September 16, 2019

California shouldn't expand the market for women's eggs

[Cross-posted from the San Francisco Chronicle]

By Lisa Ikemoto and Diane Tober

Medical researchers would be allowed to buy women’s eggs under a bill being considered by the Legislature this week. As pro-choice, feminist scholars, we are deeply troubled by this legislation.

Proponents of AB922, backed by the American Society for Reproductive Medicine and authored by Assemblywoman Autumn Burke, D-Marina Del Rey (Los Angeles County), point out that human eggs, sperm and embryos are in demand for research on fertility, stem cells, cloning and gene editing. They claim the only way to meet the growing demand is to increase supply by paying women for their eggs. California law allows such compensation for fertility purposes, but women donating eggs for research may be reimbursed only for their expenses.

The arguments for the legislation ignore the repercussions for prospective donors. While the bill claims, “Concerns that women will be exploited if compensated for providing human oocytes for research have not borne out” in other states, we can find no support for this statement.

A thriving egg trade depends on recruits in financial need. People who are likely to be screened out of the fertility market, which favors white donors and class markers such as higher education, may well qualify as research donors. That means AB922 will affect a range of low-income women, women of color and gender-non-conforming people with ovaries.

Proponents claim that hormonal stimulation for egg retrieval is safe. Yet there is no conclusive longitudinal data on the health effects of egg harvesting despite reproductive-health advocates’ repeated calls for studies. Without adequate research on the health effects of egg retrieval, informed consent is impossible.

Fresh evidence for the troubled state of egg donation comes from research that one of us (Tober) conducted with over 350 women who provided eggs for fertility purposes. The majority of participants reported that financial need was a primary motivation for their egg donations. Their average age was 24; the youngest were 18. Many were students burdened by educational debt or with incomes below the federal poverty level.

The majority of participants reported being assured that complications from the procedure are “extremely rare” or occur in “less than 1%” of cases. But the number who experienced substantial health effects belies these statements. The complications included hospitalization with severe ovarian hyperstimulation syndrome, ovarian torsion requiring removal of an ovary, surgical mishaps and internal bleeding, pain and bloating requiring at least a week away from work, and hormonal disruptions. Two 24-year-old women in the study suffered critical ovarian hyperstimulation and almost died of organ failure.

Supporters of AB922 say laws protecting human research subjects will cover those who provide eggs. But egg providers aren’t like other research subjects because they’re providing material for research unrelated to their own health. Their reactions to repeated hormone injections and surgical egg retrieval are not what’s being studied.

The law requires institutional review boards to ensure that the benefits of studies outweigh the risks to human subjects. But such boards may not weigh the risks to egg providers as seriously as they do those to typical human research subjects. In addition, risk-benefit analyses vary from institution to institution.

This bill is opposed by a number of state and national reproductive rights, women’s health, LGBTQ rights and public interest organizations. Even with amendments made last week, AB922 emphasizes scientific enterprise while ignoring the humanity of women who provide research materials. We need not sacrifice human safety to advance science.

Lisa Ikemoto is a professor at the UC Davis School of Law. Diane Tober is an assistant adjunct professor at UCSF’s Institute for Health & Aging, Bixby Center for Global Reproductive Health and department of anthropology, history and social medicine.