The AML Implications of the Human Egg Trade

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The money laundering process typically involves the furtive introduction of illegitimate funds into the legitimate financial system and the steps taken by bad actors to distance themselves from the illegal sources of these funds. When the crime is understood, the work of anti-money laundering (AML) professionals is often straightforward, but what is their role when it is unclear if the funds are derived from criminal means because laws are ambiguous?

It is easy to decry human trafficking where it is often easy to identify the victim and abuser and where the commercialisation of humans is transparently despicable. However, the reaction has been different with other outlawed activities that involve the purchase of human organs. The human egg trade has created an uncomfortable situation for many jurisdictions as they ignore a profitable industry that could be deriving funds from illegitimate sources.

This article does not take an ethical stance, but rather focuses on its nexus to potential money laundering. It is necessary to define human egg donation and outline the respective costs and benefits that this procedure entails for society to comprehend this issue.

What is human egg donation?

Medical advancements in fertility treatments have improved significantly since the first baby was born through in vitro fertilisation (IVF) in 1978. In recent years, an increasing number of individuals have opted for IVF treatments to start a family. Between 1% and 3% of all births in the US can be attributed to IVF techniques. In Europe, nearly 7,000 babies born per year are the result of over 25,000 IVF treatments.1,2 A popular IVF treatment is the artificial insemination of an egg, whereby the embryo is implanted into the uterus to continue developing.

Whilst IVF treatments have improved over the years, the process to donate human eggs remains time-consuming and it involves serious potential health consequences. An egg donor will typically undergo several weeks of hormonal therapy to stimulate the release of multiple eggs from her ovaries rather than the usual single egg. The eggs are then collected from the ovaries by medical staff. This invasive procedure may cause pain at the injection sites, including the abdominal and vaginal walls, risks attributed to sedation and pain from swollen ovaries.3 Among the most serious health risks for egg donors is a complication called Ovarian Hyperstimulation Syndrome (OHSS) that can occur when the ovaries are excessively stimulated and plasma starts to leak out of the blood vessels.4 OHSS can lead to kidney failure, breathing difficulties, ovary ruptures and possible death.5 Since IVF treatments are a relatively new medical advancement, there is a lack of information regarding the long-term health effects of undergoing multiple cycles of egg donation. Nevertheless, the American Fertility Association recommends going through this procedure no more than four times in a lifetime.6

The regulatory framework for human egg donations

Given the breadth of medical risks presented, one might ask who would willingly and voluntarily agree to undergo such a risky procedure to donate their eggs? Whilst certain individuals may have a genuine altruistic interest in donating their eggs, these cases are rare. Aside from the donors who have a personal bond with the recipient, the majority are attracted to the financial gain. In much of the western world, the demand for human egg donors far outpaces the supply, which has led to a blooming black market.7

This situation is further exacerbated by the differing regulations of jurisdictions that are in proximity to each other. For example, Canada legislates that egg donations can only be facilitated if the donor has entered into the procedure for purely altruistic reasons.8 However, in the US, there are hardly any regulations for human egg donations and no comprehensive legislations exist for assisted reproductive technologies.9 A simple Google search for ‘egg donation USA’ will instantly yield numerous results on businesses running a gamut of assisted fertility services including sale of donor eggs and how to become a donor. Compensation for human egg donors can be as high as hundreds of thousands of US dollars.

Throughout Europe, paying human egg donors is banned by Treaty No. 16410 of the Council of Europe, which most European countries have accepted. However, nations have adopted a patchwork of specific regulations around assistive reproductive technologies. In 2006, the European Commission conducted a survey in 25 EU member states on the regulatory status of reproductive cell donation.11 The results revealed that 11 states adopted some form of a compensatory framework for egg and sperm donations ranging from regulations to non-binding guidelines. Other nations, including Germany, have banned human egg donations altogether.12 Comparing the regulatory details on compensatory measures between countries illustrates how some regulations are highly prescriptive, applying monetary ranges on what can be considered acceptable compensation, whereas others take a higher-level approach.

Although regulations vary between countries, most European countries prohibit payment for donated human eggs, but do not expressly prohibit the reimbursement of expenses incurred by the egg donor for IVF treatments. This vague distinction between payment and compensation is one of the regulatory voids that allows for the human egg trade grey market to exist.

