BILL ANALYSIS                                                                                                                                                                                                    



          SENATE COMMITTEE ON HEALTH
                          Senator Ed Hernandez, O.D., Chair

          BILL NO:                    AB 2531             
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          |AUTHOR:        |Burke                                          |
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          |VERSION:       |February 19, 2016                              |
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          |HEARING DATE:  |June 8, 2016   |               |               |
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          |CONSULTANT:    |Melanie Moreno                                 |
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           SUBJECT  :  Reproductive health and research

           SUMMARY  :  Existing law prohibits human oocytes or embryos from being  
          acquired, sold, offered for sale, received, or otherwise  
          transferred for valuable consideration for medical research or  
          development of medical therapies, and prohibits payment in  
          excess of the amount of reimbursement of direct expenses to be  
          made to any research subject to encourage her to produce human  
          oocytes for the purposes of medical research.

          This bill would instead require women providing human oocytes  
          for research to be compensated for their time, discomfort, and  
          inconvenience in the same manner as other research subjects, as  
          prescribed and determined by a human subject research panel or  
          institutional review board. The bill would require the  
          institutional review board to disregard the amount of  
          compensation if a woman providing human oocytes for fertility is  
          compensated, human oocytes or embryos in excess of those needed  
          for fertility are offered for research, and certain conditions  
          are met.
          
          Existing law:
          1)Defines "oocyte" as a female egg or egg cell of a human  
            female, and defines "assisted oocyte production" (AOP) as  
            surgical extraction of oocytes following pharmaceutically  
            induced manipulation of oocyte production through the use of  
            ovarian stimulation.

          2)Prohibits any payment in excess of the amount of reimbursement  
            of direct expenses incurred as a result of the procedure to be  
            made to any subject to encourage her to produce human eggs for  
            purposes of medical research.








          AB 2531 (Burke)                                    Page 2 of ?
          
          
          3)Prohibits any human egg or embryo from being acquired, sold,  
            offered for sale, received, or otherwise transferred for  
            valuable consideration for the purposes of medical research or  
            development of medical therapies.

          4)Requires a physician, prior to providing AOP for the purposes  
            of medical research, to obtain written and oral informed  
            consent for the procedure from the subject, and requires this  
            informed consent to comply with the requirements of the  
            Protection of Human Subjects in Medical Experimentation Act  
            (Act), as specified.

          5)Requires a physician, prior to obtaining informed consent from  
            a subject for AOP for the purpose of procuring eggs for  
            research, to provide to the subject a standardized medically  
            accurate written summary of health and consumer issues  
            associated with AOP.   Requires this summary to include  
            medically accurate disclosures concerning the potential risks  
            of AOP, including the risks associated with the surgical  
            procedure and with using the drugs, medications, and hormones  
            prescribed for ovarian stimulation during the AOP process.

          6)Requires an institutional review board (IRB) to require  
            research programs or projects under its review that involve  
            AOP to comply with certain requirements, including that the  
            research program perform psychological and physical screening  
            for all subjects, and that subjects be given a post-procedure  
            medical examination. 

          7)Requires a research program that involves AOP to ensure that a  
            written record is maintained that includes specified  
            components, including the demographics of subjects,  
            information regarding every egg that has been donated or used,  
            and a record of all adverse health outcomes resulting from the  
            AOP.

          8)Prohibits a physician performing the AOP from having a  
            financial interest in the outcome of the research.

          9)Establishes the Act, which provides various statutory  
            protections for Californians involved in medical experiments,  
            including a detailed requirement for what constitutes  
            voluntary informed consent, and includes penalties for  
            violations of this Act.









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          10)Establishes, in the California Constitution, via the passage  
            of Proposition 71 in 2004, the California Stem Cell Research  
            and Cures Act and the California Institute for Regenerative  
            Medicine (CIRM), to provide $3 billion in bond funding over a  
            period of 10 years to fund stem cell research.  Requires the  
            Independent Citizens Oversight Committee of CIRM to establish  
            certain standards for the use of the funds provided by the  
            Act, including a prohibition against compensation to donors or  
            participants of the research, beyond reimbursement of  
            expenses.
          
