Third-party fertility treatments refer to use of egg donors, sperm donors, donated embryos, and/or third-party gestational carriers/surrogates to have a child. There are two main categories of fertility treatments: intrauterine insemination (IUI) and in vitro fertilization (IVF). IUI involves placement of sperm (from a donor or from the woman’s partner) into a woman’s uterus. In IVF, egg production is stimulated with drugs, after which the eggs are vaginally retrieved, fertilized with sperm in a laboratory, and then transferred into a uterus (of the intended parent or a gestational carrier) or cryopreserved for future use. Parents typically choose third-party fertility treatments because of problems with the ovaries, sperm, or uterus. When proceeding with third-party fertility treatments, donors and recipients should undergo medical review, screening for infectious disease, and psychological evaluation. Overall rates of successful pregnancy vary, with age being a key factor, ranging from 3% to 9% (with IUI) to 14% (with IVF) for women ages 40 to 41 years to approximately 50% (with IFV) for women younger than 35 years. There are many issues that adults considering IUI or IVF should consider during decision-making (eg, financial cost; legal status of parentage, which can vary by location; medical risks, which are low; psychological and ethical considerations).

Case 4. RV and AE are a heterosexual couple who have been unable to have a baby. One past pregnancy resulted in a blighted ovum. A second pregnancy resulted in missed abortion at 8 weeks’ gestation and the fetus was found to have trisomy 15. A current infertility evaluation revealed diminished ovarian reserve. They recently learned that a friend and her partner had a child via egg donation. They are interested in learning about their options.