To circumvent disadvantageous regulations to obtain IVF treatments, an increasing number of individuals are becoming ‘fertility tourists’, travelling to countries where IVF treatments are legal or more affordable than in their home countries.13 A survey conducted from 2011 to 2012 by the European Society of Human Reproduction and Embryology (ESHRE) asked 1,423 human egg donors from 60 European clinics the motives behind their donations. The results indicated that the majority of donors have partly altruistic motivations when deciding to donate but expected a financial benefit.14 This survey further highlighted that approximately 40% of donors from Greece had purely financial motivations behind their donations, whilst donors from Russia and Ukraine stated that the financial benefit was their main motive. In total, 42% of the respondents either decided to donate for purely financial motives or had a combination of altruistic and financial motives.

The varying regulatory approach for egg donations across countries is a direct reflection of society’s indecision on the ethics underlying the human egg trade. In the EU, a major driver to implement various restrictions or prohibitions to the human egg trade is the belief that commoditising the body and its parts is inherently unethical.15 The EU Charter of Fundamental Rights prohibits using the human body or its parts as a source of financial gain.16

In the US, the commoditisation of human eggs has grown to such an extent that an Ivy League student with desirable SAT scores and healthy physical features can garner as much as 200,000 US dollars for the sale of her eggs.17 On the other side of the spectrum, hot spots for human egg donations in Europe include Spain, Czech Republic and Cyprus where donors might only earn hundreds of US dollars for their donations. Whilst this may seem to fit the description of reasonable compensation, these amounts can represent a month or more of the donor’s rent and are well above what is legislated in many EU nations. Although donating human eggs may appear to be a personal decision that can be taken by a consenting adult, the current state of this industry can lead to criminal behaviours.

Human egg trade and human trafficking

The controversy surrounding the procedures for human egg donation can perhaps be better understood when these are compared to the definitions of human trafficking, which are comprehensible. In November 2000, the UN defined the acts, the means and the purpose of trafficking in its protocol to prevent, suppress and punish human trafficking.18 According to this protocol, acts of human trafficking include the recruitment of persons. Young women are heavily recruited for their eggs through advertisements and forceful salesmen who offer them large sums of money.

Methods of human trafficking can also be seen in human egg trade including coercion, fraud, deception, the abuse of power (i.e. when someone is in a vulnerable position) and the exchange of payments or benefits. Medical practitioners and persons operating fertility clinics are economically incentivised to understate potential health risks. Those who seek profits may be inclined to coerce human egg donors through large sums of money. Medical practitioners may even seek to overstimulate donors to produce more eggs, risking the health and life of the donor. There was a case of a woman who suffered a stroke and was left infertile after trying to sell her eggs.19 She was originally promised 15,000 US dollars for her eggs but received only 750 US dollars because she failed to complete her donation cycle.

The purpose of human trafficking is exploitation. Human egg donations can take on characteristics of exploitation when the balance of knowledge and wealth is skewed between medical practitioners and donors and when there is a great disparity of wealth between the recipients from richer countries and the donors from impoverished nations.

Medical practitioners may even seek to overstimulate donors to produce more eggs, risking the health and life of the donor

It can be argued that donors and donor recipients often come out of an IVF process better off than they were before and that in some countries donating human eggs provides an opportunity to make money where few other commensurate opportunities exist. However, human trafficking victims can also receive payments, but the unethical nature of using coercion for the purpose of exploitation is not acceptable in the case of human trafficking.

A legal grey zone exists that potentially excuses financial institutions from having to examine the activities of clinics and businesses that recruit women to donate or sell their eggs because such businesses are not actively pursued by law enforcement. Whilst this may be a logical and risk-based decision, there have been cases of IVF clinics that were connected to organised crime being shut down. In 2009, two Israeli doctors and a Romanian doctor were detained by a special Romanian investigative police unit after raids on a Romanian IVF clinic suspected to be involved in international human egg and stem-cell trafficking.20 More recently, 500,000 pounds were laundered through financial institutions, luxury goods and properties from a human egg trafficking and illegal adoption ring in Greece. Sixty-six individuals were arrested, including lawyers and doctors who were allegedly involved in other organised crime groups.21 It is not rare for organised crime groups to flourish in unregulated or legally grey zones.

