Donor conception, surrogacy and social infertility frameworks

A 34-year-old woman with Turner syndrome sits in your fertility clinic with her partner. She will never conceive with her own oocytes, and you can offer her a family through donor oocyte. Across the corridor, a gay couple asks whether they can have a child through surrogacy here in Australia. A third patient, a single teacher, wants donor sperm and has never tried to conceive. The technique is the easy part of these consultations — the counselling, the consent, the law and the welfare of the child are where the Fellowship marks live. This topic is that consultation.[1][20]

Overview and definition

Third-party reproduction is any treatment in which a person outside the intending parent or parents contributes gametes, embryos or gestation. The four pathways you must hold in your head are donor sperm, donor oocyte, embryo donation and surrogacy.[1][6]

Two ideas anchor the whole topic. First, the ASRM has retired the old words "known" and "anonymous" in favour of directed (identified) and nonidentified donors — say the modern terms and you signal current practice. Second, gestational surrogacy (the carrier is not the genetic mother) has displaced traditional surrogacy (the carrier's own oocyte is used) in regulated ART, because it separates the genetic, gestational and intending-parent roles and avoids the custody disputes that dog traditional arrangements.[6][9]

"Social infertility" is the umbrella term for people without a medical bar to conception who still need a third party to build a family — single women, same-sex couples, and people without a partner. The clinical pathway is usually identical to medical infertility; what differs is the access criteria, the counselling and the legal-parentage mechanics.[20]

References21Show ledgerHide ledger

1. [1]Practice Committee of the American Society for Reproductive Medicine and the Practice Committee for the Society for Assisted Reproductive Technology Guidance regarding gamete and embryo donation Fertil Steril, 2021.PMID 33838871
2. [2]Ethics Committee of the American Society for Reproductive Medicine Informing offspring of their conception by gamete or embryo donation: an Ethics Committee opinion Fertil Steril, 2018.PMID 29605404
3. [3]Ethics Committee of the American Society for Reproductive Medicine Financial compensation of oocyte donors: an Ethics Committee opinion Fertil Steril, 2016.PMID 28340933
4. [4]Practice Committee of the American Society for Reproductive Medicine and Practice Committee of the Society for Assisted Reproductive Technology Repetitive oocyte donation: a committee opinion Fertil Steril, 2020.PMID 32482251
5. [5]Ethics Committee of the American Society for Reproductive Medicine Defining embryo donation: an Ethics Committee opinion Fertil Steril, 2023.PMID 37149804
6. [6]Ethics and Practice Committees of the American Society for Reproductive Medicine Updated terminology for gamete and embryo donors: directed (identified) to replace "known" and nonidentified to replace "anonymous": a committee opinion Fertil Steril, 2022.PMID 35443924
7. [7]Shenfield F, Tarlatzis B, Baccino G, Bounartzi T, Frith L, Pennings G, Provoost V, Vermeulen N, Mertes H Ethical considerations on surrogacy Hum Reprod, 2025.PMID 39865605
8. [8]Shenfield F, de Mouzon J, Pennings G, Ferraretti AP, Andersen AN, de Wert G, Goossens V Cross border reproductive care in six European countries Hum Reprod, 2010.PMID 20348165
9. [9]Söderström-Anttila V, Wennerholm UB, Loft A, Pinborg A, Aittomäki K, Romundstad LB, Bergh C Surrogacy: outcomes for surrogate mothers, children and the resulting families-a systematic review Hum Reprod Update, 2016.PMID 26454266
10. [10]Golombok S, Jones C, Hall P, Foley S, Imrie S, Jadva V A longitudinal study of families formed through third-party assisted reproduction: Mother-child relationships and child adjustment from infancy to adulthood Dev Psychol, 2023.PMID 37053391
11. [11]Jadva V, Jones C, Hall P, Imrie S, Golombok S 'I know it's not normal but it's normal to me, and that's all that matters': experiences of young adults conceived through egg donation, sperm donation, and surrogacy Hum Reprod, 2023.PMID 36921279
12. [12]Ilioi EC, Golombok S Psychological adjustment in adolescents conceived by assisted reproduction techniques: a systematic review Hum Reprod Update, 2015.PMID 25281685
13. [13]Groundstroem H, Paulin J, Thorup E, Sydsjö G, Lampic C Donor-conceived adolescents' interest in obtaining information about their identity-release oocyte or sperm donor-results from the Swedish Study on Gamete Donation Hum Reprod, 2026.PMID 42204656
14. [14]Anderson K, Goedeke S, Bertrand S, Hamilton R, Snelling J, Ahuriri-Driscoll A, Wakeman S, Farquhar C Donor identity in Aotearoa New Zealand: a survey of parents regarding disclosure of donor conception to their donor-conceived children Fertil Steril, 2026.PMID 40780419
15. [15]Dyer S, Chambers GM, Jwa SC, Baker VL, Banker M, de Mouzon J, Elgindy E, Fu B, Ishihara O, Kupka MS, Zegers-Hochschild F, Adamson GD International Committee for Monitoring Assisted Reproductive Technologies world report: assisted reproductive technology, 2019 Fertil Steril, 2025.PMID 40513636
16. [16]Bodri D, Guillén JJ, Polo A, Trullenque M, Esteve C, Coll O Complications related to ovarian stimulation and oocyte retrieval in 4052 oocyte donor cycles Reprod Biomed Online, 2008.PMID 18681998
17. [17]Xie F, Im TM, Park D, Chiu VY, Fassett MJ, Getahun D Adverse Perinatal Outcomes by Gestational Surrogacy Status among In Vitro Fertilization Pregnancies Am J Perinatol, 2026.PMID 42331008
18. [18]Liu J, Dai Y, Song Z, Sun X, Lv D, Zhao D Obstetric and perinatal outcomes in pregnancies conceived with donor versus partner sperm: a systematic review and meta-analysis Front Endocrinol (Lausanne), 2025.PMID 40771274
19. [19]Kneebone E, Beilby K, Hammarberg K Experiences of surrogates and intended parents of surrogacy arrangements: a systematic review Reprod Biomed Online, 2022.PMID 35909052
20. [20]Fauser BCJM, Adamson GD, Boivin J, Chambers GM, de Geyter C, Dyer S, Inhorn MC, Schmidt L, Serour GI, Tarlatzis B, Zegers-Hochschild F Declining global fertility rates and the implications for family planning and family building: an IFFS consensus document based on a narrative review of the literature Hum Reprod Update, 2024.PMID 38197291
21. [21]van Bentem K, van der Hoorn ML, Banker M, de la Calle M, Elenis E, El Demellawy D, Fox NS, Jeve Y, Korb D, Letur H, Yinon Y, Farina A, Rizzello F, Rodriguez-Wallberg KA, Simchen M, Simeone S, Tarlatzi T, Giannubilo SR, Le Cessie S, Lashley E The risk for the development of hypertensive complications in oocyte donation pregnancy: a systematic review and individual participant data meta-analysis (DONOR IPD) Hum Reprod Update, 2026.PMID 41915703