V. GAMETE DONATION

Gamete donation is a procedure that enables those who wish to have children, but who cannot produce or use their own gametes (sperm or eggs), to use gametes provided by others in attempts to procreate. Those at risk of transmitting serious genetic disease to their children and those without a sexual partner (of the opposite sex) may also use the gametes of others to attempt to have children. Sperm donation is carried out by inserting sperm provided by a donor directly into a woman's reproductive tract. Egg (oocyte) donation involves merging eggs extracted from a donor with sperm in a laboratory dish by (in vitro fertilization [IVF]) and transferring some of the resulting embryos to a woman's uterus.

While the use of gamete donation has stimulated amazement and curiosity, it has also created significant ethical and public-policy questions. Concerns have been raised about whether this practice might radically alter understandings of marriage, procreation, and parenthood; whether it objectifies and commodifies gamete donors and the offspring who emerge from such procedures; and whether it harms donors, recipients, or the resulting children. There is also a rising concern about whether the procedures associated with gamete donation should be subject to greater oversight and regulation. Egg donation, in particular, is poised to expand in novel directions that will raise ethical and public-policy issues never before considered.

The use of the term donation in connection with the provision of gametes is seen as self-contradictory by some, since sperm and egg donors in many instances do not donate their gametes, but are financially remunerated for them. However, since this term is in common usage and is understood to cover both unpaid and paid suppliers, its use will be retained here.

The History of Gamete Donation

Pregnancy following sperm donation was mentioned in Western literature as early as 1790, when the Scottish surgeon John Hunter was said to have artificially inseminated a woman in London. J. Marion Sims, a New York doctor, is believed to have carried out the first sperm insemination in the United States in 1866. The practice was usually kept secret, however, because it was considered shameful and unnatural to introduce the sperm of a man other than her husband into the body of a woman. The first confirmed case of sperm donation took place in the United States in 1884, when William Pancoast, a physician in Philadelphia, inseminated a woman using sperm from a medical student. In 1953, scientists demonstrated that human sperm could be frozen and thawed for insemination to produce a normal child, paving the way for the first commercial sperm bank, which was opened in 1970 in Minnesota. By 1993 it was estimated that more than 80,000 women were undergoing the procedure each year, resulting in approximately 30,000 pregnancies annually.

Oocyte donation was first reported in 1983 in Australia. Since then, use of this procedure has grown rapidly. In 1987 it was reported to be available at 17 programs in the United States; in 1993 there were 135 known programs, and in 1998 this number had doubled to 260 programs. In 1998, a total of 5,273 egg-donation cycles were initiated, with 4,783 transfers of donated eggs to recipients, for a delivery rate per transfer of 41.2 percent (Society for Assisted Reproductive Technology).

The Practice of Sperm Donation

Sperm donation is usually performed in a medical setting by a physician using sperm acquired from an anonymous donor. It is also practiced in private contexts by those who do not want professional supervision, although this is considered extremely unsafe as the donor has not been screened for infectious diseases that might affect the woman or the resulting child. This private practice employs sperm from a known or anonymous donor using common household implements. There are three major sources of sperm: large sperm banks that ship frozen specimens nationwide, regional sperm banks with a more local distribution area, and pools of donors retained by individual practitioners.

As long as physicians could use friends, colleagues, and informal networks to acquire sperm, supply was not a problem. When these sources became insufficient in the 1980s, medical students were given a modest financial incentive to donate sperm. Payment represented closure of the transaction, and donor anonymity was guaranteed (Daniels). Donors today are primarily young single males students who are found by word of mouth and through advertising in college and local newspapers, in magazines, and on the Internet. Sperm banks attempt to recruit a pool of donors exhibiting a variety of physical, mental, and ethnic characteristics. Donors are matched with recipients on the basis of physical and other features as far as possible, while a few sperm banks specialize, offering sperm from donors of high academic or athletic ability.

