Ethical issues in oocyte banking for nonautologous use: an Ethics Committee opinion.

Ethical considerations for the banking of oocytes for nonautologous use are discussed.

Financial compensation of oocyte donors: an Ethics Committee opinion.

Financial compensation of women donating oocytes for reproductive or research purposes is justified on ethical grounds and should acknowledge the time, inconvenience, and discomfort associated with screening, ovarian stimulation, oocyte retrieval, and postretrieval recovery and not vary according to the planned use of the oocytes or the number or quality of oocytes retrieved. This document replaces the document of the same name published in 2016.

Payment to gamete donors: equality, gender equity, or solidarity?

PURPOSE: Regulation of payment to gamete donors varies substantially across countries. The development of an ethically sustainable governance system of payments in gamete donation demands that the preferences of different stakeholders be heard. This study intends to contribute to improving the understanding of payment to gamete donors by analysing the views of donors and recipients about the preferred form of payment and its associations with their sociodemographic characteristics. METHODS: This cross-sectional study included 70 donors and 172 recipients recruited at the Portuguese Public Bank of Gametes (July 2017-June 2018). Participants completed a self-reported questionnaire. Views about the preferred form of payment were collected through a multiple-choice question and an open-ended item. Associations were quantified through χ2 tests; content analysis was conducted with the open-ended answers. RESULTS: Both donors (48.6%) and recipients (40.7%) considered that reimbursement is the preferred form of payment to ensure solidarity-based motivations to donate. This option was followed by compensation for non-financial losses (41.4% of donors; 33.7% of recipients) based on gender equity. Preference for a fixed reward (22.7% of recipients; 8.6% of donors) was less frequent among younger donors and married/living with a partner or employed recipients, being based on the promotion of equality. CONCLUSION: In the context of the search for cross-border reproductive care and gamete circulation across countries, the findings from this study claim for the need to create solutions for payment to gamete donors that take into account gender equity and are simultaneously sensitive to donor's actual expenses and further health complications.

What constitutes a reasonable compensation for non-commercial oocyte donors: an analogy with living organ donation and medical research participation.

There is a growing consensus that the offer of a reasonable compensation for oocyte donation for reproductive treatment is acceptable if it does not compromise voluntary and altruistically motivated donation. However, how to translate this 'reasonable compensation' in practice remains unclear as compensation rates offered to oocyte donors between different European Union countries vary significantly. Clinics involved in oocyte donation, as well as those in other medical contexts, might be encouraged in calculating a more consistent and transparent compensation for donors if the elements that constitute a reasonable compensation are explicated. In doing so, lessons can be learnt from living organ donation and medical research participation. Practices in which the elements of a reasonable compensation for the individuals involved have already been more defined in the literature. By means of analogical reasoning, we will outline the different components of a reasonable compensation and subsequently apply these to the context of oocyte donation. We will argue that oocyte donors should first of all be reasonably reimbursed direct expenses related to the donation, without standard remuneration of lost wages. Second, donating oocytes requests a serious time investment, therefore donors are entitled to suitable compensation for their time spent and efforts made. Finally, we will explain that a reasonable compensation consisting of these two components allows for altruism to remain the key value of oocyte donation for reproductive treatment. However, if we acknowledge that donors' motives are more complex and often include reasons from self-interest, the reasonable compensation may be complemented with modest (non)monetary benefits.

Investigating knowledge and perceptions of egg sharing among healthcare professionals in the United Kingdom.

OBJECTIVE: This study aims to determine the healthcare professionals knowledge and opinions of egg sharing and does this potentially effect egg sharing numbers in the UK? STUDY DESIGN: 304 healthcare professionals undertook a large, in-depth survey about various topics related to egg sharing. This included ranking key benefits and issues related to egg sharing. Statistical analysis was performed using SPSS. RESULTS: 63.1% of respondents had little or no knowledge of egg sharing, although the majority supported the scheme once a short description was provided. Although attitudes towards egg sharing were positive, there was more support for voluntary donation. The issues surrounding egg sharing of most concern were the psychological well-being of the egg sharer if her own treatment is unsuccessful and the concern that giving away half her eggs reduces IVF success rates. Only 16.5% of respondents had previously referred a patient for egg sharing, with the majority citing lack of knowledge for the reason they hadn't referred. CONCLUSIONS: Egg sharing allows women to receive free or subsidised IVF in exchange for donating half their oocytes collected to a recipient. Although egg sharing was intended to solve the current donor oocyte shortage, egg sharing numbers have fallen over recent years. Education of healthcare professionals about the egg sharing programme and the research that supports it could improve their perceptions of egg sharing, increasing referral rates and egg sharing numbers.

Legal principles and seminal legal cases in oocyte donation.

