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

Lead Research Organisation: De Montfort University
Department Name: School of Applied Social Sciences

Abstract

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.

Planned Impact

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.

Publications

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Baldwin K (2019) On Ice: The impact of vitrification on the use of eggs in fertility treatment. in Emerging topics in life sciences

 
Description New knowledge
Our work demonstrates how several key socio-technical changes are reconfiguring egg donation within Europe and globally. These include: the growing numbers of users of third-party eggs; changes in the ways eggs are frozen (vitrified), stored and commercialised; growth in numbers and types of intermediaries such as egg banks, agencies and brokers; new methods of screening; and expansion of novel related technologies (e.g. mitochondrial donation). The emergence of vitrification (freezing) methods has been especially transformative, allowing eggs to be stored for later use or shipped to clinics within and between countries. These changes, along with other broader shifts, are indicative of an increasingly commercial landscape; giving rise to a number of policy 'blind spots' in the UK/EU.
Focussing on three cases (UK, Belgium, Spain) allowed us to explore how country level regulations, cultural and economic contexts interact to give rise to what we refer to as egg donation 'recruitment regimes'. These regimes produce and reinforce different versions of egg donation, representing a multiplicity of practices, varying moral frames and distinct economic regimes, and raising questions about the homogeneity of the phenomenon of 'egg donation'.

Our work also considered how new reproductive subjectivities emerge from the particularities of the (national and supra-national) structuring and organisation of egg donation, and related to this, how egg providers understand and frame their actions within such contexts. Our work illustrates the need to move away from individual rationalities that situate motives as part of the individual giver, instead thinking of them as part of a wider collective knowing about egg donation and what it means within a particular social, moral and economic context.

As well as highlighting national differences, our findings illustrate that collective imaginaries of femininity, gendered giving and embodied labour inform donor subjectivities across national settings. This included, for example, the perception that egg donation was about 'helping' other women and 'doing a good job'. Commonalities also exist in relation to the sometimes physically and emotionally challenging nature of egg donation and to the ways clinics provide appropriate care, support and information (or not) to egg providers.
Our findings demonstrate the need to consider not only the embodied and relational aspects of gamete donation, but also the social and cultural systems and infrastructures in which donation practices are embedded and the implications these broader systems have for the framing of donation as a culturally normative practice.

New or improved research methods developed
We developed new interdisciplinary methods which allowed us to integrate disciplinary questions and concepts. We used insights from moral philosophy, medical sociology and political economy to design two new elicitation tools for use in interviews with egg providers and professionals.

New networks and collaborations
We organised two conference panels to network with international scholars and plan to submit a further proposal to support the development of an international network on egg donation. In addition to our partner, the SEED Trust, we created new collaborations (and associated outputs) with advocacy organisations, the Donor Conception Network, Fertility Network UK and Pride Angel.
Exploitation Route Academic: our findings and tools will assist scholars working in a comparative and interdisciplinary context. They will also be valuable for academics working on other forms of bodily exchange including surrogacy and organ donation.

Policy: We identify several policy 'blind spots' relating to egg donation in the UK and Europe. These findings are of value to regulators in the UK and Europe for drafting and updating regulatory guidance.

Practice: the findings could inform professional guidelines produced by the British Fertility Society, the British Infertility Counselling Association, and the Royal College of Nursing in the UK; and the European Society for Human Reproduction and Embryology in Europe. The podcast, films, webinar and known donor resources will also enhance the work of practitioners.

Advocacy organisations: several support needs were identified amongst egg providers, including for information and peer support. These findings are of benefit to organisations supporting egg providers, including the SEED Trust, Donor Conception Network, Fertility UK, Pride Angel, Brilliant Beginnings and We Are Egg Donors.

Egg providers: we have worked with the SEED Trust and egg providers to produce independent resources to inform decision-making, including a series of short films, a webinar, a podcast and a resource about known donation.
Sectors Communities and Social Services/Policy,Healthcare,Government, Democracy and Justice

 
Description With our project partner, the SEED Trust (formerly NGDT), and other key stakeholders (DC Network, Pride Angel and Fertility Network UK), we are using the findings from the study to shape the information available to egg donors and those who are considering becoming a donor. As part of this, we have created two new collaboration agreements for on-going use of the resources (films and downloadables) with the our collaborators and will continue to track the use of the materials and the impact that they are having on practice. The films were first created in 2018/2019 and then relaunched in 2022.
First Year Of Impact 2019
Sector Healthcare,Other
Impact Types Societal,Policy & public services