Practice guidelines of the American Society of Reproductive Medicine (ASRM; formerly the American Fertility Society) recommend that sperm donors undergo medical screening that includes testing for infectious and sexually transmitted diseases. Until the 1980s most insemination with donated sperm was performed with fresh sperm, which were only sometimes tested for venereal disease. That changed dramatically in 1988 when the Centers for Disease Control, concerned about the transmission of AIDS, called for donors to be tested for HIV antibodies at the time of donation and again after their sperm had been frozen for six months before their gametes could be used. This rule was designed to reduce the risk of transmitting HIV through sperm from infected donors who did not have detectable antibodies at the time of donation. Practitioners now only use frozen sperm.

Meanwhile, according to ASRM recommendations, the recipient is also screened medically and tested for cystic fibrosis carrier status. Her partner is clinically evaluated and tested for HIV antibodies, and both are to be offered psychological counseling.

In the United States, sperm donors are paid for their time and expenses, with payment in 1998 ranging from $35 to $50 per unit. The Human Fertilisation and Embryology Authority (HFEA) of the United Kingdom currently allows a fee of U.S.$23 per donation, but it is moving toward completely phasing out payments to gamete donors. Sperm donors are not paid in New Zealand, Sweden, and France.

The Practice of Egg Donation

Egg donation is a more complex, onerous, and risky procedure than sperm donation—both for donor and recipient. Both must follow drug regimens to stimulate the production of multiple eggs and the donor must undergo an intrusive egg-recovery procedure. Consequently, egg donation is necessarily offered under medical auspices through in vitro fertilization (IVF) programs affiliated with academic medical centers, community hospitals, and private practices.

Egg donors must undergo the same drug regimens and egg-recovery procedures as women who undergo IVF. An average of thirteen eggs is collected from each donor, and up to twenty-five eggs have been reported extracted at one time. These eggs are fertilized with sperm in vitro. Some of the resulting embryos are then inserted into the uterus of the recipient, who has been injected with drugs to prepare her uterus to accept embryos. The remaining embryos may be frozen for later use by the recipient, donated to medical research, donated to others, or discarded.

Egg donation involves medical risks to the donor of varying degrees of severity. As a consequence of the use of fertility drugs, 1 percent of donors experience ovarian hyperstimulation syndrome (OHSS), which can lead to kidney or liver failure, cardiorespiratory dysfunction, or stroke, among other effects. In addition, 10 to 20 percent of donors experience moderately severe hyperstimulation syndrome, while approximately one-third are affected by milder forms of this syndrome. According to some studies, there is an association between the use of ovulation-stimulating drugs and ovarian cancer. Laparoscopy, which is used to extract eggs from donors, also carries minor risks. Even when there are no complications, the procedure is highly uncomfortable and time-consuming. Recipients of donated eggs, studies suggest, are at increased risk of pregnancy-related complications such as preeclampsia, diabetes mellitus, and anemia, as well as HIV infection.

When egg donation began, it was usual to acquire eggs from anonymous donors who were undergoing IVF and were willing to part with spare eggs. As the practice grew in the late 1980s, and as more donors were needed, infertility specialists sought eggs from known donors who were relatives or friends of recipients and were willing to contribute eggs out of a spirit of altruism. To meet the ever-increasing demand for eggs, they then moved to married women under thirty-five years of age who were not known to the recipient couple, and who had already had as many children as they wanted. Such women, it was reasoned, had exhibited that they were fertile and they were less likely than childless women to attempt to claim the resulting children in the future. Some of these women received financial compensation. Gradually, practitioners realized that they achieved better results using the eggs of young women and began to advertise for college women to serve as donors, for these women were presumed to be healthy, fertile, and in need of extra funds. Donated eggs are now derived primarily from healthy young women who are specifically recruited for this purpose, followed by relatives or friends of the prospective parents, and lastly from infertility patients undergoing IVF who agree to donate extra eggs to others.