It is possible to foresee legislators pursuing unregulated or non-compliant IVF clinics if more abusive practices get reported

Conclusion

Given the underground nature of some IVF clinics, it is difficult to gather reliable data on donors who face medical complications. However, it is possible to foresee legislators pursuing unregulated or non-compliant IVF clinics if more abusive practices get reported. Whilst it is unfair for financial institutions or regulators to lead the acceptance or denial of societal norms, they could be in a precarious situation if the expectations to report on non-compliant or unregistered IVF clinics suddenly changed. It may be in their best interest to push legislators to provide clarity on this issue. 

Katie Ngai, senior compliance officer, Bank of Montreal

Leonardo Real, CAMS, CCO, Tether

Disclaimer: The views expressed are solely those of the authors and are not meant to represent the opinion of their employer.

  1. Ashley M. Eskew, MD, Emily S. Jungheim, MD “A History of Developments to Improve in vitro Fertilization,” Missouri Medicine, May-June 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140213/
  2. Nicky Hudson, “Egg donation in the UK, Belgium and Spain: an interdisciplinary study,” UK Research and Innovation, https://gtr.ukri.org/projects?ref=ES%2FN010604%2F1#/tabOverview
  3. Alison Motluk, “The Human Egg Trade,” THE WALRUS, 12 April 2010, https://thewalrus.ca/the-human-egg-trade/
  4. Ibid.
  5. Ibid.
  6. Megan Ogilvie, “Hatching babies: Our black market in human eggs,” Toronto Star, 21 November 2009, https://www.thestar.com/life/parent/2009/11/21/hatching_babies_our_black_market_in_human_eggs.html
  7. Ibid.
  8. “Prohibitions related to Purchasing Reproductive Material and Purchasing or Selling In Vitro Embryos,” Government of Canada, https://www.canada.ca/en/health-canada/services/drugs-health-products/biologics-radiopharmaceuticals-genetic-therapies/legislation-guidelines/assisted-human-reproduction/prohibitions-purchasing-reproductive-material-selling-vitro-embryos.html
  9. Maya Sabatello, “Regulating Gamete Donation in the U.S.: Ethical, Legal and Social Implications,” NCBI, 28 July 2015 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4572724/
  10. “Details of Treaty No.164,” Council of Europe, https://www.coe.int/en/web/conventions/full-list/-/conventions/treaty/164
  11. “Report on the Regulation of Reproductive Cell Donation in the European Union,” European Commission, Health & Consumer Protection Directorate-General, February 2006, https://ec.europa.eu/health/ph_threats/human_substance/documents/tissues_frep_en.pdf
  12. Ibid.
  13. “Egg donation in European clinics: Why do women do it?” EurekAlert, 8 July 2013,https://www.eurekalert.org/pub_releases/2013-07/esoh-edi070213.php
  14. Ibid.
  15. “International trade in human eggs, surrogacy and organs,” Danish Council of Ethics, 2013, https://www.etiskraad.dk/~/media/Etisk-Raad/en/Publications/International-trade-in-human-eggs-surrogacy-and-organs-2013.pdf?la=da
  16. Ibid.
  17. Sonia F. Epstein, Paulina N. Whitehouse, “Inheriting the Ivy League: The Market for Educated Egg and Sperm Donors,” The Harvard Crimson, 30 April 2020, https://www.thecrimson.com/article/2020/4/30/inheriting-the-ivy-league/
  18. “Protocol to Prevent, Suppress and Punish Trafficking in Persons Especially Women and Children, supplementing the United Nations Convention against Transnational Organized Crime,” United Nations Human Rights Office of the High Commissioner, 15 November 2000, https://www.ohchr.org/en/professionalinterest/pages/protocoltraffickinginpersons.aspx
  19. Jennifer Lahl, “Is Egg ‘Donation’ and Surrogacy the Newest Form of Human Trafficking?” CBC, 18 September 2019, http://www.cbc-network.org/2019/09/newest-form-human-trafficking/
  20. Ben Jones, “Human egg-trafficking scam uncovered in Romania,” BioNews, 3 August 2009, https://www.bionews.org.uk/page_91747
  21. Nicky Harley, “More than 60 arrested in £500,000 European human egg trafficking and illegal adoption ring,” The National, 26 September 2019, https://www.thenationalnews.com/world/more-than-60-arrested-in-500-000-european-human-egg-trafficking-and-illegal-adoption-ring-1.915464

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