Human Reproduction vol.12 no.12, pp.2845–2852, 1997
Egg sharing and egg donation: attitudes of British egg
donors and recipients
Kamal K.Ahuja1, Barbara J.Mostyn and
Eric G.Simons
Cromwell IVF and Fertility Centre, Cromwell Hospital, Cromwell
Road, London SW5 OTU, UK
1To
whom correspondence should be addressed
The question of payment to egg donors has recently
focused the attention of both the Human Fertilisation and
Embryology Authority (HFEA) and licensed clinics. An
acute shortage of egg donors and the rising costs of assisted
conception treatment are matters of grave concern to many
patients. To understand the emotional and social effects of
egg sharing and egg donation, we conducted a survey of
attitudes in a group of women who had some knowledge
or experience of egg donation. A total of 750 questionnaires
were sent out of which 217 were returned within the
specified time limit. From these, 107 respondents had
experience of egg donation and 110 had made enquiries
about donation. The data from these questionnaires were
collated and tabulated by the National Opinion Polls (NOP)
Research Group. An analysis of the data produced the
following key findings: (i) donating or sharing eggs is a
social issue, 94% discuss it with partners/family/friends;
(ii) altruistic motives are not the prerogative of non-patient
volunteers—egg share donors felt that helping the childless
was as important as having a chance of in-vitro
fertilization (IVF) for themselves; (iii) the treatment
procedure causes the most anxiety for egg donors. The
recipients were most concerned about delays, donor
characteristics and how the eggs were allocated; (iv)
most respondents (65%) with prior experience of egg
sharing would do it again – 63% of egg share donors,
72% of egg share recipients; (v) cash rewards to egg
donors and outright advertising for donors were rejected
by 64 and 62% of the sample respectively; and (vi)
counselling was highly valued and there were no instances
of ‘shattered lives’ after treatment. The findings do not
support the recently announced intentions of the HFEA
to disallow payment to gamete donors on the grounds
of devalued consent. There is no precedent in modern
medicine for egg sharing. The patients surveyed drew a
clear distinction between egg sharing and financial
rewards. As long as egg donation is not covered by the
National Health Service, it is fairer to offer egg sharing
than to refuse treatment to those unable to pay.
Key words: egg donation/egg sharing/payment/regulation/
respondents
© European Society for Human Reproduction and Embryology
Introduction
The growing and unmet demand for egg donation has been
the subject of considerable discussion worldwide. Different
systems of health care allow different forms of anonymous
egg donation which in general fall into one of the following
four categories: (i) altruistic–anonymous donors are non-patient
volunteers who would undergo egg collection for the benefit
of someone unknown to them; (ii) commercial–anonymous
are those women who would accept money in return for
donating eggs; (iii) known–anonymous egg donation is a
scheme whereby the matched donor and recipient remain
anonymous to each other but the identity of the donor is
known to an unmatched recipient; and (iv) the infertile–
anonymous are those patients who would volunteer to donate
a proportion of their eggs in return for subsidized in-vitro
fertilization (IVF) treatment (shared egg donation). The merits
of the different schemes have been discussed previously (Ahuja
and Simons, 1996; Englert, 1996; Lockwood, 1997).
The key advantage of shared egg donation is that no third
party takes risks for the benefit of the recipient because the
donor requires drugs and an operation for her own needs.
Further it provides treatment for those who cannot obtain IVF
within the UK health care system and who must otherwise
fund it privately. Finally, it also provides an opportunity to
express altruism in a pragmatic way between an anonymous
donor and matched recipient. The safeguards to govern the
above schemes have been described previously (Ahuja et al.,
1996; Simons et al., 1996).
However, some objections to egg sharing have also been
raised. The main objection concerns the quality of consent
given by the donor. Are patients only giving their consent to
share eggs in order to obtain much desired treatment? Secondly,
it has been suggested that some children born from treatment
may suffer later in life knowing their parents paid a donor to
contribute, to their conception although the basis for this
argument is unclear. Thirdly, subsidized fertility treatment for
egg donors could be seen as contrary to a cultural preference
for voluntary unpaid donation, such as blood and tissue
donation. When declaring its opposition to any financial
compensation for gamete donors (currently £15 per act of
donation), the Human Fertilisation and Embryology Authority
(HFEA) subsequently equated egg sharing with payment in
cash for gamete donors (Johnson, 1997).
