Please kindly refer to the following articles:

Donating frozen eggs: Why treatment costs cannot be reimbursed in Australia

Donation after egg freezing: Why past treatment costs do not constitute reasonable expenses

Payment for donation of unused frozen eggs is unethical

Singapore's 'freeze and share' conundrum faces would-be mothers

Subsidies and reimbursement of medical fees - revisiting the old concept of egg-sharing donation in elective egg freezing

Introduction

      The debate surrounding the financial reimbursement of women who donate surplus frozen eggs or participate in "freeze-and-share" schemes involves complex legal, ethical, and sociological arguments. While proponents argue these measures make egg freezing more affordable and address donor shortages, there is a robust case against such practices, primarily centered on the violation of the gift paradigm, the lack of a causal link between treatment and donation, and the potential for undue inducement.

The Legal and Regulatory Argument: A Missing Causal Connection

      A primary argument against reimbursing past medical fees is that such payments do not constitute "reasonable expenses" under existing legal frameworks, such as those in Australia. The law distinguishes between de novo donors—who undergo retrieval specifically to donate—and egg-freezers, who undergo the procedure for personal fertility preservation.
      For de novo donors, medical costs are directly caused by the act of donation, making reimbursement justifiable. Conversely, egg-freezers incur these costs for their own reproductive goals, regardless of any future decision to donate. A subsequent choice to donate does not retroactively convert private treatment costs into donation-related expenses. Furthermore, Australian law specifically excludes costs incurred before an embryo becomes "excess" from being reimbursed in embryo donation; failing to apply this same standard to frozen eggs would create a regulatory double standard.

Ethical Concerns: Undue Inducement and Compromised Autonomy

      It can be argued that offering thousands of dollars in medical fee subsidies or refunds acts as an undue financial inducement. This financial carrot can "cloud" a woman's judgment regarding the significant medical risks involved in egg retrieval, such as Ovarian Hyperstimulation Syndrome (OHS), which can be life-threatening.
      Furthermore, many women become emotionally vulnerable when deciding the fate of their unused eggs. After investing time and "hard-earned money," the prospect of wasting that investment can lead to a state of despair. Offering reimbursement at this stage may exploit this vulnerability, "cajoling" them to donate primarily to recoup financial losses rather than out of altruistic intent. This trespasses on the donor's autonomous decision-making process, as the choice becomes tied to financial desperation rather than a free-will gift.

Undermining the Gift Paradigm and Commodification

      At the heart of the opposition is the protection of the "gift paradigm," which dictates that human bodily materials should be donated altruistically and not treated as market commodities. Allowing the recovery of historical costs risks shifting egg donation into a financially-motivated market.
      The purpose of reimbursement is to ensure a donor is not "out of pocket"; however, an egg-freezer is in the same financial position whether they discard or donate their eggs. Reimbursing them actually improves their financial position relative to non-donation, effectively placing a price tag on the eggs. This commercialization of human tissue is seen as a significant ethical departure that could have broad implications for all types of organ and tissue donation.

Market Forces and Social Inequality

      Despite being framed as a way to make egg freezing accessible to lower-income women, "freeze-and-share" schemes are often highly selective and market-driven. Prospective recipients typically seek specific "desirable" traits, such as high education, beauty standards (height/complexion), or specific ethnic backgrounds.
      Consequently, these programs likely exclude the very women they claim to help—those with less education or fewer "marketable" traits. This creates a system where only the "genetically desirable" can afford to preserve their fertility, while others remain priced out. Furthermore, varying levels of compensation based on donor traits can lead to accusations of racial or caste discrimination.

Psychological Risks and the "Future Offspring" Conundrum

      Donating eggs is not merely donating "cells"; it involves the creation of a child with the donor's genetic material. Women participating in these schemes may later suffer from cognitive dissonance or deep regret as they reflect on their genetic connection to a child they will never know.
      The asynchronous nature of these programs means a donor might only realize she is infertile years later, after her "best" eggs have already been used by someone else to conceive. This can lead to immense psychological trauma: being childless while knowing an unknown anonymous offspring exists elsewhere. Additionally, there are concerns regarding the rights of the donor-conceived offspring, who may suffer identity crises or be deprived of vital heritable medical history (such as predispositions to cancer or diabetes) due to anonymity.

The Obsolescence of Donor Anonymity and Privacy Risks

      Current arguments against these schemes also highlight that donor anonymity is effectively obsolete due to the advent of cheap mail-order DNA testing and online genealogy databases. Donors may face unexpected and intrusive contact from genetic offspring decades later, leading to shock and emotional trauma for both the donor's legal family and the offspring.
      There is also a documented risk of accidental incest between unknown donor offspring and the donor's legitimate children, a risk exacerbated by "genetic-sexual attraction". In regions like Singapore, where information on the number of children born per donor is not shared, this risk is particularly acute.

Professional Conflicts of Interest

      Finally, there are inherent conflicts of interest for medical professionals and fertility clinics. Clinics may aggressively advertise these schemes to "entice" young women into invasive procedures to boost their own donor egg supply. Because clinics earn additional medical fees by performing the subsequent donation procedures on recipient patients, they have a hidden financial agenda to push former patients toward donation. There is even the concern of covert egg trading or profiteering by marking up fees to recipient patients.

Conclusion

      In summary, the arguments against refunding or subsidizing egg freezing costs emphasize that such practices convert an altruistic gift into a commercial transaction, exploit emotional and financial vulnerability, and ignore the long-term psychological and legal implications for donors and offspring alike. Instead of financial incentives, it is recommended to focus on non-financial strategies, such as improving public awareness and reviewing donor eligibility criteria to be more evidence-based and just.