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Evaluating egg-sharing: new findings on old debates

23 April 2012
Appeared in BioNews 653
Egg-sharing refers to a scheme where a woman undergoing fertility treatment donates a portion of her eggs to an anonymously matched recipient in exchange for a reduction in treatment costs.

As a very specific form of egg donation, egg-sharing has generated heated debate since its introduction in the UK in 1998. While proponents argue it provides a win-win solution, allowing two women to help each other conceive, critics talk of the potential ethical and psychological consequences.

Until recently, there has been very little empirical data to inform these discussions. However, new research (1,2), conducted by myself and Professor Susan Golombok at the University of Cambridge Centre for Family Research in collaboration with the London Women's Clinic, hopes to redress this balance. The two-year study provides detailed perspectives from women who have taken part in egg-sharing, offering the first in-depth and comparative insight into the experiences, opinions and attitudes of egg-share donors and recipients.

Over the years, concerns around egg-sharing have included fears that such schemes may exploit women, especially those who are otherwise unable to afford their own treatment; compromise consent; and lead to psychological damage for unsuccessful donors who will be traumatised by thoughts of the recipient conceiving their genetic children (3-7).

We were interested in finding out as much as possible, both in terms of the objective facts that can inform such debates and also about egg-sharers' own reflections on these questions. Our questionnaire covered a broad range of topics - from motivations to anxieties, emotional reactions to retrospective reflections - and was completed by 86 women (48 donors and 38 recipients) who took part in egg-sharing between 2007 and 2009.

Overall, the data paint a reassuring portrait of egg-sharing. They suggest that some commonly held, and even intuitive, concerns about the practice may be unfounded, and highlight the feelings of empathy and reciprocity between donors and recipients. As well as engaging directly with the Human Fertilisation and Embryology Authority (HFEA) in their recent review of donation policies, the findings are reported in various articles being published this year.

Engaging directly with some of the questions surrounding consent and exploitation, our first article provides demographic details of egg-sharers and reports on their circumstances and retrospective reflections (1). We found that, contrary to some expectation, there were few demographic differences between egg-share donors and recipients: women in both groups came from similar ethnic, religious and educational backgrounds, and had similar kinds of occupations, although recipients were on average 11 years older than donors (44 years old versus 33 years old).

However, there were interesting differences regarding their relationship circumstances: although the majority of donors and recipients were in heterosexual relationships at the time of egg-sharing, there were significant minorities of donors in same-sex relationships (27 percent) and single recipients (34 percent). These findings are not particularly surprising considering the changing landscape of assisted reproductive technologies, but serve as a reminder that the tacit assumption of an IVF patient as a heterosexual woman suffering fertility problems is outdated.

In addition to the demographic data, we sought egg-sharers' own opinions on issues of consent and exploitation. Reassuringly, 88 percent of donors and 76 percent of recipients expressed disagreement or strong disagreement with the statement 'Egg-sharing is exploitative'. The large majority of egg-sharers were glad to have taken part in egg-sharing (87 percent), would still do so if they could make the decision again with the benefit of hindsight (83 percent), and believe that egg-sharing is a good response to donor egg shortages (94 percent).

In the second article (2) we focus more on the emotional and relational aspects of egg-sharing. In particular we ask how donors and recipients feel about each other, about each other's treatment outcome and any resultant offspring. Our findings revealed trends towards openness and disclosure among donors and recipients, sentiments of goodwill between the two groups, and a strong sense of reciprocity and empathy.

When women were asked to describe their feelings towards their egg-sharing partner, the two most common responses were curiosity (71 percent of donors, 78 percent of recipients) and the sentiment 'I hoped her treatment would be successful' (79 percent and 86 percent, respectively). Interestingly, unsuccessful egg-share donors were no different to successful donors with regard to how often they thought about any children the recipient may have conceived; on opinions as to whether those children should be told about the circumstances of their conception; or on feelings about potential future contact. Thus, concerns about the psychological harm to donors whose own treatment ends unsuccessfully were not borne out by our data.

In a third article currently under review, we discuss donors' motivations and concerns in depth, highlighting the multiple considerations of egg-sharers, and the feelings of empathy and reciprocity between donors and recipients. No doubt, it will prove interesting to return to some of these questions in time, in particular to find out more about the opinions and experiences of the children conceived through egg-sharing as they reach maturity. However, in the meantime, the findings should serve to ease many of the ethical and psychological concerns about egg-sharing, and to inform clinical practice and broader policy discussions about egg donation.

Currently, egg-sharing accounts for around 60 percent of donated eggs in the UK, but a severe egg shortage remains. It is possible that with greater information provision and awareness, egg-sharing schemes can further assuage the demand for donor eggs in the UK, in a way that is beneficial for both donors and recipients.

1) Gürtin ZB, Ahuja K, Golombok S. Egg-sharing, Consent and Exploitation: Examining egg-share donors’ and recipients’ circumstances and retrospective reflections
Ethics, Bioscience and Life |  27 February 2012
2) Gürtin ZB, Ahuja K, Golombok S. Emotional and relational aspects of egg-sharing: Egg-share donors’ and recipients’ feelings about each other, each others’ treatment outcome, and any resulting children
Human Reproduction |  20 March 2012
3) Blyth E and Golding B. Egg sharing: a practical and ethical option in IVF?
Expert Review of Obstetrics & Gynecology |  14 June 2008
4) English V. Egg sharing affects validity of a woman's consent
BioNews |  7 October 2005
5) Lieberman BA. Egg-sharing: a critical view
The Obstetrician and Gynaecologist |  7 October 2005
6) Templeton S. Heartbreak of infertile women who trade eggs for cheap IVF
The Times |  13 January 2008
7) Winston R. Sperm donors and secrecy
The Times |  22 September 2006
8 May 2017 - by Professor Adam Balen 
Last week the Daily Mail published an undercover investigation into certain aspects of IVF practice in the UK. Whilst this has highlighted some issues, unfortunately the meaning of published statistics has been misinterpreted and certain aspects of the investigation have been given far more weight than is just. Rather than serving the public good, this has the potential to leave vulnerable patients scared and confused.
23 March 2015 - by Professor Susan Golombok 
The spat between Dolce & Gabbana and Elton John – apart from raising the somewhat baffling question of what exactly are 'chemical' babies? – highlights the more pertinent question of what are the consequences of IVF, surrogacy and other forms of assisted reproduction for parents and children...
13 August 2012 - by Gisela Lockie 
I'm sure I'm not alone in thinking that 'Having your baby through egg donation' could happily serve as an egg donation bible. It successfully brings together all the practical, physiological, psychological, social and ethical aspects of this particular form of family building....
15 May 2012 - by Dr Jackie Leach Scully 
We know very little about what 'ordinary' lay members of faith groups - those who are not scientists, philosophers or religious leaders - think about the acceptability of new reproductive and genetic technologies. A team of researchers from Newcastle and Durham Universities is currently carrying out research exploring some of these issues and would like your help...
30 April 2012 - by Dr Berenice Golding 
An illuminating insight into the experiences of those who have used IVF, Brigid Moss' 'IVF: An emotional companion' is both informative and easy-to-read. A combination of case studies, personal reflections and expert opinions from clinicians, academics, alternative therapists and counsellors support the issues discussed. Because of its accessible format, the book would be of interest to those considering IVF or indeed those further along in their treatment...
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