          This bill:
          1)Repeals the ban on compensation in excess of the amount of  
            reimbursement of direct expenses incurred as a result of the  
            procedure for women providing human oocytes for the purposes  
            of medical research. Compensation amounts will be determined  
            by human subject research panels and institutional review  
            boards.

          2)Requires a woman providing human oocytes for research to be  
            compensated for her time, discomfort, and inconvenience in the  
            same manner as other research subjects. Prohibits this payment  
            from being for the human oocytes themselves or predicated on  
            the number of oocytes obtained, including if no human oocytes  
            are obtained. 

          3)Requires a human subject research panel or IRB to determine  
            whether a proposed compensation amount is appropriate.  
            Requires the panel or board, in the event that a proposed  
            compensation amount is determined to be inappropriate, to  
            determine an appropriate compensation amount.

          4)Requires the IRB, if a woman providing human oocytes for the  
            purposes of fertility is compensated, and any human oocytes or  
            embryos in excess of those needed for fertility are offered  
            for research, to disregard the amount of compensation if:
                  a)        The clinic performing oocyte retrieval is a  
                    member of the Society for Assisted Reproductive  
                    Technology; 
                  b)        The procurement and disposition for research  
                    purposes of human oocytes initially provided for  
                    reproductive uses, either for use by the donor or  
                    another woman, does not knowingly compromise the  
                    optimal reproductive success of the woman in the  
                    infertility treatment;








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                  c)        The infertility treatment protocol is  
                    established prior to requesting or obtaining consent  
                    for donation for research purposes and the prospect of  
                    donation for research does not alter the timing,  
                    method, or procedures selected for clinical care;
                  d)        The woman in infertility treatment makes the  
                    determination that she does not want or need the  
                    oocytes for her own reproductive success; and,
                  e)        The donation of oocytes for research is done  
                    without valuable consideration, as specified.

          5)Makes a number of findings and declarations. 

           FISCAL  
          EFFECT  :  This bill is keyed non-fiscal.

           PRIOR  
          VOTES  :  
          
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          |Assembly Floor:                     |65 - 3                      |
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          |Assembly Health Committee:          |15 - 0                      |
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          COMMENTS  :
          1)Author's statement.  According to the author, AB 2531 promotes  
            medical research in California while ensuring research  
            participants are fairly treated by removing the prohibition on  
            compensation for women participating in oocyte (egg) donation  
            for medical research. We all benefit from those willing to  
            participate in research, and the current processes in place  
            are designed to appropriately reward participants, while  
            protecting them from abusive or coercive practices.  AB 2531  
            ensures that women are treated equally to all other research  
            subjects - allowing them to actively evaluate their  
            participation in research studies and be paid for their time,  
            trouble and inconvenience when they do participate. Given that  
            compensation is allowed in 47 other states, and there is no  
            evidence of abuse, it's time to reconsider our ban, just as  
            New York did.  Lifting the ban will allow women providing  
            oocytes, just as any other research subject, to make an  








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            informed decision as to participation, and justly compensate  
            them for doing so. We should no longer deny a woman's  
            fundamental ability to make informed decisions or think for  
            herself, or tell her if she wants to participate, she can only  
            participate on terms different than for any other procedure.
          
