Getting The Eggs for Stem Cell Research: The Risks and the Ethics

The need for human eggs to be used in stem cell research has posed an ethical challenge regarding how to treat those women who allow their eggs to be removed for the research purposes. Eggs have been obtained after stimulation now for a number of years as part of the invitro fertilization process which enables the woman to have her eggs fertilized and then implanted in her uterus to attempt a pregnancy or to have the eggs donated to another family for reproduction purposes. In the case of current stem cell research, the eggs would not be used for producing a pregnancy but to create the stem cells and the tissues under study. Therefore, the woman’s participation would yield neither immediate personal benefit nor any immediate benefit for another family. Presumably, the woman’s participation would be motivated by altruism and most likely some financial benefit. The questions include whether this is sufficient to overcome the potential risks to the woman’s health that comes from this donation. What are the risks?

The risks include the ovarian hyperstimulation syndrome (OHSS) which is related to the hormones used to stimulate the ovary to produce more eggs. Between 0.3 and 5% or perhaps up to 10% of women who undergo ovarian stimulation to procure eggs experience severe OHSS, which can cause pain, and occasionally leads to hospitalization, renal failure, potential future infertility, and even death. Later and long term effects of hyperstimulation on fertility and hormone dependent cancers are also being considered. The incidence in healthy short term donors is felt to be less. Rare operative complications can occur from retrieval of the eggs from the ovary.Finally there is a possibility that psychological issues may appear with regard to the screening, the procurement process and after procurement.

And what is the benefit? Again, there is no immediate benefit to the healthy woman. In later studies, the eggs may be obtained from women who themselves or family members are ill from a genetic abnormality or who have the abnormality without symptoms. Studies with these eggs may lead to a more immediate benefit to the donor or their family.

The question also arises as to whether those women who donate who are not ill but which involves a surgically invasive procedure, should be treated as patients or as research subjects. The confusion here in defining them is because clinical research subjects are usually treated by a drug or procedure whose outcome is unknown. Their participation is experimental. The process itself, for which the egg donation women may be at risk, is not an experiment and the outcome of ovarian stimulation and egg procurement is known. Indeed, the experimental part of the research is that carried out with the procured eggs. There is also the question of whether the women should be considered analogous to a living organ donor. The difference, of course, is that the procured organ is used immediately for the benefit of a specific patient, while the eggs obtained from these women are not of immediate reproductive or therapeutic benefit to anyone. Why are these differences important? Well, it has to do with the ethics of balancing the risks vs benefits to the woman and whether protocols that guide the researchers in the procurement of the eggs should therefore be made more specific to egg donation process itself and perhaps more strict than protocols for other clinical research.

In this regard, California Institute for Regenerative Medicine (CIRM), the institution given the responsibility for the oversight and distribution of California funds for stem cell research commissioned the Institute of Medicine and the National Research Council to form the Committee on Assessing the Medical Risks of Human Oocyte [egg] Donation for Stem Cell Research in September 2006. The committee organized a workshop and prepared a workshop report of the current state of knowledge of the medical risks of human oocyte donation for stem cell research and CIRM then produced draft guidelines for the procurement and followup process.

CIRM indicated the guidelines are intended to provide institutional review boards and research oversight committees with a set of criteria to evaluate clinical protocols. If you read the summary, you will get a fuller picture of what is involved in the risks to the women who donate their eggs for research and what special precautions are felt necessary to be taken.

The purpose of this thread is to report what our California state stem cell funding organization is currently considering as important in egg procurement for stem cell research. But also I would like to get the view of my visitors regarding the whole concept of egg procurement, not for attempt to reproduce a human being, but for research into curing diseases or injury and also attempting to prevent the appearance of genetic diseases. From what you read, do you think that the benefit is worth the risks? Do you think that more women should be encouraged to participate? If so, should the motivation to participate despite the very slight to mild risk be one of altruism (a sacrifice for the benefit of mankind) or for anticipated financial benefit? Would you find that if most women participated for the cash would this motivation be acceptable? If you could participate, would you? ..Maurice.