Two fifths of eggs in British clinics are from sharing schemes swapping free treatment for genetic material. Photograph: Chris Knapton/Alamy

I t isnt a baby, of course: just a tiny clump of cells invisible to the naked eye, a dot of potential life that may yet come to nothing. So some will be bemused by this weeks fuss over the practice of women donating human eggs to fertility clinics for other womens use in return for getting their own IVF treatment free. Unless you have religious objections, whats wrong with a deal that may represent poorercouples only chances of starting a family?

So-called egg-sharing schemes have been around for 20 years and are quite legal, so long as nobody is paid outright for donating. But the results of a newspapers undercover investigation into fertility clinics make uncomfortable reading nonetheless.

Journalists posing as would-be parents too broke to afford IVF were reportedly handed leaflets in some clinics promoting loans to cover the fees at up to four times bank rates. In others, egg donation seems to have been heavily pushed. One nurse allegedly suggested the couple think of it as like donating blood, even though its a hospital procedure performed under anaesthetic after weeks of taking ovary-stimulating drugs that carry a small risk of serious side-effects, and the process carries potentially serious emotional implications. What if you fail to get pregnant, only for the egg you gave away to grow up into someone elses child with a legal right to trace their biological mother when they reach 18?

So the Human Fertility and Embryology Authority is right to promise an investigation, and should follow the trail all the way to its logical conclusion. The fertility industry isnt some benign, kindly stork, but a multimillion-pound business rife with potential conflicts between profit and patient welfare that are overdue some scrutiny. The bigger question is how far responsibility for anything that may have gone wrong should be shared by successive governments, whose failure to fund free IVF treatment on the NHS has driven poorer patients into potentially vulnerable situations.

An estimated 40% of eggs in British clinics now come from sharing schemes swapping free treatment for genetic material. Its arguably prettier than alternatives seeking treatment overseas in countries with more lax regimes, or the seedy trade in women illegally offering eggs for sale over the internet and has led to an estimated 2,000 births.

Yet sharing remains a moral grey area. Its not quite cash for babies, but its not a million miles away either. And with payment, even in kind, comes the risk of exploitation. Is a woman who effectively has no choice but to donate eggs if she wants children of her own really giving them freely, as the law demands? For, inevitably, its poorer women who will be disproportionately attracted to donating, and richer women those who can afford treatment outright who benefit. Fertility specialists insist many women undergoing IVF would be happy to donate spares for nothing. One Belgian study found a 70% drop in donation after the Belgian government promised free IVF, suggesting many donors were motivated by financial considerations. (Ironically, if the Department of Health had actually funded the three free cycles of IVF that the health watchdog NICE recommended 13 years ago, waiting lists for donor eggs might well be longer now.)

There is a web of conflicting interests to unpick here, and an obvious tension between the HFEAs guidelines which state that a donation must be altruistic and in the spirit of contributing to a wider social good to comply with British law and the reality that sharing is clearly sometimes a euphemism for something darker.

Ive spent just enough time in fertility clinics long story, but while getting pregnant naturally was easy the first time, the second time never happened to know theyre places of vulnerability. Grief, desperation and hormones cloud everyones judgment until nothing seems to matter but the baby you dont have. When I told my NHS consultant I was in two minds about IVF, given that I was lucky enough to have one child already, he blurted out, so it doesnt actually matter that much.

At the time, it felt brutally insensitive given many women find secondary infertility (failing to get pregnant when youve done it before) as distressing as childlessness. But with hindsight Im grateful not to have been pushed into endless rounds of treatment that were statistically unlikely to work. I wonder if a less scrupulous private consultant might just have banked the cheque.

There are many private clinics providing outstandingly ethical service, of course. But the lesson of too many scandals involving womens health including the disturbing case of Ian Paterson, the breast cancer surgeon convicted last week of repeatedly performing mastectomies on private patients who didnt need them is that its naive to assume there will never be rogues. Kneejerk judgments aroused by any mention of female fertility have in the past perhaps tended to shield this industry from scrutiny. Public sympathy is with the doctors, those twinkly-eyed miracle babymakers, while their customers are caricatured as silly women paying the price for leaving it too late even though women young enough to make good egg donors have, by definition, not left it too late. If they had, their eggs would be useless.

But lets be honest. Its not just patients who benefit from stretching the age or income limits for IVF treatment, as egg donation does. Almost every breakthrough expands the potential pool of paying customers. Its not enough to grunt caveat emptor when taxpayers and politicians alike have saved a fortune by tacitly shunting emotionally vulnerable people off the NHSs books and into private sector hands. Doctors are not the only ones who owe these patients a duty of care.

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Cash for babies? Not quite, but egg donors deserve protection - The Guardian