Brown ponders sale of women’s eggs for research

It’s a complex, emotionally loaded question: What kinds of women sell eggs to infertile couples in California?

For Carol Hogan of the California Catholic Conference, the answer is simple.

“Six-foot blondes with 4.0 GPA’s,” she says. But Hogan has a different picture of the women who might get paid to provide their eggs if Gov. Brown signs legislation to lift the ban on such compensation for research, as opposed to fertilization.

“Our concern is that this will be used as a recruiting tool for women who are desperately poor,” Hogan said, adding that, “there are no long-term studies about the repercussions of egg donation.”

The bill, AB 926 by Assemblymember Susan Bonilla, D-Concord, would remove California’s prohibition barring compensation for eggs donated for research purposes. The bill passed the Senate last week, 54-20, with only one Republican in favor and no Democrats against, after clearing the assembly in a similarly partisan vote two months ago.

It is major legislation that has received relatively little news coverage, but the debate on the issue has sparked an unusual lineup of partisans on both sides and resonates far beyond California.

On one side of the debate, women’s health, academic, and industry interests argue in favor of gender equality and research to improve women’s health.

On the other side, pro-life and some pro-choice groups debated the ethics of human embryonic stem cell research, potential for exploitation, and the health risks of egg donation.

“It’s very unusual in my opinion for California of all states to ban compensation because we’re so progressive,” Alice Crisci, a proponent of the bill, said. “We’re such a state that stands for equality, for gender equality, and yet we have the ban.”

Further complicating the issue is California’s role as a national leader in stem cell research, the existential question of who or what constitutes a research subject, and finally, the fact that compensation for fertility purposes is and has been legal for years in California.

“California’s sort of in a unique position nationally in terms of providing eggs,” said David Jensen, editor of the California Stem Cell Report, which tracks the voter-approved California Institute for Regenerative Medicine (CIRM).

All this wrapped into a bill that seeks to overturn a single provision of a 2006 bill and answer one question: Can California researchers compensate female egg donors?

The 2006 bill stemmed from the debate and concerns over egg donors’ health that surrounded a 2004 initiative that granted $3 billion for California stem cell research. The initiative — Proposition 71 — established the CIRM but included language prohibiting the controversial agency from compensating women for oocytes, which are egg cells.

Addressing the concerns over the effects of egg harvesting on women’s health, then-Sen. Deborah Ortiz, D-Sacramento, passed legislation, SB 1260, which included further protections for egg donors, such as a group that monitored stem cell research funded from sources other than CIRM and the ban on compensation that Bonilla’s bill would overturn.

Bonilla’s bill will only affect the ban in SB 1260, not the prohibitive language written into Prop. 71, capitol staffers said. However, CIRM itself will discuss a proposal to remove that ban on July 24.

“They’re dealing with basically the same sort of area because the stem cell agency is talking about easing its rules, so that its research could use lines derived from eggs provided by women who were paid,” Jensen said. “Obviously one of the things that stimulated a lot of interest in this is the development on cloning human stem cells in Oregon.”

In Oregon, he added, the research used oocytes that women received payment for providing. Though California is just one of three states that have such a ban, according to Capitol staffers, New York is the only state to explicitly permit the practice, when it passed legislation to do so in 2009.

“Forty-seven other states allow compensation,” Crisci said. “Those are the states where you see medical breakthroughs happening when it comes to using oocytes for research.”

California, Massachusetts, and South Dakota are the only three states with explicit bans. According to UC Davis Law School Professor Lisa Ikemoto, in South Dakota this kind of research is banned altogether, but in California and Massachusetts, states on the forefront of this area of science, the ban is significant.

“Because of our dedication to research here in California and the fact that we really do lead the way in our research universities and hospitals that there would be quite an impact,” Bonilla added. “We attract some of the most brilliant researchers to our state and facilitating their research is going to have a demonstrable impact.”

The issue becomes even more unique when one considers the nuanced arguments and atypical coupling of interests on each side.

