Certainly, guidelines provide a framework for physicians making difficult decisions, and the values of an individual physician can differ from this framework, as evidenced by the trepidation of Dr. Deans. In this particular case of caring for Lily, an otherwise healthy 53-year-old woman, after appropriate medical screening and assessment of social support, we would invoke respect for patient autonomy and uphold the ASRM guidelines by offering Lily donor-egg IVF. While physicians should indeed be aware of the greater sociocultural implications of their care, their decisions are made on an individual basis while caring for individual patients, not for society as a whole.