the EU is prohibited ('reasonable compensation' is permitted), there is considerable variation in the interpretation of these regulations between nations, resulting in significant disparity in practice.
In the UK, women who are not themselves undergoing fertility treatment can be compensated £750 per cycle. However, in the case of egg sharing - the focus of the Mail’s investigation - women can also provide eggs in return for treatment costs that may run into thousands of pounds. In all cases, financial compensation is permitted under UK law, but payment for eggs is unlawful. To add complexity, the commercialisation of (or making profit from) human biological material in a much more general sense is common practice. Charges for IVF (in vitro fertilisation) involving third party eggs are high, and as such clinics are afforded legitimate financial gain; a position egg providers are denied under current legislation. It is concern about the apparent blurring of these distinctions that is at the heart of the Mail's coverage.
Egg sharing is unique with regards to live tissue provision since women are not only seeking to conceive using their own eggs, but are also providing eggs for use, often concurrently, in another person or persons’ treatment. Commentators have argued that at worst the term 'sharing' disguises a hidden trade in eggs dependent on the desperation of childless couples, and at best is a grey area of practice where there is greater need for regulation and transparency. Vociferous debate has led to questioning about whether such practices are representative of a flourishing global 'tissue economy', even within contexts which are characterised by apparently comprehensive professional and legal regulation.
Given this context, surprisingly little research has been conducted within Europe with women who provide eggs, and in particular, in relation to the complex economic and political contexts in which these exchanges take place. The studies that do exist show that the reasons women give eggs are multiple and varied and may be related to a range of factors including a desire to help others, as well as for financial gain and that these two things are not necessarily mutually exclusive.
In relation to egg sharing specifically, a paper by Guido Pennings and Paul Devroey, illustrated that when reimbursement for IVF was introduced in Belgium (meaning people could access treatment for free without sharing eggs), egg sharing was reduced by 70 percent. However, a small number of women continued to engage in the practice even when their treatment could be funded by the state. This is an intriguing finding, worthy of further investigation.
As others have already highlighted, a longstanding and acute underfunding of fertility treatment in the UK lies beneath this story. An increase in NHS (National Health Service) funding would no doubt begin to ameliorate challenging decisions about opting for expensive treatment. We wholeheartedly agree with such demands. However, we also wish to draw attention to the urgent need for increased understanding of the multifaceted nature of egg provision, in particular the interplay between embodied reproductive practices, policy, economics, and law.
A few weeks ago, our research team began a study to consider these questions in greater depth. Our work explores egg provision in the UK, Belgium and Spain, and seeks to understand how current practices are shaped by wider social, political and economic forces. By drawing on these three European cases, we intend to develop theories about egg provision as well as to use the findings to directly inform policy and practice.
The Daily Mail coverage raises important questions around the ethics of tissue donation and the practice of commercialising human biological material. However, it also reminds us of the importance of reflecting upon how we talk about egg provision and egg providers in public debate. Labelling egg providers as either 'altruistic donors' or 'exploited victims' is unlikely to capture the ambiguities, nuances and contradictions of existing practices and importantly, how egg providers see and understand themselves, their bodies and body parts, as interconnected within wider social, moral, economic and political dynamics.
Thanks to my colleagues, and members of the EDNA research team, Catherine Coveney, Lorraine Culley, Cathy Herbrand, Vincenzo Pavone, Guido Pennings, and Veerle Provoost for their contribution to this article.
For more information about our research, visit the Centre for Reproduction Research at De Montfort University.