The greatest gift

Imagine the following scenario.  Joelle and Lucia are two women using the same fertility clinic. They are strangers and are never likely to meet. But they have one important thing in common: both have been unable to conceive.  Joelle has healthy ovaries; her partner has low quality sperm. In vitro fertilisation (IVF) offers them the best chance of pregnancy but it costs around £4,500. The clinic tells Joelle that she can “share” some of her eggs in exchange for a significant reduction of her treatment costs. Joelle undergoes hormone treatment and the 14 eggs that develop are shared equally between Joelle and Lucia, who is unable to produce her own eggs. Both women’s treatments are successful and each is delighted to be pregnant with the child they so longed for.

Now imagine a slightly different scenario. This time, Joelle’s eggs develop well and two are implanted but they do not develop into a pregnancy. She and her partner are disappointed. Lucia, however, does become pregnant using Joelle’s eggs and has a child.  How does Joelle feel in the knowledge that she may well never have a child while another woman has carried her egg to term and has fulfilled her dream of becoming a mother?  And how will Joelle feel in ensuing years while the child conceived as a result of her donation grows up and approaches his or her 18th birthday, at which point Joelle may or may not have a phone call from the child she has never known?

Controversy has surrounded the practice of egg donation ever since it began in 1984. Egg-sharing (sharing eggs by women within clinics), first introduced in 1998, has been particularly contentious.  While egg-sharing schemes initially supplied just a small proportion of the total number of donated eggs in the UK, today these schemes supply 60 per cent of the total. However, the demand for donated eggs still considerably outstrips supplies. This shortage has become more acute as a result of legislation passed in 2005 that removes donor anonymity and gives donor-conceived children the right to discover the identity of their biological parents at the age of 18.

An article published today in the online journal BioNews sets out the findings of the first ever comprehensive research into the experiences, feelings and attitudes of women who have taken part in egg-sharing programmes, either as donors or recipients.

The research, carried out by Zeynep Gürtin and Susan Golombok at the University of Cambridge’s Centre for Family Research, in collaboration with Kamal Ahuja at the London Women’s Clinic, reveals a high level of empathy and reciprocity between women seeking assistance to become parents – and shines a light on the ways in which women navigate the emotionally-fraught process of undergoing fertility treatments. Some of its findings confound expectations about women’s emotions, especially in cases with mixed or negative outcomes.

The two-year study examined the attitudes, feelings and opinions of 86 women (48 egg-donors and 38 egg-recipients) undergoing treatment at the London Women’s Clinic – a private clinic that treats 1,500 women per year. Gürtin used detailed questionnaires with a variety of both multiple-choice and open-ended questions to encourage women to describe their innermost feelings on aspects of egg-sharing – that ranged from their motivations in signing up to programmes to their retrospective reflections on their experiences.

Opponents of egg-sharing have been concerned that these programmes may have a negative and harmful impact on the long-term welfare of the women opting to donate their eggs – for example that this group of donors, known as patient donors, might be financially motivated, that their consent will be compromised if they are otherwise unable to access much-wanted treatments, or that they might suffer psychological damage, especially if their own treatment ends unsuccessfully.

Clinics operating egg-sharing schemes offer substantially lower IVF costs to those willing to donate their eggs to other women receiving treatments – and sometimes waive donors’ fees altogether. However, The Cambridge University research suggests that much of the criticism levelled at egg-sharing, including concern about financial inducements, is ill-founded.  What emerged strongly from the study was that the desire to help others played a significant part in the women’s decision-making and that money was by no means the only factor.

It was clear that both donors and recipients had thought deeply about each other’s predicaments. For example, one recipient wrote: “Taking part in the egg-sharing programme made me feel most comfortable because the donor went through the whole procedure mainly for herself and not just for me. So any health risks she took mainly because she wanted to get pregnant herself.” A donor reported simply that: “It felt right to share – I give blood, I am on the organ donor list and registered on the bone marrow register.”

“The women’s motivations to share their eggs were multiple: their own desire to have a baby, the opportunity of accessing cheaper treatment and the chance to help someone else all played an important role in their decisions. Reassuringly, we also found very low levels of regret among egg-share donors. Contrary to expectations, donors whose own treatments were unsuccessful were not resentful of recipients who became pregnant. In fact, some were comforted by the thought that their efforts, though of no direct benefit to their own situation, may have benefited someone else wishing to have a child.” said Gürtin.

“Many of the feelings and opinions expressed in the questionnaire were moving to read. Donors and recipients clearly empathised strongly with one another, as fellow women experiencing fertility problems, and imagined themselves as part of a reciprocal relationship with this important stranger. It was also clear that every woman has a different way of dealing with the experience of seeking assistance from clinics – for example, some shared information widely with family and friends, others were much more private. We’re very grateful to all the women who shared their experiences with us in order to provide some empirical evidence in a field that is by its very nature highly sensitive.”

The study enabled Gürtin to build a picture of the demographics and background of egg-sharers – both donors and recipients. “When people think about women going through fertility treatment they tend to picture heterosexual couples having problems with conceiving, however the landscape of assisted reproduction is changing. Although it’s true that the majority of our respondents fit into that category, we found that 34 per cent of the recipients in our sample were single women.  Moreover, 27 per cent of donors were in lesbian relationships.  These women had already embraced the idea of using donated sperm and so the notion of giving eggs made sense to them in a way that one of them described as ‘obvious’ and another as a ‘no brainer’: the concept of donation was something they believed in,” said Gürtin.

“When we compared donors and recipients we did not find any significant differences in ethnicity, religion, educational levels and occupations. The one striking difference was that recipients tended to be older than donors – on average 11 years older – a factor that is directly related to the fertility characteristics of the two groups.  It was apparent that, for all the women, there was a highly nuanced balancing of the issues involved, whether practical and pragmatic or emotional and financial.”

Infertility affects growing numbers of women and is the second most common reason (after pregnancy) for women aged 20-45 to consult their GP. Treatments for infertility have seen huge advances in the past 30 years – and clinics offering IVF have proliferated. The shortage of donated eggs, the expense of treatments and long waiting lists, have led to a big rise in the numbers of British women seeking treatments overseas. It is thought that many would prefer to receive treatments in their own country.

After a lengthy review of their donation policies, the Human Fertilisation and Embryology Authority (HFEA) last year announced a flat-rate compensation of £750 in order to encourage more women to donate eggs. It came in effect at the start of April. Gürtin said: “This move is clearly targeted at non-patient donors, and there was no discussion of whether or how egg-sharing within clinics should be increased. However, we think that with more information provision and more focus, egg-sharing schemes have the potential to meet an even greater proportion of the demand for donor eggs in the UK, in a way that is beneficial to both donors and recipients.”