Embryo adoption is the process whereby an embryo, created from the egg of a woman and the sperm of a man, is gestated in the womb of another woman to be raised by her and her partner neither of whom provided the gametes. Although we refer to this process as adoption, we use that term strictly in a social sense rather than in a legal one. Like traditional adoption, the couple who raises the child has no genetic connections to him or her, but unlike traditional adoption, the couple does not have to go through a legal process in order to be declared the child's legal parents. Instead of legally adopting the child after birth, however, as is the case in all other adoptions, the couple biologically adopts during the early embryonic stage-at the point of embryo transfer.

Embryo adoption is an option for couples who want to share a pregnancy experience and have neither eggs nor sperm to contribute to that process. Embryo adoption is an option for single women desiring a pregnancy who do not have a designated sperm donor and are unable to use their own eggs. It is also an option for couples in which only one member is infertile but who want to have an equal genetic (i.e. non-genetic) relationship to their child.

From a medical-technical standpoint there are two ways to accomplish the process of embryo adoption. The first is for the couple to receive a pre-existing cryopreserved embryo(s) that has been donated by its genetic parents. The second is for a woman to undergo an ovum donation cycle in which donated eggs from one source are inseminated with separately obtained donor sperm. Although both methods result in an offspring who is not genetically connected to the parents, from an ethical, emotional, and social policy perspective, these two avenues to embryo adoption are decidedly different.

We call the first option, which results from the donation of an existing embryo, embryo donation, and the second option-the intentional creation of a child through donated eggs and donated sperm-embryo creation. In both cases, the offspring has no genetic connection to his would-be parents; we thus decided to place both options under the general heading of embryo adoption. We do recognize, however, that in a sense the use of the word adoption may be somewhat misleading, as traditional adoption has never involved the intentional creation of children for the purpose of being adopted. Thus embryo donation, which finds homes/wombs for existing embryos, bears a greater resemblance to adoption than does embryo creation

. Embryo donation, like traditional adoption, began as a perceived solution to a problem. IVF programs and some of their patients were troubled by the prospect of having extracorporeal embryos that couples/individuals no longer wanted stored in their facility. This question was of particular relevance to people who had moral or religious objections to discarding embryos. The idea of donating those embryos to other infertile couples was appealing in much the same way as traditional adoption is appealing; it offered a legitimate and altruistic use for these surplus embryos and the opportunity for pregnancy and parenthood to childless couples. Embryo donation was attractive to ART programs from a legal perspective as well: by offering embryo donation they could avoid violating laws in states that prohibited experimenting on or discarding embryos.

As we will discuss later in this chapter, embryo donation has not proved to be the popular option that physicians and programs anticipated. There are fewer embryos available for donation than anticipated, for two reasons. First, most couples use their frozen embryos, either following an unsuccessful cycle or, later, after the birth of a child(ren) to expand their families. Second, many couples who once indicated they would willingly donate embryos later conclude that they are not comfortable with this choice.

Because of the apparent scarcity of embryos available for donation, and because some couples/individuals lack viable eggs and sperm, some clinics are now offering IVF cycles in which male and female donor gametes are used. To some this process may be considered a logical extension of single gamete donation; to others it is tantamount to creating children for adoption.

Although from a genetic and social standpoint offspring of created embryos are the same as the offspring of donated embryos, (they are not genetically related to either parent) the differences in their origins are substantial. In one instance the couple gestates and raises a child that began as an embryo intended for the genetic parents but now destined not to be born. In the second instance, couples are intentionally taking gametes from two separate donors and creating an embryo for the sole purpose of "prebirth adoption."

Embryo adoptions are clearly new paths to parenthood, bringing with them complex psychological, social, emotional, and ethical considerations. We have neither experience nor psychosocial research to draw upon. Thus we must borrow insights from the fields of adoption and gamete donation as we discuss this option.

Reasons for Choosing Embryo Adoption

Many people, both outside and inside the field of infertility,wonder why a couple would choose embryo adoption rather than adopting a child who is already born. There are many reasons why this alternative is appealing.

For couples who have experienced long-term infertility, embryo adoption offers the opportunity to be pregnant and give birth, as well as the opportunity to parent. Through pregnancy, embryo adoption offers the couple a chance to bond with their child prior to birth. In addition, the woman has control over her child's prenatal environment, thereby eliminating potential problems caused by unhealthy gestational conditions.

For couples who have adjusted to infertility treatment and who are willing to undergo more medical procedures, embryo adoption may be preferable to tackling what they perceive as a complicated and often daunting new world-that of adoption. Furthermore, depending on the clinic and on whether the couple's health insurance policy covers the procedure,embryo adoption may be much more affordable than adoption after birth.Embryo adoption also offers the couple the guarantee of known paternity(not always the case with traditional adoption), assuming the clinic shares medical, social, and psychological information about the genetic father in the case of embryo donation, and the sperm bank provides the same information about the sperm donor in the case of embryo creation. Embryo adoption also offers couples privacy. Traditional adoption, by definition,is always public, whereas embryo adoption can be private, allowing the couple to reveal it when and to whom they choose.

Embryo donation is appealing to couples who have problems with the idea of intentionally creating children/embryos to adopt. They prefer knowing that the embryo they adopt was conceived by a couple who longed to be parents and went to great lengths to achieve that goal. Embryo donation may be appealing to couples who believe that the blending of genes from the donating couple, whom they may imagine to be a close, loving pair, are in some way preferable to the imagined genes of birth parents who did not intend to create a child together.

Embryo creation, on the other hand, is preferable to couples who believe it can offer them greater genetic selection. Although they realize that ovum donors are scarce and that donor selection may be limited, they know they can carefully select the sperm donor. This process of combining their choice of gametes may give them a greater sense of control, as well as the illusion that they are "designing" an ideal child. Couples who are attracted to embryo creation may also feel more emotionally secure that no one will come after their child, whereas with embryo donation the couple may fear the genetic parents will someday try to claim him.

If you enjoyed reading this excerpt from "Choosing Assisted Reproduction," you'll love the book! For more information, visit http://shop.adoption.com/cgi-bin/store2/ADP00048.html.

© Perspectives Press

Credits: Susan Lewis Cooper, Ellen Sarasohn Glazer