Just a few decades ago, expanding a family through adoption was a relative rarity, and turning to fertility experts for help was considered an extreme solution—but not today. No longer is there one common or acceptable way to build a family. Rather, there are numerous alternatives out there for would-be parents. Each has its pros and cons, and each requires a great deal of faith in the chosen process. But they all have the same essential objective—to give couples who want to love and raise a child the possibility of doing so.
According to the American Fertility Association, more than 15 percent of couples in the United States have difficulty conceiving a child. In fact, RESOLVE: The National Infertility Association reports that 7.3 million people nationwide are affected by infertility, which is recognized by the American Society for Reproductive Medicine and the American College of Obstetricians and Gynecologists as “a disease that results in the abnormal functioning of the male or female reproductive system.”
Those numbers may sound like they’re on the rise, but the actual rates of infertility have not necessarily changed over the years, says Jim Toner, M.D., Ph.D., a board-certified specialist in reproductive endocrinology and infertility with the Atlanta Center for Reproductive Medicine (ACRM). The reason infertility seems to be such a prevalent topic today is because “more couples have ended up delaying their family building, and women are often in their late 30s or early 40s before they try to get pregnant,” Toner explains. The older a woman gets, the more difficult it is for her to conceive. That’s because women are born with all of the eggs they are ever going to have. As a woman ages, her number of eggs actually decreases, and the quality of the eggs that are left also diminishes. By the time a woman is 40, getting pregnant can be quite a challenge. Yet, it’s far from impossible, thanks in large part to modern medicine.
Personal Story Spotlight
Jessica Shrum: Putting a Face on Infertility
Jessica and Ed Shrum have been married for 10 years. Of those 10 years, 7 have been focused on the effort to become parents. “Emotionally, going through fertility treatments is a roller coaster,” says Jessica, who began trying to get pregnant at the age of 29. “It consumes your life. Your schedule is not your own anymore. At times, it can make you feel so alone. But getting pregnant and having a child was so important for me to experience. I would have done anything and given up every cent I had to have a child.”
Of course, the pregnancy was no easy feat either, as Jessica spent 26 out of 39 weeks on bed rest. But the result could not have made the new parents happier. “There’s an element of perseverance when it comes to fertility treatments,” Jessica notes. “You have to keep going and keep trying. Your attitude is tremendously powerful. You just have to know that everything in the long run will work out. And I’m actually thankful for all of the missteps and miscarriages because it’s true—you will be so in love with your child, and if anything had been different along the way, it would not have been that child. We are just so thankful to have her.”
The Shrums are grateful to have each other as well. Jessica reveals that they supported each other throughout the years of struggle and worked hard to stay focused on their marriage. They also decided to open the lines of communication with those around them so they wouldn’t feel so isolated. “Communication is so important,” Jessica says. “And, of course you can’t understand it when you’re going through the process, but you eventually have to just accept things. You have to truly believe that you’ll be OK if it doesn’t work out. It’s amazing how much better it can make you feel. But if you’re giving it your best and listening to your insides, then it can happen.”
Toner contends that any woman who has been trying to conceive for a year should consider paying a visit to a fertility specialist. It’s even more crucial for a woman who is older than 35 and has been trying for at least 6 months. If you fall into either of these categories, there’s one important point you should know before you make an appointment at a fertility clinic. “Not everyone who walks in the door is going to need in vitro fertilization. In reality, that’s the case in only 1 out of 4 patients,” Toner says.
As it happens, many couples can be helped with less intricate methods. Toner observes that most fertility clinics, including ACRM, take a “laddered approach” with patients who have an adequate supply of eggs and sperm, and no tubal blockages or other complications, but have, for unknown reasons, been unable to conceive. “We begin with the simplest rational therapy and go from there,” he says. Typically, the “ladder” of options includes:
- Pharmaceutical intervention. Sometimes all it takes for a woman to become pregnant is ovulation induction with fertility medications. A pill such as Clomid is taken 5 days a month to cause 2 eggs to release during a patient’s cycle, thus doubling the chance of conception. The possibility of having multiples does increase a small amount with this fertility option, but on average only 10 percent of women using Clomid give birth to twins.
- Intrauterine insemination (IUI). According to Toner, IUI, which is also known as artificial insemination, is often used in tandem with fertility medications. During this process, sperm is placed directly into a woman’s uterus via a tube. There’s no need for anesthesia and no discomfort, and the procedure increases a woman’s chances of becoming pregnant. Of course, most physicians recommend giving IUI 3 cycles to work. When used with pharmaceutical intervention, though, Toner maintains that IUI can be highly effective.