To date, the major difficulty about claims and counter claims
regarding the advantages and disadvantages of egg sharing is
that there is virtually no information available about the
feelings and opinions of donors or recipients in egg share
programmes. The success of any new treatment procedure
2845
K.K.Ahuja et al.
depends largely on how it is perceived by patients. If they
agree with the concerns mentioned above then the HFEA’s
concerns are valid. If not, then in the absence of contrary
social or medical reasons, egg sharing should be seen as a
pragmatic approach to alleviate the shortage of egg donors.
This is the view in Israel and Denmark where egg sharing is
the only form of egg donation allowed by law. It is also
supported by a growing number of British experts and
commentators (Lockwood, 1997; Ridley, 1997).
In this paper we report the results of a comprehensive survey
which addressed the emotional and practical benefits as well
as problems of donation and egg sharing for the patients
involved. The views of enquirers are also documented. It is
hoped that the results will contribute to the development of
balanced policies on donor recruitment.
Materials and methods
A senior fertility counsellor and long-term member of the Market
Research Society (B.M.) was responsible for designing and analysing
this study in collaboration with others (K.K.A. and E.G.S.). A selfcompletion questionnaire was designed to address five key areas
which affect egg donors namely: source of awareness, motivation to
participate, reactions to the medical procedures, attitudes on egg
donation issues, and finally, the perceived effects of treatment.
Participants were obtained through appeals in patient support group
magazines (Child and Issue) requesting participation of experienced
donors and recipients, as well as those interested in donating or
receiving eggs (enquirers). Anyone interested was asked to call in
for a questionnaire. Experienced egg donors and enquirers registered
with our own centres were also sent a questionnaire.
Concurrent publications in the media about egg share successes
also resulted in many requests to participate. As a result a total of
750 women were sent a questionnaire and prepaid return envelope
between May 16 and June 17, 1996. Thus, the survey described here
preceded by one month the announcement (July 22) by the HFEA of
its decision to phase out payments to gamete donors.
A total of 234 (31%) of the questionnaires were returned. This is
considered to be a good response rate for a lengthy questionnaire.
The average response rate for a postal questionnaire is 20% according
to National Opinion Polls (NOP). Those who failed to reply were
not sent reminders. Responding to questionnaires, whether conducted
on the doorstep, the street, the telephone or by post is the choice of
the respondent according to the Market Research Society Code of
Practice. The majority of questions were accompanied by space
for comments, which were encouraged. Comments provided many
quotations, some of which feature in this report.
Questionnaires were individually analysed and coded and then sent
to the NOP for collation, tabulation and formulation into tables: 553
in total. The χ2 test was used to determine the statistical significance
of differences between sub-groups. The responses to all of the
questions were statistically tested to see whether: experienced versus
enquirers; recipients versus donors; egg sharers versus anonymous/
known donors, or egg share versus anonymous known recipients
responded significantly differently.
Results
The total sample reported in this analysis was 217 (28.9% of
the total) and not 234, as 17 questionnaires were returned after
the agreed date for submission of the data to NOP. However,
2846
the views expressed in the late questionnaires were in accord
with the majority view.
The majority of participants were middle class, married,
Caucasian women who had benefited from tertiary education
(Table I). There was an equal representation of experienced
donors and recipients (n 5 107) and those who were enquiring
about donating or receiving (n 5 110). As might be expected,
the majority were aged 25–44 years.
Non-patient volunteer donors were no more middle class
(63%, n 5 12) than egg share donors (47%, n 5 49). The
difference was not statistically significant (P , 0.1) Concerns
that middle class recipients may be exploiting working class
‘poorer’ donors, especially in egg share schemes, are not borne
out by this study. Nor would it be possible to conclude that
donors, especially egg share donors, could be coerced into
donating when 50% of experienced donors (n 5 61; 49 egg
share and 12 non-patient volunteer donors) had the benefit of
tertiary education. Amongst all experienced recipients, 58%
(n 5 46) had a tertiary education.
