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Markkula Center for Applied Ethics

Eggs Are a Hot Commodity: A Bioethical Perspective on Egg Donation

Human egg cell. Photo by Sebastian Kaulitzki _Adobe Stock.

Human egg cell. Photo by Sebastian Kaulitzki _Adobe Stock.

Sophia Bouzid ’24

Sebastian Kaulitzki/Adobe Stock

Sophia Bouzid is a biology and public health double major and a 2023-24 health care ethics intern with the Markkula Center for Applied Ethics at Santa Clara University. Views are her own.


In 2021, the average age of first-time birth mothers reached a record high of 27.3 years. As more college-educated women decide to invest in higher education and careers, it is becoming increasingly common to delay pregnancy until one’s mid-to-late thirties and early forties. Consequently, the demand for artificial reproductive technology (ART) is expanding considerably. Since the 1980s, oocyte or egg “donation” has become an increasingly common ART. Though many women choose to use their own eggs for embryo creation, being age 30 or older increases the risk of depleted ovarian reserve, poor quality of ova, and ovarian damage. This reality has led to an increased market demand for young and reproductively healthy egg donors than ever before. 

UCSF Center for Reproductive Health advertises that “the knowledge that she [the donor] has had the ability to make a profound difference for a family is frequently one of the most compelling reasons young women participate so generously in this process.” However, at a time when student debt repayment is a nationally acknowledged problem, the cost of living is steadily increasing, and more women are pursuing expensive higher education, financial incentive towards participating in egg donation should not be advertised as a solely altruistic pursuit. 

According to Beauchamp and Childress’ Principles of Biomedical Ethics, personal autonomy is one’s ability to make decisions free from controlling interference or a lack of understanding. The financial vulnerability of young, college-aged women coupled with a relatively poor understanding of associated medical risks of egg donation may impair a donor's ability to make unduly influenced, informed decisions. One of the few retrospective studies on egg donors reported that 55.2% felt inadequately informed about potential future risks of the egg donation process. Finally, the majority of states do not have specific laws regarding the informed consent process of testing, egg retrieval, and potential uses of gametes. Instead, the majority of states that practice egg donation have access to a set of guidelines created in collaboration with the Center for Disease Control, U.S. Food and Drug Administration, and American Society for Reproductive Medicine (ASRM) that outlines recommended donor screening and selection, oocyte, sperm, and embryo management, and legal considerations for donation. The lack of widespread protective legislation for donors is concerning and further perpetuates the ethical concerns of current egg donation standards in the United States.

The Egg Market 

Since the 1990s, a trend of targeted advertisement to female students of prestigious universities has created newsworthy discourse, with taglines like, “$100,000 for the ova of a Caucasian woman athlete under 30; proven college-level athletic ability preferred,” appearing on the Stanford Daily

Even today, online egg donation agencies are advertising hundreds of thousands of dollars per donation cycle to highly educated women. Despite eggs historically being priced according to market value, ethical guidelines by the ASRM used to be available. However, a 2011 price fixing lawsuit was filed by a group of egg donors who did not agree with the ethically recommended $5,000 compensation guideline set by the ASRM. The egg donors won the lawsuit, and the ASRM has since removed all guidelines related to compensation. 

Implicit in the idea of human ova having “market value” is to suggest that some women can commodify themselves as valuable egg donors while others cannot. Though egg donor capability depends on the criteria of being younger than thirty and having generally good health, ova are often valued higher based on race and educational attainment of the donor. For example, because Asian donors have historically been in high demand, the compensation for Asian women reached as high as $20,000 compared to the 2011 national average of $6,000. Today, fertility clinics are still compensating Asian egg donors at higher rates due to higher demand for their eggs. Additionally, some egg donation agencies specialize in connecting potential buyers to women who have specifically attended Ivy League colleges like Yale, Princeton, and Harvard, and those who are medical students, law students, and PhD candidates. It is important to keep in mind, however, that the selectivity which characterizes the egg donation business in the United States is not a precedent for the rest of the international medical community. 

