The Moral Debate Surrounding Egg Donation and its Economic Implications

White PM donated eggs for the first time last March 20. He had been thinking about it for a long time, he had even visited some clinics to start the process, but he always received a refusal due to his family history of cancer. In his case, the feeling of “helping” another person was what pushed him to go through the process for the first time. “I have always thought that the child born from a donated egg would be happy because they are highly anticipated,” confesses the young woman. However, she plans donate again after summer and this time the reason will be “merely economic”.

The reality is that the moral debate about egg donation is in the arena. According to Royal Decree Law 9/2014, which establishes the quality and safety standards for this type of process, the donation of ovules will be in any case “voluntary and altruistic, and it cannot be receive financial compensation or any remuneration”. Although it specifies that the donors may receive limited compensation aimed at “covering expenses and inconveniences”. And it is for this reason that Alba charged at the end of the process. “I left the clinic with 1000 euros in bills of 50 stuffed in an envelope”, he tells this newspaper.

Donating eggs requires more effort than donating semen in terms of time, travel, commitment and physical discomfort

From the URH-García del Real assisted reproduction clinic, they stress that this process involves a greater effort than donating semen in time, commuting, commitment and physical discomfort, and this is reflected in the economic remuneration. In Spain, the compensation for egg donation is between 800 and 1,200 euros for each treatment cycle, while the semen it is compensated with 30 to 75 euros per sample produced.

In the opinion of the doctor, Sylvia Fernández-Shawn, director of the assisted reproduction unit of the UHR, the norm was drafted after a discussion and consultations with organizations, such as the Spanish Fertility Society (SEF) or the National Commission for Assisted Human Reproduction, which “assessed establishing an ethical and legal framework” with which to work, both in public and private health, “giving maximum security possible and respect for donors and recipients”.

four phases

In summary, the process is divided into four phases: interview, medical tests (including, but not limited to, blood tests, genetic analysis or psychological evaluation), follicular stimulation and puncture. In Alba’s specific process, from the stimulation to the intervention to obtain the oocytes, 10 days passed and right after she began to notice the consequences on your body. “I still have a terrible hormonal imbalance. My period has been delayed for up to 20 days, acne has appeared on my face and I have felt sad for no reason,” she says. In addition, he points out that the day of the puncture, which lasts about 10 minutes after sedation, she felt “quite uncomfortable”, with kidney pain and swelling.

However, reaching that step was not easy for the young woman, since she had to overcome the previous health studies with genetic, psychological and infectious disease tests “that usually seem interesting” to the patients. Among the questions of psychological test Donors are faced with statements such as: “I have some internal conflicts that cause me problems” or “I have some ideas that others find strange.”

In figures

The activity records of the Spanish Fertility Society show that in 2019 – these data are taken into account because those of 2020 are altered by the pandemic – more than 180,000 cycles were developed, something that Dr. Fernández-Shawn describes as a “significant” increment compared to the last years.

The figure means that more than 9% of those born in Spain come from assisted reproduction, that is, almost a tenth of live newborns after in vitro fertilization. Of these, the number of donated eggs “is very high,” or at least that’s how Sara Lafuente Funes, a sociologist and biotechnology researcher and expert on the subject, describes it. The latest figures analyzed by the researcher show that four out of ten of those born by in vitro fertilization came from donated eggs.

The “delay in childbearing age” causes women to “arrive at clinics later” and be directed to egg donation earlier

Lafuente points to two reasons, mainly, why the number is so high: on the one hand, that “a lot of non-resident people in Spain to get treatments” —Spanish legislation is less restrictive than in the rest of Europe—, and on the other, the “lots of problems that exist when it comes to getting pregnant” and that “are being solved with donated eggs”.

The “delay in childbearing age” means that women “arrive at clinics later”, so that “each time they are directed earlier to egg donation treatments.” The average age of the first child in Spain was 30.1 years in 2011; it went to 30.8 years in 2016 (it was delayed 0.7 years); and 5 years later, in 2021, it has reached 32.6 years. That is, she is 1.8 years late. The percentage of children born in Spain to women over 40 years of age is 10% in 2020, while the European average is 5%.

The profile of the donors

The median age ranges from 18 and 30 years and many are students or at the beginning of their working life. “Although the economic compensation they receive matters to them, many feel motivated by having relatives or acquaintances who have needed reproduction treatment to have offspring,” defends Fernández-Shaw.

Furthermore, in Spain the access to these types of techniques is “quite easy” compared to other countries. According to the SEF registry, 7% of the treatment cycles carried out in Spain in 2020 were on foreign patients. Most of these profiles use donated eggs, semen or embryos and the reasons for their transfer are “legal or economic”. Medical teams are obliged to choose donors with the greatest possible phenotypic and immunological similarity with the recipients. This implies that, more than nationality, we care about the race and color of the skin, hair, eyes and blood group of the donors,” adds the doctor.

The ease of anonymity

It also influences the fact that egg donation in Spain takes place in “anonymous format”. “It turns the act of donating into something much more delimited in time because it is not linked to a possible contact of a person in the future,” explains Lafuente. But, fundamentally, the main reason why there are so many egg donors in Spain is the economic compensation. “Obviously, if there were no money involved, there wouldn’t be as many donated eggs.” Several studies analyze how fertility clinics use the economic motive as one more strategy to attract donors and that they see it as a way to “complete their financial resources”, to pay rent, debts, etc. Although, as he points out, he does not believe that the process would disappear if the economic compensation is completely eliminated, it would simply “change”.

For Lafuente it is urgent to address this “commodification of biological material” that is taking place in Spain and not in other European countries. The researcher identifies another problem: “The moral evaluation” that is being made of these women, instead of evaluating the “market around the eggs that they are donating.” For this reason, she proposes to reflect on why “these so-called gamete donations are being managed by private clinics, unlike other donations of biological material that are transported by the National Transplant Organization“.

Lafuente sees it essential to review “the places where it is done” and that “it be regulated as another type of donation.” Even so, for this debate to take place, “in conditions”, there is a lack of information, “it would be important to see it with numbers.” For the researcher, the possible solution involves “avoid reaching the point where there are people demanding donated eggs”. “Most of the people accessing eggs donated is linked to late access to reproduction or a lack of a more specific diagnosis”, he concludes.