          2)Background on oocyte production and retrieval for donation.   
            Over the past two decades, millions of women have had oocytes  
            collected for the purpose of assisted reproduction.  Most of  
            these were women undergoing in vitro fertilization (IVF) with  
            their own eggs, but a significant minority were donating their  
            eggs to help other women get pregnant.  During the normal  
            ovulation cycle, 10 or 20 egg follicles will begin to grow,  
            eventually leading to one "dominant follicle" producing a  
            single egg, and the other egg follicles dying off.  In the  
            oocyte or egg donation process, hormones are used to basically  
            trick the body into keeping the other follicles alive and also  
            produce eggs.  The donation process involves the woman  
            self-injecting hormones to stimulate the growth of ovarian  
            follicles, plus a gonadotropin-releasing hormone (GnRH)  
            agonist to block the normal surge of luteinizing hormone (LH),  
            which could cause the woman to ovulate before the physician  
            retrieves the eggs.  Typically, GnRH agonists are administered  
            a week before stimulation to control the stimulation cycle and  
            avoid a spontaneous LH surge.  The woman subsequently  
            self-injects the hormone chorionic gonadotropin (hCG, similar  
            to LH) to affect egg maturation.  When the eggs are ready, the  
            woman is brought into surgery, where she receives intravenous  
            sedation, and the eggs are harvested via needle aspiration.  A  
            woman who has undergone the usual hormone treatment will have  
            a dozen or so eggs that can be collected.

          3)Background on compensation of oocyte donors. Under California  
            law, the prohibition against compensation to oocyte donors  
            applies only to donors for research purposes, not to assist  
            someone else get pregnant (fertility purposes). According to a  
            March 2010 report by the Hastings Center, a research  
            institution focusing on bioethics, entitled "Self-Regulation,  
            Compensation, and the Ethical Recruitment of Oocyte Donors,"  
            the fertility industry in the United States relies heavily on  
            self-regulation, which generally takes the form of guidelines  
            issued by the American Society for Reproductive Medicine (the  
            sponsor of this bill) and its affiliated organization, the  
            Society for Assisted Reproductive Technology.  The report  
            looked at egg donor recruitment advertisements on college  








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            campuses, and found that nearly half offered compensation that  
            exceeded recommended levels.  The average compensation offered  
            was approximately $9,000, with a maximum offer of $50,000.

          The oocyte donor compensation guidelines of the American Society  
            for Reproductive Medicine, adopted in 2007, state that  
            compensation should be structured to acknowledge the time,  
            inconvenience, and discomfort associated with the process, and  
            should not vary according to the planned use of the oocytes,  
            the number or quality retrieved, or the donor's ethnic or  
            other personal characteristics.  The guidelines stated that  
            total payments to donors in excess of $5,000 require  
            justification, and sums above $10,000 are not appropriate.

          According to the author, besides California, only Massachusetts  
            and South Dakota specifically prohibit compensation for oocyte  
            donors.
            
          4)Institutional Review Boards. An IRB is a committee that has  
            been formally designated to approve, monitor, and review  
            biomedical and behavioral research involving humans conducted  
            under the auspices of the institution with which it is  
            affiliated.  IRBs are regulated by the federal Office for  
            Human Research Protection, and are required to have at least  
            five members, including at least one member who is not  
            otherwise affiliated with the institution.  IRBs have the  
            authority to approve, require modifications in, or disapprove  
            all research activities under its review.  Under California  
            law, regarding any research project involving AOP, the IRB is  
            required to ensure that the research program comply with  
            specified requirements, including the following:

                 a)        That the research program provide the subject  
                    with an objective and accurate statement about the  
                    existing state of the research for which the subject  
                    is providing oocytes; 
                 b)        That the research program performs  
                    psychological and physical screening for all subjects  
                    prior to the oocyte retrieval procedure;
                 c)        That the research program ensure, after  
                    conducting AOP retrieval on a subject, that the  
                    subject be given a post-procedure medical examination  
                    at a time within the standard of care to determine if  
                    the subject has experienced an adverse health effect  
                    that is a result of the procedure, and to inform the  








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                    subject of the right to a second opinion if she has  
                    any medical concerns;
                 d)        That the research program ensure that the  
                    subject has access to and coverage for medically  
                    appropriate medical care that is required as a direct  
                    result of the procedure , and to ensure that payment  
                    or coverage of resulting expenses is provided at no  
                    cost to the subject; and,
                 e)        That the research program provide disclosure if  
                    the physician and his or her immediate family members  
                    have any professional interest in the outcome of the  
                    research or of the oocyte retrieval procedure.
          
