LETTER | It is one of those days where I got a little time to ponder about my clinical encounters. There was a 20-year-old woman who came to the clinic for STD screening. I asked her some questions to determine which are the most suitable ones for her, and her reason for wanting the test.

To my surprise, she told me it was because she wanted to sell her eggs and the fertility centre required her to do some tests. Seeing this was a rather unusual reason, I probed further and she replied "I'm doing this for money".

The encounter has left me with complex feeling about how many aspects of our society is evolving and this brings back memories from many years ago when egg donor was a topic that gained enough traction that it even reaches one of the mainstream newspapers.

The fertility rate in Malaysia has been on a steady decline since the 1960s from around 6.3 births per woman to 1.94 births per woman this year (2022).

The same can be seen throughout most of the world, which can be attributed to the rising cost of living, changes in value and attitude toward family raising, advancements in contraceptive methods etc.

Late marriages and delayed motherhood coupled with a lot of other factors have increased the demand for fertility treatment such as in vitro fertilisation (IVF). While new technologies in fertility medicine have offered new hopes to prospecting families, there is also a flip side to it.

To understand what I want to discuss later, let me give you a very simplified process of IVF. Normally, the IVF process begins with ovarian stimulation at the beginning of the menstrual cycle, in which follicle-stimulating hormone (FSH) is injected to obtain a good quality of oocytes (eggs).

The development of the ovarian follicle is monitored by regular ultrasound scans nearing the end of the maturation, a human chorionic gonadotrophin (HCG) injection is given, and the eggs are collected about 36 hours later at an outpatient setting. The eggs aspirated will be studied, and then will be fertilised using the sperms.

Now, only about 60 percent of the retrieved eggs are viable, and only about 60-70 percent of fertilised eggs develop normally. Hence, the development of the embryo (fertilised egg) is monitored, and out of all the collected eggs, only one or two of those which has the best chance of success are selected to be transferred into the womb.

The rest of the pregnancy will then be followed up closely by the gynaecologist. Women with a reduced ovarian reserve can opt for egg donation. Egg donation is where a woman (donor) gives her eggs to another woman (recipient) to allow her to have a baby.

Now in a perfect world, there may be patients which request egg donations and there are donors who give their eggs to them for purely altruistic reasons. I mean, who doesn’t want to be a major part of making other people’s life complete? However, we are living on planet Earth.

The basics of economics state that a business is driven by supply and demand. With the increase in infertility, the demand for these services is increasing. What happens when many patients have failed IVF and seek egg donors?

It opens opportunities for profit-seeking agencies to assist physicians by advertising lucrative incentives(compensation) for egg donors. Besides poaching, donors are often ranked according to their traits (so donors with high-demand traits are paid more than donors with less desirable traits). See where are we heading?

Currently, there are no specific laws governing IVF in Malaysia, and the closest thing you can get is an outdated MMC guideline on assisted reproduction published in 2006 and another guideline on stem cell research and stem cell therapy published in 2009.

Besides that, IVF treatment is considerably cheaper in Malaysia compared to neighbouring countries, hence there will be people from other countries coming to seek egg donors in Malaysia. That together with a weakened ringgit, is a honey pot for unscrupulous marketing practices.

Now, imagine if you are a fresh graduate earning about RM2,000-4,000 monthly in a big city, and an opportunity to earn a quick RM5,000-8,000 (that was the price back in around 2017) with relatively less effort presents to you, many will find it quite tempting.

Now I’m not saying egg donation is bad, just the way potential donors are recruited (and some are not even given the detailed risk of the procedure that they may go through).

Ultimately, the trend of people (yes, while I used women as examples in this article, I’m referring to both males and females) trading their genes for money is gaining popularity. Perhaps, we should also look at this problem from a financial perspective.

Are Malaysians paid less here compared to the same position when working in other countries? Are Malaysian employers paying fairly to their workers? With the incoming global recession, are young people nowadays earning enough to keep a roof over their heads? Will all these factors lead them to find easy money such as selling eggs?

This is a huge topic with a lot of socio-economical impact on the country’s development. I hope I can do more about this but for now, sharing my thoughts is all that I can.

The views expressed here are those of the author/contributor and do not necessarily represent the views of Malaysiakini.