One of the hardest decisions for many infertility patients is what to do if IVF using their own egg and sperm fails multiple times. After several failed IVF cycles, many patients face the decision between moving to assisted reproduction (donor egg, donor sperm, donor embryo) or adoption. It can be an agonizing decision.
Infertility treatment can sometimes feel like a ladder. You start with smaller easier treatments (oral medications like Clomid and Letrozole) then move up the ladder to intrauterine insemination (IUI), then on to in vitro fertilization (IVF). Most infertility patients willingly take the first steps up the ladder (if they can afford it), but what happens when they aren’t successful with IVF. What is the next step?
At this point, two options present themselves: assisted reproduction, which includes donor sperm, donor egg, donor embryo (sometimes known as embryo adoption), or/and surrogacy, or adoption. Decisions, decisions! How to decide between assisted reproduction and adoption.
The bottom rungs on the ladder are not necessarily the easiest for many women and not all fertility treatment follows this “ladder.” In fact, there is research to support that following this lock-step approach is not always the most effective or cost-effective for getting pregnant. Also, some patients at this point opt to live a child-free life rather than choosing between assisted reproduction or adoption. Nonetheless, this progression up the fertility treatment ladder is a standard scenario for many fertility patients.
The decision of what to do when IVF fails, and then fails again, and maybe again is one of the hardest decisions for many infertility patients. Do you take the next step up the ladder to assisted reproduction? Or do you step off the ladder completely and move to adoption?
Creating a Family Resources on Ending Infertility Treatment:
- What Made You Decide You Were DONE With Infertility Treatment?
- How Long Should You Try Fertility Treatment Before Stopping
Deciding Between Assisted Reproduction and Adoption
Deciding between adoption and assisted reproduction (also known as third-party reproduction) is complicated. Neither is the next logical step up the ladder of infertility treatment, and neither should be taken without pausing to consider what this means for you individually, for you as a couple (if you’re married or in a relationship), and for the child that you hope to have. In truth, even though assisted reproduction feels like the next step up the infertility ladder, it is a step off that ladder, just as is adoption.
Differences Between Assisted Reproduction and Adoption
There are obvious and not-so-obvious differences between choosing donor sperm, donor egg, donor embryo, or surrogacy and choosing adoption.
Cost can be a significant factor for most when deciding whether to use third-party reproduction or to adopt. Keep in mind that with all assisted reproduction, you also need to add in the legal cost because almost always you will need to consult with an attorney that specializes in assisted reproduction.
$1-2,000 + medical & legal costs (This includes an average cost for 1-2 vials of sperm from a commercial sperm bank. Your cost would be less if you use sperm donated from someone you know.) Creating a Family has detailed information on the cost of sperm donation.
$4000-$16,000 (Depends on whether you work through an infertility clinic or adoption agency, and how many services you want to be included.) Medical costs are included in these averages, but you may have to add legal costs if not covered with your program. Some programs require that you travel to their clinic for the embryo transfer, so travel cost would need to be added. Creating a Family has detailed information on the cost of embryo donation or embryo adoption.
$16,000-$45,000+ medical costs (Depends on whether you use fresh or frozen, how restrictive you are on characteristics of a donor, whether you share a fresh cycle, whether you use a donor or a frozen egg bank, etc.) It is also possible to save money by going abroad for an egg donor, but care must be taken with logistical and ethical issues. Creating a Family has detailed information on the cost of egg donation.
$70,000 – $90,000 (without egg donor); $100,000 – $150,000 (with egg donor). These costs usually include legal and medical. It is also possible to save money by going abroad to find a surrogate, but care must be taken with immigration and ethical issues. Creating a Family has detailed information on the cost of surrogacy.
Domestic Infant Adoption
$30,000 – $35,000 average (Depends on whether you use an agency or attorney, the services provided by the agency, expectant mother expenses, etc.) The Adoption Tax Credit is available (about $13,000) to reduce these costs by offsetting the taxes you owe the federal government. Creating a Family has extensive resources on the cost and process of adopting a baby in the US.
Foster Care Adoption
$0-2000 average (depending on if you use a private agency or state agency, the state you live in, etc.) The Adoption Tax Credit is available (about $13,000) to offset taxes you owe the federal government, and most children adopted through foster care are eligible for a monthly subsidy from the state until they are 18. Creating a Family has extensive resources on Foster Care Adoption.
$40,000- $44,000 average (depends primarily on the country you adopt from) Creating a Family has detailed information on the cost of adopting from the top placing countries to the US.