Guidelines of the ASRM and the national advisory board on ethics in reproduction (NABER), a private body that is independent of practitioners and that has developed standards for egg donation, recommend medical screening of recipients and psychological evaluation of both recipients and their partners. They also call for medical screening of donors and a genetic evaluation based largely on the donor's stated medical history. Whether HIV antibodies might be transmitted by the donor to the recipient cannot be resolved in egg donation by direct testing of eggs because donated eggs cannot currently be frozen and quarantined for the 180 days required for retesting for HIV antibodies. However, recipients of donated eggs can have the resulting embryos frozen and used six months later if the egg donor tests negative for HIV antibodies at that time. The disadvantage of this is that freezing embryos lessens the chances of successful embryo implantation. Psychological counseling is also recommended for the donor and her partner by both the ASRM and NABER.

Clinics in the United States vary greatly in how much information they offer to recipients about donors. At many programs, matches are made by physicians and nurses on the model of anonymous sperm donation. Recipients are informed about the donor's physical characteristics and given some additional nonidentifying information, and donors usually learn nothing about the recipients. At some centers, brokers recruit and screen donors for a fee. Recipient couples choose an anonymous donor from a list of candidates provided by these brokers. At still other centers, information is provided to donors and recipients about one another and they are urged to meet, a practice known as open donation that echoes a growing trend toward open adoption.

The cost of egg donation combined with in vitro fertilization in the United States rose from about $9,000 per attempt in 1991 to about $20,000 in 2001 (not including donor payment). Donors in the United States are reported to have been paid amounts ranging from $1,500 to $10,000. Some are said to have been offered $50,000 and $100,000. Egg donors in England are currently paid the equivalent of $23 and, as with sperm donation, such payments are to be phased out.

Ethical Issues

Ethical issues raised by the practice of gamete donation tend to fall into two major categories. There are those that focus on underlying conceptual questions, such as whether gamete donation is, in principle, ethically acceptable, and whether this procedure might radically alter understandings of procreation, marriage, and parenthood. Other questions are more oriented toward the consequences of gamete donation, such as its safety; its possible psychological import for donors, recipients, and children; and whether adequate informed consent has been obtained.

Procreation and the Marital Relationship

The use of gamete donation has sparked powerful philosophical differences that center on two features of procreation that many deem essential: it is exclusive and it is embodied. There was a public uproar in 1909 when it was revealed that sperm donation had been carried out by a physician some twenty-five years earlier, and the practice was condemned as a form of mechanical adultery. Some secular and religious critics voice similar concerns today, holding that the use of reproductive materials provided by individuals outside the marital relationship intrudes upon the exclusive union between spouses that is normative in marriage, and is therefore wrong. "There is, generally, strong rabbinic opinion that AID [artificial insemination by donor] should be condemned as 'an act of hideousness' or 'an abomination' or 'human stud farming'" (Rosner, p. 133). Such critics of third-party gamete donation believe that procreative acts that take place in a context other than marital fidelity are diminished and distorted. However, other commentators, including some within the Jewish tradition, accept gamete donation, maintaining that the exclusive relationship between husband and wife remains unchanged when gametes from a third party are used to achieve fertilization (Mackler). Thus, some members of a Church of England working party declared that this procedure is ethically acceptable because "there is no offence against the married partner, there is no breaking of the relationship of physical fidelity, and there is no relationship with a person outside of marriage" (Church of England, p. 57).

The other feature of procreation of special concern to critics of gamete donation, that it is embodied, is undeniably set aside in gamete donation—no act of sexual union takes place between those who will be the rearing parents of the resulting child. Many natural-law theorists hold that it is wrong to replace sexual intercourse with methods of assisted reproduction, particularly when they involve third parties, for to do so wrongly separates the procreative and unitive or loving ends of sexual intercourse. The Roman Catholic Church, in particular, rejects gamete donation because it is thought to erode the unity of body and spirit in the procreative process (Congregation for the Doctrine of the Faith). The Protestant theologian Paul Ramsey (1913–1988) once declared that an ethic that regards "procreation as an aspect of biological nature to be subjected merely to the requirements of technical control while saying that the unitive purpose is the free, human, personal end of the matter pays disrespect to the nature of human parenthood"(p. 33). The use of gametes derived from third parties outside a marriage is prohibited in Islamic law, as this risks inadvertent consanguinity ("being of the same blood") dilutes the purity of the family line, and could create confusion about the identity of a child's genetic parents and about a child's heritage (Serour).