Oocyte donation has played an increasingly important role in assisted reproductive technologies since the early 1980s. Over the past 30 years, unique legal standards have evolved to address issues in the oocyte donation procedure itself as well as the disputes over issues, such as parentage, that inevitably arise with new technologies, particularly for individuals seeking to build nontraditional families. This essay will explore oocyte donation's legal aspects as well as seminal law concerning the procedure, including statutory law (uniform and model provisions and enacted state laws) and selected judicial opinions concerning surrogacy and parentage, testing of oocyte donors, mix-ups of donated oocytes, and donor compensation.

Payment to egg donors is the best way to ensure supply meets demand.

Compensated egg donation has been available in the USA since 1984 and is subject to a variety of regulations. The impact of variation from state to state on the regulation of egg donor compensation can be discerned from an analysis of data reporting to both the Centers for Disease Control and Prevention (CDC) and the Society for Assisted Reproductive Technology (SART). Although the CDC data sets are considered as the most complete, they did not, and do not, separately account for cycles conducted with frozen donor eggs, though SART data beginning in 2013 do account for these cycles. A synthesis of SART and CDC data sets allows for the most precise estimates of egg donor supply and also allows for an analysis of the impact of compensation on the incidence of egg donation. In Louisiana, where compensation is expressly forbidden, there appear to be no anonymous, altruistic donations. However, the supply of anonymous donor eggs is reliable in states that allow compensation. This difference implies that the only way to ensure an adequate supply of donated eggs is to compensate the donors accordingly.

The making of a moral economy: women's views of monetary transactions in an 'egg sharing for research' scheme.

There are growing debates about the appropriateness of offering money in exchange for the provision of bodily materials for clinical treatment and research. The bioethics literature and many practice guidelines have generally been opposed to such entanglement, depicting the use of money as contaminating, creating undue inducement, exploitation and commodification of the human body. However, two elements have been missing from these debates: (i) the perspectives of those people providing bodily materials when money is offered; and (ii) systematic empirical engagement with the notion of 'money' itself. This article seeks to fill those gaps in knowledge by providing detailed insights from a project investigating the views and experiences of women who volunteered to provide eggs for research in exchange for reduced fees for fertility treatment. Analysis of 29 semi-structured interviews reveals multiple ways in which volunteers reason through the involvement of 'money' in this domain and shows how their accounts diverge from pessimistic understandings of the role of monies in everyday life. When volunteers speak in detail about the monetary aspects of their participation they draw major, recurring, distinctions in five overlapping areas: their depiction of the monetized world of fertility treatment; their views of the different forms that money can take; a distancing of their actions from their understandings of how markets and commodities work; their location of the transactions within a particular clinic, and the ongoing importance of their eggs, post-transaction. This article: (i) responds to calls for concrete case studies to assist understandings of the inter-relationships of money and specific aspects of social life; (ii) adds to the sociology of money literature by providing empirical insights into how notions of money are deployed; (iii) presents much-needed perspectives from providers of bodily materials; and (iv) contributes to ongoing conversations between bioethics and sociology.

Same medicine, different reasons: Comparing women's bodily experiences of producing eggs for pregnancy or for profit.

Women doing in vitro fertilization (IVF) to have a child describe it as painful and emotionally draining. Egg donors undergo the same medical regimen for a different reason - to produce eggs for another woman in exchange for thousands of dollars - and describe it as quick and relatively painless. Medical researchers typically compare bodily responses by variables such as gender, age, and health status. We use the case of "egg production" to propose a new factor that may be an important source of variation in bodily experience: an individual's reason for undergoing the medical intervention in the first place. Using cluster analysis to analyze an original survey of 50 IVF patients and 62 egg donors from the United States, we find two distinct kinds of bodily experiences - "less intense" and "more intense" - and the intensity of one's experience is associated with one's reason for producing eggs: either to become pregnant or to donate them for money.

Limitations on the compensation of gamete donors: a public opinion survey.

OBJECTIVE: To determine public opinion on gamete donor compensation. DESIGN: Cross-sectional web-based survey. SETTING: Not applicable. PATIENT(S): A nationally representative sample of 1,427 people in the United States. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Support for the compensation of gamete donors. RESULTS: Of 1,427 respondents, 51 (4%) disagreed with use of IVF for any indication, and 232 (16%) believed that oocyte and/or sperm donation to be always unacceptable. Of the remaining 1,185 respondents, 953 (80%) supported and 41 (4%) opposed paying sperm donors; 1,063 (90%) supported and 24 (2%) opposed paying oocyte donors. Of respondents, 90% believed that appropriate compensation for one cycle of oocyte donation should be less than $10,000. A total of 559 (47%) supported a limit on sperm donor compensation and 544 (46%) supported a limit on oocyte donor compensation. Individuals who had personal knowledge of someone with infertility or who used assisted reproductive technology (ART), and Republicans compared with Democrats, were more likely to support limits on both oocyte and sperm donor compensation. Divorced compared with married respondents were less likely to support limits on gamete donor compensation. Men were less likely to support limits on sperm donor compensation. CONCLUSIONS: Most respondents in a nationally representative cohort support compensating gamete donors. Although most do not support limits on gamete donor compensation, most agree the appropriate payment for one cycle of oocyte donation is in line with former American Society for Reproductive Medicine guidelines.

