Ethical Complexities of Egg Donation in the US

Approximately 10-12% of women worldwide struggle with infertility. Between 1990 and 2010, the number of infertile couples increased from 42.0 million to 48.5 million. The United Nations reports that nearly half the world’s population now lives in countries with fertility rates below population replacement level. As more women delay childbearing until later in life, rates of infertility will likely continue to rise.

Egg donation (ED) for in vitro fertilization (IVF) has emerged as a popular form of treatment for infertility. These services represent a large share of the global fertility industry and are projected to nearly double in demand by 2025. Yet, despite the rise in demand for human eggs, research focused on egg donors is lacking from the current literature—especially when compared to the magnitude of people’s experiences with infertility. Within the current body of research, there is an obvious need for studies on donor perceptions, long term health effects and experiences of the donation processes and beyond.

For my capstone research, I am working under the mentorship of Dr. Diane Tober, one of the pioneers of egg-donor-focused research. Her current project evaluates the experiences and motivations of egg donors, including interviews with donors from 19 countries. With funding from the National Science Foundation, she currently is focusing on the cultural contexts of egg provision in the US and Spain, and the broader regulatory and medical settings in which egg donation occurs. For my capstone, I am working on a quantitative analysis investigating experiences of informed consent among women who have donated eggs in the US.

During these first few weeks of the capstone period, I have had the opportunity to become more involved with additional tasks for the parent project. This includes assisting with data extraction for a comprehensive literature review. One of the aims for this piece is specifically to understand the ethical complexities of ED for intended parents and donor-conceived children. However, reviewing articles has prompted me to consider some of the additional ethical complexities related to ED specifically and the fertility industry more broadly.

One of the more striking examples of an ethical dilemma that I’ve come across is related to the potential expansion of methods of assisted reproductive technology (ART). In a meeting recently, my research team discussed a recent article on efforts to create human ova in a laboratory setting. If this technology becomes viable, it would virtually eliminate the need for egg donors. Thus, the potential for such a development has significant implications for our work. It also would introduce an even more complex set of ethical considerations, not least of which is concern over the manipulation of human genetics and reproduction.

Sourcing eggs for research is also problematic. ED for research purposes is regulated differently than for the fertility industry, a key difference being the compensation of donors. While compensation for fertility donors can vary widely (and is regulated arbitrarily at best), in many states donations for research remain uncompensated. The ongoing debate centers on the ethics of unduly motivating women to participate in ED for research, yet entirely altruistic participation remains low. This issue encouraged me to critically examine the ethics of ED from several angles, particularly as it pertains to my capstone work.

Additionally, I have found myself contemplating how ED and assisted reproductive technology fit into a broader conversation of global health issues. It is tempting to consider the fertility industry as a unique entity, but it would be remiss to consider this industry as independent from issues of women’s health, reproduction and family planning. Thus, some of the questions that I find myself continuing to struggle with include: How can we equitably distribute access to assisted reproductive technology? Is an emphasis on ART morally sound while women are losing access to reproductive care and autonomy? And, do expanded ART options and access shift focus away from more traditional means of alternative family making, such as adoption? I have not come to any satisfying answers to these questions, but I would argue that expanding assisted reproductive technology requires consideration of these ethical issues.