The oocyte paradox; a compelling cause for continued ART surveillance in a developing country

The introduction of assisted reproductive technology (ART) has revolutionised the management of infertile couples. ART is available in many developing countries, but only to those who can afford the service. This inequity in access has resulted in an unmet need amongst those who are economically vulnerable. Late presentation is common in developing countries due to the enormous cost of ART, resulting in a disproportionately larger cohort of older women seeking ART. Oocyte donation is in high demand in many developing countries, but there is often a lack of regulations and enforcement capabilities. This may inadvertently subject the oocyte to the law of supply and demand with consequent exploitation. Altruistic gamete donation has gradually been superseded by compensated donation, paving the way for commercialisation in contrast to the concept of ‘a true gift’. The value of the human oocyte becomes a function of its designation either for research or treatment during ART. In many developing countries where research in human reproduction is minimal and altruistic donation extremely low, the oocyte paradoxically attains a commercial status and is available to the highest bidder. There is a compelling need to strengthen regulatory agencies in developing countries to discourage the commodification of gametes. An important strategy involves the development of policies and guidelines for donor compensation rather than the current practice of discretion. Gamete sharing will reduce the pressure on ART recipients and, if properly implemented, will minimise desperation and discourage exploitation. In developing countries, Oocyte banking should be explored to allow equitable distribution of scarce gametes.