O&G SAQs · Reproductive endocrinology & infertility — third-party reproduction
Donor conception, surrogacy and social infertility — structured SAQ (15 marks)
FRANZCOG-format structured SAQ on donor-oocyte IVF, the mandatory counselling/consent/welfare-of-the-child gates, the obstetric and donor risks, and the ANZ surrogacy legal framework. Per-sub-part marking rubric included.
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FRANZCOGMRCOGABOG
Prompt
You are the fertility registrar. A 41-year-old woman with premature ovarian insufficiency and her 43-year-old male partner attend to discuss building a family with donor oocytes. She asks about the technique, the risks to her and to a donor, and whether the child should be told. Separately, a gay male couple has asked about surrogacy in Australia. (a) Outline the donor-oocyte IVF pathway, naming the donor arm and the recipient arm and how they are synchronised. (4 marks) (b) State the counselling, consent and welfare-of-the-child gates that must be completed before any third-party treatment, and why they are mandatory. (3 marks) (c) Counsel the woman on the obstetric risk of an oocyte-donation recipient pregnancy and on the risks to the oocyte donor. (4 marks) (d) Outline the legal framework for surrogacy in Australia and New Zealand for the gay couple, including the status of the surrogacy agreement and the post-birth parentage pathway. (4 marks)
How this SAQ is marked
Twelve SAQs, 180 marks, two 2-hour papers — roughly 15 marks and 20 minutes each. Marks come from specifics: named pathway, named legal instrument, named risk with its magnitude and source, the named gate. Write in short labelled points, not prose paragraphs. Answer the sub-part you are asked. [1]
Reveal model answer and mark schemeShowHide
(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]
References7ShowHide
- [1]Practice Committee of the American Society for Reproductive Medicine and the Practice Committee for the Society for Assisted Reproductive Technology Guidance regarding gamete and embryo donation Fertil Steril, 2021.PMID 33838871
- [2]Ethics Committee of the American Society for Reproductive Medicine Informing offspring of their conception by gamete or embryo donation: an Ethics Committee opinion Fertil Steril, 2018.PMID 29605404
- [7]Shenfield F, Tarlatzis B, Baccino G, Bounartzi T, Frith L, Pennings G, Provoost V, Vermeulen N, Mertes H Ethical considerations on surrogacy Hum Reprod, 2025.PMID 39865605
- [9]Söderström-Anttila V, Wennerholm UB, Loft A, Pinborg A, Aittomäki K, Romundstad LB, Bergh C Surrogacy: outcomes for surrogate mothers, children and the resulting families-a systematic review Hum Reprod Update, 2016.PMID 26454266
- [16]Bodri D, Guillén JJ, Polo A, Trullenque M, Esteve C, Coll O Complications related to ovarian stimulation and oocyte retrieval in 4052 oocyte donor cycles Reprod Biomed Online, 2008.PMID 18681998
- [17]Xie F, Im TM, Park D, Chiu VY, Fassett MJ, Getahun D Adverse Perinatal Outcomes by Gestational Surrogacy Status among In Vitro Fertilization Pregnancies Am J Perinatol, 2026.PMID 42331008
- [21]van Bentem K, van der Hoorn ML, Banker M, de la Calle M, Elenis E, El Demellawy D, Fox NS, Jeve Y, Korb D, Letur H, Yinon Y, Farina A, Rizzello F, Rodriguez-Wallberg KA, Simchen M, Simeone S, Tarlatzi T, Giannubilo SR, Le Cessie S, Lashley E The risk for the development of hypertensive complications in oocyte donation pregnancy: a systematic review and individual participant data meta-analysis (DONOR IPD) Hum Reprod Update, 2026.PMID 41915703