Policy formation in gamete donation and egg sharing in the UK—a critical appraisal

Prospective parents' intentions regarding disclosure following the removal of donor anonymity

This short survey of UK infertility counsellors was designed to determine whether the removal of donor anonymity resulted in noticeable changes in prospective parents' stated intentions regarding disclosure of their origins to any children conceived through donor conception. Members of the British Infertility Counselling Association working in Human Fertilisation and Embryology Authority (HFEA) -- licensed centres, before and after the legal changes, were sent a short questionnaire that included space for free comments (take-up: 62%). Three-quarters reported changes. Of these, two-thirds said prospective parents were more likely to say they would disclose, while less than a tenth said prospective parents were less likely do so. Where no changes were noted, this was primarily because the majority of prospective parents had stated their intention to be open even prior to the legal changes. Possible influences on intentions included: the culture within the centre, moves towards openness within the wider society, and parents' lack of confidence regarding how to go about disclosure. Follow-up studies are needed to improve understanding of whether influences on decision making carry through to patterns of actual disclosure; whether involvement in counselling affects outcomes; and whether access to professional assistance at the time of planned disclosure is helpful.

Egg sharing in return for subsidized fertility treatment--ethical challenges and pitfalls

Some pertinent ethical challenges in egg sharing have largely been overlooked. To maximize the number of retrievable oocytes, prospective egg-sharers are often restricted to younger women with indications for either male-factor or mild female-factor sub-fertility. Recently, there is increasing evidence that such group of patients would do better either with natural cycle or minimal ovarian stimulation. The quality of the fewer oocytes retrieved is better and there is also improved endometrial receptivity for embryo implantation. Moreover, high gonadotrophin dosages are associated with increased health risks and expensive medical fees. Hence, there could be an irony because such good prognosis patients may not require a discount if they had instead opted for nil or low dosages of expensive gonadotrophins. Secondly, there is a dire lack of guidelines and regulations specifying the appropriate discounts in medical fees given to egg-sharing patients. Perhaps, only the prescription price of gonadotrophins and medical fees for surgical retrieval of oocytes should be eligible for discount. Other medical fees such as for consultation and ART laboratory procedures should be borne separately by the egg-sharing and recipient patient. Thirdly, there must be rigorous auditing to ensure that the amount of financial subsidy given to the egg-sharing patient is exactly equal to the surplus medical fees billed to the recipient patient, or this might lead to profiteering by fertility clinics and doctors. Lastly, the abolishment of donor anonymity in many countries has potentially more ramifications for prospective egg-sharing patients, as compared to non-patient donors.

From a social issue to policy: Social work's advocacy for the rights of donor conceived people to genetic origins information in the United Kingdom

This paper outlines a 22 year campaign to introduce openness into the arena of donor conception in the UK. It identifies key aspects of the development of an advocacy based approach to such work and argues that social work values and principles can prove key to identifying structural inequalities which are not necessarily based in socio-economic disadvantage. Donor conceived people may find themselves in families which enjoy material privilege but whose exposure to a legislative framework and dominant professional cultures within the treatment centres encourages secrecy around genetic origins. Social workers' experience of adoption and family work leads them to recognise the danger of such secrets within families. Turning such social issues into policy changes requires vision, strategic long term advocacy and partnership with those directly affected.

The egg-sharing model for human therapeutic cloning research: managing donor selection criteria, the proportion of shared oocytes allocated to research, and amount of financial subsidy given to the donor

Recent advances in human therapeutic cloning made by Hwang and colleagues have opened up new avenues of therapy for various human diseases. However, the major bottleneck of this new technology is the severe shortage of human donor oocytes. Egg-sharing in return for subsidized fertility treatment has been suggested as an ethically justifiable and practical solution to overcome the shortage of donor oocytes for therapeutic cloning. Because the utilization of shared oocytes in therapeutic cloning research does not result in any therapeutic benefit to a second party, this would necessitate a different management strategy compared to their use for the assisted conception of infertile women who are unable to produce any oocytes of their own. It is proposed that the pool of prospective egg-sharers in therapeutic cloning research be limited only to younger women (below 30 years of age) with indications for either male partner sub-fertility or tubal blockage. With regards to the proportion of the shared gametes being allocated to research, a threshold number of retrieved oocytes should be set that if not exceeded, would result in the patient being automatically removed from the egg-sharing scheme. Any excess supernumerary oocyte above this threshold number can be contributed to science, and allocation should be done in a randomized manner. Perhaps, a total of 10 retrieved oocytes from the patient may be considered a suitable threshold, since the chances of conception are unlikely to be impaired. With regards to the amount of subsidy being given to the patient, it is suggested that the proportion of financial subsidy should be equal to the proportion of the patient's oocytes being allocated to research. No doubt, the promise of future therapeutic benefit may be offered to the patient instead of financial subsidy. However, this is ethically controversial because therapeutic cloning has not yet been demonstrated to be a viable model of clinical therapy and any promises made to the patient might turn out to be illusionary. Hence, it is proposed that a tangible financial subsidy on the medical fees might be the better option for the patient's welfare.

A review of family donor constructs: current research and future directions

This review addresses research on gamete donors, recipients, and offspring and demonstrates that the foci on all three within the triad are largely directed at disclosure or anonymity; and each in turn centers on the perceived importance of the genetic link. The importance attached to genetics has led some countries to review the ethics of anonymous gamete donation (e.g. New Zealand's 'open system' of information sharing) and has led other countries (Sweden, Austria, Victoria, Australia; the Netherlands, the UK) to change their laws allowing donor gamete offspring the right to obtain identifying information about their genetic parent. This review demonstrates that genealogical inconsistencies between and within members of the triad are common regardless of legislation. A discussion of future trends and concerns, relating to the use of gamete donation and the effects legislation is likely to have on the donor triads in the UK following 2005, is provided. The review also addresses the importance of testing theoretical models within future research, and argues this would lead to a better understanding of the underlying problems encountered at a psychosocial level, such as continued preference for anonymity in donors and denial in large numbers of users of the involvement of a donor in conception. Lack of disclosure effectively prevents true implementation of legislation; if a child is not informed, it is the result of donated gametes, it cannot take up the legally available option of finding out identifiable information about their genetic parent(s).

Short Communication: Previous semen donors and their views regarding the sharing of information with offspring

BACKGROUND

The UK government has decided to introduce, from 2005, rules that will allow donor-conceived persons to have access to identifying information concerning their donor. This has led to many concerns regarding future gamete donor recruitment.

METHODS

Semen donors who had been recruited between 1988 and 2002 were invited to take part in a telephone interview. The interview sought these previous donors' views on issues associated with recruitment, attitudes regarding information sharing and views concerning the offspring. Responses regarding information sharing were compared with their views recorded at the time of recruitment.

RESULTS

All 32 donors were recruited altruistically. Eighteen (56%) held the same views concerning the provision of identifying information as they did at the time of recruitment. Of those who had changed their views, eight (25%) expressed a willingness to be more open and four (12%) now wished to be anonymous having previously been unsure. Half of the donors would still have donated if they had been required to be identified to offspring, one-quarter would not have and one-quarter were undecided, although the majority of these said they may have donated under an open system.

CONCLUSION

The study shows that it is possible to recruit identifiable donors at this clinic and this suggests that it may be possible for other clinics to do likewise.