Law professor’s research sheds light on under-regulated fertility industry
In her research, professor Katie Hammond found issues with informed consent and coercive tactics at private fertility clinics. Photo from Unsplash.
As more people access fertility services in their journeys to becoming parents, Toronto Metropolitan University professor Katie Hammond says the Canadian fertility industry is in need of greater oversight.
A professor at the Lincoln Alexander School of Law, Hammond’s latest research explores the treatment of egg donors at private fertility clinics. She interviewed 14 egg donors about their medical care before and after egg retrieval procedures. What she found is alarming: the treatment of many of the donors was in direct contrast to the Canadian Medical Association’s (CMA) Code of Ethics.
“The research raises some really big concerns about the way that egg donors are being treated by the fertility clinics,” said Hammond. “There was a lot of imagery and wording related to farm animals, donors calling themselves cattle or cows. Donors felt like they were treated badly by the clinics and were just a means to provide as many eggs as possible for the intended parents.”
Hammond found the majority of donors felt inadequately informed about what egg provision truly involved. For example, risks and side effects weren’t always explained in a way donors could understand, risks were downplayed and physicians didn’t consistently tell egg donors about the lack of long-term data on egg provision.
In particular, donors felt they were uninformed about the risk of ovarian hyperstimulation syndrome (OHSS), which can occur when donors take hormone medications to stimulate the development of eggs. Some donors felt the risk of getting OHSS was presented as rarer than it is, while others were uninformed about the side effect and did not know to watch for symptoms. As a result, one of the donors who experienced OHSS had to be hospitalized.
According to Hammond, the clinics did not appear to help their patients assess the risks of egg retrieval procedures. This ultimately affected egg donors’ ability to provide informed consent, a key aspect of the CMA’s Code of Ethics. The lack of information provided also meant the clinics’ treatment of donors was contrary to the goal of the Assisted Human Reproduction Act (AHRA), which aims for informed consent to be a fundamental condition of assisted reproductive technologies.
Hammond also found some fertility clinics engaged in practices that were not in the best interest of their patients. These included stimulating donors to produce larger than needed quantities of eggs and soliciting additional egg donations from former patients. One woman in the study provided eggs 15 or 16 times, well above the Canadian Fertility and Andrology Society’s recommendation for no more than six retrievals.
“There's a certain coercive element to that,” says Hammond. “There has always been this focus on money being the thing that coerces someone into donating eggs. Not enough attention has been paid to situations where a sibling or a friend asks you, or a clinic calls you for donations. There can be a coercive element to that too.”
Greater oversight needed
Much of Canada’s fertility and assisted reproduction industry falls under private health care, with hopeful intended parents spending tens of thousands of dollars at clinics. While there is significant money to be made in the industry, there is little legal oversight to ensure the protection and care of patients.
Hammond says the federal AHRA does not include legislation regarding the care of people using assisted reproductive services. While the CMA and the Canadian Fertility and Andrology Society offer guidelines that all physicians should adhere to, there is little recourse for patients if guidelines are not followed. This leaves regulating the fertility industry to self-regulating bodies such as provincial colleges of physicians.
“This conversation about payment for donors has occupied so much space that we've overlooked people's experiences with the clinics,” said Hammond. “We've failed to see that medical care is one of the things that is a top concern for egg donors. Intended parents are also concerned with their egg donor being well-cared for.”
Hammond recommends provincial physician colleges create practice guides related to assisted reproduction, which would open an avenue for patients to file complaints if they are mistreated. She also recommends colleges develop informed consent rules specifically for assisted reproduction procedures.
Read The Business of Egg Transactions and Need for Improved Regulation of the Fertility Industry in Canada (external link) in Alberta Law Review.
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