- In vitro Fertilization (IVF). While it is the most complicated and involved of all the fertility options, IVF is also one of the most effective methods of achieving pregnancy. During this multi-step process, a fertilized embryo is created in a laboratory using a couple’s egg and sperm; it is then transferred into the uterus with the hopes of it attaching in the womb. Usually, with a number of eggs being retrieved during a minor surgical procedure, a couple will end up with several viable embryos. However, as Toner explains, “These days, if a woman is under the age of 38, it is very uncommon to transfer more than 2 embryos into the uterus. This decreases the possibility of having multiples. So, while there is a chance for twins, you don’t have to be afraid that you’ll end up like Jon & Kate Plus 8.” And as a rule of thumb, the additional embryos that are not used are frozen for future use.
Success rates of IVF are encouraging for most couples who are struggling with infertility. Toner says, “Up to the age of 38, the national delivery rate is 50 percent, and one in three of those pregnancies involves twins. In the 38-40 age range, the delivery rate drops to 30 percent, and the possibility of twins goes down to 20 percent. Over the age of 40, the delivery rate drops again to 15 percent with a rare instance of twins. So it is sensible to begin thinking about IVF as an option as early as you can—and as close to the age of 35 as possible—because the numbers do fall off quickly with the age factor.”
For some couples, a pivotal part of becoming parents is having a biological child. When a woman has difficulty becoming pregnant or carrying to term, however, it can seem like an impossible dream. But there is a feasible option—surrogacy.
“Surrogacy has become much more acceptable in recent years. For a long time, it was almost taboo. But now it is an option that many people are using,” says Kathy Stern, M.A., executive agency director of and licensed professional counselor for Surrogacy Specialists of America LLC (SSA), which has offices in Houston, Dallas and Atlanta. “For couples who want a biological child, this gives them the opportunity to have that.”
And while you may have heard many wonderful stories about a relative who was willing to serve as a surrogate for a loved one, you may be surprised to learn that this type of independent arrangement is not really the norm. According to Stern, the majority of situations involve a hired surrogate who is chosen from a database of potential candidates, usually through a surrogacy agency, and charges anywhere from $15,000 to $25,000 for her services. Once a couple chooses a surrogate, who has already gone through medical and psychological screenings, she undergoes in vitro fertilization with the help of a reproductive specialist using an embryo comprised of the couple’s egg and sperm. Biologically, the child is 100 percent that of the couple. And after the baby is delivered, the couple assumes the parental role and, Stern says, “Everyone basically goes back to their old life.”
While the legal requirements surrounding a surrogacy might seem daunting and a bit scary, they are simply safeguards put in place for the parents. And it would be an extremely rare exception if the agreement was challenged in any way. “You can rest assured that most arrangements go very smoothly,” Stern says. “People have an unwarranted fear that the surrogate will want to keep the baby. That never happens. Unless an outside egg donor is used, the baby is the biological child of the parents. And the surrogate is just overjoyed to help the couple become parents. They feel like they’ve done something really special for someone.”
In fact, couples typically become very close to their surrogate, as they are in contact often for the duration of the pregnancy. “The process is more open these days,” Stern explains. “The parents can enjoy being involved in the pregnancy, going to doctor visits and more. Couples just love hearing what’s going on every step of the way, and they are always so grateful for what their surrogate is doing for them. It really is a gift.”
The adoption option
“When you choose to adopt a child, you enter into this special fraternity of people—people who have opened their hearts and decided to be parents through any means necessary,” says Melissa Clause, executive director of AAA Partners in Adoption Inc., which is based in Alpharetta. “For people—especially women—who do not have the opportunity to have a biological child for whatever reason but want to open their arms to a child, adoption is a wonderful option.”
Personal Story Spotlight
Jenny and Jonah Levison: Meant to Be
Jenny Levison had no idea that it would only take 8 months for her to become a mother. Actually, when she began considering the adoption process as a single parent, she was not quite sure what the path ahead would bring. It was late 2002, and then-38-year-old Levison, owner of Atlanta’s beloved Souper Jenny, who had been married and divorced, knew that—more than anything—she wanted to have a child. “I always knew that I wanted to be a mom,” she says. “I considered all of my options, and after listening to my heart and really thinking about what I wanted, I decided that domestic adoption was right for me.”
