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Frequent Questions: Adopting Parents

Choosing Embryo Adoption - Is it right for me?

  1. Who adopts frozen human embryos?
    1. Couples and singles who are pre-disposed to adoption as a way of bringing a family's love to a child in need.
    2. Those who may have any of the following medical concerns:
      • You and/or your partner are infertile
      • You and/or your partner are concerned about or at a high risk of passing on genetic disorders to your potential offspring
      • You and/or your partner have had recurrent IVF failures
      • You and/or your partner are looking for an alternative to fertility treatments such as IVF or donor egg recipient IVF
      • You and/or your partner are unable to afford IVF or other methods of treatment
      • You are unable to carry to term and will, via this method, pursue using a surrogate with adopted embryos
    3. Those who do not wish to go through the expensive and emotionally exhausting process of adopting a newborn either in the USA or overseas
    4. Couples who are pursuing a second adoption

    Now couples can fulfill their desire for a family, give birth to the very child they adopted as a tiny, frozen embryo and ensure that a precious life is preserved at the same time.

    The most obvious difference between an embryo adoption and a traditional adoption is the pregnancy experience. Adoptive mothers are able to experience the joys (and challenges!) of pregnancy and labor. They also have the peace of mind of knowing their children received the appropriate prenatal care and were not exposed to alcohol or drugs during pregnancy.

  2. Why would adopting parents choose embryo adoption instead of traditional adoption of a newborn? The most obvious difference between an embryo adoption and a traditional adoption is the pregnancy experience. Adoptive mothers are able to experience the joys (and challenges!) of pregnancy and childbirth. They also have peace of mind knowing their children received the appropriate prenatal care and were not exposed to alcohol or drugs during pregnancy.

    There are certain considerations involved in embryo adoption that are not present in traditional adoption. For instance: Embryo adoption does not 'guarantee' a live birth. When more than one embryo is transferred, an adoptive couple might have twins or even triplets.

    Parents who adopt embryos are able to begin the bonding process with their child before they are born. They are giving embryos who have been frozen an opportunity for life. The embryos belong to the adopting parents before they are placed in the womb and the donating parents have relinquished all parental rights. The child born to the adopting couple is their legal child.

  3. Will offering embryos for adoption prevent waiting, available children from being adopted? Embryo adoption is a family building alternative. Couples should evaluate the pros and cons of all of the adoption alternatives available to them and make the choice that is right for their family.

    Most available newborns do not wait for parents, whereas parents frequently wait for available newborns. The parents who would pursue embryo adoption may have already researched their options surrounding the adoption of a infant. If newborns were available at the same rate as embryos, many adopting families would most likely take the child already born, since there is no guarantee of a pregnancy with embryo donation and adoption. However, there are many families for whom the possibility of being able to experience pregnancy is a crucial factor in their decision to pursue embryo adoption over traditional adoption.

    It is also important to keep in mind that some families have a preference for adopting children over a certain age or are interested in adopting sibling group. Others are more interested in working through the foster-adopt system. Embryo adoption is simply another choice available to families who are interested in adopting a child, albeit much earlier in the child's biological development!

  4. How is embryo adoption different from traditional adoption on the issue of 'risk'? Through this simple and successful adoption process you control the pregnancy and give birth to your adopted child. No costly "donated" human eggs, no expensive IVF, no traveling, no anxiety about a birthmother changing her mind, no international intrigue.

    Embryo adoption does not 'guarantee' pregnancy, but many adoption programs offer multiple matches to help assist with pregnancy success.

    On average, the pregnancy success rate for embryo adoption is 35%. This statistic varies by program and clinic, but is about the same as, if not a bit better than, for a fresh cycle of in vitro fertilization (IVF).

    A common concern with embryo donation and adoption is about the quality of embryos. How important is embryo quality? There are a variety of methods used by medical professionals to grade frozen human embryos, projecting the likelihood of pregnancy success. Many healthy children have been born from embryos given a poor quality rating.

    Potential adoptive parents are often worried that children born from frozen and thawed embryos are at a higher risk of birth defects. In the domestic animal industry, large-scale freezing and transfer of embryos has not resulted in increased birth defects. Studies to date on those human offspring arising from thawed embryos have shown children born from cryo-preserved embryos do not experience birth defects at any higher rate than children born naturally.

  5. How is embryo adoption different from embryo donation? Embryo donation programs are generally managed by fertility clinics, which receive donated embryos to be given anonymously to whomever the clinic chooses. Designated [open] donation programs give the donating family the option of choosing the receiving family and they can mutually determine the level of future interaction between families. There are websites that assist donating and receiving families to privately match with one another, establishing a context for a known donation.

    Adoption programs regard embryo donation as equivalent to a traditional adoption process since the hoped for outcome is the birth of a child. They will offer similar assistance and services as with a domestic adoption.