Proponents of gamete donation respond that to insist on physical union between man and woman in procreation is to derive ethical norms too simply and narrowly from the usual physical structure of human reproduction. Furthermore, it is to ignore that the use of donated gametes can uphold, rather than violate, the loving dimension of the relation between marital partners and lead to responsible parenthood (Laurtizen, pp. 9–12). It is sufficient that love and procreation are held together within the marital relationship as a whole.

Feminist scholars, in particular, have expressed concern about the metaphorical disembodiment that gamete donation can entail for women. Some of those who have donated gametes maintain that they are not treated as whole persons, but are divided into unrelated parts, each of which is subjected to manipulation in order to produce a child. A woman's body can thus be treated as "a field to be seeded, ploughed, and ultimately harvested for the fruit of the womb" (Raymond, pp. 61–62). Supporters of gamete donation and assisted reproduction respond that neither current ethical analysis nor public policy views women as "fetal containers" (Robertson, pp. 192, 228–229). While they acknowledge that the legitimate needs and interests of women must be recognized, they argue that new technologies such as gamete donation expand the freedom of women and assure them a large measure of control over their reproductive lives.

Parenthood and Family Relationships

Those who challenge the use of donated gametes argue that in a world where the rearing mother or father is no longer the biological source of gametes, there is no obvious answer to the question who are the "real" parents of the child. They argue that the use of third-party gametes thus vitiates lines of kinship and descent that situate individuals within particular and extended familial relationships (Meilaender). Further, when gamete donation is used to enable single women to have babies with donor sperm, and when postmenopausal women to give birth to children using donated eggs, traditional notions of the family are confounded (Cahill).

A second line of argument presented by these critics is that those who engender a biological relationship to a child, as do gamete donors, bear responsibility for the well-being of children who result. It is wrong, they maintain, for men and women to provide their gametes to couples and then leave without concern for the child who emerges. (O'Donovan). Some argue forcefully that sperm donation, in particular, institutionalizes the socially problematic phenomenon of paternal abandonment (Callahan).

Those in the opposite camp respond that while the biological connection is important to parenthood, it is not essential. In adoption, for example, the biological relationship between parent and child is sundered, and yet the practice is well accepted. It is also acceptable, therefore, to allow such separation in gamete donation. If those using gamete donation will provide a stable and caring environment in which the welfare of the child is a central focus, as is presumptively the case in adoption, there is no reason to adjudge gamete donation wrong. In this view, nurturing is of greater significance to parenthood than biological rootedness. Thus, while proponents recognize that gamete donation challenges traditional understandings of the family, they accept this as reflecting contemporary social realities (Robertson, pp. 121–122). Critics respond that this procedure is distinct from adoption, for it amounts to intentional preconception abandonment of future children by donors, as opposed to giving up already born biological children out of necessity (Cahill). Moreover, they maintain that the biological connection of children with their parents and extended family is a significant factor affecting their sense of self that ought not be disregarded.

The use of gamete donation to enable older women to have children has come under special scrutiny, not only because it raises issues of safety for mature women and the children they might bring into the world, but also because of concerns about its impact on the family. Some commentators maintain that egg donation is making biological limitations of aging irrelevant, and this, in turn, is confounding traditional notions of the family as women old enough to be grandmothers give birth to babies. Yet others observe that men have been known to father children in their mature years without criticism, and that there is no reason that the same should not be true of women. Older parents, they argue, may stretch the usual concept of the family, but they do not destroy it. Even so, the risks of egg donation and pregnancy for older women and their children can be serious. NABER and the New York State Task Force on Life and the Law recommend caution about the use of egg donation in women of relatively advanced reproductive age, maintaining that the risks to the woman and the best interests of resulting children must be considered.

