Kathleen Hammond calls for greater ethical attention to the regulation and oversight of Canadian fertility clinics.
Last month I successfully defended my PhD dissertation, a study on egg donation in Canada, for which I spent the past four years interviewing Canadian egg donors, intended parents, and fertility professionals, including doctors, nurses, psychologists, counselors and lawyers.
The focus of debate when it comes to egg donation is whether egg donors should be paid. In Canada the Assisted Human Reproduction Act, 2004 prohibits the payment of egg donors beyond their receiptable expenses. Reasons for prohibiting payment include concerns about the commodification of eggs and the potential exploitation of egg donors. Specifically, there is a concern about the possibility that women, lured by payment, will not, or cannot, fully evaluate the risks of egg donation. This might be particularly true for women of lower socio-economic status, such as students, who have greater need for the money. Despite the ban on payment, I found that egg donors and intended parents are buying and selling eggs in Canada, or are seeking egg donation in countries, like the United States, where payment is permitted.
The topic of payment is an important one, and given my findings, it is certainly one that deserves attention. It should not, however, dominate ethics discussions about egg donation. Equally (if not more) deserving of attention are the practices of fertility clinic staff, who play a crucial role in the physical and emotional experiences of donation for both egg donors and intended parents.
Amidst the examples of superb care that were shared with me during my interviews, were an alarming number of stories from egg donors and intended parents who had received inadequate care from fertility clinics. While fertility clinics tout the importance of patient care, at the end of the day they are businesses and fertility treatment is a for-profit endeavour. The profit motive of fertility clinic staff can conflict with the obligation to provide adequate care to egg donors and intended parents. I found that egg donors, who are the non-paying patients, are at a higher risk of receiving inadequate care.
A second conflict of interest is that egg donors and intended parents often receive treatment from the same doctor, even though their interests may conflict. For instance, while it is in the best interest of egg donors to receive less hormone stimulation and to produce a smaller number of eggs, it is in the best interest of intended parents to receive as many eggs as possible. My conversations with egg donors and intended parents about fertility clinic care included stories of egg donors being overstimulated, not being fully informed of the risks, being pressured to donate repeatedly, and not receiving care following egg retrieval. Intended parents spoke of doctors treating them insensitively, feeling shuffled through the process, and of clinics and agencies not following through on their promises.
There is extremely limited regulation and no oversight of fertility clinic practices in Canada. In order to minimize the conflict of interests and improve fertility clinic care, there are a number of areas we might consider regulating including: how egg donors should be informed about the risks of donation, what care should be provided following egg retrieval, how many times a donor can donate, and how many eggs should be retrieved from a donor. Infertility treatment is often a difficult experience for intended parents. Fertility clinic processes play an important role in this experience. We might consider developing guidelines that encourage fertility clinic managers to bear this in mind in developing clinic protocols, and to consider providing sensitivity training to new staff.
MP Anthony Housefather has recently taken interest in the debate of whether gamete donors should be paid. Many Canadians interested in the topic of egg donation are no doubt eagerly awaiting to see what Housefather and the House of Commons Standing Committee on Justice and Human Rights (which he Chairs) will determine in regards to whether egg donation should be commercialized. But, discussions about payment for egg donation should not detract from needed discussion about the ways in which regulation and oversight of egg donation can help to protect the interests of egg donors.
From an ethics standpoint, I, for one, am most eagerly awaiting the Canadian Fertility and Andrology Society Guideline for Third Party Reproduction, which will be available to Canadian Fertility and Andrology Society members in the coming weeks. My hope is that these guidelines will help to minimize potential conflicts of interest related to egg donation.