 
Description EDNA egg donor films 
Organisation Donor Conception Network
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution This project was a spin-out from the ESRC funded study 'Egg donation in the UK, Belgium and Spain: an interdisciplinary study (EDNA)' hosted by De Montfort University (PI: Professor Nicky Hudson). Through interviews carried out with egg providers by the DMU research team, the findings highlighted the need for up to date independent information; especially reflecting the personal experiences of egg donation. The research team have had a central contribution to this project by working with stakeholders and project partners to decide what themes the films should cover, inviting egg providers to take part in the films, and working with the filmmaker to arrange the filming day and edit the films. The research team have also disseminated the films through the CRR blog and social media pages.
Collaborator Contribution We have collaborated with 3 national fertility charities in the UK (SEED Trust, Fertility Network UK and Donor Conception Network) and a filmmaker (Mutual Shoots Ltd.) to create 8 short films. The films include the accounts of 6 egg providers who shared their experiences of egg donation. The collaborators have a vested interest in supporting women who are thinking about or undergoing egg donation and their organisations actively provide information and support to women around egg donation on their websites. The films are hosted on the charities websites. The SEED Trust have contributed to this project by providing consultancy for the project, offering advice about the topics covered in the films and having involvement in the design and editing of the films. The SEED Trust were also an official project partner. Fertility Network UK and Donor Conception Network have contributed to this project by hosting the films on their websites and disseminating the films to a relevant and wider audience.
Impact 8 short films that are currently hosted on the support pages of the collaborating organisations websites. The films are available at: https://seedtrust.org.uk/donor-experiences/egg-donor-films/ These films were first screened at the re-launch of the NGDT as the SEED Trust on May 3rd 2019 at the end of the Big Fat Festival Day of the annual Fertility Fest in London. They will be relaunched by our new collaborators in 2022.
Start Year 2021
 
Description EDNA egg donor films 
Organisation Fertility Network UK
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution This project was a spin-out from the ESRC funded study 'Egg donation in the UK, Belgium and Spain: an interdisciplinary study (EDNA)' hosted by De Montfort University (PI: Professor Nicky Hudson). Through interviews carried out with egg providers by the DMU research team, the findings highlighted the need for up to date independent information; especially reflecting the personal experiences of egg donation. The research team have had a central contribution to this project by working with stakeholders and project partners to decide what themes the films should cover, inviting egg providers to take part in the films, and working with the filmmaker to arrange the filming day and edit the films. The research team have also disseminated the films through the CRR blog and social media pages.
Collaborator Contribution We have collaborated with 3 national fertility charities in the UK (SEED Trust, Fertility Network UK and Donor Conception Network) and a filmmaker (Mutual Shoots Ltd.) to create 8 short films. The films include the accounts of 6 egg providers who shared their experiences of egg donation. The collaborators have a vested interest in supporting women who are thinking about or undergoing egg donation and their organisations actively provide information and support to women around egg donation on their websites. The films are hosted on the charities websites. The SEED Trust have contributed to this project by providing consultancy for the project, offering advice about the topics covered in the films and having involvement in the design and editing of the films. The SEED Trust were also an official project partner. Fertility Network UK and Donor Conception Network have contributed to this project by hosting the films on their websites and disseminating the films to a relevant and wider audience.
Impact 8 short films that are currently hosted on the support pages of the collaborating organisations websites. The films are available at: https://seedtrust.org.uk/donor-experiences/egg-donor-films/ These films were first screened at the re-launch of the NGDT as the SEED Trust on May 3rd 2019 at the end of the Big Fat Festival Day of the annual Fertility Fest in London. They will be relaunched by our new collaborators in 2022.
Start Year 2021
 
Description EDNA known donor resources 
Organisation Donor Conception Network
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution This project was a spin-out from the ESRC funded study 'Egg donation in the UK, Belgium and Spain: an interdisciplinary study (EDNA)' hosted by De Montfort University (PI: Professor Nicky Hudson). Through interviews carried out with known egg providers by the DMU research team, the findings highlighted the need for support resources designed specifically for women who are thinking about donating to someone that they know. The research team have had a central contribution to this project by inviting known egg donors to take part in the study and collecting the data that the resource is based on through an online survey and individual interviews, working with stakeholders and project partners to decide what content to include in the resource and designing the resource. The research team have also disseminated the resource through the CRR blog and social media pages.
Collaborator Contribution We have collaborated with 4 national fertility charities and industry partners in the UK (SEED Trust, Fertility Network UK, Donor Conception Network and Pride Angel) to create a resource that is based on the advice given by women who have acted as a known egg donor. The collaborators have a vested interest in supporting women who are thinking about or undergoing known egg donation and their organisations actively provide information and support around egg donation on their websites. The resources are hosted on the partner websites. Pride Angel have contributed to this project by providing consultancy and expertise around the topic of known egg donation and offering advice about the topics covered in the resource and are hosting the resource online. The SEED Trust, Fertility Network UK and Donor Conception Network have contributed to this project by hosting the resource on their websites and disseminating the resource to a wider audience.
Impact A downloadable resource that is available on the charity websites.
Start Year 2021
 
