A Question of Ethics

By Robin von Halle

Donor Agent Provocateur appeared last week in the New York Times Magazine column, The Ethicist, by Ariel Kaminer. The Ethicist responded to a reader’s questions regarding the ethical implications of a situation involving a fertility consultant hired by a Chicago couple interested in finding an egg donor sharing some of their ethnic background. The fertility consultant was ultimately unsuccessful in finding a donor of the particular ethnicity; however, she now refuses to refund their retainer. Did the fertility consultant behave ethically? ARR agrees with The Ethicist’s assertion that, as a professional consultant offering a service, it is unequivocally unethical to charge a fee for a service which, in reality, the fertility consultant did not intend to provide.

As a third party reproductive agency facilitating roughly 130 matches each year, ARR serves as an advocate and support system for donors, surrogates and intended parents alike. Our role is to be a resource,  providing the tools and expertise to help intended parents to make informed decisions and navigate a complex process. As opposed to the fertility consultant, ARR does not ask for a deposit until we have successfully matched a couple and donor. We do not believe it is ethical to accept payment until all parties involved are ready and willing to move forward. Intended parents are under no financial obligations until an official match has been made, and if for some reason a donor is unable to move forward, the couple would be re-matched at no additional fee.

Above all, ARR never promises unrealistic matches. It is not uncommon for intended parents to request a donor that shares some of their own traits or cultural background. We do work with couples seeking a donor of a specific ethnicity. If we do not have a donor in our database matching the particular criteria desired, then we direct the couple to Donor Network Alliance to continue their search. That being said,  in our twenty plus years of experience, an ethnic match is typically not deal a breaker. More importantly is finding a healthy, young, fertile donor with traits similar to that of the intended parents, if so desired. The majority of the time, when working with a reputable agency, a fertility consultant becomes a duplication of services, which add another layer of cost to the intended parents.

A Wake Up Call for Would-Be Egg Donors

By Mary Ellen McLaughlin

Between increased media coverage and openness by celebrity role models about their struggles with and solutions to infertility, egg donation has become more mainstream, and, as such, a more “acceptable” course for young women to take to gain financial and psychic rewards.

On the plus side, this is good for us and our intended parents, as it gives us a larger pool from which to choose. The downside, of course, is that news coverage is fairly superficial and may create expectations among prospective donors that are pretty far removed from reality.

This was brought home to me in a recent article in Jezebel entitled “Do Egg Donors Lie?”

In answer to the title question, yes, some prospective egg donors do lie, and I have caught a number of them doing so (on issues ranging like physical and mental health concerns, for example). It gets them bounced from consideration. I’ve developed a good radar for this, as a BSN who has worked with egg donors for 18 years and in women’s health for seven years before that. It helps to know what to ask and how to ask it, and our policy of interviewing egg donors face-to-face (in person and via Skype) is hugely beneficial.

Often, what they commit are sins of omission, not commission, but those still may be more plentiful because of the economic environment and, let’s face it, the prospect of “easy money” to offset the financial stresses.

And it doesn’t help that the increasingly competitive environment in our industry has driven compensation to, well, dangerous levels. The danger lies where it is less a reflection of time invested in the donation process (as per ASRM guidelines) and more one that’s essentially a bidding war for genetically ideal eggs. Is a girl who never considered donating until she wound up in dire financial straits being lured or coerced by the compensation? It’s an increasingly important ethical issue.

Of course, once prospective egg donors go beyond the media hype, they understand that egg donation may not be all so quick a buck. There’s a time commitment involved, from the medical and psychological screenings and legal consultations to medical checkups throughout the donation process, that can easily stretch past the three-month mark.

And even so, they may be accepted by the agency as a donor but still not pass the screenings. They may not get matched. They may stimulate poorly. There are no guarantees.

Egg donation is an important component of today’s fertility industry. It’s not something just any woman can do, for any number of reasons. Young women who are realistic with their expectations will happily reap both the psychic and financial rewards.

Egg Donors Seem Less Concerned Over Anonymity Factor Today

By Mary Ellen McLaughlin

The anonymity of egg donors – a norm of assisted reproductive technology here in
the United States – is steadily coming under question. And while those of use who
find donors to match with intended parents in need tend to worry that the trend will
result in a shortage of willing donors,, that actually may not be the case at all.

