Custody battles over frozen sperm and eggs. Children sired by dead men. Women giving birth to children who share none of their genes.
These are the realities of modern reproductive medicine, a rapidly evolving area of science that continues to challenge notions of parenthood.
It's murky legal ground, governed by few specific laws, with judges largely on their own to settle conflicts, and rulings that vary by court and location.
"It's really the Wild West," said Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania.
And the possibilities are numerous - about 40,000 children were born through assisted reproduction in 2004, the most recent year for which statistics are available.
In one case that illustrates the new frontier, Maryland's highest court ruled last week that the birth certificates of twins need not list their surrogate mother - or any woman, for that matter - as the legal mother. Caplan and other experts say that such situations are far from rare and likely to become more complex as new reproductive techniques emerge.
At least three women have reportedly used frozen sperm from deceased U.S. soldiers to conceive.
Kathleen Smith, a widow from Austin, Texas, gave birth to a son on July 14, 2006 - two years after her husband was killed by a sniper's bullet while serving in Iraq. Brian Smith, an Army tank commander, had banked sperm before he deployed and signed a document allowing her to decide whether to use it in the event of his death.
The soldier's father, William Smith of McKinney, Texas, said his daughter-in-law is applying for military benefits for her child. They are optimistic, he said, because the family was told that two other women who conceived using sperm from deceased soldiers had been granted benefits. "The precedent is there," he said.
A spokeswoman for the Department of Veterans Affairs said she was unable to confirm any such births or whether children conceived this way qualify for benefits based on their fathers' military service.
The banking of frozen eggs is less common than storing sperm. But the emerging practice is expected to become more widespread because it allows women to extend the reproductive window or provide eggs for others' later use.
"It may help women in their 30s not develop that panicked feeling," said Ruth Faden, executive director of the Johns Hopkins Berman Institute of Bioethics. She cautioned, however, that little is known about the long-term viability of frozen eggs or the conflicts that might ensue.
Like frozen sperm, used for decades in artificial insemination and more recently for in vitro fertilization, eggs can be stored for long periods. While eggs and sperm remain in cryogenic stasis, the lives of the donors may change - or end.
Disputes have arisen over ownership of and responsibility for frozen sperm.
In a New York case, a couple sought to take custody of their dead son's frozen sperm. Mark Speranza, 23, had banked his sperm six months before he died of cancer in 1998. When his parents learned of it, they sought to take possession of the samples so they could have a surrogate mother produce a grandchild for them.
Last fall, a judge ruled that the couple had no legal right to the sperm and ordered the tissue bank to destroy it.
In a similar case this year, an Israeli court ruled that sperm from Staff Sgt. Keivan Cohen, an Israeli soldier killed in the Gaza Strip in 2002, could be used to inseminate a woman he had never met.
The soldier's parents had the sample extracted from his body shortly after he was killed and found a woman who wished to use the sperm to become pregnant.
Experts said few federal or state laws govern the field of reproductive medicine, because legislators have remained reluctant to grapple with the politically touchy issues raised by the steady advance of technology.
"The challenge in this country is that, traditionally, decisions about reproduction have been left to the individual," said Gail H. Javitt, the law and policy director for the Genetics and Public Policy Center in Washington. "From a political perspective, you have to ask whether we would accept the government making those personal judgments for us."
Britain has a statute governing parental rights in cases that involve "assisted reproduction," the term used for advanced techniques that aid fertilization.
Seven states, not including Maryland, have adopted the Uniform Parentage Act, a model law that addresses such reproductive issues, but no such federal law exists.
Courts are thus often left to their own devices to rule on conflicts that can't be resolved in private.
"Courts are put in tough position," Javitt said, noting that the case decided Wednesday by the Maryland Court of Appeals demonstrated those difficulties.
The lawsuit was brought by a man and the surrogate mother of his twin children, who were born in 2001 at Holy Cross Hospital in Silver Spring. They agreed that she should have no legal responsibility or rights to the children, who were conceived from the man's sperm and an egg from another woman.
The two sued to have the twins' birth certificates list only the father and no mother, and the court ruled 4-3 in their favor.
In his dissent, however, Judge Dale R. Cathell worried that the decision could lead to contracts to create babies in which people could opt out of responsibility for the children.
"You see the dissent's feeling that these are really big questions and should be addressed by legislators," Javitt said.
She noted that it is becoming more common for people to seek help in producing offspring. "About 1 percent of babies are born through some kind of assisted reproductive technologies," she said.
Karen H. Rothenberg, dean of the University of Maryland School of Law, said many legal disputes revolve around questions of parental rights and responsibility.
"There are all these possible combinations of mothers and fathers," she said. "Can you legally have more than two parents? Can you have a child with no legal parents or two fathers and no mother?"
With new technologies will come new questions, experts say.
"We will get a case - say a terrible car accident - where a couple dies," Caplan said. "Someone will want to take a sperm and an egg, produce a fertilized embryo and have a surrogate mother carry the child."
Far-fetched as it might sound, the first child conceived with frozen sperm and frozen eggs was born last month in Mission Viejo, Calif. The eggs came from the woman who gave birth to the child, while the sperm came from a donor.
Jeffrey P. Kahn, director of the Center for Bioethics at the University of Minnesota, mentioned several medical advances that are envisioned. One possibility is that stem cell research might one day enable same-sex couples to have children genetically related to both partners, he said.
A man, for instance, might have one of his stem cells developed into an egg cell, fertilized by his partner's sperm, and then the embryo carried by a surrogate mother.
Ovary and testicle transplants might make it possible for a previously infertile person to conceive using organs from donors living or dead.
Another technique might allow the DNA of two women to be combined in one egg.
Kahn said that might help older women give birth, but might add another layer of confusion to parentage.
"How many mothers does that baby have?" he said.
chris.emery@baltsun.com
DIVISION OF LABOR
Reproductive medicine has made it possible for numerous people to claim parentage of a child. Here are a few possibilities:
Number ................... Scenario
of parents
Two ................. The widow of a deceased man is artificially inseminated with his sperm, which was frozen for future use.
Three ............. A man and his wife, who can't produce viable eggs, obtain frozen
eggs from a female donor. Through in vitro fertilization (IVF), the eggs are
fertilized with the man's sperm. The embryo is implanted in the womb of the
man's wife, who gives birth.
Four ................. A man and his infertile wife obtain eggs from a female donor. The eggs are fertilized through IVF with the man's sperm. The embryo is implanted in a third woman, a surrogate mother who gives birth.
Five ............... An infertile man and his infertile wife receive frozen eggs and sperm from donors (the genetic mother and genetic father). The fertilized embryo, produced through IVF, is implanted in a surrogate mother who delivers the child.