Description EDNA known donor resources 
Organisation Fertility Network UK
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution This project was a spin-out from the ESRC funded study 'Egg donation in the UK, Belgium and Spain: an interdisciplinary study (EDNA)' hosted by De Montfort University (PI: Professor Nicky Hudson). Through interviews carried out with known egg providers by the DMU research team, the findings highlighted the need for support resources designed specifically for women who are thinking about donating to someone that they know. The research team have had a central contribution to this project by inviting known egg donors to take part in the study and collecting the data that the resource is based on through an online survey and individual interviews, working with stakeholders and project partners to decide what content to include in the resource and designing the resource. The research team have also disseminated the resource through the CRR blog and social media pages.
Collaborator Contribution We have collaborated with 4 national fertility charities and industry partners in the UK (SEED Trust, Fertility Network UK, Donor Conception Network and Pride Angel) to create a resource that is based on the advice given by women who have acted as a known egg donor. The collaborators have a vested interest in supporting women who are thinking about or undergoing known egg donation and their organisations actively provide information and support around egg donation on their websites. The resources are hosted on the partner websites. Pride Angel have contributed to this project by providing consultancy and expertise around the topic of known egg donation and offering advice about the topics covered in the resource and are hosting the resource online. The SEED Trust, Fertility Network UK and Donor Conception Network have contributed to this project by hosting the resource on their websites and disseminating the resource to a wider audience.
Impact A downloadable resource that is available on the charity websites.
Start Year 2021
 
Description BBC Leicester live interview 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact The PI, Nicky Hudson, was interviewed live on BBC radio Leicester about the films made via the EDNA project collaboration with the SEED Trust. Anupa Roper, Trustee of the SEED charity was also interviewed. The piece raised awareness in the region about egg donation and what is involves.
Year(s) Of Engagement Activity 2019
 
Description EDNA stakeholder workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact On February 11, 2020, we hosted our main project stakeholder workshop hosted at De Montfort University in Leicester. This event was an international knowledge exchange workshop. Attendees included egg providers, fertility service providers and professional and academic experts from the UK, Belgium and Spain. Our key findings from Phase 1, Phase 2, and Phase 3, were presented and emerging policy recommendations were discussed. Outputs and developments from this event are on-going.
Year(s) Of Engagement Activity 2020
 
Description Egg donation in the UK, Belgium and Spain: an interdisciplinary study 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Nicky Hudson (PI) delivered a talk to members of the HFEA about the study and its early findings and potential future policy impacts. A plan was made to return with more detailed findings and to tailor future policy briefings around up-coming HFEA strategy.
Year(s) Of Engagement Activity 2019
 
Description Panel debate at UK Fertility Fest 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Nicky Hudson (PI) participated in a panel discussion on egg donation at the UK Fertility Fest, Bush Theatre London, 8th-13th May 2018. The discussion focused around the challenges and implications of egg donation.
Year(s) Of Engagement Activity 2018
URL https://www.bushtheatre.co.uk/festival/fertility-fest-2018/#anchor-festival-events
 
Description Podcast on egg donor experiences for the HFEA (Human Fertilisation and Embryology Authority) Website 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact Findings from the EDNA project highlighted the need for up-to-date independent information on egg donation, especially reflecting the personal experiences of egg donation. The podcast is therefore designed to raise awareness about the experiences of egg donors amongst a range of audiences including donors, recipients and fertility professionals.
Year(s) Of Engagement Activity 2020
 
Description SEED Films and Infographic 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact A series of eight films and an infographic were co-produced by De Montfort University, SEED Trust, Spanish National Research Council (CSIC) and Ghent University. The eight short films include accounts from six egg providers who very generously shared and reflected on their experiences. The films are based around themes raised by interviewees in the study and are therefore carefully designed to ensure the content directly addresses questions that potential egg providers might have prior to engaging with the process. These include: motivations to become a donor; the physical aspects of donation; compensation; talking to others about becoming and being a donor; writing letters; reflections and advice for other women.
Year(s) Of Engagement Activity 2019
 
Description The EDNA Project Blog 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact The EDNA Project Blog has published 26 blog entries related to the EDNA study including project information, calls for participants and papers, publications and conference proceedings, and commentaries on theory, egg donation, egg freezing, egg sharing and policy.
Year(s) Of Engagement Activity 2017,2018,2019,2020,2021
 
Description The EDNA Project Twitter Account (@edna_project) 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact The EDNA Project Twitter Account shares details of the project with a wide audience and raises awareness of the study specifically and egg donation more broadly.
Year(s) Of Engagement Activity 2017,2018,2019,2020,2021
 
Description Walking on eggshells? The morally complex practice of egg sharing (article published in BioNews) 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact A commentary on the practice of egg sharing.
Year(s) Of Engagement Activity 2017