Features in the media create awareness of egg donation for
Table I. Demographic description of the sample responding to the
questionnaire (n 5 217)
Percentage
classa
Social
Middle class (ABC1)
Working class (C2D)
No answer
Age (years)
25–34
35–44
45–54
No answer
Education
Tertiary
Secondary
No answer
Marital status
Married
Permanent relationship
Divorced
No answer
Ethnic group
Caucasian
Asian, Afro-caribbean
Chinese, Middle Eastern
No answer
Type of participation
Experienced participants
(shared egg participants)
(conventional participants)
Enquirers
60
38
2
55
33
11
1
58
39
3
80
17
1
2
84
5
4
7
49
84
16
51
aABC1 5 professional and white collar workers; C2D 5 skilled and
unskilled blue collar workers.
Table II. Sources of awareness (n 5 217)
Sources*
Percentage
Television, radio, newspaper
Friends, relatives, colleagues
Medical profession
44
21
41
*Adds to more than 100% due to multiple answers.
Egg sharing and egg donation
most donors and recipients (65%, n 5 217; Table II). This
includes information from family and friends and colleagues
who were also informed via the media. This is not dissimilar
to previously reported studies (Power et al., 1990). Respondents
in our study who were made aware of egg donation by their
consultants and general practitioners (GPs) were significantly
more likely to be experienced patients who had been involved
in egg donation 2 years or more previously (P , 0.01).
Like adoption, donating or receiving eggs is a social issue.
Virtually all the respondents (94%) in the study indicated that
they discussed it with their partner, family and friends. Only
3% subsequently discussed egg sharing with their GP prior to
initiating treatment, a phenomenon other researchers have also
found (Billett et al., 1996). Positive feed-back from prospective
fathers and close relations appears essential for participation.
Negative feed-back created doubts and anxiety, and those who
received it were unlikely to proceed.
Altruism is not the prerogative of non-patient volunteer
donors; 86% of egg share donors and 79% of egg share donor
enquirers felt that giving hope to the childless was a significant
motive for participation: ‘Helping us have a child’, was a
common statement by 75% of egg share donors and 62% of
egg share enquirers respectively (Table III).
All respondents (experienced and enquirers) were asked to
describe their main concerns about treatment and the best and
worst features of egg sharing or donation as they might explain
it to a friend. The main concern expressed (n 5 217) was
about the IVF procedure and side-effects (81%). Failure (32%),
how eggs are shared (32%), concern for the child (26%) and
not knowing the recipients outcome (18%), were additional
concerns (N.B. adds to .100% due to multiple answers).
Experienced donor and recipient patients (n 5 107) were
significantly more likely to be concerned about failure
than enquirers (P , 0.001) and 63% of experienced donors
(n 5 61) were disappointed that they would never know
whether or not the recipient became pregnant: ‘It’s like giving
a gift that is never acknowledged’. Other researchers have
found similar reactions amongst donors (Söderström-Anttila,
1995; Cook et al., 1995; Lui et al., 1995).
The worst aspects of treatment for experienced donors and
recipients (n 5 107) were physical: the drugs, the egg retrieval
and side-effects were a negative feature for 64% of the
experienced respondents (n 5 107; Table IV). Concerns about
the donor were also expressed by 67% of experienced recipients
(n 5 46), particularly details of donor screening and matching.
The resulting child was a source of concern. Many (50% of
recipients) were worried about telling the child of its origins;
whereas 31% of donors were also aware of longer term
implications such as: ‘Could they meet and marry?’. For 25%
of experienced donors (n 5 61) stress was also created by a
seeming lack of care and concern in the clinic they attended:
‘being treated as a number’, ‘brusque nurses’, ‘no time for
questions,’ were typical complaints.
