the fertility advocate

Talking, writing, educating, and change making in the field of fertility for more than twenty years

Lately, there has been a lot of stories about eggs crossing my computer screen! Whether it is about egg freezing or donor eggs – everyone is talking eggs. One of my fertility coaching clients came to me the other day very upset.  You see, she didn’t trust her doctor anymore.

We had made the transition together – she was ready after five failed cycles of IVF to move onto donor eggs. It was a big decision and it was something we had been coaching around for several months.  I had helped her find her doctor – he is a very well respected doctor and I trust him. So did she.  But then something unexpected happened.

He “highly recommended” that she use a particular egg donor agency.  Now – she and I had selected a different one – for several reasons.  And she really liked a particular donor at the agency we had selected for her. So this was really upsetting the apple cart! And very few people ever feel safe not doing what their doctors recommends…

My client spoke with her doctor, and he said that he really disapproved of the selection her agency and he really felt strongly that she go with this other donor egg agency. I couldn’t figure out why!

But somehow, my tenacious client stumbled onto some information from a friend on an infertility message board. Apparently her doctor was part owner of the egg donor agency that he was strongly encouraging her to use!  Now, her doctor never disclosed his relationship with this said agency.

I have to admit that this is a new one for me – but apparently this is a growing trend for  fertility doctors to be investing in egg donor and surrogacy agencies.  In fact, some IVF centers, I am told by an industry insider -  only directs patients to certain agencies with kick backs in place.  Sometimes, the kick backs are not in direct dollars but a promised direct referral relationship.  Really? The more I dug into this – the more surprised I became. Apparently this is not an isolated case.

So how would you feel if you needed donor eggs and your doctor told you that he highly recommended a particular egg donor agency – in fact it was his preferred agency.  You would go there right? Because you trust your doctor – and everyone knows that a direct referral from a physician or a trusted agency or lawyer has a profound effect on a patient’s choice.

Does this trouble you?

Do you think that The American Society of Reproductive Medicine should have guidelines about disclosing physician or even agency conflicts of interest in regard to these types of business interests directly to their patients?

When doctors present scientific papers and accept pharmaceutical money to support their work – they have to disclose this to their colleagues. Is this any different? Do patient’s deserve to know if their health care providers have “referral arrangements” or  business interests if it effects their care?

How would you feel if you found out that your doctor’s referrals were financially motivated? Or even the referrals to physicians from egg donor agencies? Would you like to see a statement of disclosure from infertility centers and doctors to their patients about where they have business interests -  if it effects the direction of their care? Should donor egg and surrogacy agencies have to do the same?

Would you feel comfortable asking your doctor these questions? Or would it feel too much like a confrontation?

I would love to know your thoughts. As far as my fertility coaching client went – she changed doctors.

About Pam Madsen
Talking, writing, educating and change making in the field of fertility for more than twenty years
3 total comments on this postSubmit yours
  1. What a disturbing article, Pam. Having worked with egg donors and recipients (and now also embryo donors and recipients) for more than ten years, I will share that while I have always known of physician investment in donor and/or surrogacy programs (and know very few that disclose, by the way), I am surprised to hear of a clinic that would not allow a patient to ultimately choose an agency that best suits his/her/their needs. I suppose any clinic that restricts patient options with respect to third-party service providers will see attrition…good for your client for moving on!

    Next week I am giving a presentation on the legal considerations of egg donation. I speak on this topic 3-4 times a year for various non-profits. Although much of my discussion will be about matters related to parentage and relinquishment of rights by the donor, I will also talk about what prospective recipients should be looking for, in terms of best practices, when selecting an egg donation agency.

    Prospective parents considering engaging an agency for egg donation should clarify, before signing an agency contract (typically known as a “service agreement”), that agency’s policies and practices around the following:

    1. Refund Policy: under what circumstances, if any, is the agency fee refundable;

    2. Rematching: under what circumstances, if any, will the initial agency fee be applied to a subsequent donor selection;

    3. Record Retention: For how long will the agency maintain records of the match as well as contact information for the donor (this is important in the case of a medical crisis and/or if the child simply wants to reach the donor); and

    4. Escrow Practices: In what type of account will the funds collected for estimated cycle expenses be held? Who has access to my funds? Who controls the account in which my funds are held and when and under what practices will I receive an accounting of withdrawals made from my deposit?

    In 2010, I published a blog entitled “Choosing an Egg Donation Agency” for Fertility Ties, your readers might find the information in that blog helpful:

    Thanks, as always Pam, for moving forward the focus on and awareness of patient advocacy issues, including, in this case, those matters the patient navigates when in consumer mode. Your work is of tremendous value!!! Your coaching clients, truly poised for great success!!

  2. Amy,

    Thank you Amy for your kind words and support. Yes – it is a disturbing article.

    I would now include questions directed at the physician about their investments or partnership in any egg donation, surrogacy or even legal referrals. I think patients have a right to know if the referrals that they are given are directly linked to financial partnerships – whether in money or direct referral arrangements.

    The fact that these exist does not make it wrong – but the patient has a right to know.

    All best,

  3. My presentation, next week and all those going forward (as well as consults given at my office) will now also address agency ownership and conflicts of interest. It is important to note that when working with attorneys, clients can waive conflicts of interest so that if b/c of physician ownership/investment in the agency a conflict does exist, if that agency happens to have that ideal donor the prospective parent is searching for, once informed of the conflict, the recipient can affirmatively waive it….a best case scenario following disclosure. It is good for recipient parents that you have brought this matter to an open-forum for cont’d discussion…thank you, thank you, thank you!!

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