The debate about stem cell research has focused for years on
the moral status of the human embryo, largely overlooking the
welfare of women who will provide eggs to produce those embryos.
But that situation is changing. The recent revelations about
ethical breaches in obtaining eggs for research in Korea have
brought attention to the implications for women's health and
the potential commodification of their eggs.
The current controversy surrounds Hwang Woo-suk, the South
Korean researcher who achieved celebrity status after creating
the world's first cloned human embryos in 2004. Last month,
Hwang announced the establishment of the World Stem Cell Foundation
with great fanfare, accompanied by high international interest.
Last week, however, Hwang resigned from his position as head
of the foundation after admitting that his lab had received
eggs both from women who had been paid and from two junior researchers
on his team.
Under widely accepted international guidelines, scientists
do not conduct research on human subjects who are in a dependent
relationship with them, in order to avoid exploitation. While
Hwang did not break any laws in using eggs from junior researchers
on his team, he clearly violated international standards. In
addition, Hwang subsequently denied the source of the eggs when
asked about this by journalists and other researchers.
The procurement of eggs for Hwang's cloning research has been
further clouded by the admission that a key member of his team,
Roh Sung-il, paid women the equivalent of $1,400 out of his
own pocket for their eggs. Korean television broadcast interviews
with three of the women who provided eggs. All three said they
had been in dire financial situations, and two stated they had
not been informed about the potential risks posed by the egg
retrieval process. Roh's admission came one week after he
conceded to knowingly using illegally traded eggs to perform
artificial insemination for infertile couples. Ten women and
four egg brokers were arrested in that controversy for violating
a new South Korean law that prohibits commercial trade in eggs
or sperm and carries a fine of several years in prison.
Just before the flurry of exposures in mid-November, cloning
researcher Gerald Schatten of the University of Pittsburgh abruptly
withdrew from a twenty-month partnership with Hwang. Schatten
said he had received new information that led him to realize
that Hwang had improperly obtained eggs for research.
The charges of ethical and legal violations bring attention
to the significant risks of the drugs and procedures used for
egg extraction, and to the prospect of creating a market for
human eggs that may induce young and low-income women to subject
themselves to those risks in return for payment. Many observers
saw the World Stem Cell Foundation as an effort to make an end
run around the laws that South Korea and some other countries--though
not the United States--have put in place to regulate stem cell
The World Stem Cell Foundation had been set to begin recruiting
women to provide fresh eggs for its work through the San Francisco-based
Pacific Fertility Center. After learning of the ethical breaches,
PFC backed out of the deal. "With Dr. Schatten's withdrawal,
it is impossible for us to establish the ethics of the whole
thing," said PFC medical director Philip Chenette.
The current situation in South Korea is emblematic of unresolved
issues surrounding egg extraction wherever it is practiced.
Some women's health advocates and public-interest groups have
been raising concerns about the potential for exploitation of
young or low-income women if researchers offer payments for
eggs. Last April, a committee set up by the National Academies
of Sciences agreed, and recommended that payments be limited
to reimbursement for direct expenses like transportation and
Although egg extraction is widespread in the assisted reproduction
field, it is not regulated in the United States because fertility
clinics operate as private commercial ventures. For much the
same reason, the risks this procedure poses for women have not
been well studied or widely discussed--though it is well-known
that serious adverse reactions can occur and that the drugs
used for egg extraction have caused at least two deaths.
Egg extraction for research will take place in an environment
of overheated expectations for medical breakthroughs, growing
commercial and political pressures for early stem cell results
and little oversight. Recognizing these dangers, California
State Senators Deborah Ortiz (D-Sacramento) and George Runner
(R-Lancaster) authored a bill that offered some protections
for egg providers. It was passed by overwhelming majorities
in both of the state's legislative chambers but was vetoed in
October by Governor Arnold Schwarzenegger.
Until recently, all embryonic stem cells were produced from
embryos created but not used during in vitro fertilization procedures.
The World Stem Cell Foundation was set to focus instead on stem
cells derived from embryos produced by research cloning or somatic
cell nuclear transfer (SCNT). A number of countries with active
stem cell research programs, including Canada, have decided
not to pursue SCNT for now because of concerns about the well-being
of women and the commodification of human eggs.
Many stem cell researchers have promoted SCNT, which involves
merging adult cells with eggs whose nuclei have been removed,
as a way to produce individually tailored therapies--a "personal
biological repair kit," as Ronald Reagan Jr. described
it in a speech at the 2004 Democratic National Convention. But
this approach to stem cell treatments would likely be very costly--a
bill that Medicaid, and for that matter most health insurers,
would not readily pick up. It would also require a vast number
of women's eggs.
More modest scenarios envision SCNT as a way to produce stem
cell models of specific genetic disorders for investigation
and drug testing. Researchers have not publicly estimated how
many eggs they would need for these purposes.
In order to provide eggs, women typically undergo hormonal
treatments that first "shut down" and then "hyperstimulate"
their ovaries. Surgical extraction of multiple eggs follows.
This is a time-consuming and invasive process associated with
potentially serious and occasionally life-threatening health
problems. Estimates of the number of women taking fertility
drugs who develop severe forms of a condition known as Ovarian
Hyperstimulation Syndrome (OHSS) range from 1 percent to 10
percent; the wide variation is another sign that more study
of OHSS is urgently needed. In rare cases, OHSS can be fatal.
In the UK, reports of two OHSS deaths have surfaced in the
past six months. Twenty-nine-year-old Jackie Rushton died in
June after undergoing hormonal treatment for in vitro fertilization.
Her mother, Angela Hickey, told BBC News online, "Jackie
was given a booklet that mentioned OHSS, but she thought it
was so rare that she did not take much notice of it. Some people
do not have any problems, and a percentage are very successful
and have babies. But I would not want this to happen to anyone
If stem cell research of the sort that requires large numbers
of women's eggs begins in the United States, will the absence
of any regulation regarding egg provision put women's health
in danger? Will women who provide the eggs be adequately informed
about the risks to which they're agreeing? Will they receive
medical care if they experience any adverse reactions? This
is a particularly pressing question when OHSS develops, since
it can often be reversed with prompt medical treatment.
And who would cover the costs? Will some egg donors suffering
side effects delay seeking medical care, especially those who
are uninsured or whose medical insurance doesn't cover experimental
procedures? Unfortunately, this vital question has yet to be
addressed by stem cell researchers, policy makers or media reports.
Women whose eggs are used for research are the first guinea
pigs of scientists using human cloning techniques for stem cell
research. The recent developments in South Korea illustrate
dramatically that international ethics standards are insufficient
for preventing misconduct, coercion and commercialization. In
the United States, no regulation of stem cell research exists,
allowing great potential for women to be exploited for their
eggs. The focus in the United States on the moral status of
embryos has simplified the complex issues of stem cell research
and left women's health out of the debate. We need to look beyond
the politics of embryos and focus attention on the well-being
of women, conducting this important research with integrity.
Emily Galpern, MPH, is Project Director on Reproductive Health
and Human Rights for the Center for Genetics and Society.
Marcy Darnovsky, PhD, is Associate Executive Director of
the Center for Genetics and Society.
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