A sizable share of the organizations recruiting egg donors online don't adhere to ethical guidelines laid out by the American Society for Reproductive Medicine (ASRM), according to a new study.
"I would argue that there needs to be more attention from ASRM about these agencies, because you don't want these women exploited," said Dr. Robert Klitzman, a professor of clinical psychiatry at Columbia University in New York and the study's senior author.
Women are recruited to donate eggs to fulfill a growing demand by couples seeking in vitro fertilization (IVF).
According to the Society for Assisted Reproductive Technology (SART), an organization affiliated with ASRM, among member clinics there were more than 15,000 IVF attempts using donated eggs in 2010, up from about 11,600 in 2003.
Ethical standards set forth by the ASRM specify that donors should be at least 21 years old, and those between ages 18 and 20 should receive a psychiatric evaluation first.
Also, women are not to be paid for their eggs, but all donors should be compensated equally for their time.
Donor traits like college grades or previous successful donations should not result in higher payment.
Abiding by the recommendations is voluntary, and the guidelines carry no legal authority. ASRM will sanction members who do not adhere to the guidelines, however.
But "our ability to influence the behavior of non-members is pretty limited," said Sean Tipton, a spokesperson for ASRM.
To see how well recruiters follow ASRM's guidelines, Klitzman and his colleagues, who published their findings in Fertility and Sterility, visited 102 websites recruiting egg donors.
Some of these represented IVF clinics run by a physician, and others were agencies that connect women with clinics but don't actually provide any of the medical services.
The researchers found that 34 percent of the websites offered higher payment for certain traits, most commonly, having previously donated successfully.
Some sites also offered higher payments for educational achievement, athletic skills and good looks.
Klitzman told Reuters Health the findings are concerning.
"We're not paying for the eggs...but we're compensating people for their time and effort. So, therefore, we shouldn't pay for the quality of eggs," said Klitzman, who directs Columbia's Masters in Bioethics program.
He also found that more than 40 percent of sites recruited women between the ages of 18 and 20.
"Of course we want everybody to follow our guidelines," Tipton told Reuters Health. "There's no question that there are some agencies that don't seem particularly interested in what our guidelines are, and we don't know how to impact their behavior."
Recruiters approved by the ASRM or SART were more likely to follow the guidelines than others.
About 26 percent of approved agencies or clinics paid more for certain traits, versus 63 percent of non-approved sites.
Clinics, which have a physician on staff, were also more likely to adhere to the recommendations than egg-donor agencies.
Just 10 percent of clinics advertised online that they would pay more for particular traits, compared with 59 percent of agencies.
Tipton said that ASRM checks in on members "on an on-going basis," and will ask them to change their practices to meet the guidelines or risk losing their standing as a member.
He said the best way to avoid potential ethical problems is for both potential donors and patients seeking donor eggs to be aware of the ASRM recommendations, and to ask whether the clinic or agency follows them.
"We are not convinced that this is going to require governmental intervention, because we get very nervous about government trying to make reproductive decisions for people," he told Reuters Health.
Klitzman said potential donors also need to be aware of the potential psychological and physical risks of donating eggs.
"To donate eggs is not an entirely benign procedure. It's not high, high risk. But you're taking very high doses of hormones, having needles stuck in your ovaries," he said.
He found that 56 percent of the websites did not discuss the short-term risks of donating eggs.
"The idea is to help people," he said. "The problem is you want to make sure it's done appropriately and that people are not being exploited or taken advantage of."
SOURCE: http://bit.ly/NbdQfx Fertility and Sterility, online July 27, 2012.[Photo courtesy of Flickr user Aussiegall]