14 September 2015
ByAppeared in BioNews 819
Directed by Jennifer Lahl
Available from the Centre for Bioethics and Culture website
This documentary short film produced by the California-based Centre for Bioethics and Culture (CBC) is a sequel to their 2010 film 'Eggsploitation' (reviewed in BioNews 632). To begin with, heartfelt congratulations for an obvious but nonetheless awesome pun. But, sadly, that is where my congratulations end for this film.
It tells the story of Maggie, a 33-year-old woman living in Washington state. She enjoys her work as a 911 operator as she likes to help others through their difficult moments. Maggie, who throughout her 20s donated eggs – a total of ten times –- now has stage IV breast cancer that has spread to her liver and bones. Her oncologist is surprised, given her age and lack of other risk factors, that she has such an aggressive form of cancer. This point is supported by a screenshot from the American Cancer Society Surveillance report of 2011, which shows that there are fewer than 50 cases of breast cancer per 100,000 people Maggie's age.
Maggie and her oncologist had spoken about her being an egg donor, and she recounts the look on the doctor's face that prompted her to ask if that was what had caused her cancer. The doctor avoids the question, but later said that 'they do have information to say exposure to these things can result in certain types of cancer, or at least increase your chances'. In the film, this is overlaid with a series of screenshots from reputable medical journals. At face value, they lend credence to Maggie's and CBC's view of the harm of egg donation. But, looking carefully, the articles chosen are outdated. For example, it refers to the Oxford Journal on Human Reproduction article entitled 'Money, morals and medical risks: conflicting notions of recruiting egg donors'. On inspection, the article was submitted in September 1998. A similarly outdated article is one in Nature, which was published in 2006 but tells of an egg donor in 1989. None of the statistical data is viewable on the articles themselves, and it seems the film is trying to give scientific legitimacy to their view without actually providing any supporting evidence, only scare-mongering headlines.
Maggie tells how she become an egg donor after speaking with a woman who had gone through failed IVF, who told her that the clinic she used was always looking for donors. After extensive interviews and medical tests, Maggie become an egg donor. She felt lucky to be able to donate her eggs, as if she had qualified as an X Factor contestant. She was paid $1600 for her eggs.
She recalls the nurse saying she had been able to retrieve 'a lot of eggs'. This is followed by a diagram of questionable accuracy showing that normal ovulation produces two eggs and what is dubbed 'superovulation' produces 25 eggs, which seems very high to me and may not even be based on Maggie's testimony (she doesn't say how many eggs were harvested in any of her cycles). She had felt happy about producing so many eggs as she thought it meant the recipient could freeze some for another cycle of IVF, and was not aware that the recipient could sell on the unused eggs she had donated.
According to Maggie, there was only a one-page disclosure of risk form that she was asked to sign each time she donated. The only mention of cancer was a two-line paragraph stating that in the 1970s it had been thought that exposure to these drugs could lead to ovarian cancer but that this has since been proven false. Here there is a screenshot of the form, but the paragraph referred to by Maggie is not viewable. Maybe this is the lawyer in me, but applying the best-evidence rule, if you say a document states something and take the time to present a copy, then don't omit the key paragraph! What's more, analysing the language of the document (which is viewable), it is clearly drafted as confirmation that those points were discussed with the doctor before donating, not a document that in itself explains all the relevant risks.
While she was donating at a second clinic they found pre-cancerous cells during a smear test, which the clinic then removed and Maggie continued to donate. At a later donation she discovered a lump in her breast and was referred to another doctor for a mammogram, which she was told showed all was fine. Some three months later, she consulted her primary care physician, who confirmed she had breast cancer. Although she does not say so explicitly, the implication is that the other clinic failed to diagnose her cancer in order to carry on with the egg-donation cycle.
Maggie feels she was taken advantage of and that the price she paid was too high. She recounts that a nurse told her that she could demand more money from the clinic but that she had not because she wanted to donate to help others, not for financial gain. I cannot help but feel that once she had donated a few times, she would have been able to say no without feeling guilty. To keep donating ten times across a decade, with two different clinics, cannot be put her down to being young and naïve.
The documentary is clearly trying to push an anti-IVF message and to reinforce the ethos of CBC, as is made clear in the endorsements of the film on the website:
'A must-watch film for anyone contemplating becoming an egg donor. Maggie's story shows how well-meaning women who want to help others risk their own health and indeed lives, and how unscrupulous doctors put their profit before the egg donor's state of health. Also, a must-watch for anyone contemplating using donated eggs for IVF or surrogacy. Remember, there is a woman from whose body these eggs come who might die because of your desire to have a child. Don't proceed. Stop right now.' – Renate Klein, PhD, women's health researcher and FINRRAGE coordinator.
The actual message that Maggie's story tells is that there is a need for regulated egg donation. There need to be clear guidelines and standards operating in all clinics, and this must be monitored. While this is not the case the USA, it is the case here in the UK. It may be that Maggie's treatment fell well short of good practice, but to imply that all egg donors are exploited and at risk of cancer is a step too far, in my view.
There is nothing in the documentary that proves that egg donation causes cancer – it merely shows the case of one ten-times egg donor who developed cancer. It is, frankly, irresponsible of the filmmakers not to speak with any credible experts or offer any tangible proof of this central claim. It's akin to yelling 'fire' in a crowded theatre without checking that there is actually smoke in the stalls.
The film is fairly short at 22 minutes and not widely available. In the UK it's available to rent on vimeo for £1.91. But, unless you're a fan of sensationalist film-making I would not bother. So, readers, I depart from my usual advice of telling you to watch and make up your own mind because, this time, it's just not worth it.