    Typically, placing or donating parents tend to use the term 'donation', while receiving or adopting couples tend to use the term 'adoption'. The basis for this is largely psychological. Donation is used in the sense of 'giving a gift' and offers an emotional separation from the embryos that the phrase 'placing for adoption' does not. Yet for the family wanting to parent the children born from such a gift, the term 'adoption' makes more emotional sense. It is the term that both legally and socially explains the transfer of parental rights associated with traditional adoption. Adoption also helps to describe and explain to their child the way in which they became a family, since children are 'adopted' rather than 'donated'. Frequently the terms are used interchangeably like the words lawyer and attorney.

  6. Why would receiving/adopting parents choose embryo adoption instead of embryo donation?

    Adoption agencies have proven processes, legal contracts, counseling and educational programs in place to guide families through receiving embryos. An adoption agency is focused not only on assisting their client in building their family, but in providing them with appropriate social/emotional education to support them before and after the adoption is completed.

    An adoption agency with an embryo adoption program recognizes that the hoped for end result of embryo adoption is the birth of a child, a child who is not genetically related to you. Adoption agencies have the experience to enable you to successfully help this child understand their origins and their beloved place in your family.

    Another benefit of embryo adoption is the adopting family has a chance to have a relationship with their child's placing family. Whether they share pictures and letters, have telephone conversations or choose to meet the placing parents, the adopting family will know that they have access to information about their child's history, as well as a possible match for any future medical need, such as an organ donation or blood or bone marrow transplants. The agency is available to facilitate communication between the families. The agency will educate and work with the adoptive family about how to talk to their child(ren) about their unique conception and adoption-related issues.

  7. What steps should we take in evaluating embryo adoption as the right option for us?
    1. Learn for yourself about embryo adoption.
    2. Visit with people who have adopted embryos. There are several blogs and forums posted by embryo adopters. Watch testimonial videos on this site and on YouTube.
    3. Contact agencies and determine which one offers a program to meet your needs.
    4. Decide if embryo adoption is the right choice for you. Are you willing to accept the financial risk? Are you alright with having a child that may not resemble you? Will you accept the child even if it is born with disabilities?
    5. Talk with your OB/Gyn and a local reproductive endocrinologist.
    6. Decide which agency you would like to work with OR determine if you would rather pursue donation through a clinic program.
    7. Are you willing to complete a home study?
    8. What parameters do you want to set regarding the donor family and your potential match?

    This is not a comprehensive list, but should set you on the right path for determining if embryo adoption is the right choice for you!

  8. What is the embryo adoption success rate? Will we have a baby? A study completed in 2009 by the NEDC shows women who use their own embryos will have, on average, a 32% change of delivering to term, whereas women using adopted frozen embryos will have a 35% chance of delivering to term. [Fertility & Sterility, September 2007,Vol.88, pg S267]. Why the greater chance with frozen embryos? The frozen embryos have generally already produced children for the donor family, so they have a proven viability. Families using their own genetic material (eggs/semen) may be encountering difficulty based on their age(s) or other factors. Women who use donated embryos will not have recently undergone egg retrieval, will not have any residual effects of the drugs used to stimulate the ovaries, and as such their bodies may be more receptive to pregnancy. Additionally, babies from frozen embryos had higher birth weights than babies born from fresh embryos.

    Each adoption program should be able to provide you with statistics regarding their pregnancy success rates.

    Some programs will provide you with multiple matches to donor families in order to achieve pregnancy for no additional agency fee.

  9. Is this really adoption? Current law adoption only applies to the placement of a child after they are born. While adoption law is not applicable to the embryo donation/adoption process, embryo adoption agencies will apply the rigors of the adoption process because the end result is the birth of a child. The adopting parents' relationship with the child(ren) is just as binding as a legal adoption.

    Experienced embryo adoption agencies will have legal documentation for both parties that have successfully been used by many matched families. In some States, such as Kansas, Missouri and Georgia, the adoption of embryo children may be finalized in the courts.

  10. Why use donor embryos rather than an egg donor? The simple answer is that it is less expensive. 'Donated' eggs can cost upwards of $10,000. Human eggs are purchased, human embryos are donated.

    Another consideration is the fact that there are more than 600,000 human embryos in frozen storage in the United States today. Obviously all of these embryos are not available for adoption, yet each year more families are choosing to donate remaining embryos to other people either through their clinic or through an adoption agency.

    Choosing to purchase eggs from a donor to create more embryos may simply add to the number of embryos in frozen storage after you have completed building your family.

  11. Do you have to be infertile to consider embryo adoption? Absolutely not! There are couples who are simply interested in adding children to their family through adoption. Embryo adoption also allows the woman to experience pregnancy again if she desires.

    Embryo adoption is also a viable alternative for single women to achieve pregnancy using embryos that have already been created.