In the attitude scale questions, respondents overwhelmingly
indicated that counselling was an important part of the egg
donation/egg sharing procedure (Figure 1a). In contrast only
one-third of respondents felt they wanted to discuss egg
donation with their GP (Figure 1b). The vast majority (85%)
of the experienced patients (n 5 107) felt they had been given
enough time to think about and talk through the issues of egg
donation at the clinic.
A requirement of the HFEA licence issued for egg donation
is that all patients must be properly briefed before consenting
to treatment. Potential donors and recipients applying to our
programme receive a booklet describing the procedure before
they see the consultant who will then describe the procedure
in more detail including potential risks and side-effects, as
well as success rates. Egg share (or donation) participants will
see the counsellor to ensure that they are fully aware of all
the issues and are confidently giving their informed consent.
Of 100 women who come forward as egg share donors to the
Cromwell IVF and Fertility Centres only 20% will complete
treatment. Medical, social or psychological problems will
prevent participation for many (Ahuja, 1997).
Clearly, time to talk about relevant issues with the counsellor
and ask questions of consultants, without being rushed through
treatment is important to all participants. Most respondents
(80%) felt that donors have the advantage of feeling satisfaction
and the pride of ‘giving in their lifetime’ (Figure 1c). Twice
as many agreed that a child has a right to know its origins
(46%), as disagreed (23%) (Figure 1d). The majority of all
respondents (62%) rejected advertising for donors. The main
reasons for rejection for recipients was the desire for anonymity
and a preference for the clinics and professions to arrange
donations and do the matching (Figure 2a). Some of the
experienced donors (34%, n 5 61) felt they might respond to
advertisements because they sympathized with the desperation
of the recipient.
A significant minority of the respondents in this study (36%)
wanted to see payment to donors allowed. They felt it might
encourage more donors to come forward, ‘especially the
younger, more fertile donors’(Figure 2b). Asked how much
Table III. Motivation to participate in egg donation
Help childless
Self help
Do something that makes a difference
No answer
Percentage
shared egg donors*
(n 5 49)
Percentage shared
egg donor enquirers
(n 5 67)
Percentage nonpatient volunteers
(donors and enquirers)
(n 5 19)
86
75
–
–
79
62
–
–
95
–
16
5
*Adds to more than 100% due to multiple answers.
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K.K.Ahuja et al.
Table IV. Features of egg sharing/egg donation treatment (n 5 107)
Experienced recipients (n 5 46)
Positive
%
Experienced donors (n 5 61)*
Positive
%
Only chance for a child
Egg sharing helps two couples
83
17
Good support/counselling
Egg sharing helps two couples
Rewarding/create life
Give childless a chance
70
49
43
30
Negative effects
%
Negative effects
%
Rely on unknown donor
Reactions to telling the child
Physical side: drugs/side-effects/stress
Time and cost
67
50
28
17
Physical side: retrieval/drugs/injections
Have a genetic child somewhere
Stress
Know nothing about recipient
92
31
25
23
*Adds to more than 100% due to multiple answers.
Figure 1. Attitudes regarding egg sharing and egg donation issues (n 5 217).
2848
Egg sharing and egg donation
Table V. Will the experienced respondents try again? (n 5 107)
Percentage
All respondents
Recipients only
Egg share donors only
Non-patient volunteer donors only
65
72
63
33
(69/107)
(33/46)
(31/49)
(4/12)
Figure 2. Recruiting donors with the help of advertisements and
payments (n 5 217).
minority (45%) were resigned to accepting this: ‘You pay for
what you get these days’ (Figure 2c). The majority of respondents (55%), strongly disapproved of this practice citing ‘taking
advantage of my misfortune’ and ‘it creates double stress for
recipients’ as their main reasons.
Despite the concerns expressed by experienced respondents
before going through a cycle, as well as their worst experiences
during treatment, the majority (63%, n 5 107) felt that the
treatment had been better than expected. Being well cared for,
treated with respect, with time for questions and counselling
were compensation even for those who experienced some sideeffects. Therefore, 65% felt motivated to go through another
treatment cycle (Table V). Schover et al. (1991) also found
a high percentage of donors willing to donate again. The
recipients were the most positive about another cycle (72%,
n 5 46) because the first cycle had been ‘encouraging’ and
made them ‘hopeful’. Egg share donors (63%, n 5 49) were
also positive: ‘it brought out the altruist in me’, ‘I would
hope someone would be there if I needed eggs’ reflects the
enthusiasm of many.