Secrecy and Anonymity

Whether it is wrong to keep the use of gamete donation secret has become a pressing ethical, social, and psychological issue. Secrecy in gamete donation is said to place a lie at the center of family life, and therefore to be destructive. Studies show that any lifetime secrets impose a burden on the family members and have a detrimental psychological and social impact on the resulting children. The risk of unexpected disclosure of the circumstances of a child's conception hangs over the family that has concealed this information. Some psychologists maintain that it is important to the healthy development of children that they know their biological origins (Baran and PanNor; Nachtigall). They believe that disclosure of the participation of a gamete donor in the conception of a child improves, rather than weakens, family relationships. Moreover, in a world in which genetic information is of increasing importance, children who do not know of a source of some of their genes are denied information that might be important to their health. The primary reason for concealing this information is that the children who spring from gamete donation might be stigmatized as different. Such stigmatization is decreasing, however, in a world in which families are more often composed of members of varying biological origins.

If secrecy were abjured in families, it would be necessary either that rearing parents and the resulting children at maturity know the identity of their gamete donor, or else have a certain amount of information about him or her that could lead to identification if all involved are amenable to this. Yet identifying donors has been controversial. Perhaps the oldest argument against doing so is that potential donors would be fearful of having a child born with the assistance of their gametes later appear at the front door, or that they might be held responsible for the support of such a child. Many donors would therefore decide against donating, which would diminish the pool of available donors. In addition, recipients fear that donors would seek them out and either claim the children or attach themselves to the children (Cohen, 1996). This is of particular concern when relatives are gamete donors. Coercion within families could surface, as could bad feelings if donation were followed by an adverse outcome.

For such reasons, the identity of those who donate gametes is generally not revealed to recipients. The Ethics Committee of the American Fertility Society formally embraced the principle of anonymity of sperm donors in 1994 in order to encourage men to donate and to safeguard them from unwittingly becoming responsible for the support of the resulting children.

Enthusiasm for maintaining anonymity, however, appears to be diminishing. Surveys indicate that donors are increasingly willing to be contacted after a child born of their gametes turns eighteen if they have assurance that they will have no financial or familial obligation to the child. NABER has proposed that egg donation centers move toward a policy of offering both known and confidential donors to those seeking eggs, and that donors be required to provide information about their medical history and genetic health. Children born of donated gametes would be given access to this information at the age of eighteen, if they so requested, and donors would have the option of providing either relevant identifying or nonidentifying information to them. NABER has also recommended that a centrally coordinated network of registries be established in the United States that would keep records about donors in either identifiable or coded form, depending on the choice of the donor (National Advisory Board on Ethics in Reproduction, pp. 290–291, 300).

Commodification of Procreation and Children

There is growing concern that egg donation, in particular, is being left adrift amidst a stream of commerce, and that procreation is being commodified. The current marketing of egg donation, critics contend, relegates human beings to the status of commercial objects and their gametes to that of products. Some see the current practice of paying significant sums to egg donors as coming uncomfortably close to baby buying, and they maintain that this flies in the face of the accepted view of children as individuals endowed with an underlying dignity. Several commentators observe that gametes, as the means of making new life possible, are not negligible body products that ought to be bought and sold in the open market (Lauritzen; Radin; Cohen, 1999; Shanley). Moreover, they argue, to offer large sums of money to egg donors amounts to a form of undue inducement that can vitiate the voluntary decision of donors to donate eggs. Some feminists argue that poor women, in particular, should not be enticed to turn their reproductive capacities into a commodity.

Defenders of paying women for their eggs outright maintain that women have the right to sell "products" of their bodies if they so choose. State intervention to prohibit the sale of eggs, in their view, would violate the individual liberty interests of such women. Moreover, prohibiting payment to donors would only compound the problems of those who are less well off by depriving them of a source of income (Harris). It is not the sale of human eggs that is wrong, in their view, but the fact that a bidding war for them has emerged with no industry-wide standards that set a fair price. The most prudent social policy would be to regulate the market for human eggs to ensure that egg donors receive appropriate pay for their time and endeavors. (Resnik).

Several review groups that have addressed this question advocate financially reimbursing gamete donors only for their time and inconvenience. Their primary justification for this approach is that it upholds human dignity and avoids undue inducement of women to donate their eggs. It is fair and reasonable, they maintain, to compensate donors for their expenses, travel, lost wages, and, to some extent, the risks that they incur in going through the donation procedure (National Advisory Board on Ethics in Reproduction, 1996; New York State Task Force on Life and the Law, 1998; Ethics Committee of the American Society of Reproductive Medicine, 2000). The ASRM suggests that appropriate compensation for egg donors would amount to $5,000, and that amounts up to $10,000 might be justifiable. It is inappropriate to offer larger amounts to potential egg donors, the society holds.

