Juliet Tizzard, Progress Educational Trust
05 December 2003
[BioNews, London]
his week, the UK's Human Fertilisation and Embryology Authority (HFEA) banned a form of egg donation called 'egg giving'. Aimed at women who would not otherwise be able to pay for IVF treatment, egg giving offers a reduced price IVF cycle in return for donated eggs. The women undergoes one cycle in which she donates all the eggs collected. Then she undergoes a further, cut-price, cycle, using all her eggs.The HFEA has been considering the ethics of egg giving for some months, after it received a 'number of expressions of concern from patients and licensed clinics'. However, the decision to ban the system isn't based upon the ethics of paying egg donors (in cash or in kind), but on the safety aspects of entering into an egg giving arrangement. 'The HFEA cannot allow clinics to offer a treatment where a woman, for no other reason than financial inducement, subjects herself to an unnecessary and possibly risky procedure'. In explaining those risks, the HFEA statement says: 'Although the risk to IVF patients of suffering OHSS is low, about one percent, patients taking part in egg giving programmes run this risk twice because they have to have two cycles of treatment.'
OHSS, ovarian hyperstimulation syndrome, is a condition which appears in about one percent of IVF patients, caused by an adverse reaction to ovary stimulating drugs. Although the condition is serious and women affected need hospital treatment, OHSS is usually resolved within a few weeks. Of those women affected by the condition, a small number will suffer from the severe, life-threatening form.
OHSS is a serious complication and patients need to be informed of the risk of its occurrence, whether they are undergoing IVF with their own eggs or are donating eggs to another woman. The HFEA is right to be concerned about OHSS, but it seems to be showing particular concern in relation to egg giving. However, the authority does permit a similar system called egg sharing, in which two women share the eggs from one treatment cycle rather than two. The distinction, it seems, is that in egg giving the donor has to undergo a treatment cycle which is of no benefit to herself other than the discount she will receive on her own treatment.
The HFEA says that undergoing two cycles of treatment exposes a woman to the risk of OHSS twice. This is true. But it is also true most people undergoing IVF expose themselves to this risk more than once. Fertile egg donors (just like organ donors) also expose themselves to risk, in this instance with no benefit to themselves, other than the satisfaction of helping another woman. What the HFEA seems to object to is that 'egg givers' are effectively egg donors who are giving their eggs in return for payment in kind.
The HFEA's desire to distinguish between egg sharing and egg giving, by relying on the small risk of an adverse reaction to ovary stimulating drugs seems a little like splitting hairs. More importantly, this approach to policy-making in which risks are highlighted (an approach which is increasingly used by the authority in relation to other techniques) may backfire. Talk of the risks of fringe procedures like egg giving could cause real worry for IVF patients and egg donors. After all, the ovarian stimulation risks are exactly the same whether a woman in undergoing IVF with her own eggs, she is donating her eggs or she is sharing her eggs with another woman. It would be a tragedy if, in an attempt to prohibit particular controversial procedures, the HFEA ends up damaging the reputation of established and effective treatments like IVF, which have brought so much happiness to the lives of infertile couples.
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Reproduced from BioNews with permission, a web- and email-based source of news, information and comment on assisted reproduction and human genetics, published by Progress Educational Trust.