Donor compensation, reimbursement and benefits in kind
Consultation closed
The 'Donating sperm and eggs: have your say' consultation closed on 8 April 2011. The information on this page is presented as it was during the consultation period and releates to the landscape of donation at the time.
See the consultation findings, and the current policies around sperm and egg donation in the UK:
What is the current policy on donor compensation?
The law prohibits the payment of donors but allows them to be compensated for expenses and for the inconvenience of donation. It is the HFEA’s job to decide what kind of compensation should be given to donors within these legal limits.
We last looked at our rules on donation in 2005. Since then there have been significant legislative and social changes which may impact on the ethics of donation.
Our current policy allows sperm and egg donors to claim reasonable expenses in connection with their donation (eg, travel costs). Donors may also be compensated for loss of earnings up to £61.28 for each full day (as for jury service), with a limit of £250 for each course of sperm or egg donation.
Clinics must keep a record of the expenses and compensation they pay, including receipts.
Clinics can only give donors compensation for expenses incurred within the UK. So, clinics cannot currently bring in donors from other countries. However, they can import eggs or sperm from abroad.
Currently about 20% of sperm donors and 2% of egg donors are from overseas, compared to 12% and 4%, respectively, in 2005. Overseas donors whose sperm or eggs are imported to the UK must meet the same requirements as UK donors (eg, screening tests, identifiability), including the amount of compensation for expenses and loss earnings that they can receive.
Benefits in kind
We allow egg or sperm sharing, which is a ‘benefits in kind’ system:
Egg sharing is where a woman receiving IVF treatment donates some of her eggs at the same time as undergoing treatment. In return, the clinic can offer a significant reduction in the cost of her treatment (commonly half or the full cost of treatment, which is about £5000 per cycle).
Sperm sharing schemes are offered by some clinics. Couples can get a reduction in treatment costs, or are moved up the waiting list, in return for the male partner (or another person they provide as a donor) donating their sperm.
Freeze sharing schemes have become available at a small number of clinics more recently, allowing women to store their eggs for future treatment (free for about 5 years) in exchange for donating some of these eggs.
Read more about our current donation policy:
What changes would be possible within the law?
The law on the donation of sperm, eggs and embryos is set both by UK legislation and by a European directive which was implemented in 2007. This legal framework means that the UK has a responsibility to ensure that:
- donation is voluntary and unpaid
- donors act from altruistic motives
- donation is in the spirit of contributing to a wider social good (‘solidarity between donor and recipient’ is the term used in law)
- there’s an adequate supply of donor tissues and cells.
Outright payment for donation is not allowed by law. The essence of donation is the act of giving. Because the act of giving is generous and humane, the law does allow donors to receive compensation for inconvenience. This is different from and additional to compensation for expenses and loss of earnings.
Those who donate are under no obligation to do so and they make adjustments to their daily lives and go significantly out of their way to help others who, without their help, might be unable to have the chance to have children through fertility treatment. The law on compensation for inconvenience is a way of allowing clinics to recognise the disruptive and out-of-the-ordinary impact of donation on donors’ lives.
When we last considered donor compensation, in 2005, we had concerns that offering compensation for the physical inconvenience or risk of donation may encourage some people to donate without thinking sufficiently about the consequences of donation. Therefore we do not currently allow donors to be compensated for the inconvenience associated with donation.
We are seeking your views on whether these policies should be changed.
Donor compensation in Europe
Different countries have interpreted the European legislation differently:
Denmark
Sperm donors receive 50-150 Euros (around £45-135) for the examination and use of their time and travel expenses (egg donation is illegal)
Spain
Egg donors are compensated 900 Euros (around £765); sperm donors are compensated 45 Euros (around £40) per valid sperm sample they produce. This is a blanket fee for expenses, loss of earnings and inconvenience.
France
Donors receive no compensation besides the reimbursement of travel expenses.
What does sperm and egg donation involve?
Egg donation
Clinics must offer counselling to all donors; many insist that donors undergo counselling before donation takes place.
Egg donation is an invasive procedure. Before starting, donors are tested for infectious and genetic diseases. They are then given a series of hormone injections to help develop and mature eggs within the ovaries.
Once the eggs are matured, they are collected, under anesthetic, by inserting a needle into the ovaries through the vagina. Donors will probably need at least the day after the operation off work.
Although serious side effects are rare, common side effects include:
- tiredness
- abdominal pain
- bloating
- mood swings
- headaches.
Occasionally there can be a potentially dangerous over-reaction to the hormones, called ovarian hyperstimulation syndrome. This is occurs in about 1% of egg donation cycles (according to one US study) and this figure is higher for fertility patients.
Sperm donation
Clinics must offer counselling to all donors; many insist that donors undergo counselling before donation takes place.
Sperm donation is less invasive than egg donation, but usually more time consuming. It starts with blood tests for infectious and genetic conditions, as well as giving a semen sample so that sperm quality can be checked.
Sperm donors are then asked to produce semen samples over several weeks or months.
The donor needs to abstain from sex and alcohol for at least two days prior to each donation.
Sperm donors have to go back to the clinic six months after their last donation to have further screening tests, before their sperm samples are released for use in treatment.
After the donation
- Both sperm and egg donors are asked to provide biographical information and a message to any child born from their donation.
