Oocyte recipients may be patients at an IVF clinic that offers the option of egg sharing. The terminology can be somewhat confusing. Many clinics refer to egg sharing as the process by which an anonymous donor provides her oocytes for two different recipients during one stimulation cycle. Both recipients’ cycles are then timed to coincide with that of the oocyte donor. This is considered by some to be ethically sound, provided the donor is made aware two separate couples will receive her ova. However, recipients may question whether the division of the eggs will be equitable, not only in numbers but in quality. Furthermore, this type of egg sharing increases the risk of inadvertent consanguinity since there are potentially more children who are conceived from the same donor. Current ASRM guidelines state that a single donor may donate her eggs between three and six times. Egg sharing with two recipients then may mean that a total of twelve recipients may have one or more children with the same donor. Add that potential number with the actual number of children the egg donor births (e.g., those children who remain in the donor’s own family), and one can easily understand that the risk of unsafe sexual couplings with one’s half-sibling dramatically increases.
Furthermore, sharing the oocytes between two recipient couples has been found to reduce their financial burden without compromising treatment results. Clinics adopting a policy of egg sharing between two different recipients will have more available oocyte donors. However, recipients will have half the amount of oocytes and possibly few, if any, frozen embryos.
Other clinics use the term egg sharing to describe the process requiring the recipients to pay their own medical fees in addition to most of the costs incurred by their egg donor who will simultaneously be going through IVF. Many couples are unable to receive fertility treatment because of the high costs. Through egg sharing, donors already receiving drugs to stimulate copious egg production as part of their IVF treatment can reduce the cost of their medical care by providing half of their oocytes to an oocyte recipient. However, should their cycle be unsuccessful, they will need additional medications in future IVF treatments as they are less likely to have been able to freeze embryos. Furthermore, many of these egg donors have been diagnosed with unexplained infertility, making the quality of their donated eggs questionable. I fear the lowered fees for their own treatment may unduly influence egg donors to assume some risks they ordinarily would not undertake.
The recipient’s treatment results are rarely disclosed to egg sharing donors. When IVF fails for the oocyte donors they may wonder whether the recipients received the better quality eggs and may subsequently experience resentment or remorse. Should the oocyte donor’s cycle result in a positive pregnancy, she might worry or be concerned the recipient was unsuccessful. Research supports the belief I hold, which is: that despite fears about giving away half of their eggs, women remain hopeful of a successful treatment outcome and will undergo multiple attempts in their pursuit of a child.
Although many medical ethicists believe that egg sharing should be prohibited, many others believe egg sharing is the only ethical method of oocyte donation because it does not subject healthy women to medical or surgical risks, i.e., only the egg donors who receive treatment for their own infertility have to stimulate their cycle and go through egg retrieval. Not insignificant is the finding that researchers report pregnancy rates in egg-sharing programs are comparable to those found in other types of egg donation protocols.
Egg sharing is believed to be advantageous to both women, because without the reduction of medical costs some donors might not have the opportunity to receive IVF treatment. The compensation of the egg donor is viewed differently than paid egg donation. Some ethicists believe social justice is promoted through the mutual act of sharing between the two patients, especially since both are similarly diagnosed with infertility. However, please keep in mind that egg sharing remains controversial since the egg sharers are a subfertile population.
As a psychologist interested in medical ethics I ask you to consider the following: Is it not in a woman’s best interest to retain all of her eggs? Presently, the long-term consequences of gonadotropins (the medications used to stimulate egg production) are unknown. I believe that subjecting a woman to the additional medical risks of repeated donation cycles might be viewed by many as unethical should the effects of repeated exposure to fertility medication eventually prove to be detrimental. However, one can counter that argument with the defense of free will. For example, who should have the right to prevent a woman from donating to others as long as she does not surpass the prevailing guidelines for repetitive cycles of oocyte donation. Also, we should ask ourselves who will be responsible for assessing and caring for the donor should she learn or fantasize her recipient has conceived when she has not? Psychological care is not inexpensive and may be inaccessible to the egg sharer who, were it not for the reduction of the medical costs for her treatment, did not have the means to afford fertility treatment.
Judith E. Horowitz, Ph.D. is a licensed psychologist in private practice in Broward County, Florida. After graduating Phi Beta Kappa from the University of Florida, she received her doctoral degree from UF, Gainesville, Florida, as well. Dr. Horowitz is a member of the American Society for Reproductive Medicine (ASRM) and is a certified Sexual Therapist and Diplomat of the American Association of Sex Educators, Counselors, and Therapists (AASECT). Judith is also a Diplomat of the American Board of Medical Psychotherapists and Psycho- diagnosticians.
As an active member of the American Society for Reproductive Medicine since 1994, Dr. Horowitz was instrumental in developing and establishing the Mentoring Committee of the Mental Health Professional Group (MHPG) and served as its Chair. Judith also served on the MHPG Membership Committee, as well as the ASRM Membership Committee, and recently was appointed to the Steering Committee for Funding Development of the ASRM. Judith will act as the Chair of the e-Communications Committee of the ASRM MHPG 2009-2011.
Dr. Horowitz is a member of the American Psychological Association, the Florida Psychological Association, and the Broward County Psychological Association. Judith is also a member of the American Fertility Association (AFA), fertile Hope, and the Egg Donation and Surrogacy Professional Association (EDSPA). Dr. Horowitz is a contributing author for the Parklander Magazine and writes a monthly column. She has published numerous articles on the psychological impact of infertility and has lectured nationally. Dr. Horowitz has authored Ethical Dilemmas in Fertility Counseling, which is being published by APA Books and due to be released in 2010.