This chapter discusses the legal issues and the efforts that legislatures, courts, professional guidelines, programs, and patients have made to resolve them, in the hope of giving professionals some guidance in these evolving areas. Preserving male fertility through sperm collection and freezing is the most commonly recognized, and likely most frequently performed, of all fertility preservation measures. Donor gametes have also been involved with legal claims regarding embryo donation, discard, or custody of resulting children. Use of donor insemination to create a family raises additional legal issues for infertile men, their spouses or partners, and the sperm donors involved. Donor screening is required under a variety of state and federal laws, as well as professional guidelines. Posthumous reproduction raises additional legal complexities, including determination of the legal status of any resulting child under applicable law, which varies from jurisdiction to jurisdiction, within the United States as well as internationally.

A small proportion of malignancies have a clear genetic aetiology resulting from mutations in genes inherited usually as an autosomal dominant trait. Risk assessment and genetic counselling around genetic testing and reproductive decision-making should be undertaken in a regional genetic service. If a mutation is identified within an individual, it should be confirmed in another affected member of the family, if possible. A predictive genetic test is then available for unaffected adult members of the family. Adoption or conception using donor gametes may be alternatives for families with genetic conditions who wish to avoid prenatal diagnosis. The issue of the appropriateness of prenatal diagnosis and of preimplantation genetic diagnosis (PGD) for inherited conditions with an onset in adulthood is controversial. PGD may be more acceptable than prenatal diagnosis as it obviates the need for termination of an affected pregnancy.