What Levison wanted was to adopt a little girl that she could name after her grandmother. She also wanted an open adoption so she could be part of the entire process and learn as much as possible about the birth mother. Not really knowing how to begin and feeling overwhelmed by all of the information about adoption, Levison turned to Gloria Hawk, executive director of Adoption Advice & Guidance, in early 2003 to be her guide and serve as a liaison between herself and the adoption agencies out there. And guide her Hawk did, personally taking Levison step by step through the process, from home study to matching and handling all communication with the chosen agency. She was the perfect resource, having worked with single-parent adoptions many times before meeting Levison.
“I always say that Gloria single-handedly got me my child—especially after the first adoption fell through,” she says. Initially, Levison was matched with a birth mother in Tennessee for an open adoption. When the young woman went into labor in November of 2003, Levison got in her car and headed north. Halfway there, she got a phone call saying that the teen had changed her mind. Devastated, she turned around and called Hawk, who, within 24 hours, had stunning news for Levison. There was a birth mother in Los Angeles who was in labor. She wanted a closed adoption, and Levison was first on the list. After conferring with her family, she got on a plane to California. When she arrived at the hospital, a nurse handed her a little boy, whom she named Jonah. “He was mine from the moment he was put in my arms,” she says, recalling how the discharge nurse wanted her to have the same experience as any new mother and had her ride in a wheelchair out of the hospital, tears of joy streaming down her face.
Six years later, Levison and her little boy are the epitome of a happy family. Jonah knows that he has a birth mother, but Levison says that it doesn’t faze him at all. She is the only mom he’s ever known, and that’s good enough for him. And for her, having a boy was a wonderful twist of fate. “I was supposed to have a boy. I wouldn’t even know what to do with a girl now,” she muses. “And he even looks like me.”
For Levison, the adoption process had it highs and lows, but the joyous end result is one that she hopes others will be able to experience as well—once they set their mind to it. “If you want to be a parent, you have to be honest with yourself. You have to look at the bottom line of what you want. Then you have to start the process when you’re ready,” she says. “And you would be surprised—it really can happen quickly.”
Of course, if you have been attempting to conceive for a long time, possibly even years, then changing your perspective to focus on the option of adoption may be a bit disquieting and uncomfortable. However, Clause believes that you will know when you are ready to move ahead in this new direction. “You know what you need to complete your family,” she explains. “And when having a child, no matter what, is everything you think about, that’s when you’re ready.”
As with all of the pathways to parenthood, there are important decisions that have to be made when you choose adoption. First and foremost is whether you will pursue a domestic or international adoption. You’ll need to base your decision on a number of factors, from the age you would prefer the child to be to how long you would expect to wait for the adoption process to be complete. Thoroughly researching both options is critical, but you need to understand the fundamentals at the outset.
- Domestic adoption. There are many children in the United States who need loving homes and nurturing parents. As of 2008, the U.S. Department of Health and Human Services reports that 129,000 children were in the foster care system waiting to be adopted. According to the Evan B. Donaldson Adoption Institute, that number does not include the nearly 14,000 children who are put up for adoption each year through licensed private adoption agencies. While many children in foster care are older, those being adopted through private agencies often range in age from newborn to 5 years old.
- International adoption. International, or intercountry, adoption has become much more prevalent in recent years. In fact, the Department of State’s Intercountry Adoption Office of Children’s Issues reveals that the number of adoptions into the U.S. peaked in 2004 at nearly 23,000. The Evan B. Donaldson Adoption Institute adds that the number of internationally adopted girls exceeds that of boys; in addition, approximately 46 percent of the adopted children are under the age of 1, and 43 percent fall between the ages of 1 and 4. The children typically are born in China, Russia, South Korea, Ethiopia and several other countries, although the ratio of children being adopted from these locales is changing over time as rules within the countries are amended often.
Once you’ve chosen your adoption path, the paperwork begins. With both domestic and international adoptions, a home study with a licensed social worker is required. This process, which Clause says can take about 4 months, includes interviews, home visits, fingerprinting, background checks, medical checks, references and more to make sure that the prospective parents and their home will be a safe and happy environment for the adopted child. With an international adoption, another layer is added—the dossier that is prepared and sent to the government of the adoptive parents’ chosen country. This document contains detailed information and a variety of notarized documents, from medical records and financial statements to employment verification. When these hurdles are crossed, then the matching process can begin. This often is the most difficult part, as it can take months or even years to bring together parents and child, depending on the circumstances. For couples going the domestic route and working with an agency, the wait can involve meeting a birth mother and actually being involved in the pregnancy. And for couples who choose international adoption, multiple trips to the chosen country may be required before the adoption is complete. But in the end, when that child is placed in your arms, there will be no feeling like it.
