Consequences for Australian recipients of cross border oocyte donation in South Africa: double embryo transfer and donor anonymity

Background: Due to the shortage of oocyte donors in Australia, Australian women increasingly travel overseas for oocyte donation. South Africa is a recognised ‘repro-hub’ due to the accessibility of relatively affordable, high-quality assisted reproductive technology services and the availability of donors. In contrast to Australia, where only known and identity release altruistic gamete donation is permitted, in South Africa, oocyte donors are anonymous and receive fixed compensation. Aims: To explore the consequences for Australian recipients of cross-border oocyte donation (CBOD) in South Africa. Materials and Methods: Semi-structured interviews were conducted with 12 Australian recipients who had at least one live birth after oocyte donation in South Africa between 2012 and 2020. Interviews were transcribed and transcripts analysed thematically. Results: Most participants had failed assisted reproductive treatment in Australia before travelling to South Africa. Inability to secure an Australian donor led to CBOD. Ten recipients had at least one double embryo transfer (DET). Of the 15 pregnancies, participants reported one third were twin pregnancies. Some had more than one double embryo transfer cycle. Donors were anonymous, creating disparity around access to genetic information between children conceived with an Australian donor and those conceived with a South African donor. Some Australian recipients used sleuthing methods to locate donor siblings whose recipient parents had used the same donor. Conclusions: Double embryo transfers increase the possibility of multiple pregnancy and its associated risks of poorer obstetric outcomes, and donor anonymity prevents donor conceived children's ability to officially access information about the donor through donor registers. Strategies to address the shortage of Australian oocyte donors could alleviate the need for CBOD. Education about the consequences of DET and donor anonymity is needed.