Peer Pressure: Lord Winston decries egg sharing in the UK

For some years, Robert Winston, a member of the House of Lords who was also pioneer of in vitro fertilization and pre-implantation genetic diagnosis, has publicly skewered the National Health Service and private physicians in the U.K. for dubious practices in the treatment of infertility.  He has written about overcharging for fertility services and engaging in “a huge amount of exploitation” of vulnerable couples whose desires for children often lead them to shoulder outsized financial burdens. As he told the Times of London in 2011, by charging sometimes double what they should, private clinics were “also putting the health of mothers and babies at risk as many couples opted to implant two or more embryos instead of undergoing several expensive IVF cycles.”

Additionally, Lord Winston has been an outspoken critic of “savior siblings”—IVF babies conceived to provide tissues that might help cure brothers or sisters who are ill—and has warned about “designer babies” and the dangers of neo-eugenics.

So it was no surprise recently when Winston spoke out against the practice of so-called egg sharing in the UK.  According to an investigation by undercover reporters for the Daily Mail published online May 1, multiple physicians were found offering IVF patients the opportunity to trade their eggs for discounts in their own (putative) IVF treatments.

A few days later, in a companion piece to the investigation, Lord Winston lamented that the government’s Human Fertilisation and Embryo Authority (HFEA) hadn’t been living up to its regulatory responsibility. Despite being tasked at its founding in 1990 with oversight of all work involving the creation, donation, and storage of eggs, sperm, and embryos, Winston noted that HFEA “has not prevented the disgraceful exploitation of patients, mostly women.” Regarding egg sharing, he identified clinicians’ motives as ethically problematic. According to Winston:

[P]ersuading women to donate their eggs can be extremely lucrative. It also means that clinics have an incentive to maximise the chance of getting as many eggs as possible. Therefore, they may be tempted to give the woman donating her eggs more stimulation than is strictly needed, or than is advisable from the point of view of the woman’s health.

He added that high exposure to stimulation drugs could cause the ovaries to produce eggs with more chromosomal abnormalities that would, in turn, yield more spontaneous miscarriages.  

For Lord Winston,the HFEA has also fallen short of fulfilling its mission, because couples are being treated via IVF without necessarily having gone through a standard infertility workup to determine the root of their inability to conceive. This violates best practices in infertility treatment that have been agreed upon for decades and means that some couples are being funneled into the most expensive option, IVF, when cheaper ones might exist for them.  

Reaction from the medical establishment was also (not surprisingly) negative.  

On May 17, Adam Balen, president of the British Fertility Society, wrote an extended post on his professional blog titled, “Daily Mail Misses Mark on Infertility.” Balen took major issue with the notion that egg sharing was widespread. Balen asserted that “the IVF sector is the mostly highly regulated of all areas of medicine in the UK,” and that the Mail’s reporting misinterpreted published statistics and distorted the situation. For him, the Mail was generalizing erroneously from a few “pockets of bad practice,” which he said exist in all fields of medicine.  

Yet for Balen’s claim that such practices are rare, he provided no evidence besides the professional probity of IVF practitioners. Instead, Balen used the opportunity to fault Clinical Commissioning Groups, which set levels of service for around 200 local UK medical sectors.

Citing figures revealing that only about 16 percent of Clinical Commissioning Groups cover the full three cycles, Balen pressed for them to ensure that women throughout the country be covered for three cycles, as recommended by the National Institute for Health Care Excellence, an independent body sponsored by the Department of Health.  However, these figures came from Fertility Fairness, a group that lobbies for equal access to IVF treatment in the UK and is funded by the pharmaceutical companies Merck Serono and Ferring Pharmaceuticals which sell key drugs used in fertility treatment.

Balen took unequivocal exception to the idea that physicians, the BFS, the HFEA, and the NHS as a whole had fallen short:

The UK leads the way with innovation in IVF and other infertility treatments and the BFS works with our community to share good practice. We also work with the regulators and policy makers to ensure that ethically challenging issues are embraced with tight but permissive regulation. In theory, the UK is one of the best places in the world – scientifically and medically – to be a person dealing with infertility, but without NHS funding for treatment this point is moot.

Here, Balen seems to undercut his argument, because it is, in fact, the structural circumstance of limited NHS funding that has created the moral dilemma represented by egg sharing. Doctors are attempting to offer poorer patients fair treatment according to the recommendations are bending ethical rules; meanwhile, patients, driven by the desire to have a child, are increasingly accepting a questionable bargain in order to avoid major debt.

And this is the point Lord Winston made by focusing on patients and their experiences rather than on the high ethical standards supposedly ensured by the HFEA.  Balen defends the field and its oversight and rejects the Daily Mail’s findings as anomalous; Winston understands that lack of access and social inequality creates the very conditions that promote exploitative practices.

In the last several years, we have seen the HFEA and the British government make multiple decisions privileging the norms of research over other social considerations, always under the rubric of eliminating suffering in the form of genetic disease or infertility.  As a consequence, the weight has always come down on the side of institutionalized aims at the expense of more prolonged and truly inclusive discussions of how these practices impact individuals and their future offspring.  The IVF industry has rarely managed to engage in a true critique of its methods and goals, generally preferring to hide behind the feel-good claim that they are bringing people happiness in the form of take-home babies.  Voices like those of Lord Winston, who critique the field’s assumptions and practices, serve a noble purpose.