Chapter 2 explores the right to make use of medically assisted procreation to conceive a child, upheld by the Strasbourg Court as an expression of private and family life. It discusses limitations based on ‘the rights of others’ (e.g. the other gamete provider in disputes over embryos) and ‘morals’ (e.g. public policy objections to heterologous fertilisation, surrogacy and the posthumous use of cryopreserved gametes/embryos). The chapter argues that the refusal to treat couples with donated gametes imposes a choice between genetic parenthood and the continuance of marriage to an infertile spouse, affecting both prospective and existing family life. It further maintains that reproductive autonomy should extend to posthumous reproduction where the deceased left advance directions and there are no overriding child welfare concerns. The chapter notes the recognition of legal ties between children and genetic parents in foreign surrogacy cases, albeit exclusively through the lens of children’s privacy (identity) rights.

Chapter 5 examines the impact of gender, sexual orientation and civil status on access to ART and the enjoyment of family life formed through ART. Aspiring single parents, women in a relationship with a same-sex or transgender male partner, and men in a same-sex relationship are reliant on gamete donation (as well as, in the case of male couples, surrogacy) in order to have a biological child and are particularly disadvantaged by prohibitions on third-party reproduction. These remain, nonetheless, within States’ margin of appreciation. However, where a child was born following the use of donated gametes or surrogacy abroad, the Strasbourg Court requires measures of protection. Significantly, the relationship of surrogate-born children with the intended non-biological parent is equally protected whether the genetic father has an opposite-sex or same-sex spouse. The chapter criticises, however, the less favourable treatment of commissioning mothers based on a conservative understanding of motherhood as gestational.

Donor insemination (DI) has undergone radical changes in the last 25 years, for example exclusive use of frozen semen, and increasing use of DI for single women. A summary of these is presented as are the potential challenges we still face. The latter include key questions such as what are the key methods for optimising treatment. Can we improve our success rates? If so, how can this be done? Moreover, the use of DI as a research tool, often ignored, is presented.