Embryo donation: practices, ethics, and regulatory frameworks

Embryo Ovum Donation

Embryo and Ovum Donation: The Gift of Life"

Over the past 30 or more years the science and technology associated with reproductive medicine has increased exponentially. This change has come at a time when the age of first conception or the first significant attempt to have a child has increased by several years, in some cases as much as 15. (Henderson, 2006. p. 102) This occurrence has deemed reproductive medicine much more in demand, as some couples find that the older they get the harder it is to conceive and bring a healthy child to term, of their own volition. There are many theories as to why fertility declines with age, but it is known that it is much more affective toward women than men, as the limitation and age of potential pregnancies, i.e. The ovum is in some way negatively affected, in most women, by age. (Sloan, 1993, p. 18) Sloan also points out that the age of a women tends to negatively effect the endometria, the flexible lining of the uterus and the size of the uterus, but points out that the viability of ovum donation and/or embryo donation is still excellent as:

recent studies involving ovum donation suggest that, as long as a woman receives supplements of hormones to boost endometrial development, the age of her endometrium may not be a barrier to supporting a growing embryo. (Sloan, 1993, p. 200)

The reality then becomes, that with the biological aspects of age tot the body resolved, through artificial means, women at any age can potentially carry a full term child, either of their own or for surrogate. This reality opens the door for many couples who previously believed that they were incapable of having a child. For many this possibility or option is enough to create hope, where previously there was none. For these reasons and many others the option to conceive through ovum or embryo donation processes should be expanded through a public awareness campaign as well as demonstrative expansion of reproductive research to improve technologies and procedures. The practice must have as limited a number of constraints as possible to maintain a reasonable ethic of care and increase the numbers of available donated gamete materials. This work will first provide and introductory explanation of reproductive technology, with an emphasis on ovum donation options and will then discuss some of the ethical considerations associated with the growing practice.

Reproductive Technology:

One aspect of reproductive technology is in Vitro Fertilization (IVF) which has been used since 1974 (but more widely since the 1980's) to artificially inseminate a women, using the sperm of her partner or a donor to fertilize her own natural ovum. (MacCallum, Golombok & Brinsden, June 2007, pp. 278-287) in most cases IVF is performed external to the body and then the fertilized, viable embryo is placed in the uterus to implant and hopefully produce a full term pregnancy and ensuing child. There is another less widely used and known procedure where intra-fallopian fertilization is employed called gamete intrafallopian transfer, or GIFT. The other difference between GIFT and IVF is that when a female donor gamete is used it is in the form of an ova, as apposed to an embryo. (Sloan, 1993, p. 204, 207) Most frequently, IVF (or GIFT) is first performed with the couple's own gamete matter and then donor's are tried first male (sperm) and then female (ovum), and as a last case scenario, when all other attempts at successful IVF have failed and if the couple still seeks fertility a donor of both genders or an implantation of a donor embryo are tried. The embryo are usually gleaned from the successful IVF raw materials from another couple who has either stopped attempting IVF to conceive or has done so effectively and therefore created a surplus embryo. (Hamberger, February, 2007, p. 51) (Vastag, May 19, 2007, pp. 317-318) Though IVF has historically not been exceedingly successful there are many doctors in the field who contend, even without research that IVF procedures and practices have been greatly improved since funding for research was suspended in the early 1980's due to government concerns about the ethics of IVF, and that IVF is therefore much more effective than previous research contends. (Sloan, 1993, pp. 203-204) Ovum donation on the other hand, the donation of non-fertilized female gametes is achieved through a limited number of donor advocacy outlets and occasionally through the social circle of the recipient family. (Ehrensaft, 2005, p. 42) the physical process of ovum donation will be described later in the work.

Ethical, Legal and Moral Questions:

AS the reader has been shown in the above work, the range of options has increased substantially for infertile couples and individuals as has the controversy surrounding the ethic of care and the ethic of surplus potential human life and of course desired anonymity or potential desire by offspring for genetic disclosure. Dr. Hamberger provides an extensive look at the legal and ethical issues surrounding the development of reproductive technologies, in a very concise but meaningful form. Hambereger also makes clear that the legislation of morality seems to be just as sticky an issue as it has always been mainly because we do not usually know the full unintended or intended effects of such legislation until many years after a law or ruling has come into effect. (Hamberger, February, 2007, pp. 50-53) MacCallum, Golombok & Brinsden add to the body of knowledge by discussing not only the ethical but follow up information on the family dynamics associated with embryo and ovum donation, helping to ally concerns that such a practice might unknowingly negatively effect the parent child and family dynamic. The experts in fact found that the biggest danger in such families, with young children was over parenting, i.e. emotional over involvement and secrecy, but also found that most families were actually doing quite well. (June 2007, pp. 278-287)

