This chapter demonstrates how major divergences have occurred in the fatwas being issued by Sunni and Shia religious authorities regarding the permissibility of third-party reproductive assistance. In recent years, new fatwas emerging from the Shia world have condoned third-party gamete donation, whereas gamete donation continues to be banned across the Sunni Muslim countries. These divergent Sunni and Shia Islamic approaches toward gamete donation have affected the moral decision making of infertile Muslim couples in ways that are only beginning to be realized. The degree of consensus across the Sunni Muslim countries is quite striking, as are the ways in which these fatwas have guided the clinical practices of the Middle Eastern IVF community.