Since the very first IVF procedure, the theoretical ability to perform egg donation or gestational surrogacy has existed. It took doctors and society a few years to realize this fact and get comfortable with the concept. Considering the wide variation in the legal status of egg donation and surrogacy throughout the world, it is also clear that not all societies have gotten comfortable with these procedures. In the U.S., especially in California, these procedures are helping many couples have children when they may not have been able to in the past. In addition, their high success rates demonstrate the true potential of assisted reproduction when all factors have been optimized. This article will review the medical indications for both egg donation and surrogacy. We will briefly consider how egg donors and surrogate mothers are chosen and screened. Since the process for egg donation and gestational surrogacy are actually similar, we will discuss them together. Finally, a few thoughts about the legal and ethical aspects of third party parenting will be considered.

Egg Donation

The first egg donor cycles reported were actually donor embryo cycles, where frozen embryos from one couple were transferred to the uterus of another woman. These early reports proved that women could carry a pregnancy, even if they had no ovarian function. From these humble beginnings, there are now an estimated 2500 ovum donor cycles performed annually in the U.S. In 2003, Huntington Reproductive Center performed approximately 200 egg donor cycles. In the early years, each center devised rather casual arrangements to provide egg donors. With the increasing demand for donors, and increased public scrutiny, more formal procedures are used to find and screen donors.

Indications for Egg Donation

Women who benefit from egg donation can be divided into two groups: non-menstruating and menstruating females. Non-menstruating candidates are women with premature ovarian failure or physiologically menopausal women. The medical necessity and benefits of egg donation to these women is clear. Society is still struggling with the question with establishing an upper age limit for the latter group.

Menstruating women who may benefit from ovum donation include: 1) Women with waning ovarian function. These women may have high baseline FSH levels or respond poorly to ovarian stimulation when they try IVF. 2) "Older" women. As women mature, a higher percentage of the eggs they ovulate contain abnormal chromosome numbers. Women over age 43 almost never conceive with their own eggs through IVF, and eventually need to consider egg donation. 3) Women with poor egg quality. Some women who experience multiple IVF failures may produce poor quality embryos, regardless of their age and FSH levels. These women often conceive with donor eggs. 4) Women who carry genetic or chromosomal abnormalities. Examples of these conditions are recessive traits like cystic fibrosis, dominant traits such as Huntington