Should we be paying people to give parts of themselves away? More specifically should we be paying those with ovaries to donate their eggs? This is the question that has recently come to the fore in England with the Human Fertilisation and Embryology Authority (HFEA) announcing that from 1 October 2024 they will be increasing the compensation paid to egg donors from £750 to £986 per donation cycle. It is currently illegal to pay for eggs in the UK, but it is possible to offer compensation for expenses, which is what the £750/£986 figure represents. The maximum compensation for sperm donation is £35 per donation.
The reason given by HFEA for this increase is partly to reflect price rises. The amount paid to donors has been £750 since 2011 and it is therefore now worth significantly less than when the payment was introduced.
“It’s going up to just under £1,000 which the HFEA felt was a right balance between compensating people for their time but really recognising that, in the UK, egg donation is an altruistic act,” explained Clare Ettinghausen, director of strategy and corporate affairs at the HFEA, as reported by the BBC.
I am familiar with the old figure, as I have donated eggs on a number of occasions and have received this compensation. Young women (between 18 and 35) on social media may also be familiar with this figure, as it appears prominently in the many adverts they will likely have seen from fertility services seeking donors.
In addition to the inflationary explanation for the increase, it is also suggested that the increase will encourage more people to donate, as there is a shortage of donors, particularly from Asian and Black backgrounds.
The prominence of offers of payment, the reported shortage in donors and the imminent increase in compensation are a source of concern in some quarters, as set out in some detail by the Independent, where campaigners express the view that donation can in no way be considered altruistic when there is payment involved.
Helen Gibson of Surrogacy Concern, a campaign group which opposes surrogacy puts the issue this way:
We do not pay kidney or blood donors: why is an exception made to incentivise women to sell their eggs, which are then often sold on in packages by fertility clinics at huge profits? We are clear: this is exploitation of women.
The article also sets out a concern that disadvantaged women are being encouraged to damage their bodies and their own fertility for the wealthy.
I am fairly confident in stating that donating eggs is significantly more involved and taxing than donating blood, and somewhat less taxing than donating a kidney. I am as close as someone can get in the UK to a ‘professional’ body part donor; I do it a lot. I am on the bone marrow register. I have donated blood 45 times and counting. I have donated eggs on multiple occasions. It is only the strong objections of my loved ones that have kept both of my kidneys inside my body up to this point. I am working on it. Â
I am also a stereotypical egg donor in terms of demographics, an affluent white woman.
Blood donation takes around an hour of my time every 4 months. As a result, I experience mild discomfort from the needle in the arm and the need to take it slightly easier for the rest of the day. I am given biscuits and crisps and zero money.
Egg donation has asked much more of me in a number of ways. In terms of financial commitment, it involves at least half a dozen trips to the hospital with parking costs and time out of work. There are invasive and uncomfortable transvaginal ultrasounds, frequent blood tests and medication with unpleasant side-effects. This includes taking the oral contraceptive pill for a period of time to control the timing of the cycle.
The donation process itself involves going through the first half of IVF. This involves the overstimulation of the ovaries to mature a much larger number of eggs at one time, as opposed to the usual one or two per menstrual cycle. This is done through the self-injection of various drugs/hormones on a daily basis for several weeks.
After that stage came the retrieval procedure, where I was sedated and the eggs retrieved through the vaginal wall with a whacking great needle. This led to some bleeding, period-like cramps, and feeling fairly delicate for the remainder of the day.
I have felt significantly unwell on a couple of occasions as a result of some of the medications and the retrieval procedure. It interrupts the usual menstrual cycle, and there are a long list of potential complications including a small risk of damaging my own fertility. I am at higher risk of Ovarian Hyperstimulation Syndrome (OHSS) which is a potentially fatal condition. OHSS is a particular worry of Surrogacy Concern, which I will come on to.
Those are the practical and physical ramifications. There are also the emotional expenses. Pumping a large amount of fertility and contraceptive hormones into the body unsurprisingly has an impact on how you feel mentally. There is also the emotional impact of the importance of what you are doing: choosing to assist in the creation of a child or children, who you may never know anything about beyond their year of birth and assigned gender. There are then other lifestyle impacts, such as navigating the feelings of my own family and partner around the idea of my procreating but no one from my family playing a part in the children’s lives.