Only one third of non-patient volunteer donors would
consider doing it again as the procedure involved ‘too
much emotional upheaval, disrupting life, work and family’.
Lockwood (1997) and Saunders and Garner (1996) have also
pointed out that there are many emotional pitfalls in known
donation such as coercion, feelings of obligation and guilt,
families falling out and even manipulation, e.g. donating to
pay a debt, all of these contribute to a low rate of repeat
treatment offers from volunteer donors.
The most negative feelings expressed immediately after
treatment were from recipients and non-patient volunteer
donors (Table VI). Recipients were significantly more negative
than donors immediately after treatment (P , 0.005). When
asked to focus on longer term effects, feelings were noticeably
more positive amongst recipients as well as donors. The one
exception was donors with long-term side-effects, representing
7% of all donors. While this 7% is unfortunate, the findings
clearly indicate that participation in egg sharing or egg donation
does not result in ‘shattered lives’.
should be paid, responses ranged from £10 to £50 per ovum
to as high as £2000 per procedure. The majority (64%) who
rejected cash payments felt it would encourage the wrong
people for the wrong reasons, or they were repelled about
putting a price on a baby.
There was virtually no support for the idea that the clinics
should charge the recipient and the donor two full fees
for providing independent treatments. However, a significant
Discussion
An interesting positive profile of egg share donors emerges
from this survey. They are not the put-upon poor, but a welleducated middle class group of self determined women who
are capable of addressing the issues. They initiate contacts
with infertility clinics and use the counselling sessions to
explore various issues. They make a distinction between cash
incentives which they reject, and the treatment benefits, which
2849
K.K.Ahuja et al.
Table VI. Post treatment feelings among experienced respondents (n 5 107)
Experienced donors (n 5 61)*
Immediate effects
%
Experienced recipients (n 5 46)
Immediate effects
%
Happy I tried/feel better person
Good experience/do again
Hopeful/try again
Regrets: failure/time lost
39
33
28
22
Stop, takes over your life/lost time and money
Failed again/isolated
In limbo/stressed
No answer
36
35
26
3
Long-term effects
%
Long-term effects
%
Proud/more contented
28
Adopt/come to terms
23
Save for embryo transfer/do again/encourage others 20
Still suffering from side-effects
7
No answer
22
Adopting/financially better off/change life style 43
Another go/hopeful
22
Happy we tried
20
Coming to terms with childless lifestyle
9
No answer
6
*Adds to more than 100% due to multiple answers.
they respect and need. They ensure family support and then
make a commitment to give hope to the childless, as well as
to themselves. They do not appear to suffer post-treatment
problems and, if required, 63% would share eggs again. This
is hardly the profile of women who could easily be induced
into consenting to a treatment procedure that would jeopardize
their own chances of a family, and scar them psychologically,
just to obtain partial funding.
The purpose of the research was to gain an insight into the
feelings and opinions of donors and recipients who have
experienced egg sharing or egg donation as well as those who
are considering doing so. The findings will be discussed in
the light of the three reservations about egg sharing which
have been recently raised by the HFEA.
Firstly, donors will feel coerced into donating to gain a
financial advantage. This research has shown that 86% of egg
share donors and 79% of egg share enquirers were motivated
to participate in order to help others, as well as wanting to
help themselves (75% donors, 62% enquirers). The majority
(58%) had the benefit of tertiary education (including 51% of
all egg share donors). Nearly half (49%) of the egg share
donors were middle class making it difficult to conclude that
these donor women, aged 30–35 years, were socially vulnerable
and easy to persuade. Nor is it conceivable that in a highly
regulated system, such as exists in the UK any licenced clinic
would disregard the rigid code of practice.
