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Katherine Dawson is searching for siblings she’s never met.

The 35-year-old is one of an estimated 60,000 Australians who are donor-conceived and whose biological fathers’ identities were kept a mystery.

“I was told you’re not allowed to know who he is, you’re not allowed to know who any of your siblings are and I was really blocked from knowing that information,” Ms Dawson said.

Ms Dawson began researching the missing pieces of her genetic heritage by visiting clinics to find records and taking ancestry DNA tests.

So far, she’s confirmed she has 53 half-siblings living across South Australia, Victoria and Queensland, as well as overseas.

But she believes she may have up to 700 siblings, including some who may not know they are donor-conceived.

She’s desperately trying to find them to pass on potentially life-saving medical advice about an elevated cancer risk that runs in the family.

“I can’t just sit back and go live my life and forget about it,” she said.

State register allows ‘personal journeys’

Ms Dawson is one of 428 people on South Australia’s Donor Conception Register, which was launched in February last year.

The SA government has described it as the first publicly accessible electronic register of its kind in Australia to operate in real-time with retrospective effect.

The online register allows adults who were conceived through donated sperm, egg or embryo in SA — and the parents of a donor-conceived person — to access information about their donor and siblings, such as names, date of birth and gender.

The register is backdated to include treatments carried out in the 1970s and donations made under the condition of anonymity prior to September 2004.

As of December 2025, the register included 428 individuals — 53 donors, 115 donor-conceived, and 153 donor-recipient parents. The remaining 107 were profiles generated for minors whose personal information is protected.

SA Health deputy chief executive for clinical system support and improvement, Robyn Lindsay, said the register allowed people to share personal information, such as contact details or medical history.

Prior to 1988, doctors and clinics had no legal requirements to keep records of donor conception treatments.

Ms Lindsay said finding historical records had been challenging, given that some fertility clinics had closed and records could be damaged or missing.

“Information about the donor, and those who received treatment, were even deliberately kept quite separately,” Ms Lindsay said.

“Records deteriorate over time and doctors’ writing, even in the first instance, is often hard to read.”

She said SA Health was trying to verify records with the Births, Deaths and Marriages registry — a process that could take months to complete.

“It’s really important that this information is of high integrity, and it is verified, so that can be frustrating when people are looking for a complete set of information quickly,” Ms Lindsay said.

An urgent health warning

Ms Dawson met her biological father in 2023. She discovered that he was a prolific donor who visited multiple clinics in Victoria over at least six years during the 1980s and under different names.

She hopes the register will be able to link her to more siblings in SA and warn them of a family-cancer risk.

“There might be siblings I’ve got already that have developed bowel cancer, given some of them could be in their 40s now and they should be checking from their mid-20s,” she said.

Ms Dawson said she’d like to see a national register established. It would help other donor-conceived people easily access their genetic information without having to navigate legislation in different states and territories.

“We should be thought about in the long term, and prevented from the potential trauma and potential difficulties and hardships of essentially being stuffed around,” she said.

Growing calls for a national register

Bec Kilday’s search for her donor’s identity has also taken her across state borders.

The 36-year-old, who grew up in Adelaide, has been genetically linked to a Victorian donor whose sperm was sent interstate.

“I actually reached out to the fertility clinic that my parents used fairly early on in the journey and asked for what information they might have available … and I got no response,” Ms Kilday said.

But Ms Kilday has so far discovered 27 half-siblings and believes there are more.

She joined the register hoping to uncover more information — not only for herself, but for her donor and Victorian-based siblings, whose IVF procedures weren’t performed in SA.

Ms Kilday said a national register would eliminate some of the difficulties she had experienced in seeking information from interstate.

“It’s not to say a national register is necessarily going to be quicker — it’s just that if they had access to all of the information it wouldn’t be double handling as much,” she said.

Australian Medical Association SA president Peter Subramaniam said the development of a national framework was a “logical next step”.

“We are one country and people in Australia move around,” Dr Subramaniam said.

He said having a patient’s medical history was a huge benefit for doctors to start preventative early treatments and screenings, but added that it was essential that personal data be handled with sensitivity.

“One of the key risks for any registry such as this is to make sure we get the right information, so we need to have data integrity and data fidelity,” Dr Subramaniam said.

In September, a federal “rapid review” of the assisted reproductive technology and IVF sector highlighted the risk of unregulated donations and the absence of a national donor register.

The report found while some jurisdictions have their own donor register, the databases are managed independently and are not linked.

“The lack of a nationally linked resource also compromises the ability of donor-conceived individuals to identify or verify donors, siblings, or medical information,” the report found.

The federal health department said ministers had agreed to make a referral to the Australian Law Reform Commission to explore options for harmonising and modernising relevant legislation nationally.

“Opportunities that seek to create more consistency in laws and regulations across jurisdictions for donations should be considered in the future to address this issue,” a spokesperson said.

Use of metformin did not reduce progression in male patients with low-risk prostate cancer on active surveillance, though the observed adverse effects (AEs) in patients with obesity may warrant further investigation, according to results from the randomized, double-blind phase 3 MAST trial (NCT01864096) published in the Journal of Clinical Oncology.

