We Need to Talk About Egg Donor Ads

I found this little gem on the Internet the other day:

“Females… Get paid for selling your healthy eggs!”

It got me thinking about all the egg donor ads I’ve seen over the years. You’ve probably seen them, too: They are flyers splashed about American college campuses; they’re peppered throughout the “Etc” jobs section of Craiglist; they’re all over the #EggDonation Instagram hashtag. These recruitment advertisements tend to promise the same thing: thousands and thousands of dollars.

But are these ads accurate? This article investigates key issues and considerations concerning egg donor ads. We invited Hillary Alberta-Sherer, a PhD candidate at Georgia Tech’s School of Public Policy, to take a close look at some egg donor ads from a feminist perspective. By closely scrutinizing these marketing practices, we inch closer towards supporting informed choice.

Don’t miss the end of the article, because egg donors are invited to get in touch with her to be interviewed for her book!

Enter Hillary.

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Here’s an egg donor ad I found the other day.

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If you go onto Craigslist for any major city and type in “egg donor” or “egg donation” you will find a handful of results within the jobs or even gig section displaying an egg donor recruitment ad similar to the one shown above. What is it about this ad that immediately pops out at you and grabs your attention? Perhaps it is the chance to make $8,000? Maybe it’s not the money, but instead the opportunity of “helping others”. Maybe your attention went directly to the three young women, laughing and smiling, looking happy and carefree, resulting in your desire to be and do whatever they’re doing because it looks too good to miss out on.

These are all perfectly normal immediate reactions to an egg donor ad like this. These ads highlight all things positive: the chance to make significant compensation (and quickly!), the chance of making extra money without it interrupting your school or work, and the chance to help infertile couples achieve their dreams of having a child and give them the “gift of life”!

Egg donation does include a medical procedure, so what about the risks involved with the process?

They are not listed on this ad, but you likely find yourself wondering about them: what are the risks of egg donation, and how likely are they to happen?

Or, do all the positive advantages listed on the advertisement outweigh any initial concerns you might have with the potential risks of egg donation?

As a researcher, I believe it is important that potential egg donors be made fully aware of all possible risks associated with donating their eggs, regardless of the dollar amount being offered, how happy the models look, or even the desire to help give someone the gift of life.

This article will help you make a choice, so you can protect your own body and your own life.  

ARE EGG DONOR RECRUITMENT ADS REGULATED?  

There is little policy in the U.S. that directly concerns the practice of egg donation or the rights of egg donors and no federal laws that specifically address egg donor ads. There are, however, self-regulatory guidelines that were developed by two professional organizations: the American Society for Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART).

Although these recommended guidelines have no formal regulatory power, they do suggest that all ads that list a financial benefit also list the risks and burdens associated with egg donation.

The only state regulation specific to egg donor ads was passed in California in 2009 (AB 1317). The California law requires ads that offer financial compensation for egg donation to also include potential risks.

This leads to the question: Do egg donor ads actually adhere to these risk disclosure guidelines delineated by a “self-regulating” fertility industry?

In short, no.

Let’s look at some ads to illustrate what’s going on, and what can be made better.

As you saw in the first ad, any risks associated with egg donation are not listed. In November 2011, I analyzed 435 unique egg donor advertisements to answer the question: Is this omission of risks normal? And to what extent do egg donor recruitment ads -- specifically ads that list one or more benefits of egg donation -- also include a risk disclosure of any kind.

Here’s how I did it.

For this study, I was able to collect 435 unique egg donor ads from Craigslist in a one-week period by searching the top 50 metropolitan statistical areas (MSAs). I wanted to be as representative as possible to provide the most clear and accurate picture of what information egg donor ads looked like across the country. You can see from the example shown below, that egg donor ads have not changed much between 2011 and now.

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I performed a content analysis on each of the Craigslist ads to determine if they included the term “risk(s)”, and if they did included the term, I evaluated the use of the term to ensure it was referring to the potential risk to the donor. Of the 435 ads collected, 424 (97%) listed benefits, specifically financial compensation. According to the self-regulations, these 424 ads that listed compensation should also include a risk disclosure. However, of those 424 ads, only 68 (16%) also included the term “risk(s)”, which left 358 (84%) of the ads listing the benefits of egg donation without any mention of risk. In simple terms, a majority of the ads from Craigslist were not compliant with the risk disclosure self-regulations.

In a nutshell, the big takeaway was: Ads did not comply with self-regulations. A large majority of the ads found on Craigslist did not mention any associated risks of egg donation, specifically when they also listed one or more benefits of donating eggs.

Adequate Risk Disclosure Supports Informed Choice

Risks should be disclosed in egg donor ads and here’s why: When thinking through whether or not risks should be disclosed in egg donor ads, it’s important to consider the ethical concerns associated with egg donation. These concerns are anchored in the concept of autonomy and protecting the donor’s right to make an informed decision of whether to become an egg donor or not. Autonomy is of primary concern here because of the known and unknown physical and psychological risks associated with egg donation, which could result in the donor’s autonomy being significantly constrained without adequate or full disclosure of the risks.

There is more information on the short-term physical risks associated with egg donation than the long-term risks.

