Egg sharing and reimbursement of IVF
Guido Pennings, Professor of Ethics and Bioethics
Ghent University, Belgium
Progress Educational Trust24 August 2006
Egg sharing remains a highly controversial procedure. The discussion on whether or not egg sharing in return for a free or reduced IVF cycle constitutes a kind of payment has been going on since the very beginning of the practice. However, from an ethical point of view, it might be more important to answer the question of whether it constitutes an inducement that may jeopardize the validity of the patient's consent, as stated by the chairman of the Ethics Committee of the British Medical Association last year. It is very difficult to find a definitive answer to that question. Still, some evidence may shed some light on this point. There has been evidence reported by Rapport in 2003 that women are reluctant to part with their eggs but still go ahead because of a desire to have a baby.
In a recent article by Pennings and Devroey (2006) in Reproductive Biomedicine Online, a different route was followed to find out about the influence of the offer of a reduced or free IVF cycle on the patients' decision to donate. On 1 July 1 2003, Belgium began providing full reimbursement for six IVF cycles. The authors compared the numbers of egg sharers before and after this date. The main finding was a drop of approximately 70 per cent. This finding seems to confirm the fear that the majority of the egg sharers donate because of restricted financial means. However, since the motivation to donate is multidimensional, one should be careful in interpreting this result. The data show that the financial incentive is the main motivation for a large majority of egg sharers. It does not show how large the group is in which there is also an altruistic motive present, be it insufficiently strong to bring the women to donate without financial return. This indirectly shows a degree of coercion. More positively, it also shows that about one in four women were prepared to donate without any incentive beside the wish to help others.
The next question obviously is how one should react to this finding: should one stop compensated egg sharing to prevent this from happening? This solution would not help anyone. Instead of shooting at the piano player, one should take away the cause of the phenomenon. The real solution lies in providing more extended funding of infertility treatment for the financially needy.
Reproduced with permission from BioNews, an email and online sources of news, information and comment on assisted reproduction and genetics.