Among the 408 eligible patients who were enrolled in the trial and randomly assigned to either the metformin arm (n = 205) or the placebo arm (n = 203), 144 experienced either therapeutic or pathologic progression, with 70 cases of progression in the metformin arm and 74 in the placebo arm. In the metformin arm and placebo arm, the progression-free survival (PFS) probability was 94% (95% CI, 90%-97%) and 96% (95% CI, 93%-99%), respectively, at 12 months, 62% (95% CI, 54%-70%) and 69% (95% CI, 62%-76%) at 24 months, and 58% (95% CI, 51%-67%) and 60% (95% CI, 53%-68%) at 36 months. Per the Kaplan-Meier survival curves, there was no significant difference in time to progression between the treatment arms (P = .59). Notably, the HR for progression in the metformin group was 1.09 (95% CI, 0.79-1.52).

Overall, pathologic progression was observed in 136 patients, with 66 instances in the metformin arm and 70 in the placebo arm. In the metformin arm and placebo arm, the PFS probability was 94% (95% CI, 91%-98%) and 96% (95% CI, 94%-99%), respectively, at 12 months, 64% (95% CI, 57% to 72%) and 70% (95% CI, 63% to 77%) at 24 months, and 58% (95% CI, 51% to 67%) and 61% (95% CI, 54% to 69%) at 36 months. No statistically significant difference was observed (P = .66; HR, 0.77; 95% CI, 0.77-1.51).

A planned a priori analysis was stratified by body mass index (BMI). Patients with a BMI of 30 or greater who were assigned to the metformin group had a higher risk of pathologic progression per Kaplan-Meier survival curves.The HR for progression in the metformin group was 2.36 (95% CI, 1.21-4.59; P = .0092), highlighting the significantly increased risk associated with metformin use in this subgroup, whereas in patients with a BMI less than 30, the HR was 0.82 (95% CI, 0.55-1.23; P = .33). In the Cox proportional hazards model including the treatment group, BMI category, and interaction term, the interaction between BMI and treatment arm was significant (P = .0092).

Overall, the HR for progression in the metformin group was 1.09 (95% CI, 0.78-1.53; P = .60). In the BMI less than 30 and BMI of 30 or higher subgroups, the HRs were 0.86 (95% CI, 0.58-1.29; P = .48) and 2.19 (95% CI, 1.13-4.26; P = .021), respectively.

Further, therapeutic progression was observed in 45 patients, with 27 cases in the metformin arm and 18 in the placebo arm. In the metformin and placebo arms, the PFS probability was 97% (95% CI, 94% to 99%) and 98% (95% CI, 97% to 100%), respectively, at 12 months, 83% (95% CI, 77% to 89%) and 91% (95% CI, 87% to 95%) at 24 months, and 81% (95% CI, 75% to 88%) and 90% (95% CI, 86% to 95%) at 36 months. The difference between the 2 arms was not significant (HR, 1.73; 95% CI, 0.95-3.14; P = .068). The per-protocol sensitivity analysis revealed that the HR for the metformin group was 1.76 (95% CI, 0.97-3.20; P = .063).

“In conclusion, these findings demonstrate no benefit in adding metformin as a means of delaying progression among patients with low-risk [prostate cancer] on [active surveillance]. Furthermore, a potentially harmful effect was noted among obese men,” wrote lead study author Neil E Fleshner, MD, MPH, FRCSC, of the Division of Urologic Oncology at Princess Margaret Cancer Center of University Health Network in Toronto, Ontario, Canada.

A total of 408 patients were included in the analysis and randomly assigned, in a 1:1 ratio, to either receive metformin at 850 mg once daily, escalating to 850 mg twice daily over 1 month, or receive placebo. Eligible patients were between 18 and 80 years old with a biopsy-confirmed, low-risk, localized prostate cancer, and decided to undertake expectant management as their primary treatment. Those who received prior prostate cancer treatment, had any prior use of metformin, sulfonylureas, thiazolidinediones, or insulin, and a diagnosis of type 1 or 2 diabetes were excluded from participation.

The median age of patients was 62.0 years (IQR, 57.5-67.0), and 93.5% of patients were White. Most patients had clinical stage T1c disease (93.7%). The mean baseline BMI was 28.0 kg/m² (SD, 4.0), and 73.4% were considered nonobese and defined as having a BMI less than 30.

The primary end point of the trial was time to progression, defined as the earliest occurrence of therapeutic or pathologic progression.

The B0 rate at 18 months was 27.3% in the metformin group and 28.1% in the placebo group (P = .880); at 36 months, it was 41.0% vs 31.1%, respectively (P = .181).

Regarding safety, the most reported adverse effects (AEs) were gastrointestinal, which occurred more frequently in the metformin group. Diarrhea occurred in 19% of the metformin group vs 8% of the placebo group, and nausea, dyspepsia, or abdominal pain occurred in 9% of the metformin group vs 1% of the placebo group. These AEs were typically mild or moderate in severity, and no significant differences were observed in serious AEs between the 2 groups.

Reference

Fleshner NE, Bernardino RM, Izawa J, et al. Metformin active surveillance trial in low-risk prostate cancer. J Clin Oncol. 2025;43(34):3662-3671. doi:10.1200/JCO-25-01070