Making babies, pushing the limits: the great Greek fertility market

No universal guidelines

The science of assisted reproduction is still in its infancy – we are far from solving the infertility conundrum – but it is already generating scenarios that were once the preserve of science fiction. The ethical debate that accompanies it tends to involve variations of the same question: should a certain procedure be performed simply because it can be performed and because there is a demand for it? And if not, where to draw the line? To what extent should parents be allowed to “modify” their child’s genes by screening for the embryo? Does everyone have the right to have a baby? And should we try to meet the demand for babies by paying for the eggs or uteri necessary for their creation?

Regional differences in the answer to these questions have created an international market for fertility treatments. Websites promoting Greece as an IVF destination boast of procedures such as surrogacy and egg and embryo donation for single women and couples. Many procedures are prohibited or prohibitively expensive in much of Europe, but are facilitated in Greece by liberal laws.

International demand for these procedures has helped Greece’s fertility sector, dominated by private clinics, become the driving force behind a medical tourism industry worth hundreds of millions of euros. The industry’s demand for egg donation is being met by the ranks of anonymous donors like Lina and Violeta, some of whom are motivated by financial need.

Like blood as well as kidneys and other organs, eggs are not intended for sale. Greek law says that eggs can only be donated for altruistic reasons, in accordance with ethical guidelines observed more or less around the world. In practice, however, women often donate for monetary reasons, tempted by the only form of payment clinics are allowed to make – “compensation” for lost income and the stress of the procedure. The payment is capped at 1,500 euros, which can represent around two months’ salary for low-income women.

Every time Lina gave her eggs, she received 1,200 euros from the clinic. She kept 1,000 euros for herself and diligently handed over 200 euros in commission to the Scout who had organized the donation. While the scout had explained the procedure to her beforehand, Lina says she received no information from the clinic about the potential health risks and side effects. She went ahead anyway, “softened by the 1,000 euros”.

Lina’s friend Violeta said she would no longer give, even though she still needed the money. “I didn’t have such a good experience the second time around,” she said. “I thought I was going to die. For Lina, too, what had seemed like a good idea in her twenties is less so now. “I’m done with this thing,” she said. “I blew the money anyway.”

The risk of serious health complications for women undergoing fertility treatment is usually low and gradually decreases. Hormonal therapies are increasingly sophisticated and diets will often be tailored to individuals. Clinics also run regular tests to make sure the ovaries aren’t at risk of over-stimulation – the likely cause of Violeta’s condition. But while fertility treatment is undoubtedly becoming safer, much remains unknown about its long-term effects.

“There is some concern that every time a donor undergoes another cycle, she puts herself at a medical risk,” said Diane Tober, medical anthropologist and assistant professor at the University of California at San Francisco who has researched the fertility industry. “Without long-term studies, no one knows to what extent donors can experience long-term complications. “

There’s a doctor who has decent donors, normal girls next door. I pay this doctor more than the others… because only half of this work is medical work. The other half is shitty work…. Another doctor only has Georgian women… I am not a racist but these women are victims of prostitution, so I will not take care of him.

– “Christina”, senior employee in an IVF clinic

There are also questions about the extent to which artificial stimulation of egg production could lead, over time, to a reduction in their quality, which could influence a woman’s chances of conceiving later in her life. life. Any procedure about which so much is unknown requires informed consent. But as Lina’s experience suggests, she isn’t always wanted.

Uncertainty about the long-term impact of fertility treatment on a woman’s health and on the quality of her genetic material, underpins one of the main arguments in favor of stricter regulation of donation. of ova. The benefits of donation will outweigh the potential costs, the argument goes, as long as clear limits are set on the number of times a woman undergoes the donation procedure and on the number of eggs harvested in each cycle. Don.

Another argument for stricter regulation stems from concerns about the long-term health of the general population. As the donation of genetic material tends to be done anonymously, it creates a risk of inadvertent inbreeding among adult half-siblings who share a biological parent. To minimize this risk, many countries set limits on the number of children born from genetic material donated by an individual.

According to the European Society of Human Reproduction and Embryology, ESHRE, a Brussels-based NGO that advocates for reproductive medicine, there are “no universal guidelines”. Each country sets its own limits, an ESHRE spokesperson said in an email to BIRN, with some choosing to restrict the number of times a woman can “undergo the donation procedure” while others “Only care about the number of babies born”.

