Giving oocytes to women in need: permitted, forbidden, or pressured? A commentary

This is a commentary on http://www.ijhpr.org/content/1/1/15/ webciteThe paper by Shalev and Werner-Felmayer [1] highlights the different approaches in assisted reproduction (ART) in Israel and Austria, and focuses on some of the ethical problems encountered when egg donor recruitment is performed on a purely market basis, treating eggs as a commodity, and not as a precious cell given by generous women to help others.Interestingly, the call for "harmonization" in legislation comes from these two very different countries--one where assisted reproductive law is restrictive, and where there is little evidence that it is not adhered to, Austria; and the other, Israel, where the law is broad and favors a pro-natalist policy, but where a substantial minority of IVF specialists (22.5%) claimed they did not follow existing national guidelines and "exercise full discretion in offering treatment to patients" [2]. It is not unusual to hear calls for "harmonization" of laws when there are major differences in Europe, but this is not within the remit of the EU, which leaves a fairly wide "margin of appreciation" to different countries in health matters. The only existing unifying document is the Tissue Directive concerning standards for the keeping of human "tissues", which includes gametes [3].This article, however, concentrates on the differences in gamete donation, particularly oocyte donation, and they cannot be starker, as it is actually forbidden in Austria. There, the situation is rendered more complex as physicians also have a responsibility to the gamete donors.As fertility specialists, we must ensure that they are not put at disproportionate risk of medical complications, or abused when they sell rather than donate eggs. Again this entails professional responsibility, and this is why ESHRE (European Society of Human Reproduction and Embryology), the European Society representing over 5000 fertility specialists as well as nurses, embryologists, and psychologists, created