Ahuja K K, Simons E G, Fiamanya W, Dalton M, Armar N A, Kirkpatrick P, Sharp S, Arian-Schad M, Seaton A, Watters W J
Cromwell IVF and Fertility Centre, Cromwell Hospital, London SW5 0TU, UK.
Hum Reprod. 1996 May;11(5):1126-31. doi: 10.1093/oxfordjournals.humrep.a019310.
The present acute shortage of eggs for donation cannot be overcome unless adequate guidelines are set to alleviate the anxieties regarding payments, in cash or kind, to donors. The current Human Fertilisation and Embryology Authority (HFEA) guidelines do not allow direct payment to donors but accept the provision of lower cost or free in vitro fertilization (IVF) treatment to women in recognition of oocyte donation to anonymous recipients. Egg-sharing achieved in this way enables two infertile couples to benefit from a single surgical procedure. However, the practical guidelines related to this approach are ill-defined at the present time leading to some justifiable uncertainty. A pilot study was therefore undertaken in order to establish the place of egg-sharing in an assisted conception programme. The current HFEA guidelines on medical screening of patients, counselling, age and rigid anonymity between the donor and recipient were followed. The study involved 55 women (25 donors and 30 recipients) in 73 treatment cycles involving fresh and frozen-thawed embryos. Donors were previous IVF patients who, regardless of their ability to pay, shared their eggs equally with matched anonymous recipients. They paid only for their consultations and tests right up to the point of being matched with a recipient. The sole recipient paid the cost applicable in egg donation of a single egg collection, although both received embryo transfers. The results indicate that although the recipients were older than the donors (41.4 +/- 0.9 versus 31.6 +/- 0.5 years), and there was no difference in the mean number of eggs allocated, the percentage fertilization rates, or the mean number of embryos transferred, there were more births per patient amongst recipients than amongst donors (30 versus 20%). We conclude that providing the donors are selected carefully, this scheme whereby a sub-fertile donor helps a sub-fertile recipient is a very constructive way of solving the problem of the shortage of eggs for donation. There are also the advantages of including a group of women who would otherwise be denied treatment. Problems related to 'patient coercion' can, in our view, be fully overcome by the application of strict common-sense safeguards. The ideal of pure altruism is not without its medical and moral risk. The success of egg-sharing depends on shared interests and a degree of altruism between the donor, the recipient and the centre. The current HFEA guidelines should be applauded for enabling a highly effective concept of mutual help to develop.
除非制定适当的指导方针来缓解捐赠者对现金或实物报酬的担忧，否则目前卵子捐赠严重短缺的问题将无法得到解决。目前的人类受精与胚胎学管理局（HFEA）指导方针不允许直接向捐赠者支付报酬，但认可为女性提供低成本或免费的体外受精（IVF）治疗，以表彰她们向匿名受者捐赠卵母细胞。通过这种方式实现的卵子共享使两对不孕夫妇能够从单次外科手术中受益。然而，目前与这种方法相关的实际指导方针并不明确，导致了一些合理的不确定性。因此，开展了一项试点研究，以确定卵子共享在辅助受孕计划中的地位。遵循了HFEA目前关于患者医学筛查、咨询、年龄以及捐赠者与受者之间严格匿名的指导方针。该研究涉及55名女性（25名捐赠者和30名受者），共进行了73个涉及新鲜胚胎和冻融胚胎的治疗周期。捐赠者以前都是IVF患者，无论其支付能力如何，她们都与匹配的匿名受者平等分享卵子。她们仅支付直至与受者匹配之前的咨询和检查费用。唯一的受者支付单次取卵的卵子捐赠适用费用，尽管两人都接受胚胎移植。结果表明，尽管受者比捐赠者年龄大（41.4±0.9岁对31.6±0.5岁），且分配的平均卵子数量、受精率百分比或移植的平均胚胎数量没有差异，但受者中每位患者的出生率高于捐赠者（30%对20%）。我们得出结论，只要仔细挑选捐赠者，这种由生育能力低下的捐赠者帮助生育能力低下的受者的方案是解决卵子捐赠短缺问题的一种非常有建设性的方式。这也有好处，即纳入了一群原本会被拒绝治疗的女性。我们认为，通过应用严格的常识性保障措施，可以完全克服与“患者胁迫”相关的问题。纯粹利他主义的理想并非没有医学和道德风险。卵子共享的成功取决于捐赠者、受者和中心之间的共同利益和一定程度的利他主义。目前的HFEA指导方针促成了一种高效互助理念的发展，值得称赞。