Greek law does not set limits on the number of times a woman undergoes fertility treatment to donate her eggs, nor on the number of donated eggs that are collected and fertilized in each treatment cycle. These decisions are left to the discretion of each clinic. Greek law only states that no more than 10 babies must be born from a single donor – a somewhat arbitrary number believed to minimize the risk of inbreeding among the population.

In practice, however, compliance with the ten baby limit – the only limit required by law – is also left to the discretion of individual clinics. It cannot be verified because there is no mechanism for monitoring clinics. The regulator has not been able to function effectively, while the central donor registry – the only way to track the number of babies born from a person’s genetic material – was created just two years ago. .

Without anyone monitoring their books, unscrupulous clinics have been free to push ethical boundaries, ignoring legal boundaries in search of profit. “Many donors have donated too many eggs without any supervision,” said Katerina Fountedaki, former vice-president of the Greek National Authority for Assisted Human Reproduction, the regulatory body that was supposed to maintain the registry. In the relatively sparsely populated areas of Greece, she added, there were “serious concerns that many children would be born with the same. [biological] mother, with the risk of incest that this entails.

“Do you really mean it?… Alright, so I formed four football teams, plus substitutes. “

– “Lina”, on the prospect of having up to 50 biological descendants

In the absence of a central registry, a fertility clinic faces an unenviable task if it wishes to comply with the law limiting the number of babies per donor. In theory, the conscientious clinic worker will ask a potential donor if she has had egg retrieval at other clinics. The donor, who will not know how many babies were born from her eggs, will provide a list of other clinics. The employee will then contact these clinics to compile a count of the number of children born to this donor, ensuring that any further embryos created with her eggs remain within the limit.

In practice, however, a clinic faced with a huge demand for eggs may simply not do too much research into the donor’s past. If this is the case, the donor may, for various reasons, not disclose all prior procedures. And if the donor provides an accurate disclosure, previous clinics may not have kept records of the number of babies born or – if the law had ever been broken – may choose not to share that record.

“We cannot know if the donor also went elsewhere,” said Christina, a senior worker at a reputable clinic, who spoke on condition that her real name was not disclosed. “And maybe there isn’t any trace of it because not everyone keeps track of it. It doesn’t have to be because they necessarily want to hide something. It could also be due to a lack. time, organization, etc. The truth is, she said, investigating records from other clinics is “a huge problem and will put you in conflict with a lot of people.”

Christina describes a case where her clinic discovered that a woman who had just donated her eggs had already exceeded the allowable number of births. Doctors and clients were furious that valuable genetic material had to be destroyed due to ethical breaches. “We threw dozens of eggs,” she told BIRN. “It was a mess, you can’t imagine what happened. If you had seen it, you would cry.

Lina has no idea how many eggs are harvested from her body over five cycles of treatment, or how many viable embryos have formed and possibly babies. He was only assured that his ovaries were productive. Experts say productive ovaries can produce anywhere from 10 to 40 eggs per cycle, depending on factors such as the hormonal regimen administered and the donor’s biology. If an average of 10 eggs were fertilized per cycle, a generous estimate, Lina could have had as many as 50 biological children by now – a possibility she hadn’t considered until her conversation with BIRN. “Do you really mean that?” she said smiling. “Very good, I formed four football teams at the time, plus substitutes.”

International fertility hub

It is believed that some 200,000 babies give birth each year in Europe using procedures such as IVF. As population growth rates decline in the wealthier parts of the world, with more and more people choosing to start families later in life, if at all, assisted reproduction has been hailed as a technological solution to a socio-economic conundrum. But the technology is far from perfect, and many causes of reproductive difficulties in men and women remain a mystery. Embryos created by IVF tend to have a high failure rate, which places a huge financial and emotional burden on those seeking treatment.

The high failure rate contributes to the demand for healthy eggs, which many Greek clinics try to meet by using the same donors more often than recommended. “While I can’t excuse it,” said Christina, senior director of the reputable IVF clinic, “the demand is so intense that I can understand why various clinics don’t even claim to follow the rules and keep recycling them. same people. “