          5)Institute of Medicine report.  Following passage of  
            Proposition 71 in 2004, CIRM asked the Institute of Medicine  
            and the National Research Council to convene a committee of  
            experts to ascertain the medical risks of oocyte donation for  
            stem cell research.  A workshop was convened in 2006, and  
            issued a report in 2007 entitled "Assessing the Medical Risks  
            of Human Oocyte Donation for Stem Cell Research" (IMR report).  
             According to the IMR Report, years of experience with  
            assisted reproduction have identified a number of potential  
            risks associated with egg donation, falling into three main  
            categories: (1) the potential risks arising from the hormone  
            regimen that women are given to stimulate egg production,  
            including ovarian hyperstimulation syndrome (OHSS), perhaps  
            problems with long-term fertility, and breast, ovarian, and  
            endometrial cancers; (2) the risks associated with the  
            surgical procedure, including the anesthesia, which involves  
            many of the same issues that anyone having surgery faces; and  
            (3), the potential risks that are psychological in nature,  
            including anxiety, mood swings, and post-donation adjustment.   
            These risks are summarized below.  However, the IMR Report  
            stated that there was a need for more and better data.   
            According to the report, one of the most striking facts about  
            in vitro fertilization is just how little is known for sure  
            about the long term health outcomes for the women who undergo  
            the procedures. The IMR Report notes that there are no  
            registries that track the health of the people who have taken  
            part, and without such registries to draw from, most of the  
            studies have focused on relatively small groups of people.   
            The IMR Report did acknowledge that the available data come  
            primarily from IVF patients and not from healthy subjects, yet  
            it is healthy women and not those coping with infertility who  
            will be donating eggs for research, which raises the  








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            possibility that the existing data overstates the potential  
            risks for healthy donors.  The bottom line, according to the  
            IMR Report, is that there is a great deal of uncertainty about  
            the potential risks for oocyte donation for research.

                 a)        Risk of Ovarian Hyperstimulation Syndrome. OHSS  
                    is the most common side effect of the use of fertility  
                    drugs, and is described in the IMR Report as an  
                    "exaggeration of a desired response" - which is to  
                    override the female body's natural mechanism of  
                    getting a single egg during an ovulation cycle.  The  
                    administration of the ovulation-inducing hormone hCG  
                    is a key factor in the development of OHSS.  OHSS  
                    symptoms include enlarged ovaries, an accumulation of  
                    fluid in the abdomen.  Moderate cases of OHSS are  
                    characterized by more than minimal discomfort, a  
                    significant fluid buildup in the abdomen, leading to  
                    shortness of breath, nausea and vomiting. These cases  
                    can normally be handled on an outpatient basis.   
                    Serious cases are rare - about 100 to 200 cases for  
                    every 100,000 stimulation cycles, but they can have  
                    serious complications, including blood clots or kidney  
                    failure in the most severe cases, requiring  
                    hospitalizations.  

                 b)        Risk of cancer. The IMR Report noted that  
                    because women with infertility itself are at higher  
                    risk for cancer, it is more difficult to ascertain the  
                    extent to which egg donation increases cancer risk,  
                    because many of the women undergoing egg harvesting  
                    are doing so because of infertility problems.  Taking  
                    this into consideration, the IMR Report stated that  
                    there was no evidence that fertility drugs elevate the  
                    risk of breast cancer, and that there was no  
                    systematic evidence at this point that fertility drugs  
                    elevate the risk for invasive ovarian cancer.  But for  
                    uterine cancer, the IMR Report stated that while the  
                    data are too sparse to lead to any conclusion, there  
                    is greater concern.  The IMR Report also noted a  
                    concern that these effects may not be evident until a  
                    longer period of time has elapsed between the  
                    exposure, the assisted reproduction therapy, and the  
                    cancer.  According to the report, one study in  
                    particular found that as time elapsed since the  
                    treatment, there did seem to be an increased risk for  








