Cracking the Egg Donation Market
The booming US egg donation industry requires more regulation to ensure donor welfare.
“Earn up to $ 50,000!” “Help a Family!” “Donate Your Eggs!”
Such slogans regularly appear on college bulletin boards and social media feeds for many young women in the United States, promoting the altruistic – and financial – benefits of donating their eggs to would-be parents.
But behind these advertisements hides a poorly regulated industry buying and selling human egg cells, with possible negative health effects for donors.
Unlike countries like the UK and Canada, the United States doesn’t have federal regulations specifically addressing advertising to potential egg donors. No US agency is tracking the long-term health effects of egg donation. And there’s little control over the donation process – which involves injecting someone with hormones for at least ten days and then piercing the vaginal wall with a thick needle to remove eggs from the ovary.
At first glance, it might seem that egg donation companies are at least somewhat regulated. Ultimately, the U.S. Food and Drug Administration (FDA) oversees all facilities that harvest, process, or distribute human reproductive tissue, including eggs. These clinics must register with the FDA and list their “tissue-based products” according to federal standards, which also require egg donors to be tested for infectious diseases.
But while the FDA has published guidelines on the eligibility of egg donors, it has taken few steps to ensure donors are treated fairly by egg donation companies. In short, the FDA regulates who can be egg donors – but not how the for-profit egg donation industry treats donors.
And although payments for organ donation have been banned in the United States since 1948, payment from egg donors is perfectly legal. The economic incentives are potentially limitless, although egg donation companies insist that altruism and “women who help women” drive the industry.
Surely the thousands of donors who pay off student loans and other expenses through egg donation payments understand the economic value of the industry. Compensation for a single donation can range from $ 5,000 to $ 50,000, depending on factors such as the donor’s physical profile, SAT scores, and level of fitness.
The advertisements that these donors recruit are also underregulated. Although federal agencies enforce general “truth in advertising” laws, these general requirements have rarely, if ever, been applied to egg donor advertising. Only one state has moved to explain what truth means in advertising related to egg donation. A California law passed in 2009 required that advertising egg donors with compensation information must include warnings about health risks.
Unfortunately, such health risks can be disclosed haphazardly and have not been well studied. A survey of egg donors found that most donors did not receive comprehensive information about health risks prior to donating. Short-term side effects of donation – such as bleeding and infection – are often not reported as clinics rarely look for donors. Although some donors later report health problems such as ovarian cysts and infertility problems, the potential long-term risks of egg donation are unknown. Some studies have also linked an increased risk of cancer to hormonal stimulation of egg production.
These uncertainties remain as the egg donation market continues to grow. The number of women who donate their eggs rose from 10,801 in 2000 to 18,306 in 2010 – a 70 percent increase, partly motivated by the “increasing practice” of pregnancy delay and increasing demand for assisted reproductive technology. As of 2018, industry analysts estimated the US egg donation market at $ 487 million. Prominent egg donation companies – with names like Extraordinary Conceptions and Premier Egg Donors – have carried out a number of investor-driven mergers and acquisitions over the past several years.
But government regulation has not been able to keep pace with this industry growth. Two professional organizations have attempted “self-regulation” guidelines for egg donation companies, but with mixed success.
The minimum training standards of the Society for Assisted Reproductive Technology for clinical staff are largely undisputed. However, another organization, the American Society for Reproductive Medicine (ASRM), faced a lawsuit after trying to cut compensation for egg donors. ASRM advises that payments over $ 5,000 must be “justified” and that amounts over $ 10,000 are “inappropriate”. In response, four egg donors sued the organization, arguing that the price caps undercompensate women for a “painful and risky” procedure. In 2016, after four years of litigation, the organization agreed to remove the financial caps from its policies.
ASRM also insists that egg donors have “the same duties as in the normal doctor-patient relationship”. However, the egg donation model complicates this due diligence as doctors employed by egg donation companies are financially motivated to ensure that women donate their eggs. A researcher posing as a potential egg donor observed that doctors “focused primarily on the infertile recipients” of the eggs – and less on the donor who was undergoing invasive surgery.
These ethical issues in the egg donation industry can be addressed through a variety of regulatory solutions. The U.S. Department of Health could set up a national egg donor registry and initiate further government-funded studies on the long-term effects of donation. Such efforts can provide potential donors with “unbiased” information rather than forcing them to rely on advice from egg donation companies. In addition, through the development of regulations, the ministry could transpose doctor-patient care and the upper limits of compensation through private health organizations into federal law.
At the structural level, the “fragmentation” of the US health system could hinder better tracking of the health effects of egg donation. The uninsured, financially-powered donation process used by U.S. egg donation companies separates the donors from their general health care provider. In contrast, Scandinavian countries with nationalized health systems have produced “robust” data on the health effects of reproductive techniques by prioritizing the health of donors and providing insurance coverage for egg donation.
While the future of egg donation regulation may be uncertain, it is now clear that the appeal of up to five-digit payments provides “fertile ground” for persistent ethical and medical concerns that deserve better regulation to protect donors.