Ethical Considerations Involving Oocyte Donation and Gestational Surrogacy

Oocyte donation and gestational surrogacy are now well established modalities in the treatment of human infertility. Both have greatly enhanced the scope of possibilities of reproduction and as such have greatly enhanced the reproductive choice of infertile couples of all ages. Oocyte donation has made motherhood possible for women without functioning ovaries. Initially offered primarily to those with premature ovarian failure under the age of 35 and to those who do not wish to pass a genetically heritable defect, this technology has increasingly been used to overcome the aging of the human oocyte in women over the age of 40.' More recently, oocyte donation has been extended to the treatment of women over the age of 50. Gestational surrogacy provides the infertile couple with a surrogate uterus and is therefore useful in cases where the uterus is absent due to a congenital defect or prior surgery. Gestational surrogacy may also be applied when the female partner has a medical problem that would make pregnancy inadvisable. Oocyte donation in the classic sense is thought of as purely the donation of one gamete. However, this treatment may be combined with the simultaneous use of donor sperm. In this case, the procedure might better by termed embryo donation. Whereas the addition of donor sperm does not in any way add to the complexity of the medical procedure, it does add to the ethical complexity. Embryo donation may then also be applied to spare embryos that were cryopreserved as part of an assisted reproductive technology (ART) cycle of an infertile couple. If at some point in the future the couple wishes to give these embryos up for adoption, such "preimplantation adoption" falls into the realm of embryo donation. Gestational surrogacy in the classic sense refers to a situation in which the gametes (both sperm and oocytes) are provided by the infertile couple. However, it is again intuitive that the medical complexity of gestational surrogacy is not enhanced if either donor sperm or donor oocytes are introduced into the equation. The ethical complexity, on the other hand, is enhanced. There is no longer an obvious answer to the question, "Whose baby is it?"