By Brenda Gazzar
Friday, July 11, 2008
As donated eggs run low for infertile couples in Israel, a push is on to widen the ranks of possible donors. But one of the country's oldest women's rights groups fears the possibility of financial exploitation and wants tighter oversight.
JERUSALEM (WOMENSENEWS)--Ofra Balaban knows how important a gift of ova can be: She conceived her two sons with eggs donated more than a decade ago.
That was before allegations of ova theft in conjunction with a rising demand and donor restrictions contributed to a shortage of ova in Israel.
One scandal in particular, involving ovum extraction and medical dishonesty in 2000, has tainted the industry with the odor of exploitation and discouraged ova donors, who, by current law, can only be women who are undergoing in vitro fertilization treatment themselves.
Around 20,000 in vitro fertilization cycles are performed each year in Israel, a tiny country that is a world leader in fertility treatments and places a high value on having children for cultural, religious and demographic reasons. But only a fraction of women who go through IVF are willing or able to donate quality eggs to other women who want to conceive. It is estimated that some 3,000 women in Israel are waiting for egg donations.
"It began with the fact that there weren't enough," Balaban said. "But today, unfortunately, we have reached the situation where there are zero ova donations in Israel."
As chair of the Chen Patient Fertility Association in Holon, Balaban has helped spearhead a legislative proposal on ova donation that would allow, for the first time, women who are not undergoing fertility treatment themselves to donate ova for research and to other women who wish to conceive.
The proposal, which must pass three readings before becoming law, passed its first reading last year in the Israeli parliament. While a second reading has yet to be scheduled, discussions in the relevant committee have intensified in recent months.
"I think it's a very good proposal because it finally allows donations to be done in Israel with women who are dedicated donors, something that hasn't existed until now and something that does exist outside Israel," said Neri Laufer, professor and chair of obstetrics and gynecology at Hadassah University Hospital, Ein Kerem, in Jerusalem. "It fixes an imbalance in Israeli medicine."
But the legislation is running afoul of one of the oldest women's rights groups in the country, the Haifa-based Isha L'Isha (Woman to Woman) organization, founded in 1983.
The group says donations should be restricted to humane or altruistic impulses, such as kinship or compassion for someone who needs eggs, to reduce the risk of egg "trafficking."
"How many women would really be ready, today, out of philanthropy, without financial trouble or exploitation, to go through a painful and difficult process for someone she doesn't know at all?" asks Hedva Eyal, general coordinator for Isha L'Isha. "They will do it because of financial trouble or to help a friend or a relative."
Balaban's version limits payment to about $1,500 per donation cycle, which supporters say is reasonable compensation for the time and trouble of donating.
In the United States, women are allowed to donate eggs for research and fertility purposes in exchange for monetary compensation. Young women, who are solicited through college newspapers and through Internet sites like Craigslist.org, are often offered up to $10,000 to sell their eggs.
Nili Karako-Eyal, an Israeli law professor at Rishon LeZion's College of Management and the chair of a patient rights' organization, says while it is true that women do not need all of their ovum, there are still risks in the procedure that are fundamental.
Unlike Isha L'Isha, which completely opposes ovum donations for medical research in part because of these risks, Karako-Eyal doesn't mind "if someone who donates for fertility also decides that a portion would be used for research as long as it's not in exchange for money and as long as there exists a mechanism for close supervision."
The ethics committee of the American Society for Reproductive Medicine, based in Birmingham, Ala., found in a 2007 report that financial compensation of women donating eggs for infertility therapy is justified on ethical grounds but that total payments to donors of more than $5,000 require justification and sums above $10,000 are not appropriate.
Many other countries, including Canada, have banned the selling of women's eggs altogether. The British government, which had long banned the sale of eggs, announced last year that women undergoing fertility treatment can donate their eggs to medical research in exchange for about $500 plus travel and child-care costs.
Isha L'Isha also wants a Health Ministry-appointed committee to monitor donations.
Eyal says this boils down to a request for better supervision and the same kind of checks and balances that are required for organ donors to make sure there is no exploitation and that donors understand the risks.
Last year, a judge revoked the medical license of a gynecologist for two and a half years after he was convicted of removing large quantities of ova from women without their consent. The scandal, which first broke in 2000, sent shock waves throughout the fertility industry.
Due to the shortage, many Israeli women in need of ova travel abroad, often to poorer countries in Eastern Europe, and receive treatment there.
Researchers, too, say there is a need for ovum in the country for stem cell research.
Unlike donating sperm, ova extraction is a risky procedure since it involves full anesthesia and the possibility of hemorrhage and infection, says Isha L'Isha spokesperson Yahel Ash Kurlander. Women must undergo hormonal treatment before the process, which involves a risk of ovarian hyper-stimulation and could result in hospitalization and in very rare cases, death. Thus, Kurlander says, the amount of hormones given to a woman should be better regulated.
The group is also advocating for an independent donation center or an ova bank so that doctors who treat ova donors would not run into conflicts of interest by also treating women who require donations or conduct research requiring ova supply.
Balaban and other proponents argue that the proposed legislation has multiple safeguards in place to protect donors.
"The whole law, from beginning to end, especially protects the volunteer donor," Balaban said. The law says women cannot donate eggs more than three times in their lifetime to prevent exploitation and help minimize health risks.
It also would limit the number of women who receive the donated eggs per cycle to three, with each recipient paying about $500.
In addition, under the proposal, women who donate would be covered by a Israeli health plan and by malpractice insurance, she said.
According to the proposal, at least 51 percent of a woman's donated ova must go to fertility while no more than 49 percent can go to research.
Brenda Gazzar is a U.S. freelance journalist based in Jerusalem.
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