14 March 2005
Scientific Director, and Professor Ian Craft, Director, London Fertility CentreAppeared in BioNews 299
At present, a wait of one or two years is not unusual for egg donation and this, coupled with the shortage of sperm donors, has led the Human Fertilisation and Embryology Authority (HFEA) to consider increasing the allowable expenses payment. A consultation exercise is currently underway to review payments and benefits in kind for sperm, egg and embryo donors. Unfortunately, this exercise may be too little, too late. The law change has already changed the way fertility specialists practice medicine by making overseas referrals commonplace for those who can afford it. Furthermore, the legislation may have been introduced prematurely, since it would have been preferable if initiatives promoting identifiable donor recruitment had been in place before removing anonymity, rather than the reverse. Also, the spirit of the new law may not be upheld by parents - 80 per cent of Swedish parents using donated gametes have not told their children about their biological origins since the 1985 law change in Sweden (Pennings, RBM Online 2005: vol 10 p307-309).
Everyone seems to have an opinion about the effect that the new legislation will have on egg donor recruitment but until now, no-one has asked donors themselves, let alone recipients. To investigate whether or not removal of anonymity would influence participation, we surveyed past egg donors and recipients from our centre. Questionnaires were sent to 504 former egg donors and 363 recipients, who were anonymous to each other. Response rates were good for donors (32.7 per cent) and recipients (39.1 per cent). Of donors, 36.4 per cent say they would not have participated had donor anonymity been waived, 69.1 per cent would donate anonymously again and only 52.1 per cent would donate again as identifiable donors. Of recipients, 53.5 per cent would not have proceeded and a similar proportion (52.1 per cent) would decline further donated eggs after the change in law, whereas 96.5 per cent would receive anonymously donated eggs again (Craft et al, RBM Online 2005: vol 10, p325-329).
Our results indicate that removal of anonymity for egg donors is likely to lead to a further restriction of an already unsatisfactory service. We estimate that some 700 fewer egg donation cycles a year will be available in the short term, unless radical new initiatives are implemented to step up identifiable donor recruitment. We understand the Government and Department of Health's viewpoint on this issue, and we await with interest the results of the 'Give Life, Give Hope' publicity campaign, promoted in January 2005 to attract new donors.
Some fertility programmes have introduced egg-sharing to circumvent delays for recipients and simultaneously help couples who cannot afford to pay privately for IVF. However, egg-sharing will be less successful in achieving a complete family for a recipient than conventional egg donation, since half the eggs are retained by the sharer, and some donors are sub-fertile.
We propose an 'all-inclusive' financial allowance for donors to promote donor recruitment and shorten the waiting time to treatment predicted to increase with the loss of anonymity. To avoid donor exploitation, restrictions such as a maximum number of annual and total donations are proposed. We agree that there is an imperative to maintain the concept of altruism for donation of gametes at all costs. Despite this noble aim, we have an obligation to provide services appropriate to the cause of infertility and not have one group of infertile patients discriminated against because of a lack of donors. Ideally, we would wish to increase egg donor numbers to ensure equity of service provision, and prevent the need for recipients to seek treatment overseas.
But clearly, for some donors, no amount of money can adequately allay fears about loss of anonymity. Such concerns properly need to be dealt with during counselling. Our 'all-inclusive' allowance should be regarded less as 'payment as inducement' and more as 'compensation for inconvenience and discomfort'. Such a distinction might seem like splitting hairs to philosophers but would be common sense to those actually donating their eggs, or considering it. The current 'payment' of £15 to gamete donors is frankly derisory when one considers the amounts given to volunteers in clinical trials with less risk and inconvenience.
In addition to implementing new campaigns (of unproven effectiveness) to attract donors, more research is needed to identify those most likely to donate their gametes and embryos and under what circumstances. Survey research in New Zealand indicates that older men with complete families may be more likely to donate sperm without payment with loss of anonymity, but this may not be the same in the UK. Even now too few mothers act as egg donors, who are required by the HFEA to be under 35. Radical new imperatives are essential if the UK is to avoid a total collapse of its gamete donation service and halt the increasing exodus of reproductive tourists to more 'fertile' lands.