  12. How is surrogacy different from embryo adoption and donation? In surrogacy, an agreement is made for embryos to be transferred into a woman's uterus, and she carries the pregnancy for the benefit of the intended parents. The intended parents are specifically making embryos in vitro for placement into the surrogate using either their own genetics or purchases donor genetics. The surrogate may be impregnated using artificial insemination using the intended father's semen and her eggs. Surrogacy laws exist in each state and may differ by state.

    Compare that to embryo adoption and donation, where the adopting mother herself carries the child or children. The placing couple relinquishes their rights to any children born from the embryos prior to the transfer of those embryos into the adoptive mother's womb. The child that the adopting mother carries and gives birth to is the child that she and the adopting father will parent.

  13. What is an anonymous embryo donation? An anonymous donation occurs when donors and recipients do not know one other's identities. No contact is made between the donor or the recipient, either now or in the future. Anonymous donation most often takes place through a fertility clinic, but may be facilitated by an adoption agency.

    Most clinics that have an embryo donation program provide very limited information to the recipients about the donors. Donors are rarely involved in the process of selecting recipients, but are sometimes permitted to set stipulations for eligibility to receive their donation. Medical information about the donated embryos is provided to the recipient.

  14. What costs are involved with embryo adoption? Embryo adoption costs are primarily paid by the adopting family. Generally the donating family does not receive payment for their donation nor should they expect the recipient family to cover any of the IVF expenses they incurred. Embryo storage costs prior to the match are also the responsibility of the donor family. The recipient family may be asked to pay for storage fees after the match is made.

    Agency Fee*
    *Additional travel expenses may be incurred for centralized programs.
    $2,500-$10,000 May or may not include legal fees, embryo shipping, matching services,
    counseling, additional medical screening
    Home Study/Family Assessment $1,000-$2,500 Costs vary by state
    Clinic Frozen Embryo Transfer (FET) $2,500-$5,000 Costs vary by clinic
    TOTAL $6,000-$17,500 Generally less expensive than domestic or international adoption

  15. How do we get started? Wow! At first the concept of embryo adoption might be a bit overwhelming. The good news is that many couples have found embryo adoption to be the answer for adding children to their lives.

    Step One is to learn as much as you can and then determine if you prefer to work through an agency adoption program, a clinic donation program or attempt a direct match.

    Continue to look through our website to gain more information on embryo donation and adoption and to hear from other people who have been donors or recipients. The Personal Stories section includes people's experiences with donating or adopting embryos.

    Our Videos inform about frozen embryo adoption and portray the decision-making process of donating and adopting families.

    There is also a list of Articles on embryo adoption. If you decide to adopt embryos you can find a list of agencies with embryo adoption programs, a list of agencies who provide embryo adoption home study services and a list of clinics who have embryo donation programs.

    Questions? Contact us and we'll do out best to answer them!

The Embryo Adoption Process

  1. Describe at a high level the process of embryo adoption.
    1. The first step in embryo adoption is to check with your OB/Gyn to see if you are able to carry a pregnancy to term.

    2. Evaluate the embryo adoption providers and select the agency/organization you would like to partner with for your adoption.

    3. Complete the agency's application.

    4. Select a clinic/physician for the medical procedures.

    5. Select a home study provider and complete a home study.

    6. Review matches presented by agency and agree to a match.

    7. Complete legal contracts.

    8. Embryos ship to chosen clinic.

    9. Schedule frozen embryo transfer(FET)with physician.

    10. Wait approximately nine months for a baby.

  2. What are the basic requirements for an adopting family? The adopting mother must be able to carry a child to term. Her doctor will be asked to provide a letter stating that there are no contraindications to pregnancy [no medical reason that will prevent her from carrying a pregnancy to term].

    The family will need to select a medical professional (usually in a fertility clinic) to assist with preparing the woman's womb for and providing the frozen embryo transfer.

    In their application with an adoption agency, the adopting family will have an opportunity to detail their desires regarding the donor family and their embryos. Legal contracts are generally provided by the adoption agency. If the family chooses to work directly with a clinic with a donation program or directly with a donor, they should be sure to include legal contracts releasing the embryos to their ownership prior to the frozen embryo transfer.

    The adopting family must also have completed an adoptive home study if working with an agency. This home study is the same study used to evaluate and educate adopting parents in traditional adoptions.

  3. What other stipulations may affect my ability to adopt embryos? Each adoption agency has various eligibility requirements for adopting parents. These include, but are not limited to:
    • An age limit for the adopting mother
    • Eligibility of couples who do not have an infertility diagnosis
    • Whether adoptive couples can use a surrogate mother to carry their adopted embryos
    • Out-of-state embryo adoptions
    • Out-of-country embryo adoptions
    • Eligibility of single women
    • Eligibility of homosexuals

  4. How do we find the right embryo adoption agency?

    A list of agencies and organizations who offer embryo adoption services is available on this website.

