Stem Cell

Introduction

This report investigates the ethical issues surrounding the participants of egg harvesting for the purpose of stem-cell research. Egg-harvesting for the purpose of stem-cell research is a growing international industry and the process involved often results in the health of donors placed at risk. Currently, thousands of women donate their eggs each year (Kalfoglou & Gittlesohn 2000). The procedure involves a number of weeks of daily hormonal injections which initially 'shut down' and then 'hyperstimulate' the woman's ovaries. This is followed by the surgical extraction of multiple eggs. The participants' eggs are then used by technicians to clone embryos which can be used for the purpose of stem-cell research (Galpern 2006) Such manipulation of the normal bodily functions coupled with the invasive procedure of egg extraction has raised ethical controversy worldwide.

This report examines the key contributing factors which place participants at risk during the process of egg-harvesting for stem-cell research, the results of this and possible solutions or recommendations for this growing dilemma.

Discussion of the Issue

There is an increasing concern regarding conflict of interest between researchers and participants which may contribute to exploitation of women. The Woo Suk Hwang case of Korea demonstrates the extent to which researchers are motivated to expand their research through paying donors, using oocytes from his team of junior scientists and lying to the world about how the oocytes were obtained (Steinbrook 2006). In addition, the degree to which participants are informed regarding procedures may result in women undergoing treatment without a sufficient understanding of the process and risks involved. This is due to the use of ambiguous language with the task of understanding the consent forms and the process becoming unnecessarily difficult (Beeson & Lippman 2006). Also, exposure to powerful hormonal drugs is an obligatory part of the process of egg harvesting with the aim being the manipulation of the body in order to produce multiple eggs as it is better to have more eggs for research (Norsigian 2005). Currently, there is worldwide uncertainty surrounding the effects of the used drugs and procedures involved in egg harvesting (Mertes & Pennings 2007).

The main contributing factors which place participants at risk are:

1. Conflict of interest between researchers and participants

Various studies (Mertes & Pennings 2007; Kalfoglou & Gittelsohn 2000; Beeson & Lippman 2006) suggest that science and women's welfare are conflicting to the extent of incompatibility, with researchers facing the choice of exploitation of women for the advancement of research or slowing down research progress. According to Kalfoglou & Gittelsohn (2000), donors were concerned that 'their best interest was not a primary concern of the medical staff. At least three women mentioned that they thought they were kept on hormones longer than necessary just to produce more eggs.

The betrayal of trust between researchers and subjects is most clearly reflected in the 2005 Woo Suk Hwang case (Steinbrook 2006). 'Between November 2002 and November 2005, Hwang worked with 2061 eggs from 129 women' (Steinbrook 2006). Like many other researchers, Hwang may have been struck by the need for a medical breakthrough and advancements. According to Steinbrook (2004), the need to maximise the number of eggs extracted from the donor places pressure on health care providers to hyperstimulate the ovaries. This no doubt increases the chances of advancing research; however, it also places the well-being and position of donors as second grade to research.

2.  Insufficient or misleading information regarding the egg-harvesting procedure.

Egg harvesting participants face the dilemma of being ill informed about the process of donation and signing informed consent forms packed with misleading and scientific jargon which may leave them baffled (Beeson & Lippman 2006). Beeson & Lippman (2006) also state that the focus is put on promises of imminent 'cures' for diseases. Women who are thus concerned about their loved ones who may have serious health issues are more inclined to participate in egg donation.

Steinbrook's (2004) study of informed consent from donors regarding the egg harvesting procedure found that serious omissions are made in the process. Thus, donors are not always prepared for the procedure ahead, with insufficient knowledge of 'how strenuous donation will be, or how much time it will take' (Steinbrook 2004, p.262). In a recent survey conducted (McMahon, Gibson, Leslie, Saunders, Porter & Tennant 2003) it was found that none of the respondents who participated in the given questionnaire had sought any form of counselling or guidance regarding the decision posed. As a result, participants may have a vague idea of what is involved and the future implications. Steinbrook (2004) further reasserts that donors may be unaware of the medical complications which may arise from the treatment as well as who would pay for these expenses. Therefore, subjects frequently place themselves at risk, benefiting others but not themselves (Steinbrook 2006).

3. Exposure to hormonal treatments and lack of follow-up research based on long term effects

The process of egg-harvesting involves a two step procedure whereby many clinical visits are required, multiple injections of hormones, and minor surgery at the least (Beeson and Lippman 2006). The first stage is ovarian suppression and the second involves ovarian stimulation - both require the use of powerful hormones and other drugs to manipulate a woman's body into producing multiple eggs rather than the one egg which is produced naturally each cycle (Beeson and Lippman 2006). The mature eggs are then surgically extracted for use in research or IVF. It is important to note that although short term effects of hormonal therapies have been documented, inadequate follow up results in a lack of understanding of the long term risks posed to participants (Beeson & Lippman 2006).  

In a study (Kalfoglou & Gittelsohn 2000) conducted on the experiences of women undergoing hormonal treatment, 27% of women were suspected to have experienced hyperstimulation syndrome with the remaining participants reporting non-life threatening side-effects. Moreover, 'most participants reported little to no concern about their long-term well-being' (Kalfoglou & Gittelsohn 2000) with their concerns being merely passing thoughts and not considered a dilemma. In contrast to the former study which places the focus on the view of participants regarding their well-being, Beeson & Lippman (2006) emphasis the lack of conclusive studies regarding the long-term effects on subjects. There are conflicting conclusions which suggest that their may be a possible association between hormonal treatment and uterine cancer, breast cancer and ovarian cancer (Beeson & Lippman 2006). The data based on the effects are sorely lacking; therefore, before more women are exposed to hormonal treatments, the implications of ovarian stimulation should be answered (Beeson & Lippman 2006).