Personal Story Spotlight
Suzanne and Evan Klarer: Making It Happen
According to Suzanne Klarer, “I never had the strong desire to get pregnant or carry a child, but I knew that I wanted to be a mother.” A successful, single woman, Klarer decided that it was time to make her wish become a reality and began the process of domestic adoption. “I was financially stable, my family lived nearby and I was getting older,” she explains. “I decided that there’s never a right time, so I started doing some research and got the ball rolling.”
The adoption consultant gathered all the information about Klarer’s situation and hopes and educated her about every aspect of the process from the laws affecting adoption to the costs involved to the details of adopting as a single parent.
Still reeling from the disappointment, Klarer went to Hilton Head with friends to get away from it all. Her first day there, while sitting on the beach, she received a phone call. It was her agency. “It was Thursday, and there was a birth mother on the way to the hospital. The agency wanted to know if I would agree to the adoption and get on a plane to Las Vegas,” she recalls. She said yes, not knowing if it was a boy or a girl, and told her contact that she could get out on a Sunday flight. Upon her arrival in Las Vegas, accompanied by her mother, she headed directly to the hospital to meet her 8 pound, 6 ounce baby boy, whom she named Evan. The law required her to remain in the city for 9 days so all of the paperwork could be filed and she could be granted permission to take Evan across state lines. When the new family headed home, Klarer knew in her heart that she had made the right decision.
“The adoption process is definitely a crazy one. There are a lot of unknowns, and you have to educate yourself. You have ask a lot of questions and make sure that you are 150 percent comfortable with everything that’s going on,” Klarer says. “There are always going to be challenges and hurdles, but you have to forge ahead no matter what. I’m proof that if you want something enough, you can make it happen."
Personal Story Spotlight
Speaking from experienceMy sister and I are both mothers. She has a 3 ½-year-old daughter, and I have a 1 ½-year-old son. While our children are very similar—both are charming, spirited, funny and just downright adorable—our paths to parenthood took dramatically different turns. I spent 9 months being pregnant and 29 hours in labor before my little boy arrived; she spent two years waiting for a picture to be sent to her and 15 hours on a plane to get to her little girl. You see, I was fortunate to have the chance to start a family with my husband in the most traditional way. My sister and her husband, on the other hand, were given the remarkable opportunity to adopt a child from China. Interestingly, our divergent experiences are actually a reflection of what is happening more and more often these days. Fate decided how we would build our families. And neither of us would change one event that brought our darling children into our lives. That’s because when we look at our little ones, we realize that they were not only destined to be ours, but also to be cousins. They may be different in some ways, but they are very much the same. When they play together, they are merely two kids having fun with each other, and we look forward to them being close as they grow and change into the people they’re going to become. What’s more, because my niece has introduced our entire family to her beautiful and compelling culture, my son’s life undoubtedly will be enriched as he gets older and learns about her heritage. It’s clear to us that we were meant to be one big happy family. Call it serendipity. Call it kismet. Whatever it was that brought us to this place, it has made my sister and I two of the proudest parents around.
— Amy Meadows, writer for Best Self Atlanta
Did You Know?
According to Jim Toner, M.D., with the Atlanta Center for Reproductive Medicine, the commonly referred to number of $25,000 per in vitro fertilization (IVF) round is not an accurate figure. Typically, one IVF cycle costs around $12,000. What’s more, Toner says, “Nearly 40 percent of couples seeking treatment actually have some kind of insurance coverage to help with the cost.”
Know The Terms
When considering surrogacy, you need to know that there are two different types. The first, according to Kathy Stern of Surrogacy Specialists of America LLC, is traditional surrogacy, in which a surrogate undergoes artificial insemination of her own egg with the sperm from the couple. This arrangement would require the non-parent (in this case, the woman) to adopt the child once it is born. Because of the numerous legal issues surrounding this process, traditional surrogacy is not recommended and not used often these days. The second type of surrogacy is gestational surrogacy, in which the surrogate receives a fertilized embryo from the intended parents. This is much more commonly used today and allows the couple seeking the help of a surrogate to have their own biological child.
Did You Know?
Melissa Clause, executive director of AAA Partners in Adoption Inc., reveals that a private adoption can cost between $20,000 and $30,000. The cost of an international adoption can fall into the same range.