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                    breast, ovarian, and endometrial cancers, stating that  
                    this study raised the possibility that many studies  
                    have missed the increased cancer risk because they  
                    haven't followed their subjects for enough years.

                 c)        Risk of long-term fertility effects.  The IMR  
                    Report stated that one of the concerns that had been  
                    raised was that the retrieval of up to 20 eggs instead  
                    of the normal ovulation of one egg per cycle could  
                    hasten the onset of age-related infertility.  However,  
                    based on both ovarian physiology and clinical  
                    experience, the report stated that is no reason to  
                    think that repeated ovarian stimulation poses a risk  
                    to a woman's long-term fertility.  The IMR Report  
                    acknowledged, however, that not everything is known on  
                    the subject, and there are several important questions  
                    that have not yet been answered.  The IMR Report  
                    stated that it would be helpful, for example, to have  
                    a longitudinal study that followed woman who had  
                    ovarian stimulation all the way to menopause to find  
                    out what their reproduction future holds. 

                 d)        Risk of surgery. The potential risk of surgical  
                    complications from oocyte retrieval is generally very  
                    small.  A related concern is whether the trauma  
                    applied to the ovary by the needle during harvesting  
                    could increase the risk of infertility.  The IMR  
                    reports that several studies have found that women who  
                    have undergone oocyte retrievals have a greater  
                    prevalence of antibodies to ovarian tissue, and these  
                    antibodies have been shown to be associated with IVF  
                    failures, but it is difficult to know whether  
                    antibodies play any role at all in infertility. 

                 e)        Psychological risks.  One form of psychological  
                    risk associated with donating eggs is that the  
                    screening process may reveal some previously unknown  
                    psychological or medical condition that disqualifies  
                           the woman from donating and that is uncomfortable or  
                    psychologically threatening to the patient.  After the  
                    eggs have been donated, the main psychological issues  
                    that donors experience are related to worries about  
                    future fertility, about which the IMR Report states  
                    that more and better research should be done on the  
                    risks of oocyte donation so that these risks can be  








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                    reported to the donors and they can be clear about  
                    what they are getting themselves into.

          6)National Academy of Sciences. The National Academy of  
            Sciences' (NAS) Guidelines for Human Embryonic Stem Cell  
            Research states that women who undergo hormonal induction to  
            generate oocytes specifically for research purposes should be  
            reimbursed only for direct expenses incurred as a result of  
            the procedure, as determined by an IRB.  The Guidelines go on  
            to state that "no payments beyond reimbursements, cash or  
            in-kind, should be provided for donating oocytes for research  
            purposes. Similarly, no payments beyond reimbursements should  
            be made for donations of sperm for research purposes."  When  
            developing the 2010 amendments to these guidelines (the most  
            recent update), NAS noted that since the prior update in 2008,  
            the ethics committee of the State of New York's Empire State  
            Stem Cell Board adopted a resolution allowing New York  
            State-funded stem cell researchers to compensate women who  
            donate their oocytes directly and solely to research for the  
            time, risk and burden involved in donating. Amounts of  
            compensation are to be comparable to those received by women  
            in New York State for similar donations for reproductive  
            purposes.  NAS stated that while it "acknowledges that the  
            circumstances surrounding the issue of compensation to oocyte  
            donors continues to evolve, it chose not to change the  
            National Academies' Guidelines."  NAS went on to state that  
            while it was leaving its guideline on no payments in place, it  
            recognized that "other states and entities may choose to set  
            their own policies, as New York has done."

