Payment for donation of unused frozen egg is unethical 

It should be viewed as an undue financial inducement that could potentially trespass on donors’ autonomous decision-making

Recent years have seen an increasing occurrence of age-related female infertility worldwide, as more highly-educated women delay marriage and motherhood in pursuit of educational, career and lifestyle objectives. However, many older women often face severe difficulties in conceiving a child due to a sharp decline in their fertility above the age of 35, as menopause approaches. This in turn has led to increasing demand for clinical assisted reproduction services.

For many older women without viable eggs in their ovaries, their only means of getting pregnant would be to utilize donated eggs from younger women. Nevertheless, there are profound moral and ethical problems with egg donation; such as the fractured personal identity of donor-conceived children, and the lack of awareness of their family medical history.

In countries where payment for egg donation is banned, such as Australia and Singapore, there is often a severe shortage of voluntary egg donors who are altruistically motivated. However, an alternative major source of donated eggs would be the leftover unused frozen eggs of women who had undergone elective egg freezing for non-medical or social reasons, which have been increasing over the past few years.

Indeed, a number of studies have demonstrated conclusively that the overwhelming majority of women who elect to freeze their eggs for non-medical reasons, do not eventually use them. It was estimated that at best, only one in five patients will return to use their eggs for IVF treatment. Hence in many countries that permit social egg freezing, there would be an accumulated surplus of unused frozen eggs available for donation.

Studies have reported that the majority of patients (some 50 percent) prefer to donate to research, about 25 percent to 30 percent prefer to donate to another patient, while around 10 to 20 percent prefer to discard their eggs.

For women who opt to donate their unused frozen eggs to another patient, the pertinent question that often arises is whether it is morally and ethically justifiable for them to receive monetary compensation or reimbursement from recipient patients.

This is a particularly contentious issue in countries where payment for egg donation is banned, such as Australia and Singapore.

Before addressing this question, it must be noted that there are some differences in ethical issues between the donation of unused frozen eggs versus conventional egg donation. For example, prospective donors of unused frozen eggs tend to be much older at the time of donation, compared to conventional egg donors, which would drastically lower their chances of having a biological child after the donation process. Hence they need to think much more carefully about their choices.

Another key difference is that prospective donors are not paying any medical fees in conventional egg donation, whereas in the donation of unused frozen eggs, they would have already spent a substantial sum of money on medical fees.

On the one hand, it can be argued that payment in return for donation of unused frozen eggs would just constitute refund of expensive medical fees that women had already spent on freezing their eggs, so moral and ethical problems associated with commercial egg trading and undue financial inducements do not apply.

On the other hand, it can be counter-argued that such reimbursement/compensation trespasses on the patient’s autonomous decision-making process, and cloud their independent judgment on whether or not to donate their unused frozen eggs.

Many women become emotionally vulnerable when the time comes for them to decide what to do with their unused frozen eggs. Very often, due to changing life circumstances, such as natural conception after getting married, the majority of women who undergo elective freezing for non-medical reasons find that they no longer need to utilize their stored frozen eggs. However, after investing money, time and effort in egg freezing, and paying for expensive storage fees over several years; they would naturally feel a sense of loss if their unused frozen eggs were simply discarded or donated for research.

The offer of compensation/reimbursement in return for donation of their eggs to other patients could thus exploit the vulnerable emotional state of these women in despair over the impending wastage of their hard-earned money, and in dilemma on what to do with their unused frozen eggs, by cajoling them to recoup their losses via donation.

To further ‘sweeten the deal’, fertility clinics and doctors may also exploit the ‘feel good’ factor of doing a kind deed, by convincing prospective donors that they are bringing much joy and happiness to an infertile woman trying to conceive a child.

Indeed, medical professionals may have a hidden agenda and conflicting interests in wanting their former patients to donate their unused frozen eggs because additional medical fees will be earned by performing the egg donation procedure on other patients.

Most disturbingly, the offer of reimbursement/compensation could push prospective donors to make hasty decisions that they may regret later in life. In particular, there may be some women who might have a change of heart, of no longer wanting to have children after freezing their eggs.

For such childless women deciding to donate their unused frozen eggs, there is no turning back the biological clock once the eggs have been donated; so they may possibly later regret having lost their only chance of having a biological child in the future, as well as deal with psychological issues of remaining childless while being unsure of whether they have an unknown donor-conceived offspring out there. Even prospective donors who already have children of their own may later regret losing the opportunity of having additional children with their frozen eggs.

Moreover, there are also other social and psychological issues, which would require much hard thinking and soul-searching by women contemplating donating their unused frozen eggs. For example, they may have to consider whether their partner, children and other family members should know and approve of their donation.

There is also a risk of accidental and unintended incest between unknown donor offspring and natural children of the donor, which could be exacerbated by the phenomenon of genetic-sexual attraction (GSA) that has been widely reported in the news media.

Prospective donors must also be mentally and emotionally prepared for unexpected contact with their unknown genetic offspring in the future, even in countries where donor anonymity still remains in force; because the advent of widespread direct-to-consumer genetic testing and associated online genomic databases has made the concept of donor anonymity obsolete.

Additionally, restrictive criteria and varying levels of compensation/reimbursement in the donation of unused frozen eggs may spark accusations of unfairness. Very likely, only women who had frozen their eggs at a young age would be eligible for compensated donation, while those with older and lower-quality eggs would most likely be excluded.

The compensated donation may also be subject to market forces, such as the preference of recipient patients for certain races/ethnicity, or even socially-desirable traits like high education, well-paying jobs and beauty standards related to height and complexion. This could in turn lead to more ‘desirable’ donors receiving higher levels of compensation/reimbursement for their unused frozen eggs, which could spark much dissatisfaction and controversy.

A particularly sensitive issue would relate to egg donors of certain races, ethnic groups, or even castes (Indians and other South Asians) receiving higher levels of reimbursement/compensation over others, simply due to higher market demand for their donated eggs. This may in turn lead to accusations of racial or caste discrimination.

In conclusion, compensation/reimbursement for donation of unused frozen eggs should be viewed as an undue financial inducement that could potentially trespass on donors’ autonomous decision-making. It could also exploit the vulnerable emotional state of these women over the impending loss and wastage of their hard-earned money, together with the undeclared conflicts of interest and hidden agendas of fertility clinics and medical practitioners.

Dr. Alexis Heng Boon Chin is an associate professor of biomedical science at Peking University, China. He had previously worked in the field of human clinical assisted reproduction research in Singapore and has authored 50 international journal publications on ethical and legal issues relating to new reproductive technologies in addition to publishing more than 250 scientific journal articles. The views in this article are those of the author and do not necessarily reflect the official editorial position of UCA News.

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