The phenomenal growth of infertility treatment in South Africa


The use of egg donation for fertility treatment in South Africa has grown phenomenally, especially over the last five years. South Africa is a sought after destination for infertility treatment, especially from the African countries, Australia, Europe and increasingly, the Americas. The right to anonymity for egg donors, well-established processes and guidelines, affordability and very importantly, the availability of donor eggs have driven this growth. As there is no central database and no registry for egg donation, it is difficult to calculate numbers, but the growing demand highlights the acceptance of egg donation in principle as well as the views of the country’s healthcare professionals.  

The increase in egg donation is a subject for debate. Is it due to an increase in infertility or due to an increase in the acceptance of egg donation as a means to conceive and therefore its availability? It is in truth a combination of the two factors.

Guidelines on egg donation in South Africa

Egg donation in South Africa follows national guidelines to ensure an ethical service is offered, that the necessary care and attention is paid to the various aspects of egg donation and to protect the rights and interests of all. The South African Society for Reproductive Medicine and Gynaeological Endoscopy (SASREG) have developed egg donation guidelines and require professional egg donation agencies to confirm their compliance by signing their acceptance. There are seven egg donation agencies in South Africa that meet the guidelines. Fertility clinics are encouraged to work only with egg donor agencies that have signed the code of conduct. Egg donation agents are encouraged to maintain a close professional relationship with SASREG.

There is a limitation on the number of egg donations per egg donor. Legislation in South Africa requires that no more than six children may be conceived via a specific egg donor. The egg donation guidelines also require that egg donors limit the number of egg donations to six. This maximum number can only be reached if an egg donor is found to respond well to egg donor treatments and of course is available and willing to donate with each treatment.  The actual number per year should be limited to four donations. A professional medical opinion is always sought on the egg donor's suitability to donate again, regardless of the outcome of the donation.

The issue of payment for egg donation is also covered by the guidelines. No person may be paid for donation of human tissue. Egg donors are given a nominal amount, which is paid via the fertility clinic, for their time and efforts, and not for the actual donor egg.

Anonymity of egg donation

Egg donation in South Africa is completely anonymous and confidential. Recipients may view childhood pictures of egg donors up to age 10 (if these are available). Their full profiles are also available, including medical information, family background, detailed educational, behavioural, philosophical and physical information and this information enables recipients to select their egg donor. The egg donor’s responsibility ends on the day of egg retrieval; there is no registry and no means to contact the egg donor later in life. Recipients are also protected and can elect to keep all details of the conception via egg donation a private matter from loved ones and of course the child conceived via egg donation.

Medical aspects of egg donation

The medical aspects of egg donation remain the responsibility of the fertility clinic. So, whilst an egg donor agent can carry out an assessment of the egg donor's level of readiness, the ovaries can only be assessed via scans and hormone level tests. Fertility specialists will consider the egg donor’s suitability and will have the final say as to whether the egg donor is likely to provide the recipient with a good chance of conception. An egg donor's previous fertility, via her own children or aiding a recipient to conceive with her eggs, are not always an indication of her ability to contribute to another conception. The re-testing of hormone levels prior to new egg donations is vital. All egg donors require a new psychological assessment at least every year.  

Women who require egg donation as a form of fertility treatment or supporting their IVF are often those who have reached advanced maternal age. Partners may only be met later in life and/ or people want to prepare for their future and offer their offspring the best by saving and planning for a later birth.  Sometimes when that time has arrived, it is too late to conceive with one's own eggs. Generally, woman start to consider egg donation in their late 30's. Egg donation is also recommended if people have had several failed treatments with their own eggs or have chromosomal or genetic challenges that they wish to end with the solution of egg donation. Another reason is the onset of premature ovarian failure, menopause, or early menopause.

The egg donation process

The egg donation process is in itself, reasonably short. An egg donor can be medically and psychologically assessed and be ready for egg retrieval within a couple of weeks. Her actual participation requires a series of injections to stimulate the ripening of the eggs. It is also important to note that egg donors do not give any more eggs in an egg donor cycle than what they would in a normal month. The use of medication aims to recover eggs that would ordinarily have been lost. Egg donors participate for around 14 days, from the start of their menstrual cycle until they ovulate, around day 14. This process is planned after the menstrual cycles have been aligned and all parties have agreed to the dates. The actual egg retrieval process takes place under sedation or anaesthetic. The eggs are retrieved from the follicles, which are hair like structures, that develop at the end of the ovaries. Eggs are retrieved with a catheter vaginally and, essentially, sucked from the follicles. This process marks the end of the egg donor's participation. The recipient's partner's sperm fertilises these eggs. The sperm is very often frozen and so recipients need only to stay for a few days for an egg donor program in South Africa. This is usually a day for the scan, to confirm the readiness of the uterus and then the transfer of the developed embryos, usually five days after the retrieval. So whilst recipients are encouraged to be in South Africa for around 10 days, they do not need to stay in one place over this period.

The professional approach, the existence of established ethical guidelines, donor anonymity, and favourable success rates mean that South Africa is an attractive destination for infertile couples.



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