          7)Prior legislation. AB 926 (Bonilla), vetoed by Governor Brown  
            in 2013, was substantially similar to this bill.  AB 926 would  
            have lifted the prohibition on compensation for egg donations  
            for medical research, and would have established guidelines  
            for the use of IRBs relative to egg donations and  
            compensation.  Governor Brown's veto message read:

                 Not everything in life is for sale nor should it be.

                 This bill would legalize the payment of money in exchange  
                 for a woman submitting to invasive procedures to  
                 stimulate, extract and harvest her eggs for scientific  
                 research.

                 The questions raised here are not simple; they touch  








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                 matters that are both personal and philosophical. 

                 In medical procedures of this kind, genuinely informed  
                 consent is difficult because the long-term risks are not  
                 adequately known. Putting thousands of dollars on the  
                 table only compounds the problem.

                 Six years ago the Legislature, by near unanimity, enacted  
                 the prohibition that this bill now seeks to reverse.  
                 After careful review of the materials which both  
                 supporters and opponents submitted, I do not find  
                 sufficient reason to change course. 

                 I am returning this bill without my signature.
            
            AB 1317 (Block, Chapter 523, Statutes of 2009), required that  
            all advertisements for egg donations for fertility  
            (non-research) purposes to include a warning that there is a  
            screening process, that not all potential donors are selected,  
            and that not all selected donors receive the compensation  
            amount advertised.  AB 1317 also requires the advertisement to  
            include a warning that there may be risks involved, and  
            required egg donors for fertility purposes to be provided with  
            the same risk information required to be provided to donors  
            for research purposes, and to comply with the same informed  
            consent requirements.

            SB 1260 (Ortiz, Chapter 483, Statutes of 2006), established  
            various requirements related to the donation of eggs for  
            research.  The prohibition against compensating donors beyond  
            reimbursement of direct costs, which this bill is seeking to  
            repeal, was among the provisions established by SB 1260.
            
          8)Support.  The American Association of University Women and the  
            American Congress of Obstetricians and Gynecologists, District  
            IX (California) (AAUW/ACOG) state that all other research  
            subjects can be compensated for their time, trouble, and  
            inconvenience related to participating in research, except for  
            this population.  AAUW/ACOG contend that this bill ensures  
            that women are treated equally to all other research subjects  
            - allowing them to actively evaluate their participation in  
            research studies, and that it will remove barriers to women  
            participating in research that could result in improvement in  
            care for reproductive health, including infertility and cancer  
            care.  AAUW/ACOG state that this research could benefit untold  








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            numbers of women in the future.  The California Life Sciences  
            Association states that California is one of three states  
            banning compensation for oocytes, which ultimately deters  
            participation among women who are willing donors and stalls  
            research excellence. California Cryobank states that to single  
            out egg donors is inherently discriminatory so few, if any  
            women, participate in oocyte research in California, creating  
            barriers to reproductive and other biomedical research that  
            could result in major medical advancements in cancer and  
            degenerative diseases. The National Association of Hepatitis  
            Task Forces, the California Hepatitis C Task Force, and the  
            Fair Allocation in Research Foundation state that the gender  
            inequality regarding women and research will be resolved by  
            having a requirement for women providing human oocytes for  
            research to be compensated. Equality California writes that  
            despite all of the protections to guard against the dangers of  
            exploitation in laws and informed consent procedures, women  
            are the only ones singled out and prohibited from being  
            compensated for research purposes in cases of oocyte donation  
            and that as a result of the prohibition, all research is  
            suffering due to lack of needed tissues. RESOLVE states that  
            while some fear potential exploitation of women for their  
            oocytes, in the 47 other states which permit compensation  
            there is no evidence of exploitation or abuse. The National  
            Center for Lesbian Rights states that if paying for oocyte  
            donors is an acceptable practice for infertility treatment, it  
            should also be acceptable to compensate donors who provide  
            their eggs for research. The California Chronic Care Coalition  
            writes that this bill will ensure that women are treated  
            equally to all other research subjects, allowing them to  
            actively evaluate their participation in research studies and  
            be paid for their time, trouble, and inconvenience when they  
            do participate.
            

