Researchers urge pay for egg donors
■ Policies that limit compensation to women for the time, discomfort and risks involved in oocyte donation is impeding research progress, scientists say.
By Kevin B. O’Reilly — Posted Sept. 15, 2008
Stem cell scientists in growing numbers say their work is being hampered by restrictions on the financial compensation that can be offered to women who donate oocytes for research.
The biggest complaints have come in California, where voters in 2004 approved $3 billion to fund stem cell research. California accounts for more than half of federal, state and private U.S. spending in this area, according to an August 2007 study by the Rockefeller Institute of Government and the Alden March Bioethics Institute's Federalism and Bioethics Initiative.
Limits on compensation are making it hard to find women willing to undergo the time-consuming, often painful process of egg donation, which involves taking a regimen of hormone shots to stimulate oocyte production for surgical retrieval, said Samuel H. Wood, MD, PhD, who is CEO of Stemagen, a private embryonic stem cell research firm in La Jolla, Calif.
"Why would a woman take 40 injections and go through everything else involved in oocyte donation in exchange for bus fare?" Dr. Wood asked. "It's wrong to ask women to go through this process and not pay."
California and Massachusetts outlaw egg donor compensation that goes beyond reimbursement for direct expenses such as travel costs and lost wages. The National Academies of Science adopted similar ethical guidelines in 2005. The restrictions are justified, supporters say, because big-money payouts could induce women unduly into taking risks they otherwise would avoid.
The restrictive payment rules stand in stark contrast to the practice in fertility clinics, where the national average payment to egg donors is $4,217, according to a survey published in the May 2007 Fertility and Sterility. The American Society of Reproductive Medicine says payments of more than $10,000 are inappropriate, but highly educated and therefore highly prized egg donors have sometimes been paid much more.
Clinical research subjects are usually compensated for the risks and discomfort associated with invasive procedures such as bronchoscopy or endoscopy.
American Medical Association policy supports federal funding of research on embryonic stem cells, among other types of pluripotent cells. The AMA has no policy on egg donor compensation.
Eggs needed for cloning research
The biggest risk from egg donation, according to a National Academies report published last year, is ovarian hyperstimulation syndrome. Symptoms include nausea and vomiting, bloating, hemoconcentration, breathing difficulties, hospitalization and kidney failure, in rare cases.
Fresh oocytes are required to pursue one promising kind of human embryonic stem cell research known as somatic cell nuclear transfer, or therapeutic cloning.
In SCNT, the donor egg is fused with the nucleus of a diseased cell to create a genetically identical blastocyst. Stem cell lines can be derived from the embryo and studied for clues about how the disease develops and how to treat it.
Dr. Wood co-authored a paper published in the Jan. 17 Stem Cells that documented Stemagen's creation of a cloned embryo using SCNT. He also is medical director of a fertility clinic in La Jolla and persuaded couples going through in vitro fertilization to donate, without pay, oocytes for his research.
However, Dr. Wood and a group of other researchers doing SCNT were denied funding by the California Institute of Regenerative Medicine, the agency charged with distributing the state's research dollars.
In June, CIRM President Alan O. Trounson, PhD, said at a public meeting that the agency turned down grant applications for therapeutic cloning research because of the egg shortage.
In an effort to address the shortage, CIRM voted to allow researchers to use frozen oocytes or embryos that were secured before July by paying donors as part of in vitro fertilization.
At its next meeting, to be scheduled, the agency is likely to consider whether to allow researchers to use eggs from donors compensated for donating to infertile couples. But that use would only be allowed if there is no discussion beforehand about donating for research, said CIRM spokesman Don Gibbons.
Whether such a policy change would yield the thousands of fresh human oocytes researchers say they need is unclear.
Marcy Darnovsky, associate executive director of the Center for Genetics and Society in Oakland, Calif., opposes compensation beyond direct expenses for women who donate eggs for research because it would encourage women to take unnecessary risks for an uncertain benefit.
"There is a really important difference between going through these risks in order to provide another couple with a chance of having a child," Darnovsky said. "We know that IVF succeeds a significant percentage of the time. ... But in the case of SCNT, we are talking about highly speculative, early-stage research and providing the raw materials for it."
Others disagree. Kerry Howley accepted pay to donate eggs to an infertile couple and wrote a cover story about her experience in Reason magazine, a libertarian public affairs monthly headquartered in Los Angeles. She said denying payment to women who donate eggs for research is "unbelievably condescending" because the policy assumes donors are incapable of judging the risks once money enters the picture.
"For research, these restrictions are saying, egg donation should only be motivated by altruism, which is ridiculous because nobody else in the process is motivated only by altruism," she said.