- Since the law was changed in 2005, children born from a donation will be legally entitled to access identifying information about the donor once they reach the age of 18, which means that anyone who donated after this change in the law, might, in the future, be contacted by children conceived as a result of their donation.
- Donors have no financial or legal obligations towards the child.
"...the law on compensation for inconvenience [of donation] is a way of allowing clinics to recognise the disruptive and out-of-the-ordinary impact of donation on donors’ lives.."
What does egg sharing involve?
Women donating eggs in an egg sharing arrangement undergo the same procedures and are subject to the same requirements as egg donors.
Some of the eggs collected from the egg sharer are used for her treatment and some are donated for use in another woman’s (or sometimes for two women’s) treatment. The egg sharer and the egg recipient do not meet each other.
Many clinics insist that eggs sharers have counselling to ensure that they have considered the implications; including the possibility that the recipient may become pregnant and have a child, but they may not.
Egg sharing differs from egg donation, as it is an option for women undergoing their own treatment. Some believe the benefits in kind provide a powerful incentive to donate and are, in fact, no different from paying donors.
Others see it as improving access to treatment for women who might not otherwise be able to afford IVF and improving access to donated eggs for women who are unable to use their own eggs in treatment.
Concerns have been raised that egg sharing may cause psychological harm to the donor if she is unsuccessful with her treatment, but the recipient conceives. However, these concerns have not been borne out in the small number of studies on the experience of ‘unsuccessful’ sharers.
Overall, the limited knowledge about egg sharers’ experiences of treatment suggests that they feel adequately prepared and the majority are satisfied with their treatment.
What motivates people to donate?
Little is known about what motivates people to donate sperm or eggs, but what is known suggests that:
- some donors want to help a friend, family member or stranger to have a family
- in other countries some wish to receive financial compensation
- most egg sharers would not donate if there were no incentive to do so
- many egg sharers want to both help themselves and to help someone else.
Certainly in relation to egg donation the benefits in kind are part of the reason why people donate, but the main motivator appears to be a desire to help others. Outcomes of a survey we carried out with UK fertility clinics and interviews with some sperm and egg donors support this.
Comments from clinicians included:
“I don’t think that most donors are doing it for the money but we would probably get more donors if they felt valued and the reimbursement was more proportionate.”
“The amount is part of the whole jigsaw of what encourages a donor to donate.”
During this consultation, we will be talking further to donors, recipients and clinics about what motivates people to donate and what might encourage more people to do so.
What principles should we keep in mind?
The question of whether donors should be financially compensated and, if so, how much, evokes strong views.
The issue forces us to consider our values and principles on the nature of giving, the value of life, and how life should come about.
There are competing principles and concerns. Some of the principles relevant to the issue of financially rewarding donors include:
- Altruism (selflessness) – anything that would benefit the donor directly – such as a financial reward – might be seen to undermine altruistic motivation.
- Fairness – it may be unfair for donors to be out of pocket as a result of donation, especially if clinics benefit financially from their donation, and recipients are charged for their donated gametes.
- Free choice – family pressure or incentives to donate may impact on an individual’s ability to make a free choice.
- Welfare of the future child – financial rewards to donors may have an emotional and psychological impact on future children, who may believe they were “bought”.
- Safety of donors, patients and donor conceived people - donors are screened for diseases but financial rewards may encourage donors to lie about their health.
- Respect for family life – for some, donated sperm, eggs or embryos represents the only chance, other than adoption, of forming a family. In order for such people to start a family, there needs to be an adequate supply of donated gametes; imposing barriers to donation may affect some people’s ability to form a family.
- Pragmatism (a practical solution) – any compensation scheme must be straightforward to implement with minimum burden on donors, patients and clinics.
It may not be possible to reach a solution that respects each principle equally.
For example: to emphasise altruism we could insist that donors do not receive financial compensation, not even for expenses or loss of earnings. This would mean, however, that donors could end up out of pocket, while clinics may make money from their good will, which could, in turn, conflict with the principle of fairness.
How could the current system change?
Our current policy tries to ensure that donors do not benefit from their donation but allows for compensation for loss of earnings and expenses.
Feedback from clinics, however, shows that not only do some donors end up being out of pocket (eg, if they can’t prove their loss of earnings to the clinic), but also that the system is more complex than it needs to be.
Some clinic staff tell us that losing out on income or expenses can deter potential donors. Ensuring donors are not out of pocket or paying some sort of compensation for inconvenience may remove a barrier to donation, rather than provide an incentive.
This would result in more donors and allow more people to have treatment with donated sperm and eggs. However, different people will be motivated by different amounts of money - a removal of a barrier to some, may be an incentive to others.
People will weigh these various principles differently and reach their own solutions. We’d like to know what you think the ideal compensation scheme would look like and what principles such a scheme would be based on.
Factsheet - key points and summary
This factsheet provides a summary of the ‘compensation, reimbursement and benefits in kind’ section of the full consultation.
Consultation results
The consultation period of 'Donating sperm and eggs: have your say' closed on 8 April 2011.
Feedback from the consultation will be analysed and reported to the Authority on 13 July 2011.
Page last updated: 21 January 2011
This factsheet provides a summary of the ‘compensation, reimbursement and benefits in kind’ section of the full consultation. 
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Should the number of families created with sperm or eggs from one donor should be capped?.jpg)