Egg donation in the UK, Belgium and Spain: an interdisciplinary study

IVF with donor eggs was first intended for use with younger women suffering from ovarian failure or dysfunction. More recently there has been a sharp increase in use of donor eggs for women with age-related infertility, and a growing demand among gay male couples who combine the use of an egg donor and a surrogate in order to have a child. The increase in egg donation treatment has been enhanced by developments in freezing and storage techniques, meaning eggs can now be used independently of the time and place of their retrieval. Donated eggs are now used in over 25,000 IVF treatment cycles in Europe, creating over 7000 babies per year, yet little is known about the motivations, decision-making and experiences of women who provide their eggs for use in infertility treatment, particularly in the European context.

The growing use of egg donation treatment is the subject of fierce political and ethical debate and presents a number of dilemmas for practice professionals and policy makers. While the selling of human eggs in Europe is formally prohibited according to EU legislation ('reasonable compensation' for egg providers is permitted), there is considerable variation in the interpretation of relevant regulations between countries, resulting in significant differences in practice. The UK, Belgium and Spain represent three countries at the cutting edge of technological developments in the infertility field but which have developed differing practices relating to how egg donation is practiced and governed.

The overall aim of this study is to explore the social, political, economic and moral configuration of egg donation in the UK, Belgium and Spain. Our research questions are: How are egg donation practices shaped by national economic, political, cultural and moral contexts? How do new reproductive subjectivities emerge as a result of (gendered) socio-technical processes such as egg donation? How do egg providers understand and frame egg donation in the context of infertility treatment and how is their moral reasoning shaped by a neo-liberal, bio-economic context? What is the role of professional rationalities and commercial choreographies in a global reproductive marketplace? How can a comparison of contrasting policy and practice contexts facilitate improvements in egg donation?

The study is largely qualitative and uses multiple methods of data collection, organised across five phases, to achieve its objectives. Phase one is a context-setting phase which will involve: reviewing the small number of existing studies; a detailed analysis of relevant policies and regulations about donation; and 12 interviews with key European and country-level stakeholders. Phase two will involve analysis of donor recruitment and marketing campaigns to explore how donation is represented and to gain insight into recruitment practices. Phase three comprises detailed interviews with 75 women who have provided their eggs (25 in each country) as well as 45 interviews with professionals involved in donation (15 in each country). It will explore the experiences, motivations and ethical decision-making of women who provide their eggs as well as generating evidence about the practical, political and economic organisation of donation in the UK, Belgium and Spain. The objective of Phase four is to synthesise the findings from the previous phases for discussion at two workshops held in collaboration with key stakeholders and designed to help us develop recommendations from the study. Phase five will include an end of project conference and further dissemination. Stakeholders will be engaged throughout, via a specially convened advisory group. As well as developing theories about the provision and commercialization of human tissue, the findings will be used to directly inform policy and practice in the UK and Europe. Beneficiaries therefore include policy makers, infertility clinicians, egg providers and related advocacy organisations.

The existing empirical data about egg donation as a practice makes it difficult to know how to proceed in relation to ethical, policy and legal concerns, especially in the light of a lack of public consensus and the polarisation of attitudes that exists in some countries. Comparative qualitative work on the experience of egg donation would add an invaluable perspective for policy and legislative work in this area. The project will have a number of impacts for UK and European non-academic beneficiaries.

1.Policy (Human Fertilisation and Embryology Authority (HFEA), European Society of Human Reproduction and Embryology (ESHRE))
The study intends to impact the development of policy and professional guidance in the UK and Europe. This will be achieved via two main routes: the HFEA's Donor Strategy Group, whose objective is to improve the 'customer service' that egg providers receive in the UK; and ESHRE's Special Interest Group on Ethics and Law, the professional special interest group within Europe responsible for current pan-European guidance on the care and support of egg providers. Policy briefings will be prepared for these bodies and will permit evidence-based decisions about UK and European policy and allow updates to current donation guidance. Representatives from these organisations have contributed to the development of this application and will participate in the stakeholder advisory group. Relevant European-level professional bodies (European Board and College of Obstetrics and Gynaecology, International Infertility Counselling Organisation), as well as key national professional bodies in UK, Belgium and Spain (British Fertility Society, Sociedad Espanola de Fertilidad, Comision Nacionel de Reproduccion Humana Asistada, Belgian Society for Reproductive Medicine) will benefit from specific country-level policy recommendations, developed to improve care and support for egg providers.

2. Professionals (clinicians, nurses, counselors, embryologists, donor co-ordinators)
UK professionals working with egg providers will benefit from increased knowledge and insight regarding the egg donation experience in the UK as well as from other national contexts. This evidence will improve the ways clinics organise the care, support and information given to women who provide their eggs for use in fertility treatment. Professionals will be directly targeted via the National Gamete Donation Trust's (NGDT) newly developed 'Donor Centre of Excellence' initiative, which is designed to reward UK clinics that reach a gold standard in donor care. Findings and recommendations from the study will be provided to the NGDT (a study partner) to directly inform the way in which clinics are assessed and accredited under this scheme. In addition, UK fertility clinics will be provided with a summary of the study, which will include specific recommendations for practice as well as information about the NGDT scheme. Whilst the main focus of this impact will be for UK beneficiaries, practice recommendations will also be tailored for audiences in Belgium, Spain and Europe and are intended to have impacts in those contexts.

3. Donors and organisations
Organisations which facilitate networking, support and information for women who act as, or who are considering becoming egg providers (Brilliant Beginnings, NGDT, Altrui, We Are Egg Donors, Nosotras Somos Vida) will benefit from the findings from this research, which can be used to inform support and information provision. Representatives from these organisations have been involved in the development of and are supportive of this research. Their involvement will enhance the validity of the research as well as ensuring that recommendations are relevant to users and embedded in the wider context. This will improve the ways in which egg donation is understood amongst women who provide their eggs for use in fertility treatment, contributing to the well-being of this group.