Surrogacy with three parent IVF

Surrogacy, a practice dating back centuries, has evolved significantly in recent decades, particularly with the integration of advanced reproductive technologies like in vitro fertilization (IVF). More recently, the concept of “three-parent IVF” has emerged, offering novel solutions to address genetic disorders and infertility. 

Three Parent Surrogacy: Picture of newborn baby in clinic with doctor.

A genetic disease arises from abnormal genetic mutations passed down through generations, impacting various aspects of health, including pregnancy complications. Among these conditions, mitochondrial diseases are particularly complex, involving mutations in mitochondrial DNA (mtDNA) crucial for cellular energy production.

The Evolution of Surrogacy

Surrogacy involves a woman (the surrogate) carrying a pregnancy with the intention of delivering the child for another individual or couple (the intended parents). Traditionally, surrogacy could be categorized as either traditional (involving artificial insemination with the surrogate’s own egg) or gestational (involving IVF with an embryo created from the intended parents’ genetic material).

Enter Three-Parent IVF

Three-parent IVF, also known as mitochondrial replacement therapy (MRT) or mitochondrial donation, represents a paradigm shift in reproductive medicine. It addresses mitochondrial diseases, which are caused by mutations in mitochondrial DNA (mtDNA) and can lead to severe health issues. Unlike nuclear DNA, which is inherited from both parents, mtDNA is inherited exclusively from the mother. Therefore, mitochondrial diseases are typically passed from mother to child.

Types of mtDNA Mutations

Mitochondrial diseases manifest through two primary types of mtDNA mutations:

Homoplasmic Mutations: All copies of mtDNA are uniformly mutated.

Heteroplasmic Mutations: A mixture of mutated and normal mtDNA exists within the mitochondria.

Transmission of mitochondrial diseases follows a complex mechanism not yet fully understood, leading to significant challenges in preventing their inheritance.

Understanding Mitochondrial Donation Techniques

There are two primary techniques used in mitochondrial donation:

Pronuclear Transfer: In this technique, the nuclear DNA from a fertilized egg affected by mitochondrial disease is transferred into a donor egg that has had its nucleus removed but retains healthy mitochondria. This reconstructed embryo then develops using genetic material from both intended parents and healthy mitochondria from the donor.

Spindle Transfer: This method involves transferring the spindle of chromosomes from the mother’s egg (which contains unhealthy mitochondria) to a donor egg that has had its own nucleus removed. The resulting embryo carries nuclear DNA from both parents and healthy mitochondria from the donor egg.

Apart from these two processes, cytoplasmic transfer is also one of the options. 

Cytoplasmic Transfer: Initially explored in 1997, this technique involves transferring a small amount of cytoplasm from a donor oocyte to a recipient oocyte. While it introduces healthy mitochondria, it does not eliminate mutated mtDNA, limiting its efficacy.

Ethical and Legal Considerations

The integration of three-parent IVF into clinical practice raises several ethical dilemmas:

Genetic Modification: Critics argue that altering mitochondrial DNA could potentially lead to unintended consequences or ethical dilemmas related to genetic modification.

Parental Rights and Identity: The involvement of a third party (the mitochondrial donor) raises questions about parental rights and the child’s sense of identity.

Regulatory Frameworks: Different countries have varying regulations regarding the legality and ethical acceptability of three-parent IVF, posing challenges for widespread adoption and access.

Clinical Applications and Future Prospects

Despite the ethical and regulatory challenges, mitochondrial donation offers hope for families affected by mitochondrial diseases. Clinical trials and research studies have shown promising results, with successful pregnancies and healthy births reported in several countries where the technique is legally permitted.


Surrogacy and three-parent IVF represent two interrelated fields at the forefront of reproductive medicine, offering solutions to complex genetic and infertility issues. While these technologies offer hope and possibilities for many families, ongoing ethical discussions and regulatory frameworks are crucial to ensuring responsible use and equitable access worldwide. As research continues and public awareness grows, the landscape of assisted reproduction will likely continue to evolve, providing new opportunities and challenges in the pursuit of healthy pregnancies and births.

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