Egg-sharing in assisted conception: ethical and practical considerations

The present acute shortage of eggs for donation cannot be overcomeunless adequate guidelines are set to alleviate the anxietiesregarding payments, in cash or kind, to donors. The currentHuman Fertilisation and Embryology Authority (HFEA) guidelinesdo not allow direct payment to donors but accept the provisionof lower cost or free in-vitro fertilization (IVF) treatmentto women in recognition of oocyte donation to anonymous recipients.Egg-sharing achieved in this way enables two infertile couplesto benefit from a single surgical procedure. However, the practicalguidelines related to this approach are ill-defined at the presenttime leading to some justifiable uncertainty. A pilot studywas therefore undertaken in order to establish the place ofegg-sharing in an assisted conception programme. The currentHFEA guidelines on medical screening of patients, counselling,age and rigid anonymity between the donor and recipient werefollowed. The study involved 55 women (25 donors and 30 recipients)in 73 treatment cycles involving fresh and frozen-thawed embryos.Donors were previous IVF patients who, regardless of their abilityto pay, shared their eggs equally with matched anonymous recipients.They paid only for their consultations and tests right up tothe point of being matched with a recipient The sole recipientpaid the cost applicable in egg donation of a single egg collection,although both received embryo transfers. The results indicatethat although the recipients were older than the donors (41.4± 0.9 versus 31.6 ± 0.5 years), and there wasno difference in the mean number of eggs allocated, the percentagefertilization rates, or the mean number of embryos transferred,there were more births per patient amongst recipients than amongstdonors (30 versus 20%). We conclude that providing the donorsare selected carefully, this scheme whereby a sub-fertile donorhelps a sub-fertile recipient is a very constructive way ofsolving the problem of the shortage of eggs for donation. Thereare also the advantages of including a group of women who wouldotherwise be denied treatment Problems related to ‘patientcoercion’ can, in our view, be fully overcome by the applicationof strict common-sense safeguards. The ideal of pure altruismis not without its medical and moral risk. The success of egg-sharingdepends on shared interests and a degree of altruism betweenthe donor, the recipient and the centre. The current HFEA guidelinesshould be applauded for enabling a highly effective conceptof mutual help to develop.