Donor conception, surrogacy and social infertility — structured SAQ (15 marks)

(a) Donor-oocyte IVF pathway (4 marks)

One mark per correctly described element, maximum four. ^[1]

• Donor arm: the oocyte donor undergoers ovarian stimulation (typically a GnRH-antagonist protocol), a trigger for final oocyte maturation, and transvaginal oocyte retrieval; the oocytes are fertilised by ICSI using the partner's (or donor) sperm, and the embryo is transferred fresh or cryopreserved.^[1][16]
• Recipient arm: the recipient's endometrium is synchronised to the embryo — oestradiol to proliferate the endometrium, then luteal-phase progesterone to convert it to secretory phase and open the embryo transfer window.^[1]
• Synchronisation principle: the embryo is the fixed point; the donor's follicular development and the recipient's endometrial preparation are timed so the uterus is ready to receive the embryo at the correct developmental stage. Cryopreservation decouples the two arms when needed.^[1]
• Single-embryo transfer is the norm where possible, because multiple pregnancy magnifies the obstetric risk already present in oocyte-donation recipient pregnancies.^[21]

(b) Counselling, consent and welfare-of-the-child gates (3 marks)

One mark per gate, with the reason it is mandatory. ^[1][2]

• Implications counselling — distinct from support counselling and mandatory under the NHMRC ethical guidelines and state ART acts; it explores what donation means for the donor, the recipient, the child and the family across a lifetime.^[2]
• Valid informed consent — covers the procedure, the identity status of the donor, the information available to the donor-conceived person, and (for surrogacy) the fact that the agreement is generally not enforceable and parentage does not pass at birth.^[2]
• Welfare / best interests of the child — a prospective-parent assessment that is a clinical and ethical gate, not a courtesy; the NHMRC guidelines make the child's welfare paramount, and the ASRM Ethics Committee favours informing offspring of their conception.^[1][2]

(c) Obstetric risk to the recipient and risk to the donor (4 marks)

Two marks for the recipient risk (with source and magnitude), two for the donor risk (with named complications and source). ^[16][21]

• Recipient — hypertensive risk: an individual participant data meta-analysis confirms oocyte-donation pregnancies carry increased risk of pregnancy-induced hypertension and preeclampsia compared with autologous conceptions, persisting independent of maternal age, parity and number of embryos transferred; counsel on closer hypertension surveillance.^[21]
• Recipient — multiple pregnancy: the avoidable magnifier of all obstetric risk; single-embryo transfer lowers it.^[21]
• Donor — retrieval complications: in a large series of 4052 donor cycles, oocyte retrieval complications occurred in about 0.42 percent (intra-abdominal bleeding, severe pain, ovarian torsion); about 0.35 percent were hospitalised.^[16]
• Donor — OHSS: moderate or severe OHSS occurred in about 0.87 percent of donors in that series, all related to HCG triggering; rare fatal cases are reported. The donor must be consented for these and counselled that long-term safety (breast cancer, earlier menopause) remains incompletely characterised.^[16]

(d) ANZ surrogacy legal framework (4 marks)

One mark per element. ^[7]

• Altruistic only: altruistic surrogacy is permitted across all Australian states and territories; commercial surrogacy (paying beyond reasonable expenses) is a criminal offence in every Australian jurisdiction.^[7]
• Extraterritorial reach and enforceability: the commercial-surrogacy prohibition extends extraterritorially in several states; altruistic surrogacy agreements are generally not legally binding.^[7]
• New Zealand: only altruistic surrogacy under the Human Assisted Reproductive Technology (HART) Act 2004; clinic-assisted arrangements require Ethics Committee on Assisted Reproductive Technology (ECART) approval before treatment.^[7]
• Parentage does not pass at birth: in Australia, intended parents apply for a post-birth parentage order (mechanics vary by state); in New Zealand, the carrier is the legal parent at birth and the intended parents must apply to the Family Court to adopt the child, with the carrier's consent. Plan this before treatment, not after.^[9]