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federal legislation regarding PMSR, leaving the burden on individual clinics and hospitals to address.CONCLUSIONS: There are complex questions about PMSR that must be answered carefully and with sensitivity. The history of this process is one that has been forced to decipher the ownership of gametes, inheritance of an unborn child, and consent of the deceased. Medical, ethical, and legal leaders have taken decades to define guidelines on the use of PMSR. This is a process that will likely need to be repeated as our technological advancements present heretofore unresolved challenges.