ETHICAL CONSIDERATIONS INVOLVING OOCYTE DONATION AND GESTATIONAL SURROGACY

Oocyte donation and gestational surrogacy are now well established mod alities in the treatment of human infertility. Both have greatly enhan ced the scope of possibilities of reproduction and as such have greatl y enhanced the reproductive choice of infertile couples of all ages. O ocyte donation has made motherhood possible for women without function ing ovaries. Initially offered primarily to those with premature ovari an failure under the age of 35 and to those who do not wish to pass a genetically heritable defect, this technology has increasingly been us ed to overcome the aging of the human oocyte in women over the age of 40.(1,2) More recently, oocyte donation has been extended to the treat ment of women over the age of 50.(3,4) Gestational surrogacy provides the infertile couple with a surrogate uterus and is therefore useful i n cases where the uterus is absent due to a congenital defect or prior surgery. Gestational surrogacy may also be applied when the female pa rtner has a medical problem that would make pregnancy inadvisable. Ooc yte donation in the classic sense is thought of as purely the donation of one gamete. However, this treatment may be combined with the simul taneous use of donor sperm. In this case, the procedure might better b y termed embryo donation. Whereas the addition of donor sperm does not in any way add to the complexity of the medical procedure, it does ad d to the ethical complexity. Embryo donation may then also be applied to spare embryos that were cryopreserved as part of an assisted reprod uctive 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 don ation. Gestational surrogacy in the classic sense refers to a situatio n in which the gametes (both sperm and oocytes) are provided by the in fertile couple. However, it is again intuitive that the medical comple xity of gestational surrogacy is not enhanced if either donor sperm or donor oocytes are introduced into the equation. The ethical complexit y, on the other hand, is enhanced. There is no longer an obvious answe r to the question, ''Whose baby is it?''