Egg share donors feel negative about both cash incentives
and targeted advertising for donors. This contrasts sharply
with their view of egg sharing which they regard as altruistic
and helpful to both participants. Further, donors, especially
egg share donors, had more positive reactions about the
treatment procedures, in particular the support they received
during treatment. As a result 63% of egg share donors were
hoping to donate again. Egg share donors also had more
positive post treatment feelings including a desire to encourage
others to consider donation.
The second reservation expressed by the HFEA is that
children born to recipients might suffer later in life knowing
their parents had paid a donor. (Johnson, 1997). To date there
has been no evidence or support for this speculative suggestion.
The majority of would-be parents already pay large sums of
2850
money to undergo IVF as there is little treatment available
through the National Health Service (NHS). Indeed most NHS
centres in the UK are profit-oriented because they encourage
full fee paying private patients into the system. According to
the College of Health, nearly 80% of all treatment cycles in
this country are privately funded, a situation which has not
changed significantly since the early, 1980s. In addition, those
who wish to adopt from abroad, because they feel unable to
take on the care of older more difficult children available for
adoption in the UK, are required to pay local authorities
£2000–£3500 just to conduct their Home Study (Bennett and
Mostyn, 1991; Baines, 1993). Furthermore, a typical surrogacy
arrangement will cost, in expenses alone in excess of £10 000
in the UK. If paying to become a parent is deemed inappropriate
it would seem sensible to stop all forms of payment to
create families.
Most children resulting from donor insemination (DI) are
never told of their origins despite initial intentions to do so
(Amuzu et al., 1990; Cook et al., 1995). For decades UK
patients have obtained DI on a self funding basis with no
recorded ill effects on the children or the family. Indeed,
Golombok et al. (1995) have shown that children born following DI and IVF, as well as adopted children, are happier, better
adjusted and spend more time with their parents than natural
children. Money has been seen as an acceptable form of
exchange for infertility treatment by the HFEA, until it is
applied to egg donation or egg sharing, when it becomes
unacceptable. It is also curious that a regulatory body that is
itself partly funded by a licence fee from those receiving IVF
treatment should choose to attach such a rigid moral stance
with respect to money.
The third objection of the HFEA was that compensation for
egg donors, either monetary or in the form of infertility
treatment, is seen as wrong because other more established
forms of donation such as organs and blood are conducted
without compensation. It is suggested that there is a cultural
preference in the UK for unrewarded donation and that
compensating donors diminishes their altruism (Johnson,
1997). One of the most important findings of our survey was
the emergence of a clear distinction between cash payments
and the so-called ‘treatment in kind’ medical procedures such
Egg sharing and egg donation
as egg sharing. The majority (64%) of respondents objected
to cash rewards for egg donation which is consistent with the
requirements of the 1990 Human Fertilisation and Embryology
Act. However, a similar proportion of experienced egg share
donors and recipients (65%, n 5 107; Table IV) supported
egg sharing. This contrasts sharply with the proposed HFEA
view that, for egg donors, cash rewards and subsidized IVF
treatments are equivalent.
Widespread opposition in the profession has been registered
in the UK against the HFEA policy and this is based upon
practical concerns about the likely reduction and escalating
costs of sperm donations for fertility treatment (Cooke, 1996;
British Fertility Society, unpublished; British Andrology Society, unpublished; Dawson, 1997; Ridley, 1997). This is supported further by recent pilot studies which have failed to
recruit sperm donors without compensation (Cooke, 1996;
McLaughlin et al., 1997). The present study also questions
the validity of the stance taken by the HFEA who regard cash
rewards and subsidized fertility treatment as ethically the same.
Respondents drew a clear distinction between self interest and
benefits on the one hand, and disinterested cash payments on
the other; egg sharing created a logical link between self
interest and the common good for most respondents.