Last month, Washington state passed a new law guaranteeing children conceived
with gametes from Washington egg donation agencies access (when they’re 18) to
their donors’ medical histories and their full names— unless the donors specifically
opt out of being identified. It also applies to children born of donated sperm.

Twenty years ago, when we were just starting in this business, donor anonymity
was a huge concern to all of the parties . Today, we see fewer who need that
assurance. And a spot survey Alternative Reproductive Resources recently
conducted of our egg donor base gave us some data to back up the anecdotal
evidence.

Just over half the survey group was new (51.9%) and one-time (29.6%) donors. Of
the entire base, fewer than 10% said anonymity was “very important” in weighing
their decision to donate. A whopping 55.6% called it “somewhat important”; and
nearly 40% said it wasn’t important at all.

So it’s not surprising that over 80% of the respondents said they would still donate
their eggs if anonymous donations were disallowed, and fewer than 20% said they
would opt out of being identified if legislation like Washington’s was more broadly
adopted.

In their comments, it was clear that our donors understood and were comfortable
with the need of children born of donated eggs and/or sperm to know as much as
possible of their biological roots. Their “responsibility” as egg donors was a common
theme.

What was a greater concern was the potential for any legal responsibility.

One donor noted: “I value the anonymity, but I think children will always be curious
where they came from. Making a decision as big as donating eggs comes with a certain
responsibility, and I would give the child the opportunity to find out about me if that was
important to them.”

Another said: “Giving them the opportunity to easily understand where they came from

is potentially part of our duty as donors. However, I do not believe that this knowledge
should ever result in the pursuit of mandated legal obligation for care or finances without
the donor’s reciprocated agreement.”

This is an issue that is not going to go away. We find it interesting that donors, arguably
the group with the most at stake, have adopted a more open attitude toward anonymity in
recent years. Let us know what you think!

On Today’s Assaults on Women’s Reproductive Rights

By Robin von Halle

We normally stay away from politics in this blog. Religion, too, for that matter.

But a very troubling movement has been stepping up the pace lately.  Some legislators at the state and national level are proposing measures that would severely cut away at women’s reproductive rights.

Fertility. Infertility. They are opposite sides of one coin. And these proposals have implications for both of them.

Here’s how blogger Keiko Zoll, a self-described “infertility advocate” put it:

“…Infertility patients need to pay attention to healthcare legislation, particularly anti-abortion legislation. Anti-abortion legislation, in a cruel twist of fate, can pose a serious threat to our access to care. Here we are, trying our damndest to have our own children, and yet (I know how ironic this sounds) we need to be vigilant about others’ rights and access to terminate their own pregnancies.”

In Iowa, proposed legislation would define life as beginning at conception, effectively making abortion illegal there. What would that mean for infertility patients? It would mean that if all the eggs collected were fertilized during an IVF cycle, it would be illegal to dispose of any of them, even those not biologically suited to be transferred to the uterus.

In opposing the legislation, the American Society for Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART) pointed out:

“In human reproduction…fewer than 20% of fertilized eggs implant in the uterus. Given the uncertainty…it is unreasonable and imbalanced to give constitutional rights to fertilized eggs or embryos. HF 153 would result in a requirement that all embryos be used for procreation purposes, or be kept in a frozen state forever. We question whether it is the intent…to grant those frozen embryos the right to vote upon reaching 18 years in frozen animation?”

Similar “Personhood” legislation is sweeping across North Dakota, Montana, Texas, and Oklahoma. Then, there’s Georgia, where a bill would require any miscarriage, whether in a hospital or elsewhere, to be reported and investigated. And, of course, there’s the de-funding of Planned Parenthood, a much-needed resource for overall women’s health services going far beyond abortion.

We’re a small business. We don’t have a political action committee. We just want to help people create families, finding and matching them with egg donors and gestational surrogates. But as part of the larger community, we all need to be aware of changes in the environment that might affect both sides of the reproduction coin. And be prepared to give voice to our concerns.

What happens to the birth certificate when a surrogate gives birth?

Birth certificates are a tricky issue in the process of surrogacy. When a surrogate gives birth, can an intended parent’s name be put directly on a child’s birth certificate or must the parent legally adopt the child?