Paying a woman for her eggs to use in stem cell research has been a bioethical no-no for years. But this past June, New York State decided to allow just that, becoming the first state to permit public money to be used in this way. The decision, which allows payment of up to $10,000, will likely jump-start donations—and thereby research. Many bioethicists, however, worry that the financial incentive could exploit women and compromise their health.
Ethical issues surround egg donation because the process is not without risk. It requires a series of hormonal stimulation injections as well as an invasive procedure to retrieve the eggs. The long-term health effects and risks of complication are not well known. A woman who provides eggs for research is “assuming unknown risk for unknown benefits,” says Debra Mathews, a geneticist at Johns Hopkins University. The lingering unknowns prompted the National Academy of Science to issue in 2005 nonbinding guidelines to prohibit payment (but allow direct reimbursement for expenses), as a means to protect underprivileged women in particular.
Various research teams have observed those guidelines and tried to recruit women to donate their eggs for free. But these altruism-dependent attempts failed to find any takers. Instead scientists have primarily relied on eggs left over from in vitro fertilization (IVF) procedures. The secondhand supply, however, is small, and some question the quality of these eggs. Many may have been rejected for implantation because they were subpar to begin with. Storage and transport can also be problematic; as Mathews explains, “We’re not good at freezing and thawing eggs yet.”
The lack of quality eggs, along with an 11-year, $600-million directive from the New York State legislature to further stem cell research, persuaded New York’s Empire State Stem Cell Board to allow payment to women for egg donation. The board governs publicly funded stem cell work and is in charge of overseeing grants for related research.
Proponents of the board’s decision note that payment for similar services is not unheard of. “We pay people to participate in research that has zero benefit to them [but carries] risk all the time, and we trust people to make that decision for themselves,” says Mathews, who is also a member of the Johns Hopkins Berman Institute of Bioethics. Other bioethicists, including Insoo Hyun of the Case Western Reserve University School of Medicine, echo that sentiment. Hyun wrote a 2006 commentary piece in Nature in which he argued that just like others who volunteer for research, women should be paid to donate eggs for stem cell studies. (Scientific American is part of the Nature Publishing Group.) Moreover, research donations do not have to be seen as something different from fertility donations, points out Ronald Green, director of the Ethics Institute at Dartmouth College. “In a sense, infertility is a disease, so women are helping [other] women overcome a disease,” just as they could be helping to find treatments for additional diseases.
Opponents worry that offering up large sums of money for egg donation may be too good an offer for some women to pass up—especially those who might not qualify for paid fertility donation, which screen women based on intellectual and physical attributes. The financial incentives might also drive some to overdonate, Green notes. He says that some “serial egg donors” have donated some 20-odd times, risking their own health and reproductive abilities. He recommends some kind of national register to keep track of donations and ensure that women give no more than a few times.
The move to pay for eggs destined for research may also reflect changing mores. In 1978 the birth of Louise Brown, the world’s first baby to be conceived by IVF, set off much debate about the control of embryos, women’s reproductive rights and ominous Brave New World correlations. Yet test-tube babies became common, and since 1978 more than three million have been born worldwide. Except when it is used to select and screen embryos for certain characteristics, the procedure brings along little ethical hand-wringing today—even with its hefty financial rewards to female donors.