Introduction This third and final empirical chapter discusses how both professionals being active in the ART field, in reproductive medicine, and actors outside of the “inner circle” of biomedicine work to disrupt institutions and the present regime which makes it possible to open up for new activities and for new groups to advance their interests, as explained at the end of Chapter 2 in Part I of the book. The term “disruption” stresses a moment and quite violent overturning of a specific regime, but as the empirical data reported indicate, disruptive institutional work is not so much a matter of storming the Bastille as it is of participating in relatively civil and ongoing conversations and debates regarding the limits of ART and reproductive medicine. This does not suggest that there are no emotions or heated arguments involved in this work, but the inertia built into the health care and political policy-making system makes emotional outbursts quite insignificant. At the end of the day, for good and for bad, the work to disrupt institutions unfolds as a politico-administrative process concerned with the balancing of many different objectives and interests in a world of limited budgets and growing health care costs. The chapter continues by examining how actors in the field shaped the legal environment, including: the role of the legal and regulatory frameworks of practice, legal enforcement, how professionals shape the policy-making process and the sources of regulatory debates. Also, debates and critique of the legal environment and the work of patient and activist groups, with the example of gay couples advocating commercial surrogacy are further examined.