I had to have ‘implications’ counselling along with my partner. This was a lengthy interview with a counsellor going through my reasons for donating, and the potential implications for me and for others of donating. There was discussion around the small risk of damage to my own fertility, and my own plans in terms of children as well as how my personal relationships would be affected should any children born as a result of my donation choose to seek me out once they turned 18.
I was advised at multiple points about the potential risks of the treatment. In preparation for this piece, I have gone through the papers provided to me for each of my donations. They go into significant detail about the potential health implications for me and symptoms to look out for. In total each cycle has lasted several months.
I do have some criticisms of the process having gone through it a number of times. These are criticisms I have raised with the organisation that my donations were coordinated by. For example, a lot of the written material provided was generic, as it was to cover everyone who was undergoing the egg retrieval process – the vast majority of whom will be trying to create their own embryos and hopefully become pregnant themselves. The booklets recording my treatment also included sections for embryo transfer and pregnancy. Being provided with all of this information in addition to the information specific to me had the potential to make me feel like an after-thought – something that was all the more acute given the heightened hormone-induced emotional state.
Beyond this, however, I was given copious amounts of information about the impact on me, access to counselling, and the ability to pull out at any time up to the eggs being implanted in another person. While it is true that risks to the donor are not explicitly set out in adverts, they are thoroughly dealt with during the process. The same is true for blood donation, or indeed any form of elective medical procedure.
My reasons for donating are complex and personal to me. The £750 was never a factor in my decision. To some extent this may be because I am a professional with a good income. I almost certainly lost more money in lost work time than I gained in donation compensation. However, the highly involved nature of the process and the timescale make it hugely unlikely that someone would engage in this process purely for financial gain.
HFEA currently allow donors to create up to ten families, where multiple families could be created through one donation. Even if this involved ten donations and they took place every six months, this would equate to an annual income of £1972 over five years, if the donations were back to back. It’s not exactly lucrative, given the time of other work required – time a regular job may well not allow for.
I would submit that being paid £750 or £986 in expenses for this process is not particularly enticing or exploitative.
Surrogacy Concern also express the view that egg donation is too dangerous for donors, pointing to there having been two deaths related to OHSS in England in recent years. Looking into this, there are two reported deaths that occurred in 2005 and 2006 in the UK – they are recorded by the Office for National Statistics in a report recording deaths attributed to OHSS between 2001 and 2016. A cursory google also throws up an autopsy case report from 2022 for an OHSS death that occurred in India.
There is no information available about whether these deaths occurred in women who were simply donating eggs, or those going through IVF for their own fertility. The risk of OHSS was the biggest concern that was discussed during my own treatment, and a lot of mitigations were put in place to minimise that risk. While any death caused by treatment is a terrible thing, that there have been two reported deaths in the UK – almost 20 years ago at that – suggests the risk is well within the window of tolerance for medical procedures in the UK.
As the name suggests, Surrogacy Concern’s main issue appears to be with the broader concept of surrogacy – of which egg donation can play a part. Their website sets this out more explicitly:
We believe surrogacy to be a form of human trafficking. We do not believe it is right to separate a baby from its mother, and do not believe surrogacy is a legitimate way to create a family.
We believe the days and weeks after birth are crucial to a baby’s future development and health, and believe women’s bodies and reproductive capacity should not be exploited or commodified.
We do not believe the law should be liberalized on surrogacy, but that it needs to be significantly tightened.
Elsewhere Helen Gibson has set out a view that essentially excludes gay couples from using surrogacy to become parents.
Rather than a fear over the exploitation of women, Surrogacy Concern’s objection here appears to be more a moral or ethical one around the necessity or otherwise of being raised by a biological mother.
IVF egg donation and surrogacy are ways of creating families and very dearly wanted children who would otherwise not exist. I think this is something which should be celebrated. So, while groups like Surrogacy Concern seek to withhold this opportunity from families, I hope that the increase in compensation, as well as the subsequent publicity these reports have generated, will encourage more and a more diverse group of donors in the future.