Groups that fundamentally oppose stem cell research such as the California Catholic Conference and other pro-life groups are natural opponents of the bill, but they are joined by a number of pro-choice groups who expressed concerns over the limited research on the effects of egg donation on women’s health. Compensation for eggs given for fertility purposes is legal in California.

“To me it’s unconscionable that these things have been happening for 20 years,” said Diane Tober, associate executive director of the Center for Genetics and Society in Berkeley. “Women have had numerous complications and nobody has investigated what harms come to women.”

Jensen and Ikemoto pointed out that when couched in the issue of human fertility, egg donation has been less controversial, however.

“On the fertility side, it’s politically hard to touch because it’s all around family formation. Nobody wants to restrict family formation,” Ikemoto said. “On the research side, when the issue of payment for eggs came up, it was connected with human embryonic stem cell research, and human embryonic stem cell research was politicized from the outset.”

Because the bill would improve access to eggs for fertility research, it is backed by the fertility industry, with sponsorship from the American Society for Reproductive Medicine among others.

“By backing this bill the industry has told us that they need it to either maintain or improve their own businesses,” Jensen pointed out. “There’s nothing wrong with that, but let’s get it on the table, so we know exactly what’s going on.”

Meanwhile, other supporters have framed the bill primarily as a matter of gender equality, arguing that egg donation is one of the only categories of research participation that does not allow compensation, by contrast to sperm donations, for example.

For some proponents, like Crisci, the issues of fertility and reproduction remain more galvanizing. She preserved her eggs following a cancer diagnosis at age 31, in order to maintain her fertility, and she believes the reproductive research that might emerge from this bill would help women who face similar situations.

“We’re preventing science from happening,” Crisci said. “As a cancer survivor myself, there are particular studies that researchers I know can do to measure the true quality impact that chemotherapy has on our egg supply, which will then allow us to come up with better ways to do fertility preservation and also for women to be more informed in their decision making,”

But that issue of informed decision-making has been one of the major arguments against the bill. Pro-choice opponents of the bill, such as the Center for Genetics and Society in Berkeley argued that without a registry that tracks the health status of donors, there is no way to know what the effects of the process truly are, raising debate about the ethics of oocyte extraction for any purpose, Tober said.

In addition to the standard of informed consent, Tober and others argue that the bill would violate the requirement of human research that no compensation constitute undue influence, and that this bill would create a market that may exploit impoverished California women.

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That concern over paying women to provide such sensitive tissue was echoed by opposing legislators.

“This bill would create a market that runs opposite to the guidelines of the U.S. National Academy of Sciences and endangers the well-being of the women who choose to participate,” said Assemblymember Allan Mansour (R-74), who opposed the bill in committee and on the floor.

Even Bonilla pointed out the ethical dilemmas implicit in paying women money to provide eggs.

“There could very well be future legislation that would really look at the outrageous amounts of compensation on the fertility side and try to bring that in line with best practice and bring that in line with what we’re seeing globally in this whole area,” she said.

The market itself raises another host of complex issues regarding how much compensation is provided and what exactly that compensation is for:

“The more the amounts vary, the more it looks like you’re selling eggs,” Ikemoto said. “The explanation for allowing payment is you’re paying people for their time, energy, and the services that they’re providing, but the higher the amount is, and the more the amounts vary, the more it looks like you’re selling the eggs themselves, and you’re paying people by trait.”

Regardless, Bonilla and the bill’s supporters argue that without such a market, egg donors for research are nearly impossible to come by without such compensation. Jensen cited a Harvard study that demonstrated with $100,000 spent on outreach only one woman volunteered to donate eggs altruistically.

According to Ikemoto, though the National Academy of Sciences’ guidelines that are in opposition to compensation for research are significant, in any state that there is no explicit ban, it is legal to compensate women for providing eggs.

The debate is complicated and filled with gray areas. Between questions of gender and economic equality, the morality of stem cell research, the ideological debates over women’s autonomy, and many other economic, legal, and ethical issues, the bill sent to Brown’s desk is anything but black and white. Researchers, donors and the public need a roadmap.

“What science needs is explicit permission,” Jensen said of the limitations of such de facto legality. “They don’t want to go into gray areas.”