Oversight

Some legal commentators maintain that individuals have a constitutionally protected right to reproduce, a right that extends from coital reproduction to such methods of assisted reproduction as gamete donation. The use of gamete donation should thus be a matter of individual decision, and the state should play only a limited regulatory role to ensure safety and prohibit uses that would substantially harm others (Andrews; Ethics Committee of the American Fertility Society, 1994, p. S13; Robertson, pp. 41, 119–123). Others agree that individuals have a right to reproduce coitally that lies in a sphere protected from most state intrusion, but they reject the view that methods of assisted reproduction clearly fall under the aegis of this right. They are concerned about the use of gamete donation without sufficient regard for the interests and health of donors, recipients, and the resulting children. Some have therefore recommended that there be national standards and a federal regulatory system governing this and other forms of assisted reproduction (Rao; Massie; Cohen, 1997).

Yet no federal laws govern the procedures of gamete donation in the United States, and no review of novel assisted-reproductive techniques is required by federal regulation. IVF clinics that practice gamete donation are not required to set up institutional review boards or to review innovative treatments under the regulations of the Department of Health and Human Services. The Clinical Laboratory Improvement Amendments of 1988 covers only the laboratory analysis of sperm for purposes of quality control. The Food and Drug Administration requires registration, but not licensure, of sperm banks, although it has indicated that plans to develop guidelines for screening donated sperm to prevent transmission of communicable diseases. Under the Fertility Clinic Success Rate and Certification Act of 1992, data regarding clinic-specific pregnancy and delivery success rates for assisted-reproductive procedures, including oocyte donation, are collected and published by the Centers for Disease Control along with various professional societies (Society for Assisted Reproductive Technology). This produces useful information, but does not regulate procedures of gamete donation. Thus, there is a dearth of federal oversight of the methods and materials used for sperm and egg donation.

There is some state law regulating sperm donation but the vast majority of states do not require sperm banks to be licensed. There is almost no state law regarding egg donation. Judicial holdings in this area have been limited and have focused on deciding who should serve as the rearing parents of children born of gamete donation. In the private sector, a voluntary association of tissue providers, the American Association of Tissue Banks, has developed detailed standards for sperm donor screening, the ASRM has published practice guidelines for egg and sperm donation, and NABER has developed recommendations for egg donation. However, these guidelines do not have the force of law and offer no mechanism for surveillance or enforcement.

Commentators and review groups observe that in a market-driven environment that has been blighted by occasional scandals and misrepresentations, there is a compelling need to provide oversight of the use of gamete donation and other methods of assisted reproduction in the United States (Annas; ISLAT Working Group; National Advisory Board on Ethics in Reproduction; Cohen, 2002; New York State Task Force on Life and the Law). NABER, in 1996, called for a national regulatory body to license and monitor the quality of services of infertility centers and proposed that in the interim a task force composed of practitioners, outside experts from various disciplines, and lay persons should develop uniform intercenter policies to inform and safeguard donors, recipients, and resulting children (National Advisory Board). It also recommended numerous changes in professional guidelines and standards, as well as state and federal law. In addition, in 1998, the New York State Task Force on Life and the Law identified major problems in the provision of gamete donation and drafted guidelines and model consent forms to improve information given to donors and recipients. It, too, offered detailed recommendations for changes in professional standards that would provide some degree of uniformity in practice, and it proposed changes in state law to protect those involved in gamete donation and the children born of these procedures. Also in 1998, the ISLAT (Institute for Science, Law and Technology) Working Group recommended a federal law that would set a minimum standard for the provision of assisted-reproductive technologies and urged that noncompliance should result in criminal or civil liability. Few of these proposals have been adopted.

