Ethical questions complicate the recruitment of egg donors

Recruiting women to donate eggs for stem cell research brings scientists into new ethical territory where the standards are still being worked out, ethicists say.

Women who donate eggs have to take drugs and undergo minor surgery. This puts them at risk for side effects, yet there is no immediate benefit to them or anyone else -- an uneasy and probably unprecedented combination.

People volunteer to be a part of other types of research that promise them no benefit, but the risks are negligible.

On the other hand, there are many patients who volunteer for research that poses real risks, such as studies of experimental drugs, but this is offset by the immediate possibility that they might be helped. And living kidney and liver donors face risks, but with the immediate benefit of helping the person who needs the organ transplant.

Today, fertility clinics routinely recruit women to donate eggs, but the eggs are used to help other women become pregnant, and there is a reasonable chance of success. In contrast, the chances of success for cloning human embryonic stem cells are unknown, creating a quandary for ethicists and society: How much risk should a woman be allowed to take in the name of research when the benefit is unclear?

``This is really something that is unique," said George Annas , chairman of the Department of Health Law, Bioethics, and Human Rights at the Boston University School of Public Health. ``We are just developing rules about it now."

Egg donation is a common procedure. Every year, US fertility clinics make about 13,000 attempts to help a woman become pregnant using donated eggs, according to the American Society for Reproductive Medicine . To obtain the eggs, a woman is given drugs to stimulate her ovaries. A different drug then causes the eggs to finish maturing and release.

These eggs are collected from the ovaries by passing a needle through the vaginal wall. The outpatient procedure takes about 10 minutes and is done under general anesthesia, according to Douglas Powers , the scientific director of Boston IVF, which will handle the egg extraction for one of the Harvard teams.

Egg donors, like women who are undergoing fertility treatment, are at risk for a condition called ovarian hyperstimulation syndrome, a complication from the drugs. It can require hospitalization and may be life-threatening. Severe cases occur in about 1 percent of women who have their ovaries stimulated, according to a 2002 survey published in the journal Human Reproduction Update.

The risk of hyperstimulation, however, can be sharply reduced in women who are donating eggs for research, said Dr. William Gibbons, president of the Society for Assisted Reproductive Technology. Women receiving ovarian stimulation drugs are closely monitored, and doctors see estrogen levels in the blood climb much faster in women who are at risk for developing the syndrome.

Women trying to have children will generally accept this risk, but if this happens in women donating eggs for research, the doctors can withhold the drug that causes the ovaries to release the eggs. Without this drug, Gibbons said, the risk of the syndrome is small.

The Harvard protocol requires that the estrogen level be kept fairly low and that the cycle be stopped if it goes higher, Powers said.

A final risk is not as well understood: the potential long-term side effects of fertility drugs.

The drugs have not been studied well enough, and so there is no way to adequately inform women of the risks they face, said Marcy Darnovsky , associate executive director of the Center for Genetics and Society, a liberal organization in California that supports stem cell research, but wants more attention paid to its implications for egg donors.

Further complicating the complex debate over egg donation is the possibility that cloning could be done without putting women at any risk.

During fertility treatment, doctors find immature eggs among the ones they gather from patients.

Usually, these are discarded, but it may be possible to mature them in a laboratory dish, and then use these eggs for cloning.

Another possibility, scientists suggested, is to use eggs from rabbits. The resulting stem cells could not be used as a therapy, but they could still be valuable for research.

GARETH COOK