EGG-SHARING IN ASSISTED CONCEPTION - ETHICAL AND PRACTICAL CONSIDERATIONS

The present acute shortage of eggs for donation cannot be overcome unl ess adequate guidelines are set to alleviate the anxieties regarding p ayments, in cash or kind, to donors, The current Human Fertilisation a nd Embryology Authority (HFEA) guidelines do not allow direct payment to donors but accept the provision of lower cost or free in-vitro fert ilization (IVF) treatment to women in recognition of oocyte donation t o anonymous recipients, Egg-sharing achieved in this way enables two i nfertile couples to benefit from a single surgical procedure, However, the practical guidelines related to this approach are ill-defined at the present time leading to some justifiable uncertainty, A pilot stud y was therefore undertaken in order to establish the place of egg-shar ing in an assisted conception programme, The current HFEA guidelines o n medical screening of patients, counselling, age and rigid anonymity between the donor and recipient were followed, The study involved 55 w omen (25 donors and 30 recipients) in 73 treatment cycles involving fr esh and frozen-thawed embryos, Donors were previous IVF patients who, regardless of their ability to pay, shared their eggs equally with mat ched anonymous recipients, They paid only for their consultations and tests right up to the point of being matched with a recipient, The sol e recipient paid the cost applicable in egg donation of a single egg c ollection, although both received embryo transfers, The results indica te that although the recipients were older than the donors (41.4 +/- 0 .9 versus 31.6 +/- 0.5 years), and there was no difference in the mean number of eggs allocated, the percentage fertilization rates, or the mean number of embryos transferred, there were more births per patient amongst recipients than amongst donors (30 versus 20%), We conclude t hat providing the donors are selected carefully, this scheme whereby a sub-fertile donor helps a sub-fertile recipient is a very constructiv e way of solving the problem of the shortage of eggs for donation, The re are also the advantages of including a group of women who would oth erwise be denied treatment, Problems related to 'patient coercion' can , in our view, be fully overcome by the application of strict common-s ense safeguards, The ideal of pure altruism is not without its medical and moral risk, The success of egg-sharing depends on shared interest s and a degree of altruism between the donor, the recipient and the ce ntre,The current HFEA guidelines should be applauded for enabling a hi ghly effective concept of mutual help to develop.