HIgher Egg Donor Payments, a New PGD Technique, and Giuliana Rancic

Lots of interesting reproductive news this week. Here are a few of the stories making headlines:

In Britain, the regulatory body tasked with overseeing assisted reproduction has agreed to raise egg-donor compensation, from a former level of £250 (plus expenses) to £750. The Human Fertilisation and Embryology Authority (HFEA) wanted to strike a balance between fair compensation for women, who undergo significant medical procedures to donate eggs and take on the risks associated with high doses of fertility drugs and minor surgery, and keeping payments low enough to ensure that women will donate for altruistic and not monetary reasons. This change has several implications. First, low egg-donor compensation has been a driving force in bringing British women to American clinics for IVF treatment, because here they can access a much larger pool of egg donors. It will be interesting to see whether this change influences this type of fertility tourism. Second, the change highlights the muddled relationship among gamete donation, altruism, and compensation. There seems to be much more discomfort around the altruism/compensation relationship for egg donors than for sperm donors. Last week, I wrote about a study showing that egg donors more often cite altruism as their motivation, while sperm donors cite compensation. Men who donate sperm, including the "super-spawners" who have made headlines recently, have obvious financial motives for their donations. When was the last time you heard a sperm donor say, "I just want to make a couple's dreams come true?" But clearly, compensation is also a significant factor influencing egg donors; I don't think American women are more altruistic than British women. They are just paid a lot more. Yet we're much less comfortable with the idea that women would donate eggs for money. Perhaps because the risks are so much greater for egg donors than sperm donors, so it's obvious that women are risking their health to pay their college tuition. Perhaps because we expect women to be more empathetic and selfless than men. Probably a little bit of both.

A New Jersey fertility clinic has released results of a study showing that preimplantation genetic diagnosis (PGD) is much more likely to lead to successful conception if the embryo is biopsied on day 5 after fertilization, rather than day 3. In PGD, embryos are usually biopsied on day 3 after fertilization, when the zygote consists of 6 to 8 cells. Clinicians remove one or two cells from the fertilized egg and test those cells for whatever genetic mutation the parents are testing for. By day 5, the fertilized egg (called a blastocyst now) consists of several hundred cells. So when the biopsy occurs at this stage, a far smaller percentage of cells is removed. The New Jersey clinic compared pregnancy results of day 3 vs. day 5 biopsies, and found a higher pregnancy rate for day 5 biopsies. When I did PGD, our biopsies took place on day 3, and this is still the most common method in fertility clinics worldwide.

Finally, E! News anchor Giuliana Rancic (married to the first-ever Apprentice winner Bill Rancic) has publicly shared her struggles with infertility, miscarriage, and IVF. Now, she has announced that testing required for her next round of IVF treatment revealed that she has a treatable form of breast cancer. (I could not find an article identifying the exact type of cancer, but from the treatment plan—surgery followed by six weeks of radiation—it sounds like she likely has DCIS, which is the cancer I had last year.) In the wake of this news, medical experts have stressed that "based on the best evidence, there is no clear link has been between IVF and breast cancer." This reminded me of the film Eggsploitation, which I reviewed after watching it with some friends last spring. The film, which makes a case for more research into the long-term health consequences of egg donation, implies a direct causal link between fertility treatments and cancer. The film announces in grave tones that one egg donor died of colon cancer (the narrator doesn't say the treatment caused the cancer, but by including that information, the filmmakers apparently hoped to make us think it did). In another scene, an egg-donor tells us that she is sure her breast cancer resulted from her egg-donation experience, because she had no family history of breast cancer. Well, neither do the majority of women who get breast cancer. And just because a patient is sure she knows the reason for her ailment doesn't make her opinion fact. While I heartily support the need for additional research into the long-term health effects of fertility treatment, both for patients and donors, it's important that we advocate for quality science rather than falling back on junk science. So while I'm a little weary of Giuliana Rancic's name showing up in my Google "in vitro fertilization" alerts day after day, I'm glad that her announcement is setting the record straight on the current state of research into the cancer/fertility treatment link. It's certainly possible that future research will reveal such a link, but for now, the evidence just isn't there.