Financial compensation of oocyte donors: an Ethics Committee opinion.

Financial compensation of women donating oocytes for infertility therapy or for research is justified on ethical grounds and should acknowledge the time, inconvenience, and discomfort associated with screening, ovarian stimulation, and oocyte retrieval, and not vary according to the planned use of the oocytes, the number or quality of oocytes retrieved, the number or outcome of prior donation cycles, or the donor's ethnic or other personal characteristics. This document replaces the document of the same name, last published in 2007 (Fertil Steril 2007;88:305-9).

How Agencies Market Egg Donation on the Internet: A Qualitative Study.

We systematically examined the content of the websites of 46 agencies that buy and sell human eggs to understand how they market themselves to both donors and recipients. We found that these websites use marketing techniques that obscure the realities of egg donation, presenting egg donation as a mutually beneficial and fulfilling experience. Sites emphasize egg donors' emotional fulfillment (71.4%) and address recipients' anxieties by stressing the ability to find the perfect "fit" or "match" (56.5%), suiting recipients'"preferences"/"desires" (19.6%), and even designing/customizing a child (15.2%). Agencies attempt to create a sense of connection between the recipients and donors by reporting donors' personal characteristics - e.g., interests/hobbies (63%), traits (34.8%), mood/temperament (20%), and self-reported childhood behavior/memories (15%). Sites present donors as caring/generous (54.3%) and smart/successful/beautiful. These data, the first to examine several key aspects of egg donation agency websites, reveal critical aspects of how these companies communicate to prospective donors and recipients, raising several ethical concerns. Websites frame information in ways that may bias consumers, making emotional appeals that may distract from appropriate risk/benefit assessments and obscure the ethical challenges of egg donation. These data highlight needs for improved practices, adherence to guidelines, and consideration of enhanced guidelines or policy.

Kamakahi vs ASRM and the future of compensation for human eggs.

A recent lawsuit that alleges that the American Society for Reproductive Medicine (ASRM) engages in price-fixing by capping the amount of compensation paid for human oocytes has several critical ethical and policy implications that have received relatively little attention. ASRM has argued that ceilings on donor compensation prevent enticement, exploitation, and oocyte commodification. Critics counter that low donor compensation decreases supply, because fewer women are then interested in donating, which then increases prices for the service that physicians, not donors, accrue, and that ethical goals can be better achieved through enhanced informed consent, hiring egg donor advocates, and better counseling and screening. Yet, if compensation caps are removed, questions emerge concerning what the oocyte market would then look like. Informed consent is an imperfect process. Beyond the legal and economic questions of whether ASRM violates the Sherman Anti-trust Act also lie crucial questions of whether human eggs should be viewed as other products. We argue that human eggs differ from other factory-produced goods and should command moral respect. Although eggs (or embryos) are not equivalent to human beings, they deserve special consideration, because of their potential for human life, and thus have a different moral status. ASRM's current guidelines appear to address, even if imperfectly, ethical challenges that are related to egg procurement for infertility treatment. Given public concerns about oocyte commodification and ASRM's wariness of government regulations, existing guidelines may represent a compromise by aiding patients who seek eggs, while simultaneously trying to avoid undue influence, exploitation, and eugenics. Although the ultimate outcome of this lawsuit remains unclear, policy makers, providers, lawyers, judges, and others should attend seriously to these issues. Alternatives to current ASRM guidelines may be possible (eg, raising the current caps to, say, $12,000 or $15,000, potentially increasing donation, while still avoiding certain ethical difficulties) and warrant close consideration. These complex conflicting ethical issues deserve more attention than they have received because they affect key aspects of clinical practice and the lives of countless patients.

[The gift of human body's products: philosophical and ethical aspects]. / Le don de produits du corps humain : aspects philosophiques et éthiques.

In continental Europe, there is a very strong moral condemnation against putting parts or products of the human body on sale-and, consequently, against putting sperms and oocytes on sale. Only a gift is morally permissible. The situation is different in Anglo-Saxon countries. Who is right? Above all, it must be noticed that two views of the human body are facing each other here: for the first, the human body is a part of the person (so, it partakes of the person's dignity), whereas for the second, the human body is a possession of the person (the person is the owner of his/her body). In my opinion, the argument of dignity comes up against serious objections, and the property argument is more consistent. However, it does not follow that it would be judicious to put parts and products of the human body for sale on a market.