Surrogacy arrangements involve paying another woman to carry a child. In most cases, the surrogate mother is artificially inseminated with sperm. In a few cases, mainly where a woman has healthy eggs but would have difficulties during pregnancy, the surrogate has her eggs implanted, so that the child is biologically not hers at all.
The advantage of surrogacy is that it is the only option in cases where the cause of infertility is a woman’s inability to carry an embryo to term. There are, though, practical difficulties. Finding a woman willing to bear a baby for somebody else is not hard, and in many countries this can only be achieved through making large financial payments to the surrogate mother.
In the UK this is illegal surrogate mothers can only be used if they are not being paid. The small number of people willing to endure the difficulty of pregnancy without some personal benefit has kept the number of surrogate pregnancies quite low in the UK. In the US, where surrogacy is legal in some states, surrogacy is limited by the high cost. Overall, surrogacy can cost tens of thousands of dollars.
Surrogacy also has a reputation for being emotionally traumatic for both the parents and the surrogate mother, and in some cases the surrogate mother has been unwilling to give up the baby as planned. Admittedly, this reputation is based in large part on media reports of particularly unsuccessful cases.
Sperm donation is an option where a couple’s failure to conceive is caused by male infertility. In medical terms, the process of using donated sperm is basically identical to that of artificially inseminating a partner’s sperm.
If you choose this route, you’ll need to decide where to obtain the sperm. “Sperm banks” are now well established, offering sperm from vetted, anonymous donors.
The other option is using a “known sperm donor” that is, requesting a sperm donation from a personal friend. The emotional entanglement this involves is clearly intense, but not necessarily negative. In particular, the potentially traumatic experience when a child discovers him- or herself to be the product of donated sperm can be diminished if they can be told that their biological father is somebody they already know. The process of storing semen is discussed above, in the ‘semen storage’ section.
Adopting a child needn’t be seen as a last chance for when fertility treatment fails. Many couples with biological children choose to adopt, and many infertile couples see adoption as preferable to undergoing the rigors and expense of infertility treatment.
Finding a child to adopt usually requires you to go through some kind of intermediary, either state or private, and to deal with a good deal of administrative work. The law covering adoption varies from country to country (and from state to state in the USA), so it isn’t possible to cover all the possibilities here. Almost every country does have a state adoption system, and adoption through this system can be the simplest option, legally and bureaucratically. Still, many parents choose to use a private agency, such as one connected to their church.
Different intermediaries will place different requirements and restrictions on those wishing to adopt. At a very minimum, there is usually a legal requirement for the new parents to demonstrate that they understand and accept the commitment involved in adoption, and that they will make competent parents. Most intermediaries impose a maximum age limit on those who can adopt. Many will only place children with long-term heterosexual couples, although there are now some opportunities for adoption by same-sex couples and by singles.
Don’t underestimate the emotional and social difficulty of adoption. You’ll have to consider whether you want an open or confidential adoption that is, whether you would like any contact with, or knowledge about, the biological parents of your adopted child. And you’ll need to think through some of the issues that will arise over the course of childhood, such as how to answer the child’s questions about his or her adoption, and how open to be with the rest of the world.
It’s important to realize that adoption isn’t a cure for the distress of infertility. Even with an adopted child, it is normal to feel grief at the inability to have a biological child. There is a danger of treating adoption as an imperfect substitute for a biological child, rather than as a wonderful experience in its own right. This is particularly true when a couple decide on adoption after the failure of fertility treatment, and is one reason why some people decide to pursue adoption instead of, not after, fertility treatment.
When you are embroiled in the complexity of fertility treatment, it’s easy to lose sight of the fact that it is possible to have a fulfilling, caring life without raising children. What has in recent years come to be known as the ‘childfree movement’ tries to highlight this possibility, although the same ideas have also been expressed in different ways in other cultures. You don’t need to become a parent to care for children.
Many schools, play-groups and other organizations welcome adults who want to spend some time looking after children, and you will find no shortage of couples who welcome another child-concerned adult to help them out from time to time. Even more so than with adoption, it’s important not to treat this as a complete substitute for parenthood, but as an alternative with its own benefits, drawbacks, and activities.