There are now at least twenty legal jurisdictions around the world that have enacted legislation regarding the uses of the new reproductive technologies. Countries that allow gamete donation combine the prohibition of certain procedures with licensing requirements to limit who may perform reproductive procedures. The use of eggs from donors, for instance, is prohibited by law in Germany, Norway, Sweden, Switzerland, and Japan. Countries that have adopted uniform standards for the infertility industry, such as the United Kingdom and Australia, began by appointing a commission or committee to study the issues and make legislative recommendations, and they then acted upon those recommendations.

Future Directions

Demand for donated eggs will increase in the future, not only to accommodate ever greater numbers of couples and individuals seeking to have children, but also to bolster new areas of research. Investigative programs, such as those in basic human embryology, embryonic stem cells, cloning, and cryopreservation of human eggs, will require large quantities of human eggs before they can proceed. Other sources of human eggs, in addition to living donors, are therefore under investigation for both clinical and research uses.

Researchers have begun to delve into the possibility of using fetal eggs, derived from aborted fetuses and matured in vitro, for clinical egg donation programs. Some have prophesied that this could lead to the development of egg farms, in which some of the thousands of eggs in a young woman's ovaries that would otherwise fall by the wayside could be salvaged to increase the number of eggs available for personal use or the use of others (Gosden, p. 152). It is not yet known whether the early female eggs, which normally are subject to a high degree of degeneration, can develop into mature eggs capable of giving rise to a normal fetus after fertilization. Moreover, an aborted fetus could be the carrier of a metabolic or genetic disorder that could manifest itself in the resulting child. If such eggs were used to overcome infertility, this would raise concern about the psychological well-being of the resulting children, who might experience harm either from being told that their genetic mother was an aborted fetus or from not being told of this. Since there is currently no compelling need to use fetal oocytes, the ASRM has recommended that this avenue of investigation not be pursued (Ethics Committee of the American Society of Reproductive Medicine, 1997, pp. 6S–7S).

Frozen, stored ovaries are another possible source of human eggs for clinical use. A slice of ovary contains thousands of immature eggs, and ovarian tissue could be removed during surgery for ovarian cyst or endometriosis, or during prophylactic surgery for ovarian cancer. Freezing and storing ovarian tissue currently appears more promising than freezing mature eggs. Moreover, storage of ovarian tissue is relatively easy. This is an experimental procedure that is under development and, consequently, there has been little comment about its safety or its import for the interests of the resulting children.

Because women are currently the sole source of eggs that can be used to create human embryos, and because there is a paucity of eggs for research, women will increasingly be called upon to provide eggs for investigative purposes. This raises significant ethical questions. Women asked to contribute eggs to stem-cell research or research cloning, for instance, would receive neither health benefits to themselves nor the satisfaction of assisting in the birth of a child to others (Baylis). Their primary motivations for undergoing egg donation procedures in such cases would either be the satisfaction of assisting medical science or the prospect of financial reward. If such research were carried out in the public sector under current federal guidelines for stem-cell research that had been extended beyond current restrictions on the sources of such lines, women would be barred from receiving financial compensation for their endeavors and risks in donating eggs. They would provide eggs solely to assist medical research. Thus they would constitute human subjects participating in nontherapeutic investigations that expose them to more than minimal risk, and the Common Rule requiring full, written, informed consent would apply. However, it is clear, commentators have observed, that the common rule for informed consent is currently not being adhered to in either federally or privately funded research when deriving eggs from women to create embryos from which stem cell lines are developed. Therefore, they argue that to protect the voluntary choice and health of women, fully informed consent should be rigorously sought in the future from women whose eggs are used in scientific research, no matter who provides those eggs or what the source of funding for that research.

cynthia b. cohen

SEE ALSO: Abortion; Adoption; Cloning; Embryo and Fetus; Feminism; Fetal Research; Genetic Counseling; Genetic Testing and Screening: Reproductive Genetic Testing; Healthcare Resources, Allocation of: Microallocation; Law and Bioethics; Maternal-Fetal Relationship; Moral Status; Population Ethics; Sexism; Transhumanism and Posthumanism;Women, Contemporary Issues of; and other Reproductive Technologies subentries

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