Egg Donation: Lacking Research and a Registry

A recent New York Times article, “Do Egg Donors Face Long Term Risks?,” raises the case of Jessica Grace Wing, a Stanford graduate who died of metastatic colon cancer at 31, a few years after donating her eggs multiple times.[1] She had no family history of cancer and was in good health. After Jessica’s death, her physician mother investigated whether the hormone treatment her daughter received as a part of the egg donation process could have triggered cancer growth. Her mother discovered that not only was there little research on the connection between egg donation and cancer, there was indeed limited data about previous egg donors; this awakening catalyzed her to advocate for establishing an egg donor registry and for further research into the longer-term effects of egg donation.

Egg donation is not new. In the 33 years since the first birth via egg donation, minimal research has been done into the longer-term effects of egg donation, and women are poorly informed about the risks involved. As a $6.5 billion dollar, largely unregulated industry,[2] egg donation clinics have a moral imperative to propel research surrounding the potential risks involved for egg suppliers, and must better inform potential donors about these risks.

From 2000 to 2010, annual donor oocyte cycles increased by almost 8000, from 10,801 to 18,306.[3] The procedure itself involves a two-phase treatment: The first stage is ovarian hyper-stimulation, where the egg supplier takes hormone medications to increase the amount of eggs produced per cycle. The next stages involve releasing eggs from the ovaries and surgically removing the eggs.  The short term risks of egg donation include ovarian hyper-stimulation syndrome, intra-abdominal bleeding, infection, ovarian torsion, short-term subfertility, and psychological impacts.[4]

Some evidence suggests a correlation between increased hormone exposure and cancer. One study found that “patients who received treatment with gonadotrophin-releasing hormone agonists or orchiectomy had a 30%–40% increased risk of developing colorectal cancer relative to those who did not have the therapies.”[5] Another study found that patients who had been treated with ovulation promoting hormones were at a higher risk of ovarian cancer.[6] Insufficient data, however, exists to fully assess the risk of post-donation cancers, especially because there has not been enough follow-up and research on previous egg donors.

To be sure, there has been some research that finds no correlation between hormone treatments involved with egg donation and long-term cancer. A study done in 2016 in the Journal of Cancer Research and Clinical Oncology found that “no increased risk of the development of ovarian cancer throughout the study period in patients that underwent ovulation induction was documented.”[7] The mean follow up duration with the patients in this study was twelve years. This paper further summarizes other studies that have yielded the same results.

Women nevertheless must be properly informed of potential risks. If and when a physician’s compensation depends on the success of the clinic performing the procedure, then the incentives for a physician to properly inform a donor about all the potential risks becomes compromised. Egg donation is an elective medical treatment taken on by a healthy woman. There must be complete disclosure of risks, and these risks must be minimized, especially because the woman receives no added benefits to her health from the procedure. Autonomous decision making can only occur if the donor has complete information, which should include the explicit discussion of all material risks, and the acknowledgement that more research needs to be done.

Furthermore, egg donors are often offered monetary compensation through marketing targeted towards young women who are looking for quick money, such as university students. These ads appeal to a donor’s sense of altruism by invoking romanticized rhetoric. The risks of the procedure are not set forth on these ads. On cigarette ads, the risks of smoking are listed. The consumer, in this case, young women, cannot fairly assess the benefits and risks of the egg donation procedure when only the benefits are promoted.

Because fertility clinics operate as medical facilities, they have to meet certain federal and state standards. Government regulations, however, do not force clinics to submit data on egg donors to a national registry. The CDC only requires recording the age of egg donors; they are not tracked or monitored for the long term. Perhaps more troubling, there is no system in place that tracks how often women donate. A woman may only be permitted to donate a certain number of times at a single clinic, but by going from clinic to clinic, a woman potentially increases her risk of a negative outcome from the repeated egg donations. While some may argue that restricting repeated donation impinges on women’s autonomy, the safety of young women should be protected, especially those who may be receiving skewed information.

There are potential obstacles to effectively creating a donor registry, such as the reluctance of clinics to pay for the service, or hesitation by egg donors to provide information about themselves. Egg donation can be highly stigmatized, and women may be reluctant to engage in an ongoing relationship with the clinics. Nevertheless, compelling clinics to submit data to a national donor registry in order to receive a state license to operate would enable more robust research to be conducted on a large sample of women. This engagement could help determine more concretely the medical and psychological long term risks of egg donation.

Egg donation has helped thousands of women who would not be able to have children otherwise, but there must be better measures implemented to protect young donors from exploitation. Ads targeted at young donors should include the risks and burdens involved with the process. The donor should know that she is at risk before consenting and should be monitored carefully once she completes the donation process. Perhaps with government funding, there could be increased research surrounding the longer-term effects of the procedure. Lastly, clinics should only be able to obtain a state license to operate if they agree to certain regulations, such as better tracking of their donors and the submission of that data to a national registry. The issues arising within egg donation are complex and multifaceted, but protecting young women remains most important.

[1] Brody, Jane E. “Do Egg Donors Face Long-Term Risks?” The New York Times. 10 July 2017. Web.

[2] Aaron D. Levine, “Self-Regulation, Compensation, and the Ethical Recruitment of Oocyte Donors,” Hastings Center Report 40, no. 2 (2010): 25-36.

[3] Kawwass, Jennifer F., et al. “Trends and outcomes for donor oocyte cycles in the United States, 2000-2010.” Jama 310.22 (2013): 2426-2434.

[4] Woodriff, Molly, Mark V. Sauer, and Robert Klitzman. “Advocating for longitudinal follow-up of the health and welfare of egg donors.” Fertility and sterility 102.3 (2014): 662.

[5] Lin, Jennifer H., and Edward Giovannucci. “Sex hormones and colorectal cancer: what have we learned so far?” (2010): 1746-1747.

[6] Sanner, Karin, et al. “Ovarian epithelial neoplasia after hormonal infertility treatment: long-term follow-up of a historical cohort in Sweden.” Fertility and sterility 91.4 (2009): 1152-1158.

[7] Kessous, R., et al. “The risk of female malignancies after fertility treatments: a cohort study with 25-year follow-up.” Journal of cancer research and clinical oncology 142.1 (2016): 287-293.

About Rachel Linfield

Rachel Linfield is an intern at the Montefiore-Einstein Center for Bioethics. She is a rising junior and pre-med student at Princeton University, and is pursuing a major in the History of Science.

Like what you’ve read? Subscribe here!