The stem cell research debate: What are women's concerns?
An interview with Emily Galpern, Project Director on Reproductive Health
and Human Rights, of the Center for Genetics and Society.
By Kathambi Kinoti
AWID: Stem cell research is a very controversial subject. What is the
debate around the subject?
EMILY GALPERN: More and more women's health and reproductive rights
advocates here in the United States are raising concern about the lack of
regulation of stem cell research and the need for attention to women's
health and safety. Until recently, the debate around stem cell research had
primarily been dominated by the moral status of the embryo; whether it is
ethical to do research on embryos and whether it is ethical to create
embryos for research.
This debate has been polarized between religious conservatives on the one
hand who oppose
all research on embryos, and political progressives on the other hand who
support research but, in reaction to the religious right, often take the
position that all scientific progress is good, even with inadequate
regulation. The politics of abortion dominate the
debate so much that the ethical concerns about women's health and rights
have been overshadowed, but this is changing.
My organization, the Center for Genetics and Society supports embryonic
stem cell research, particularly research that uses leftover embryos from
in vitro fertilization (IVF) procedures. Our primary concern centers on
research cloning, where there is potential for harm to women's health and
for the exploitation of women and the commercialization of their
reproductive material. One of the primary issues in the debate is whether
women should be paid for their eggs. Paying women will likely be a
financial inducement for economically vulnerable women to undergo a process
in which the long term effects are not clearly understood. Already in the US
a woman can be paid as much as USD 80000 to donate her eggs for IVF
procedures. Women recruited for their eggs for IVF are often college
students who have been selected for their 'top genetic makeup.' In research
cloning it does not matter whom the eggs come from because the nucleus
(which contains the genetic material) of the egg is removed. This means
that low income women of colour are more likely to be targeted for
recruitment. We are concerned that a market in women's reproductive tissue
will be created in the research context.
The recent scandal involving the South Korean researcher who was disgraced
for fabricating data highlights the ethical concerns surrounding stem cell
research. Apart from the fabrication, unethical procedures were used to
obtain eggs from women.
AWID: What are some of the health risks involved in the harvesting of
women's eggs for stem cell research?
EG: One approach to stem cell research, somatic cell nuclear transfer
(SCNT) poses particular problems. This technique is otherwise known as
'research cloning', and requires a large number of women's eggs. There are
risks concerned with the egg retrieval process, which is time consuming and
invasive. During egg retrieval, a woman's ovaries are stimulated with
hormonal drugs in order to produce multiple eggs in one cycle. We do not
yet fully know all the risks involved and some of the drugs used in the
procedure have never been subjected
to rigorous safety studies. However, we do know that many women undergoing
IVF procedures experience side effects from the egg extraction process,
primarily caused by the hormonal drugs. The drugs used to stimulate the
ovaries can lead to Ovarian Hyperstimulation Syndrome (OHSS) which when
mild can cause ovarian cysts and abdominal discomfort. Severe cases can
lead to hospitalization, infertility and even death. For instance, in the
UK five women have
died from OHSS when undergoing fertility treatments.
The data on long-term risks of egg retrieval is widely acknowledged to be
inadequate. It is not yet clear whether the drugs can be linked to
reproductive cancers; the few studies that have been conducted have not
followed women for a long period of time.
We advocate for scientific study into alternatives to hormonally-stimulated
egg retrieval. Some scientists are trying to find safe alternatives by
investigating methods that do not require hormonal drugs or so many eggs.
These could include natural cycling, in which a
single egg is extracted without hormonal stimulation; egg extraction during
ovariectomy or tubal ligation; and biopsy of ovarian tissue during
gynecological surgery, in which many immature eggs could be collected and
matured in vitro. Researchers could also investigate alternative ways to
obtain genetically specific stem cells, to minimize or even eliminate
the need for eggs in stem cell research.
AWID: Are there adequate legal and medical safeguards for women who donate
or sell their ova for IVF or for research? What improvements can be made to
the existing frameworks?
EG: There are no adequate national policy or legislative safeguards for
women who provide their eggs for research in the US. For this reason there
is a lack of oversight of research and a lack of accountability on the part
of researchers. There are voluntary guidelines issued by the US National
Research Council and Institute of Medicine of the National Academies, and
two states (California and Massachusetts) have some type of regulation.
California's law is the most comprehensive regarding egg retrieval for
research, and includes provisions to safeguard women's health and prevent
commodification. Canada and the United Kingdom have more comprehensive
legislation. In Canada, women's health is more central both to the debate
around stem cell research and to policy.
The California law can be a model for other state and national policy in
the US: women who provide eggs for research are defined as research
subjects, affording them all the state and federal protections already
established for research subjects; if women experience adverse reactions
they have access to health care at no cost; and physicians who perform the
egg retrieval process are prohibited from having a financial conflict of
interest in the research.
There should also be federal regulatory supervision of drugs used for egg
retrieval, and fertility clinics and stem cell researchers should be
required to report any adverse reactions experienced by women who undergo
the process.
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