Monique Deveaux highlights some ethical concerns with cross-border egg ‘donation’.

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While international surrogacy grabs more headlines than paid transnational egg ‘donation’, the latter is far more common. Donor eggs are often used in contract surrogacy when the intending mother’s eggs are nonviable, or when the commissioning parents are both male. Some countries, like India and Thailand, specifically prohibit surrogates from using their own eggs, chiefly to avoid conflicting claims of maternity. Aside from their use in contract surrogacy, the use of eggs from paid providers in what is called “donor-egg in vitro fertilization (IVF)” has become increasingly widespread. There are over 20,000 donor-egg IVF cycles annually in Europe, and nearly that number in the United States.

The laws regarding donor-egg IVF vary widely, as do the guidelines on compensation for egg providers. Consequently, individuals or couples seeking donor-egg IVF are increasingly crossing borders to gain access: Canadians typically go to the U.S., Italians and Britons go to Spain, Germans go to the Czech Republic, Australians go to Thailand or India, and so on. Indeed, donor-egg for IVF is now a leading cause of cross-border travel for reproductive care.

Egg providers also travel to commercial IVF clinics, where their eggs are extracted and used in treatments for pre-arranged clients from abroad. Egg brokers sometimes pay egg providers to travel to clinics in Asian assisted reproductive technology (ART) hubs such as Bangkok and Mumbai, where foreign clients avail themselves of Asia’s more economical IVF treatment. In the case of donor-egg IVF, commissioning parents typically prefer the eggs of providers who are phenotypically similar to them.

But who is providing these eggs and why?

In the European centres for donor-egg IVF, such as Spain and the Czech Republic, young women are typically recruited locally. Studies suggest that financial motives are important to these egg providers, as many of them are students and/or underemployed, and sometimes migrants. Being paid for their eggs is also important to girls (some as young as 17) and women recruited by local fertility clinics in India, which has a rapidly growing egg market.

Yet the young women who are paid to provide eggs are sometimes not well-treated, particularly when egg brokers are involved. The stories of egg donors reveal a shady underworld of paid egg provision arrangements that operate in a grey legal zone, at best. A South African donor, for example, recounts traveling to Mumbai to undergo extraction, and being very poorly treated by the agency that sent her there. The shoddy treatment of international egg donors working with brokers or agencies that are attempting to skirt national laws is one reason to be wary of cross-border egg donation.

Whether or not borders are crossed, when women provide eggs in a commercial setting, there is a short-term incentive on the part of brokers, agencies, and even medical staff to maximize the “yield” for paying clients. This translates into higher doses of hormones to stimulate ever-more egg follicles, which increases health risks to egg providers.

The addition of travel — whether that of would-be parents or egg providers — contributes additional pressures to have egg providers “cycle” at a time that is convenient for the recipients, regardless of the risks to egg providers. For example, cycles that should be cancelled due to concerns about a woman developing ovarian hyper-stimulation syndrome — a fairly common side-effect of the hormones taken — are less likely to be cancelled when thousands of dollars are on the line. For clinics in middle-income and poor countries that are marketing their services to a global clientele as inexpensive alternatives to first-world fertility clinics, there are financial incentives for disregarding the health of egg providers and for shifting some costs (e.g. for medical follow-up) onto these young women.

The cross-border dimension of egg provision also makes medical follow-up and long-term tracking of egg providers more difficult — even when clinics resolve to treat them well. Little is known about the long-term health consequences (especially in terms of fertility and cancer risk) of IVF. Still less is known about the health impact of hormonal stimulation and egg extraction on young donors. We should be advocating for greater study and regulation of commercial egg provision. Better regional and international coordination of ART legislation is needed, though this does not seem likely anytime in the near future.

In the meantime, would-be parents willing to cross borders to pay for donor eggs should avoid using egg brokers and fertility agencies. Intending parents should demand credible assurances that egg providers at the clinic they select are fairly treated and compensated. Most importantly, intending parents should also demand that egg providers receive the highest standard of medical care and follow-up.

Bioethicists should continue to debate whether the growing market in human eggs entails the exploitation of egg providers, and if so, what should be done about it. Clinical psychologists, social workers, and others should continue to question the social and ethical consequences of creating families from donor gametes, especially those procured through commercial transactions.

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Monique Deveaux is a Professor and Canada Research Chair in Ethics and Global Social Change at the University of Guelph.