Ethical questions complicate the
recruitment of egg donors
Boston Globe
June 7, 2006
Recruiting women to donate eggs for stem cell research brings
scientists into new ethical territory where the standards are still
being worked out, ethicists say.
Women who donate eggs have to take drugs and undergo minor surgery.
This puts them at risk for side effects, yet there is no immediate
benefit to them or anyone else -- an uneasy and probably unprecedented
combination.
People volunteer to be a part of other types of research that promise
them no benefit, but the risks are negligible.
On the other hand, there are many patients who volunteer for research
that poses real risks, such as studies of experimental drugs, but this
is offset by the immediate possibility that they might be helped. And
living kidney and liver donors face risks, but with the immediate
benefit of helping the person who needs the organ transplant.
Today, fertility clinics routinely recruit women to donate eggs, but
the eggs are used to help other women become pregnant, and there is a
reasonable chance of success. In contrast, the chances of success for
cloning human embryonic stem cells are unknown, creating a quandary for
ethicists and society: How much risk should a woman be allowed to take
in the name of research when the benefit is unclear?
``This is really something that is unique," said George Annas ,
chairman of the Department of Health Law, Bioethics, and Human Rights
at the Boston University School of Public Health. ``We are just
developing rules about it now."
Egg donation is a common procedure. Every year, US fertility clinics
make about 13,000 attempts to help a woman become pregnant using
donated eggs, according to the American Society for Reproductive
Medicine . To obtain the eggs, a woman is given drugs to stimulate her
ovaries. A different drug then causes the eggs to finish maturing and
release.
These eggs are collected from the ovaries by passing a needle through
the vaginal wall. The outpatient procedure takes about 10 minutes and
is done under general anesthesia, according to Douglas Powers , the
scientific director of Boston IVF, which will handle the egg extraction
for one of the Harvard teams.
Egg donors, like women who are undergoing fertility treatment, are at
risk for a condition called ovarian hyperstimulation syndrome, a
complication from the drugs. It can require hospitalization and may be
life-threatening. Severe cases occur in about 1 percent of women who
have their ovaries stimulated, according to a 2002 survey published in
the journal Human Reproduction Update.
The risk of hyperstimulation, however, can be sharply reduced in women
who are donating eggs for research, said Dr. William Gibbons, president
of the Society for Assisted Reproductive Technology. Women receiving
ovarian stimulation drugs are closely monitored, and doctors see
estrogen levels in the blood climb much faster in women who are at risk
for developing the syndrome.
Women trying to have children will generally accept this risk, but if
this happens in women donating eggs for research, the doctors can
withhold the drug that causes the ovaries to release the eggs. Without
this drug, Gibbons said, the risk of the syndrome is small.
The Harvard protocol requires that the estrogen level be kept fairly
low and that the cycle be stopped if it goes higher, Powers said.
A final risk is not as well understood: the potential long-term side
effects of fertility drugs.
The drugs have not been studied well enough, and so there is no way to
adequately inform women of the risks they face, said Marcy Darnovsky ,
associate executive director of the Center for Genetics and Society, a
liberal organization in California that supports stem cell research,
but wants more attention paid to its implications for egg donors.
Further complicating the complex debate over egg donation is the
possibility that cloning could be done without putting women at any
risk.
During fertility treatment, doctors find immature eggs among the ones
they gather from patients.
Usually, these are discarded, but it may be possible to mature them in
a laboratory dish, and then use these eggs for cloning.
Another possibility, scientists suggested, is to use eggs from rabbits.
The resulting stem cells could not be used as a therapy, but they could
still be valuable for research.
GARETH COOK
© Copyright 2006 The New York Times Company