Egg donation in the United States operates via a free market model that lacks regulation to protect the donor’s best interests. Comparatively, Spain holds the second largest global egg donation economy and regulates its market with strict guidelines. Under Spanish law, egg donors are offered a fixed and modest compensation to encourage altruistic intent (approximately 900-1300 USD), and donated eggs are anonymously matched to recipients by a physician based on phenotypic similarity between the donor and prospective parents. 

Though the egg donation industry in Spain has health and age-related donor-selection criteria, the required anonymity imposed on donors in Spain decreases the likelihood of coercion and self-commodification that a “free-market” model encourages. Standardized compensation and selection criteria of donors also perpetuates the idea that regardless of ethnicity or educational background, donors are equally valuable. Comparatively, Spain’s practices lack the eugenic undertones of the United States’ egg donation industry. 

Addressing Risk

The egg retrieval process is not without risk. Egg donors undergo several weeks of daily hormonal injections, followed by surgery under anesthesia to harvest the matured ova. Typically, patients are informed of immediate risks regarding the anesthesia and potential damage to the ovaries, but are less often informed in detail of long-term complications like ovarian hyperstimulation syndrome, infertility, or poor mental health outcomes. One of the most recent egg donor surveys found that 39.4% of donors experienced complications from their procedure, and that emotional and physical risks were “downplayed” by health care professionals. Because long-term risks associated with egg donation have not been adequately researched, there is not enough data to associate some egg donor’s development of early onset reproductive cancers, infertility, or ovarian hyperstimulation syndrome on the hormonal injection process of egg retrieval. An egg retrieval consent form from the University of Rochester Medical Center states that:

“In current studies that take into consideration the increased risk of cancer due to infertility, there does not seem to be an increased risk of cancer due to the fertility drugs alone. More studies need to be done to confirm whether there is an association of cancer with the use of fertility drugs.” 

To not fully inform young donors of the possibility of severe risks associated with the use of fertility drugs, especially to those undergoing multiple cycles of egg retrieval, is a breach of their autonomy. The lack of longitudinal research surrounding egg donor health outcomes draws into question the validity of fertility clinics that label egg retrieval as “safe with no long-term risks.” Interestingly, associated risks of ovarian hyperstimulation, such as ovarian cancer, for typically older IVF patients is much more established than for young, fertile egg donors despite these populations undergoing identical processes. 

Recently, a study on the prevalence of egg retrieval and Ovarian Hyperstimulation Syndrome (OHSS) found that out of 298 egg donors, 26% experienced mild OHSS, 9% experienced severe OHSS, and 1% experienced critical OHSS. Of the participants, three quarters underwent at least one additional donation cycle after the first, likely experiencing OHSS during following cycles if indicated during the first. 

Recent studies such as these are important because they are addressing previously negated risks of egg donation, especially cumulative risk from multiple cycles. Without increased longitudinal research, it is impermissible for agencies or providers to assert that long-term risk either does not exist or is negligible. Potentially implicating the reproductive health of young, healthy women/donors at the expense of people experiencing infertility is an issue of beneficence. Fertility health care providers have a responsibility to act in the best interest of both the donors and recipients of gamete and embryo donations. The health and safety of egg donors should be a top priority, which is why more research that may expose risk is imperative. 

Moving Forward

Though choosing to become an egg donor can be a generous and rewarding experience, the process itself is not sufficiently protective of the donor’s autonomy. In accordance with recommendations made by the The Ethics Committee of the ASRM in 2021, compensation should be equitable and not an enticement that could implicate clear decision making. Additionally, egg donation agencies, banks, and fertility clinics should implement more effective information disclosure that adequately addresses up-to-date risks. 

As the need for oocyte donation increases, capitalist markets will surely perpetuate the coercion of young women to donate their eggs, which is why ethical guidelines must be constantly updated and followed by fertility providers. Donating one’s eggs should not be treated as a simple business transaction, but rather, a strongly informed decision primarily made with altruistic intent to help those experiencing infertility. Moving forward, the egg donation industry can ethically improve through market-value regulation, detailed informed consent laws, and increasing longitudinal research efforts. 


Apr 9, 2024

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