Since the advent of egg sharing more donors have become
available. Egg sharing enables ‘altruistic reciprocity’ between
two couples in need of unobtainable IVF. In modern society,
just as in the entire biological kingdom altruism is never
diminished by reciprocal needs (Trivers, 1971; Mount, 1996;
Ridley, 1997). Indeed, appeals for reciprocity are often used
to recruit organ and blood donors. In his famous survey of
blood donors, Titmuss (1973) found that mutual aid was a
main motivation for participants. Responding to the slogan
‘the life you save may be your own’ does not diminish the
gift of blood donation.
Egg sharing, also, does not diminish the feeling of mutual
well-being between egg share donors and anonymous recipients
regardless of treatment outcome. Egg share donors were more
positive about themselves after treatment than the non-patient
volunteer donors who were the most likely to complain of
side-effects. Attempts to make egg sharing fit into the stereotyped mould of ‘volunteer’ blood and organ donation
(Shenfield and Steele, 1995; Johnson, 1997) ignores the many
factors which make egg donation unique. Indeed, as long as
egg donation is not covered by the NHS, it is fairer to offer
egg sharing than to refuse treatment to those unable to pay.
In fact, it is our view that there is no precedent in modern
medicine for egg sharing. Whilst all donors of any tissue are
to some extent giving for altruistic reasons, the basis of
giving for each type of tissue differs significantly. In most
circumstances, organ donors are dead before their organs are
removed. Blood donors are inconvenienced for an hour or so
and have to complete a simple procedure which is virtually
risk free. In contrast egg sharers and donors face challenges
of numerous visits to the clinic, accept possible unknown sideeffects from ovulation inducing drugs and then undertake an
operation to retrieve eggs. All of these were considered by
egg donors to be the worst aspects of treatment.
Large sums of money are budgeted for publicity directed
towards potential blood and organ donors. This is unlikely to
be forthcoming for egg donation because the procedure is
unlikely to attain sufficient priority in the NHS. It would be a
gross distortion of the facts to presume that there is a preferred
national culture of unrewarded giving which becomes dogma
and embraces all forms of tissue donation in the UK, regardless
of the risks involved. Parliament would hardly base a key
policy on an unbalanced view of the medico–social evidence
which has emerged since the passage of the Human Fertilisation
and Embryology Act of, 1990. Nor would the media remain
a disinterested onlooker when the proposed policies lead to
patient anguish, due to the short supply of gametes.
Even if sufficient non-patient volunteers could be recruited
there is increasing unease about medical aspects of their
treatment which cannot be ignored. There are reports of an
association between ovarian stimulation and cancer (Banderra
et al., 1995; Dor et al., 1996; Shusan et al., 1996; Ahuja and
Simons, 1998). These have quite different implications for a
patient who requires IVF in order to have a child and opts to
take the risks associated with ovarian stimulation compared to
a known or anonymous donor who is likely already to be a
mother of young children (Ramogida, 1997). Would she be
willing to take the risk once she understood the issues unless
there was undue family or peer pressures? Sister donors have
shown a decreased ovarian response to stimulation even when
large doses of drugs are used (Sung et al., 1997). There is
also evidence of a high incidence of family turmoil and
reproductive traumas amongst non-patient volunteers, including child abuse. Also, know donor situations can be an
emotional minefield of manipulation and abuse, e.g. donation
to pay a debt (Schover et al., 1991; Saunders and Garner,
1996; Lockwood, 1997). These findings should not be ignored.
It would indeed be ironic if a patient who is menopausal
following cancer treatment is obliged to call on a sister to
donate only to subject the donor to a possible cancer risk
(Simons and Ahuja, 1998).
By all accounts implementation of the HFEA proposals
would result in a marked reduction in egg donation in general
and potentially expose egg donors to risks which are as yet
unclear. We doubt very much whether that would have been
the intention of the 1990 Act.
Acknowledgements
We gratefully acknowledge permission granted by Sir Naren Patel
FRCOG, President Royal College of Obstetricians and Gynaecologists
to use an unpublished paper by Profesor Ian Cooke FRCOG. We
thank Mrs Stephanie Sharp, Mrs Doreen Hagan, and Mr Hugh Todd
for help with the analysis of the results and for the preparation of
the manuscript.
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Received on August 1, 1997; accepted on October 16, 1997