Who puts a price on infertility?: Ian Craft says advertisements offering donor eggs should shake up the medical profession

TUESDAY'S national newspaper advertisement placed by an American fertility institute, offering an immediate supply of donor eggs, seems to have caused offence to some UK doctors and fertility specialists. It has also upset the Human Fertilisation and Embryo Authority (HFEA), which controls fertility treatments.

The prominence and wording of the advertisement smacked of commercialism, playing on the fact that infertile British couples, who may need donor eggs to overcome premature menopause, inherited disorders, repeated failures of test-tube treatment or the advanced age of the woman, cannot obtain treatment because of the lack of donors and long waiting lists. For ethnic minority couples the situation is almost hopeless. This controversy comes after recent media debate over the potential use of foetal ovarian tissue - soon to be banned by Parliament - and of cadaver ovaries, for example, after road accidents. That row also was prompted by the shortage of available egg donors.

To desperate couples, the immediate availability of donor eggs in the US may seem a life-line, provided they can overcome the problems of expense and geographic dislocation involved - plus, of course, the fact that the treatment cannot be guaranteed successful. Indeed, there must be a question as to whether prospective British recipients can be assured they will receive the same standards of screening and counselling in the US as exist in the UK under the HFEA's supervision.

In Britain, we frown on the idea that donors should be paid for contributing 'life-giving' eggs, sperm or embryos, and yet we delude ourselves by accepting that these same donors receive 'expenses': in reality, this must encompass some element - however token - of payment.

Perhaps our deep-felt objection to payment stems in part from the adverse media reaction that surrounded the Kim Cotton affair, which resulted in Parliament hastily enacting the Surrogacy Arrangement Act, 1985. This outlawed the setting up in Britain of agencies aimed at recruiting host mothers for women unable to carry their own children because of medical disorders.

Under this imperfect legislation, doctors and lawyers remain under potential threat of prosecution when making an arrangement that is based on a fee for service, and yet most host mothers receive payment for their involvement - if only as an informal arrangement between the respective parties.

What is so inherently wrong about paying for a surrogacy service? The child is no less loved because of it. And, other than a close relative or friend, it is hard to imagine who would carry a potential child for nine months for totally altruistic reasons.

We should face openly the complex issues surrounding egg, sperm and embryo donation, and surrogacy, and consider setting up a government- controlled national body to facilitate the provision of such services, including the recruitment of donors who wish to act altruistically and those who will act provided they receive a sensible and realistic payment. This would prevent overseas organisations trying to exploit the British scene. It would also provide more donors throughout the UK.

Going overseas for eggs should not, in any case, be necessary. It arises because there is no co-ordinated central approach to donor recruitment. The French are more pragmatic, providing a countrywide donor sperm service. They even go so far as actively recruiting the husbands of recently delivered women to act as donors. Because the UK has no comparable organisation, it is almost impossible for those of certain ethnic minority backgrounds - Afro-Caribbean, for example - to obtain matched donor sperm, even in a metropolis such as London.

Our own medical profession could be far more efficient in maximising potential donor resources. Why is it beyond the ability of gynaecologists and fertility specialists to liaise with each other so that women under 35 undergoing routine gynaecological operations, such as sterilisation, are asked at the same time whether they would consider acting as egg donors?

Many would consider doing so if they were given appropriate information showing the need for such donation and what is actually involved. There are enough sterilisations performed each year on men and women in the UK to cover all the needs for donor egg and sperm - indeed, this was the main source of eggs for the early research that paved the way for test-tube treatment many years ago.

In view of the official disapproval of a more liberal approach, it is surprising that the Human Fertility and Embryology Act passed in 1990 did not directly outlaw the setting up of commercial agencies to provide donor eggs in the UK. But the HFEA has been so concerned about the activities of one British agency that a circular has been sent to every fertility centre indicating its disapproval and recommending the centres to have nothing to do with that agency.

We should now rethink the whole problem of gamete donation afresh. Clearly, some of the reasons for egg and sperm shortages are remediable, so why not consider setting up a national government-sponsored organisation to recruit donors who could be properly counselled, informed and screened, whether or not any payment is made. There are clear benefits: the public would be reassured as to the professional nature of such a service; and it would eliminate the need for other organisations to set up in business providing donor eggs for potential gain.

As far as infertile people are concerned, such a development could only be good news.

The writer is director of the London Fertility Centre.

(Photograph omitted)