ASRM, the Institute of Medicine (IOM), and other infertility specialists have noted bleeding, infection and ovarian hyperstimulation (OHSS) as potential complications caused by the stimulation of egg maturation during the donation process.

Long term risks include the potential impact on the donor’s future fertility and the potential link between fertility medications and various forms of cancer to include: uterine, colon, breast, ovarian and endometrial cancers.

There have been short-term studies of these physical risks that have found it to be uncommon for donors to experience these risks. However, there is a lack of egg donor studies, specifically with respect to long-term risks, making it difficult to accurately discuss the likelihood that donors will experience any of these physical risks. Without the long-term risks of egg donation being fully understood by specialists, it is even more difficult for potential donors to fully understand the risks and make truly informed decisions when deciding to participate.

The lack of egg donor studies that evaluate the long term risks associated with egg donation  leads to the ethical issues of coercion and inducement.

The Belmont Report of 1979 defines coercion as intentionally using an “overt threat of harm” to obtain compliance and undue influence is defined as using “an offer of excessive, unwanted inappropriate or improper reward or other overture” to gain compliance. You might read these definitions and think they sound extreme or unlike your own donation experience: it’s not like someone threatened your life to coerce you into donating your eggs. However, when offering compensation to egg donors, there is a tension between the use of compensation to incent potential donors to participate and also protecting the wellbeing of the donor through the donation process. This highlights the struggle of whether participants should receive payment for their donation or whether their donation should be viewed as the actions of a volunteer. The concern with compensation is that it could unduly influence donors’ decisions and result in donors disregarding any potential risks of donating her eggs.  Arguments are also made in support of payment based on the concept of compensation being an offer rather than a threat, therefore making it a benefit to the donor and not coercion.

Undue influence (Noun):

Influence where a person is induced with an offer to act otherwise than by their own free will or without adequate attention to any possible consequences of the action.

This matters because women have the right to make an autonomous choice when deciding whether or not to donate their eggs . We can see how broader ethical issues about the decision-making process factor into how compensation may or may not influence the decisions of potential donors.

Essential to this decision is the disclosure of both known and unknown risks. If only the promise of high compensation is provided to potential donors without the disclosure of risks, the payment could become an extreme form of influence that prevents a potential donor from making an autonomous decision. The disclosure of risks is most often connected with the informed consent provided to and signed by the donor before she proceeds with the donation.

But is there a relationship between the recruitment ad and the informed consent, thereby making it necessary to disclose risks even in the ads?

The U.S. Food and Drink Association (FDA) view recruitment ads for participants as the start of the informed consent process and the initial steps in the selection of participants. In addition, the most recent ASRM guidelines that discuss the rights of an egg donor note that it is a donor’s right to be fully informed of the risks and the medical and emotional issues involved with donation to enable them to make a fully informed decision.

The argument can be made that these rights begin when information is first presented to a potential donor, that is, on the recruitment ads, not waiting for the informed consent to fully disclose the potential risks.

WHAT SHOULD POTENTIAL DONORS LOOK FOR IN AN AD?

The places that you might find egg donor recruitment ads have certainly expanded since I originally started evaluating the ads from Craigslist in 2011. Living in Atlanta, it is common to see a billboard or hear a commercial on the radio seeking a young, healthy woman who wants to give the ultimate gift to a family in need and as a thank you, receive considerable compensation. But with the growth and popularity of social media, I suppose it should be no surprise that egg donor ads can now readily be found on popular platforms, such as Instagram.  

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This 2015 Instagram ad shows that the content of egg donor ads has not changed. Emphasis is still on the compensation, with it being front and center and in bold font. That is followed by a focus on what it means to be an egg donor and the chance to help other women and couples that are struggling to create or grow their own family. When these ads focus on compensation and/or the altruistic act of donating, without mentioning even the possibility of risks, it can be incredibly easy to leap head, or really heart, first into the donation process. Who can blame you for wanting to help another person and give them the “ultimate gift”?

But before making the decision to donate, remember that this is an ad just like other ads you see. It’s meant to sell you on the idea of donation, and in doing so, some critical details like the potential risks of donation might be left out and revealed later in the donation process.

This isn’t to say that you should avoid donation, but rather be aware that just because the ad doesn’t list risks, it doesn’t mean they don’t exist. Learn and gain a comprehensive understanding of the potential risks so that when you make your decision about donating your eggs, it’s truly an informed decision.

Contact the advertising company, have conversations with your doctor or medical professional, but make sure that even if the ad doesn’t fully inform you, you find other resources to be fully informed.

Get in touch

Alright, now I hand it over to you.

I’m in the final writing stages of my dissertation and after graduation, I’d love to expand this research even further through the stories of egg donors. Whether you’ve already donated your eggs or you’re in the beginning stages of thinking about donating, your story is important and worthy of being heard.

My goal is to organize a book that combines my dissertation research with interviews and real stories to create a piece of literature that is accessible but also informative for someone like you and me, who are the target of the egg donor ads we are starting to see more frequently and in more places.

My goal is to add to the conversation regarding egg donation but also help inform and provide accessible, accurate information to help women, but especially those that might be thinking about donating.

If you are interested, you can contact me at: halberta@gatech.edu.