Egg Donation and Surrogacy

(Article in New Scientist: “Cheap IVF offers hope to childless millions”)

Despite the public perception that Africa is overpopulated, the majority of infertile couples reside in Third World countries, especially in Africa. The causes of infertility in Africa are much different from those in Europe and the US. In my experience, Western couples seek IVF and egg donation because of premature ovarian failure, polycystic ovarian syndrome, reproductive organs damaged by cancer, or unexplained infertility, either primary or secondary. In Africa, it is caused mainly by epidemic, untreated sexually transmitted disease and infection. Furthermore, there are horrific conditions unimaginable in the West, such as early teenage intercourse and pregnancy that leads to vaginal fistula or other complications, infections from genital mutilation, and the severe social ostracism associated with these genital diseases and infertility.

So low-cost ART (assisted reproductive technology) in Africa is controversial, since it treats a symptom, rather than a cause. But efforts to find low cost methods of treatment have created some ingenious, low-tech methods. One is the INVOcell, a capsule that uses the intended mother as an embryo incubator, rather than a costly mechanical incubator that requires electricity. The most typical treatments are less invasive (such as IUIs) that avoid costly IVF, although the success rates are lower than those in developed countries.

There are programs that raise money for equipment and training for these clinics: see the site for the Low Cost IVF Foundation.

I have yet to read any reference to egg donation or surrogacy (traditional or gestational) in regard to Africa yet; it is probably too costly and controversial.

I have praised Dr. Gupta on the blog before ["Egg Donation and the Economy", October 28] as the only journalist to point out the biggest flaw in the “egg donor surge” story: most women who apply for egg donation, about 9 out of 10, do not qualify.

He was able to get the story right because he is a doctor as wellas a journalist.

Some people are reacting to his nomination as if Obama asked General Hospital’s Dr. Alan Quartermaine to be Federal Reserve Chairman. But the Surgeon General is really a spokesman, basically, and Dr. Sanjay Gupta really is a doctor, and I think he is a great choice. People know him and will likely listen to him. He appears enlightened and independent. He is also younger and better looking than the average Surgeon General, but let’s not hold that against him.

I couldn’t imagine Obama attempting to politicize the position the way that Bush did with Richard Carmona. Maybe Dr. Gupta could make a real impact on the public awareness of stem cell research, reproductive rights, assisted reproduction and infertility, and other controversial issues. During the conservative Reagan era, C. Everett Koop bravely and sensibly took on the AIDS epidemic when there was a great deal of public fear and misunderstanding. It would be great if Gupta could keep public health issues focused on good science rather than politics, religion, and prejudice.

CNN video: “Egg Donors on the Rise” – click the “Play” button below to watch:

The CNN segment on egg donation (“Egg Donors on the Rise”) was pretty fair, but it left some large components out of the story:

• The Doctors.
  • The reporter did not speak to any fertility doctors who perform these medical procedures to get their opinion on the alleged surge in egg donation. This may be because doctors are probably not seeing any actual increase. As we’ve said many times on this blog, any woman can apply to be an egg donor, but the majority will never actually donate because they are not qualified, or cannot find an egg donor recipient to be matched with. Fertility treatments are expensive, and the economy may affect patients’ ability to pay for them just as much as it motivates women to donate.
  • Doctors could also speak to the efficacy of egg donation (about 50% of embryos transfers result in a live birth), as well as the risks, which I believe were overstated in the piece. The chance of hyperstimulation is about 1%, and since it is always treated, it is not severe.
• The Donor Egg Recipients.
  • Infertility is why egg donation exists in the first place. Maybe it would have been hard to find a family willing to admit on national TV that they used an egg donor, but they could have acknowledged the disease of infertility (I was able to, briefly). It affects millions of people.

I was also surprised to see Debora Spar (an economist who is now president of Barnard College) express such a negative view of compensated egg donation. It seems at odds with the attitudes expressed in her book, The Baby Business, which describes the need for political debate and regulation. She is extremely knowledgeable, but her five-second sound bite left a bad taste in my mouth. Fertility treatments are indeed highly regulated by the FDA and professional organizations (the ASRM, for example), yet analogies to the “wild west” persist.

Nothing in the story was new, but the background of the bad economy makes the headline “Women Sell Their Eggs for Money!” all the more sensational. Commercial egg donation has been around for at least fifteen years. If it weren’t for the compensation, it would be difficult to get donor eggs for infertile couples. So egg donors are paid, according to ASRM regulations. In the United States, it’s legal and safe. As usual, most journalism is not particularly interested in the reality of egg donation and surrogacy, which is indeed fascinating but too complicated for a three-minute story.

I would recommend Liza Mundy’s Everything Conceivable (Knopf, 2007) for a multifaceted, intelligent, and compassionate journalistic treatment of the subject.  (See also Randi Kaye’s “Eggonomics” entry on the CNN site.)

Date: Monday, December 10

Time: 10:00 PM

<Click to watch the CNN video, “Egg Donors on the Rise”>

Tune to CNN for Anderson Cooper’s coverage of egg donation, which features Northeast Assisted Fertility Group:

TONIGHT: Dough for eggs!  Tough times can mean ‘eggceptional’ measures. See why women are lining up in clinics across the nation to donate their eggs! You won’t believe the going rate.  Go to CNN.com to read the rest.

Click here to watch the Anderson Cooper 360 webcast, or tune into the studio webcam.  CNN is also welcoming bloggers (or anyone interested in egg donation) to join the Anderson Cooper Live Blog to discuss the segment in real time.

NAFG’s position remains steadfast: we believe that infertility is a disease, for which egg donation is an effective treatment. NAFG egg donors are paid only for their time and effort, and not for the outcome of the egg retrieval.  Our recipients, in turn, get the opportunity to have a child. As long as egg donor compensation is not coercive, we believe that all parties will benefit — with minimal medical or financial risk.

The choice of an apparent paragon of fecundity for the Republican VP (and the attention given to her pregnant teenage daughter), touch gingerly on the abortion issue, just a small point on the reproductive freedom spectrum that spans from adoption to stem cell research. It highlights the Republican position against abortion: overturning Roe. v. Wade is at the very top of McCain’s “Human Dignity and the Sanctity of Life” agenda, which he characterizes as “only one step in the long path toward ending abortion.” So Republicans will force all women, even rape victims, to bear unwanted children, but what about people who want to have babies?

As it stands, insurance coverage for infertility treatment is non-existent or very limited. On June 27, 2007, Representative Anthony Weiner (D-New York) introduced the Family Building Act of 2007 (H.R. 2892), which would require insurance coverage for the treatment of infertility. It has made no progress since, and will have to be reintroduced once the new Congress is in session. Of its approximately twenty cosponsors, all are Democrats. Wonder how Republicans can be against “family building”? As a staff member from Weiner’s office explained to me, Republican lack of support is based on reluctance to challenge the health insurance industry. [RESOLVE, the infertility support organization, has advocated this bill.  A handful of states already offer some limited insurance coverage for fertility.]

Infertility is a public health issue (one of its many causes is sexually transmitted disease). Obama supports biomedical research and NIH funding, sex education, and increased access to contraception. McCain does not address these issues.  [The candidate’s positions appear in detail on their Web sites: John McCain on Health Care, and on Human Dignity and the Sanctity of Life.  Barack Obama on Health Care and Women.]

Infertility is a disease that affects millions of men and women, no matter their income, class, education, or politics. Adoption, which McCain offers as the abortion alternative, is not a cure. Although neither candidate addresses the issue directly, it appears likely that infertile couples seeking treatment will fare better with a Democrat in the White House.