          9)Opposition.  Former California State Senator Deborah Ortiz,  
            who authored the legislation that this bill seeks to repeal,  
            states that In 2006, she stood alongside women's health and  
            reproductive rights advocates to call for more studies on the  
            long-term health outcomes for women undergoing egg retrieval.  
            Senator Ortiz states that the health risks to women are not  
            only significant, but there is wide recognition that they are  
            understudied and that the many reports of harm to women who  
            provide eggs in the fertility context should not be ignored.  
            Senator Ortiz further states that the research has advanced  








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            very little in the last 10 years, reinforcing the need for  
            more data before expanding the market in eggs and that the  
            absence of data should urge caution, not serve as a rationale  
            to support inducements for medical procedures that carry  
            risks.   A number of organizations, including Breast Cancer  
            Action, Black Women for Wellness, Friends of the Earth, and  
            National Women's Health Network write that while they support  
            reimbursing women for the reasonable expenses of egg donation,  
            they oppose paying women over and above those amounts because  
            women providing eggs are not research subjects, and egg  
            harvesting is very different from a clinical trial and the  
            health risks of egg harvesting are substantial, but there is  
            insufficient evidence about their extent and severity to be  
            able to provide true informed consent. These supporters  
            further state that this bill conflicts with recommendations by  
            the National Academy of Sciences, and with policies that apply  
            to CIRM-funded researchers and are part of the California  
            constitution. Black Women for Wellness also writes that they  
            are concerned about the lack of oversight to protect  
            vulnerable women from being preyed upon for research purposes,  
            especially with the lack of clarity around the longer term  
            health consequences of egg harvesting. We Are Egg Donors  
            states that they understand that research with human oocytes  
            can contribute to important knowledge that can be used for the  
            greater good, but with no provision in this bill to protect  
            the health of women who would be providing these oocytes,  
            based on their collective experiences as egg providers, feel  
            it would be imprudent to pass it. The Alliance for Humane  
            Biotechnology states that in clinical trials, investigators  
            study the reactions and health outcomes of subjects who take a  
            drug, use a device, or undergo a procedure and that in a case  
            of egg harvesting, investigators are not studying, or seeking  
            to understand, the effects of the procedures on women.  The  
            Alliance for Humane Biotechnology states that egg providers  
            are thus quite different from research subjects. The  
            California Catholic Conference states that this bill puts  
            women's health in jeopardy by creating and, in effect, result  
            in a marketing dynamic designed to exploit women who are most  
            in need of resources, including college students, immigrants  
            and women with economic challenges.  
            

           SUPPORT AND OPPOSITION  :
          Support:  Alliance for Fertility Preservation
                    American Association of University Women








          AB 2531 (Burke)                                    Page 14 of ?
          
          
                    American Congress of Obstetricians and Gynecologists
                    American Society for Reproductive Medicine
                    California Chronic Care Coalition 
                    California Cryobank
                    California Hepatitis C Task Force
                    California Life Sciences Association 
                    Equality California
                    Fair Allocation in Research Foundation 
                    Fertile Action
                    National Association of Hepatitis Task Force
                    National Center for Lesbian Rights
                    Resolve: The National Infertility Association 
          
          Oppose:   Alliance for Humane Biotechnology
                    Black Women for Wellness
                    Black Women's Health Imperative
                    Breast Cancer Action
                    California Catholic Conference, Inc.
                    California Nurses for Ethical Standards
                    California Right to Life Committee, Inc. 
                    Center for Genetics and Society
                    Friends of the Earth
                    Forward Together
                    National Women's Health Network
                    Our Bodies Ourselves
                    Pro-Choice Alliance for Responsible Research
                    We Are Egg Donors
                    Five Individuals 


                     

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