For GIFT and/or IVF to be a possibility for any individual or couple the availability of Ovum and Embryo must be increased. Given the controversial issues surrounding reproductive technology and the demonstratively difficult manner in which ovum are readied in the donor body and removed from the donor body seriously inhibit the number of donations of ovum that occur. MacCallum, Golombok & Brinsden found that the number of couples willing to donate surplus embryos either to embryonic stem cell research or for reproductive use by other couples increased substantially when these couples were offered information regarding the intended use of their surplus embryo. Interestingly a greater percentage were comfortable donating to stem cell research projects than were willing to donate to other infertile couples, in the Spanish research study. (June 2007, pp. 278-287) in general awareness has always been associated with efficacy and reduced attrition and the population of infertile couples, who have previously had to go to the relative extreme of IVF to create a viable pregnancy would seem a rich resource for those who seek donor embryos. The Spanish study conducted by MacCallum, Golombok & Brinsden, seemed significantly slanted toward couples receiving information on stem cell research rather than embryonic donation to infertile couples, and it may therefore be biased on this regard. (June 2007, pp. 278-287) in a relatively anecdotal newspaper article, found in the Washington Times it is made clear that the incidence of embryonic donation is increasing, in the U.S. As well. ("Embryo Adoption on Increase," 2006, p. A03) Though, conjecture is required, from such a source it is likely that increased awareness of embryo donation options as well as increased utilization of improved reproductive medicine has likely contributed to elicit improvement in donation numbers.

Another important issue is the issue of donor age, again the viability issue and the health differences between ages 21-40. If potential donors are culled from the healthy young population the understanding of the duress associated with infertility seems to be a rather limited commodity, unless the individual has experienced infertility vicariously through friends or family. It is therefore clear that ovum donation awareness opportunities for this population the potential for success, pending the answering of a couple of important issues. One of those important questions is brought up my Hamberger when he discusses the concept of payment for ovum donation, which is legislatively capped in some places to include only those costs incurred for the donation. (February 2007, p. 53) the problem with this, as many would attest is that a healthy youthful population may need incentive, beyond expenses to endure the relatively difficult process of preparation for donation, which involves hormone supplementation (stated by some to be an extremely difficult and emotive process) and procedural removal of the Ovum or Ova that result. The process of Ova donation is describes as follows:

This is a complex procedure for all parties and is particularly invasive for the donor, as it is she who must undergo hyperovulation and egg retrieval. The menstrual cycles of both donor and recipient have to be artificially coordinated. [often a time consuming process that requires frequent donor visits to clinic] the donor receives hormones to stimulate her ovaries to produce extra eggs, and these eggs are then collected, either under general anesthetic using laparoscopy or more commonly through a variety of ultrasound techniques. A range of side effects has been reported in donors undergoing all of the above. Donation also makes demands on a donor's time, energy, and emotions. (Burfoot, 1999, p. 269)

For women who are receiving IVF, with their own Ova these side effects and ensuing risks are likely to be palatable, as the lasting effect if all goes well is a full term healthy child. For Ova donors the incentive of a pure, altruistic act might not be enough to allow her to make a discernible decision of sacrifice vs. reward, and this would likely be particularly true in the case of young women, who are less likely to have experience with infertility and who relatively recently experienced the hormonal turmoil of puberty, which is comparatively minor, as noted by some, to the artificial hormonal syncing and stimulating that occurs prior to Ovum retrieval. Ehrensaft stresses throughout her work that the process of donorship is an exceedingly emotional process which can seriously effect the lives of those who chose to donate, the procedures are invasive and time consuming and the medical aspects of artificial hormone therapy create havoc in the mind and body of the individual donor. (2005, pp. 90-97)

While some argue that compensating Ovum donors beyond a cost incurred basis, without cap could potentially result in recipient family deception where a donor might unethically and possibly illegally embezzle significant funds from the recipient couple. This rare but controversial occurrence has been sensationalized in some surrogate deception situations as well as in adoption scandals, which have occurred over the years. (O'Hanlon, 1997, p. 8) Another, scandalous concern associated with embryo and ovum donation has also occurred with regard to unscrupulous physicians misappropriating genome materials, which again has occurred in a limited fashion over the years, partly in response to limitations of legitimate opportunities for embryo retrieval for scientific research or reproductive use and partly as a result of simple greed, as in the case of surrogate or donor scandals. (Bender, 2003, p. 1)

To counter these ethical concerns one must understand that their occurrence is exceedingly rare, but fear is generally associated with these practices, as individuals seeking such care are in an very precarious and some would say desperate emotional state, thinking only of successful pregnancy and the development of a family. (Ehrensaft, 2005, pp. 95, 246) it is also possible that these unscrupulous events occurred as a result of limited supervision, which often occurs with regard to early medical bioethical technology use. Hamberger suggests that this could be countered by legislation developing a cap on non-expense related compensation to donors. (February 2007, p. 53) Another issue of bioethical concern is the development of a system where anonymity and/or non-anonymity is legislated in the case of genome donation. Hamberger makes clear that this issue is not easily answered as removing anonymity from the picture seriously reduces the likely hood of donor participation and conversely demanding anonymity may eliminate the possibility of close relative or friend donation, which for many couples is a viable and reasonable option. Hamberger's suggestion, to resolve this conflict is to develop a legislative model that mirrors that of Finland or Iceland, where donor anonymity or non-anonymity is left for all parties involved to decide, therefore reducing the limitation effect of non-anonymity and the recipient fear of being unable to explain to a child beget of this process their genetic and gestational history. (February 2007, p. 53) These sentiments are mirrored by Ehrensaft when she demonstrates the fact that making such choices, on the part of the donor and the recipient is an exceedingly personal process and that as such it should be treated with individuation in decisions regarding awareness or lack there of. (2005, p. 105) Ehrensaft's work, considered a seminal work on the development of the psychological and social aspects of new reproductive technologies stresses that individuation of all decisions in the process must be ensured, as well as the increased awareness of donation options to be stressed to the public. (2005)