What price parenthood?
Payments to egg donors are to triple to £750 a time. The fertility authority says it is to cover the costs of those wishing to help childless couples –but will it simply encourage vulnerable women to sign up to what is a potentially life-threatening procedure?
Jeremy Laurance is a writer on health issues. He is former health editor of The Independent and the i and has covered the specialism for more than 20 years. He thinks the harm medicine does is under-appreciated, the harm it prevents over-rated, and that cycling works better than most drugs. He was named Specialist Journalist of the Year in the 2011 British Press Awards.
Thursday 20 October 2011
Making babies by artificial means is not without risk. Nina Thanki, 37, from Leicester, died in 2006 from a pulmonary embolism – a blood clot on her lung – triggered by the egg-retrieval procedure she had undergone just a few days earlier.
The previous year, Temilola Akinbolagbe, 33, collapsed at a bus stop in Croydon, South London, two days after hormone treatment prior to egg collection. She died of ovarian hyperstimulation syndrome, a usually mild condition that in her case caused a heart attack.
Both women were having IVF. However, they highlight the risks –though rare – to those donating eggs who undergo the same procedures to help ease the shortage of donor gametes in the UK.
Yesterday the Human Fertilisation and Embryology Authority (HFEA) recommended tripling the payments to egg donors from £250 to £750 to encourage more to come forward.
The authority sought to strike a balance between twin evils – enticing donors with financial inducements to take risks with their bodies; and leaving childless women unable to find an egg donor with no option but to seek treatment abroad.
The decision followed a two-year review, including a public consultation, of the medical, social and ethical issues.
It concluded the UK system should "compensate both egg and sperm donors a fixed sum, which reasonably compensates them for any financial losses as well as recognising their time, commitment and dedication to helping others form a family". The £750 fee now on offer is similar to the level in Spain, where egg donors are more plentiful. British women have sought treatment there for that reason.
But it is well below the reported level in the US, where some women have sold their eggs to the highest bidder and attracted in excess of $10,000 (£6,300) for Ivy League students with film star looks.
The HFEA was keen not to weaken the altruism that should underpin all donations and is the best guarantee of a safe system. Donors responding to financial inducements are likelier to take unnecessary risks or to lie about their health.
But it also had to respond to the growing shortage of donor eggs (and sperm) that has worsened since donor anonymity was removed in 2005 (children now have the right to learn the identity of their biological parents when they reach 18).
In one month last year, a survey found 53 women seeking fertility treatment who went abroad to 46 clinics, most in the Czech Republic. It implies possibly thousands going abroad each year.
The HFEA faced a dilemma. Paying might encourage people to take risks, but the alternative might be increasing numbers of women being driven abroad for treatment, where it is less well-regulated.
Demand is so great that Nottingham-based Care Fertility this year began importing eggs from the US and offering treatment at £12,000 per cycle, nearly three times the cost of using donor eggs in the UK. Professor Lisa Jardine, head of the HFEA, yesterday denied the £750 payment would be an inducement to women to donate eggs purely for money.
She insisted:"It is a fair reflection of the effort and the time and the discomfort and the pain of some of it."
Hugh Whittall, director of the Nuffield Council on Bioethics, also backed higher payments. "We believe altruism should remain the primary motivation," he said. "However, we also believe egg donors should not be left out of pocket."
But David King, director of Human Genetics Alert, said: "This is a disgraceful decision that puts young women's health at risk. Anyone who thinks £750 is not a financial incentive knows nothing about life on income support or with your students fees tripled." He said the glut of Spanish donors was a result of higher payments and claimed there was a "massive spike" in applications when the financial crisis hit in 2008. "In reality, this is about the interests of the IVF industry in stopping the flow of IVF business to Spain," he added.
About 40 per cent of all donated eggs come from women who receive compensation worth £2,500-£5,000 when they agree to share their eggs in return for cut-price or free IVF treatment. The HFEA considered whether this was an unethical incentive but decided to retain the present egg-sharing system. It concluded that women saw benefits in kind as being distinct from cash payments and that there was a sense of solidarity with the women they helped. The authority also recommended £35 per donation for sperm donors.
But Laura Witjens, chair of the National Gamete Donation Trust, said: "No money will ever repay what an egg donor does to help childless couples. This priceless gift changes lives and donors truly do it to help others."
Being a donor: What is involved
The donation of eggs
An invasive procedure which involves a physical examination, screening to ensure the donor does not have any serious genetic or infectious conditions and a series of hormone injections which accelerate the maturing of the woman's eggs. Once the eggs are matured, they are ready for collection, which involves a procedure either carried out under sedation or general anaesthetic, during which eggs are removed by inserting a needle into the ovaries through the vagina.
Donors will probably need at least the day after the operation off work. Although serious side effects are rare, common side effects include tiredness, abdominal pain, bloating, mood swings and headaches.
The donation of sperm
The process begins with a physical examination and screening to ensure the donor does not have any serious genetic or infectious conditions and an assessment of sperm quality. Sperm donors are asked to produce semen samples over a period of several weeks or even months. On each occasion a sample is provided the donor will be required to abstain from sex and alcohol for at least three days prior to the donation. Sperm donors are required to go back to the clinic six months after their last donation to have further screening tests before their sperm samples are released for use in treatment.
Both sperm and egg donors will be asked to provide biographical information about themselves and a message to future donor-conceived children. These children will be legally entitled to access identifying information about the donor once they reach 18.
Claire Cousins, 27, Oxford
My sister donated eggs to me after I went through early menopause aged 22. I didn't want an unknown donor. I didn't like the thought of someone saying, 'your baby has your eyes' and me knowing it wasn't true. Now I can look at my boy Harry, and see my mum in him, because we have the same genes, which made a great difference. The whole process took about a month, in spring last year, and Harry was born in February. He's good as gold. I could never thank my sister enough. We need more donors. The waiting list is so long, I was told to go abroad. Anything that helps people to donate is brilliant, so I'm all for this new incentive. The other price that should change is the cost of IVF treatment. It's hard to get it on the NHS, and restrictively expensive if you can't.
Eleanor Clapp, 33, Sawston near Cambridge
I have donated eggs twice and am about to do so again. I feel very lucky to have had two happy, healthy children without any complications in pregnancy or birth. I can't imagine life without my kids now, I love them. I imagined what it must feel like to be childless, and decided that, being blessed, I wanted to spread the luck around a bit. It can be a long and quite invasive process – none of it really hurts though. I think £750 is a perfectly reasonable amount to compensate donors. It's a really good thing to do but if you're going to be out of pocket and inconvenienced, then there isn't much incentive. This won't lead to people wanting to "sell" their eggs. No one can donate or receive eggs without a counselling session with a counsellor. If it's not right for you, or you're not doing it for the right reason, they will say so.
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