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Are We Protecting the Well-Being of Egg Donors?

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*Katie Hammond is a Gates Cambridge Scholar. She recently completed her MPhil in Multi-Disciplinary Gender Studies, and will be starting her PhD at the University of Cambridge in fall 2012 as a Smuts International Scholar. She is exploring the experiences of egg donors and the impact of regulation surrounding egg donation, focusing on Canada. Picture credit: Creative Commons and kicksie.

According to the World Health Organization 8-12% of women are unable to conceive without medical facilitation. The last 25 years have brought about hope for those facing infertility, with spectacular scientific developments in assistive reproductive technologies (ARTs): technologies that assist in achieving and monitoring a pregnancy. One example being in vitro fertilisation (IVF).

The use of donor eggs in IVF treatment has become an increasingly popular option for women experiencing difficulties achieving pregnancy, spurring markets for egg donors. Multiple jurisdictions have developed legislation in order to regulate the use of ARTs and the resulting markets, citing as an objective: protection of the well-being of individuals engaging with ARTs.

Differences across jurisdictions are most prevalent in regards to reimbursement and compensation for gamete (ie sperm and egg) and embryo donation, as well as for surrogacy. In Canada, for instance, only reimbursement of egg donor expenses is permitted, whilst in the USA women can be paid for their eggs.

Egg donation is a complicated, time-consuming and invasive procedure. There are risks to a woman's physical health and mental well-being. For women in particular, ARTs and the market that stems from them have brought about a variety of concerns and dilemmas. Pertinent to egg donation are concerns around donor autonomy when engaging with these technologies - centrally, the role that compensation plays in these markets. There are concerns for women surrounding the business side of egg donation: concerns of a conflict of interest on the part of clinicians and researchers. Also, egg donation brings with it opportunities of coercion by financial incentive or other.

Legislation in various jurisdictions has been put in place in order to limit risks stemming from the use of ARTs. While many feminists have critically evaluated the impact of ARTs, less attention has been placed on the impact of ART regulation, specifically, whether regulation seeks to alleviate concerns for participants, such as egg donors.

The predominant regulation debate regarding egg donation has centred on whether or not egg donors should be compensated. And if so, how much? Making compensation debates the dominant focus, however, has perhaps misconstrued our perception of the problem by diverting our attention from all components of the issue.

A core issue of ARTs, for instance, is that the market for egg donors is a unique one - fuelled by intended parents willing to go to great lengths to conceive, including crossing international borders to go to jurisdictions where donors may be more available. Neglecting these components inhibits us from creating legislation that might help us in achieving our goal: to best protect the well-being of individuals, such as egg donors, engaging with ARTs. For instance, if our goal is to 'protect' the well-being of donors should this not include those women beyond the physical boundaries of our own jurisdiction?

ART regulation in all jurisdictions should not be blindly assumed to fulfil its goals and needs to be considered in its context: a legal system that has often failed to encapsulate female reproduction. We need to look beyond the compensation debate. In order to address all concerns, ART legislation might best be critically evaluated in terms of whether it helps to solidify systems that promote donor well-being. Promoting donor well-being should perhaps include regulation that enhances a donor's ability to determine whether donation is a good decision for them. Also, through regulation such as around medical practice that minimises harm to a donor's physical well-being.

It is important that we remain mindful that the ramifications of our 'solution' to the dilemmas posed by egg donation should not be any less scrutinised than the dilemmas posed by the technologies themselves.