Creating a Family’s Annual Update on Adoption Data:
The Risk that You Will Spend the Money and Not Become a Parent
At the risk of oversimplification, the risk of any type of assisted reproduction is that the treatment won’t work, and you or the surrogate will not get pregnant. The odds of pregnancy per IVF cycle are highly dependent on your diagnosis, age, and history with maintaining a pregnancy, and should be determined with consultation with your doctor. Money is usually not refundable when treatment fails.
The risk with domestic adoption is that the expectant mother will change her mind and decide to parent rather than place her child for adoption. Whether or not you lose the money you have spent depends on the agency or attorney.
The risk with foster care adoption is if you are fostering to adopt, the child may well reunify with birth family or extended family. If you are adopting a child that is already legally free for adoption, there is little risk that the adoption won’t be completed.
The risk in international adoption is that it may take longer than expected, and every once in a while countries will close to adoption. Whether or not you lose the money spent will depend on the agency.
Control over Genetics and Prenatal Care
It’s a myth that we have control over genetics whether we conceive naturally or with assisted reproduction or adoption. However, with assisted reproduction, you have some control over the appearance, intelligence, and basic personality traits of the child because you will have access to this information when choosing a donor. Since you will be carrying the child, you have a fair degree of control over the prenatal care and environment.
With embryo donation (embryo adoption) you often have much less information on the donors depending on whether you obtain the embryos from a clinic or agency. Since you will be carrying the child, you have a fair degree of control over the prenatal care and environment.
With surrogacy, you will have a contract with the surrogate that specifies that she follow her doctor’s recommendations about prenatal care and environment. You have to trust that she will follow through.
With adoption, you have little control over the genetics or prenatal care or environment. Knowledge of appearance, personality, traits, talents, and family medical history of birth parents varies by type of adoption and ranges from often a great deal of knowledge with domestic infant adoption to very little with foster care or international adoption.
Creating a Family Resources on Nature Vs. Nurture:
- Nature, Nurture, Genetics, and Environment
- Importance of Genetics in Determining How Our Kids Turn Out
Emotional Factors to Consider When Deciding Between Assisted Reproduction and Adoption
When deciding between assisted reproduction and adoption, in addition to the practical considerations such as cost, the likelihood of success, and control, you also have to factor in how you feel on a deep level about each method of creating your family. In our opinion, there is no morally superior way to build your family, and there is no correct way to feel. Spend some time individually and as a couple (if married or in a relationship) to think through the following questions.
- Genetic Connection- How important is it to you or your partner to have a genetic connection to your child? Do you fantasize about a child that looks like the perfect mash-up between you and your spouse or partner, or do you long to carry on the family line and grandpa’s big nose and grandma’s musical talent?
- Pregnancy and Breastfeeding – How important are the physical aspects to you? Do you long to be pregnant and breastfeed? Do you and your partner want to experience together this physical manifestation of impending parenthood? Do you want to have your own labor and birth stories to share at playgroup or around the water cooler?
- Exhaustion – Are you sick and tired of the roller coaster of fertility treatment? Do you worry that you simply can’t take another failure? Adoption has its own share of failure and exhaustion, but for some people, it is a welcomed relief.
- Familiarity – Adoption is an easier process to explain to the rest of the world since most people will have some basic understanding of adoption. This is not the case with assisted reproduction.
- Comfort with telling the story to the child-We strongly recommend that you tell the child regardless of whether you adopt or use assisted reproduction. Which story are you more comfortable telling? Something to consider is that there are more resources to help parents tell the adoption story, but that is likely to change as more children are conceived by 3rd party reproduction.
Creating a Family Resources on 3rd Party Reproduction:
- Teens Born Via Sperm/Egg Donation or Surrogacy Are Doing Fine
- Is Adoption Morally Superior to 3rd Party Reproduction?
No Right Answer
There is no one right answer. Each of you will have to decide for yourself what is best for you and your family. Creating a Family has tons of resources on each of these options, and we strongly encourage you to become educated before you make a decision. If you feel stuck, please spend a few sessions with a therapist that specializes in infertility to help you think through the pros and cons of your options.
- Using donor sperm
- Using donor egg
- Using donor embryo
- Using a surrogate
- Adopting a Baby
- Adopting from Foster Care
- Adopting from Abroad
We also encourage you to listen to this excellent Creating a Family Radio show on Choosing Between Assisted Reproduction and Adoption.
Originally published in 2017; Updated in 2019 Image Credit: wistechcolleges