    When researching your alternatives here are some things to consider:

    1. Do you want to choose your own physician? Some programs require you to use the clinic which operates or is in partnership with the embryo adoption process.

    2. Some programs are centralized, one-stop shops which may be your best alternative. Everything is managed from one central location. Additional expenses for traveling to the centralized site should be included in your cost calculations.

    3. How long has the program been established?

    4. Do they have any special requirements?

    5. What do their legal contracts include? Are you able to make changes to them to meet your desires?

    6. What is the estimated time frame for being matched and giving birth?

    7. How comfortable are you with the people in the agency with whom you will be working?

    8. What exactly does each of the fees charges by the agency include? Matching? Legal contracts? Shipping coordination and costs? Additional medical testing? Home study? Medical costs? (This is not an all-inclusive list of questions to ask.)

  5. May an adopting family be registered with a traditional adoption program AND work with an agency offering embryo adoption? Each adoption agency and embryo adoption program is different. An adoptive family should check with both the adoption agency and embryo adoption program with which they are working to determine if this is allowed.

  6. How long does embryo adoption take? After you have submitted your application to an adoption agency you will need to complete a home study (unless you have completed one within the past 12 months). On average it will take about six months to match you with a donor family. The length of time will vary based on many factors including: Your age, the requirements you specified on your application for the donor family, and the 'quality' of the embryos you and your physician require.

  7. What questions should an adopting family ask when looking for a fertility clinic?
    • Is the clinic willing to accept embryos from another clinic for a frozen embryo transfer (FET)?

    • How much does it cost for a FET, including necessary prescriptions?

    • Does the clinic have any testing or screening requirements? Are there any other conditions involved in accepting and transferring the embryos?

    • What are the in-house statistics regarding thawing and transfer of embryos?

    • What paperwork is required by the clinic? How long will it take the clinic to process the paperwork?

    • What are the short-term and long-term storage fees at the clinic?

    This is not a comprehensive list of questions. Adopting families may have to educate a clinic about embryo adoption and/or donation with assistance from their chosen agency representative.

  8. Can we use our own doctor? Many embryo adoption agencies allow you to choose your own physician to perform the frozen embryo transfer (FET). The agency should be able to provide you with a list of clinics in your area that they have worked with successfully.

    Some clinics are reluctant to accept embryos that were created in another clinic. Statistics around the creation, freezing, thawing and birth rate using frozen embryos are important to clinics. They use these statistics to draw patients to their facilities. Looking at these statistics is one indicator for choosing a clinic for your own medical treatments.

    Other embryo adoption programs require you to use the physician(s) associated with the program.

  9. Why should an adoptive home assessment or home study be performed when embryo donation/ adoption is generally not recognized as a true adoption proceeding in the United States?

    The importance of the home study lies in its purpose to help couples have not only healthy children, but healthy families.

    An adoptive home study for the recipient couple ensures that the safeguards currently in place for traditional adoption also protect the child, the placing parents and the receiving parents in an embryo adoption situation.

    Despite the fact that the adoptive mother gives physical birth to a child from an embryo donation, that child is still an adopted child; he or she shares no genetic relation to the adoptive mother or father. When children are born into a family to whom they are not genetically related, they may have the same types of questions as those of children adopted through traditional means. The home study process is 20% screening and 80% education. It provides the adoptive family with an opportunity to learn about and anticipate these types of issues and questions. The home study also educates the parents of the best way to address and answer these questions with sensitivity to the needs of the child.

    The home study process benefits donating parents by assuring them that the adopting family:

    • was evaluated for any health issues that may affect their ability to care for and raise a child,
    • was screened for any criminal and child abuse issues,
    • was educated concerning the potential issues of parenting a non-genetically related child

  10. How can an adopting family find a local agency to conduct their home study? For most embryo adoption programs, a traditional domestic home study with some modifications is all that is required. It is best to find a private licensed adoption agency to work with because most state agencies or social services departments do not perform pre-placement home studies, and the ones who do most often will not provide a copy to an outside agency. A list of agencies in your area offering embryo adoption home studies can be found on this website.

  11. May the home study be used for a traditional adoption if an adopting family determines that at some point they no longer wish to adopt embryos? With the completed home study, an adopting family is in the position to look at traditional adoption if they determine that they are finished with the embryo adoption program. This determination is different for each family.

    A family should set limits at the onset of their embryo adoption process and move on to another program when those limits have been reached. Limits can be based on time, a determined number of transfers, money, or a combination of the above. If an adopting family makes several attempts at embryo adoption and is still not able to conceive, they may want to consider domestic or international adoption. An adopting family should discuss this option with their social worker while still in the home study process.

    There are time limits regarding the validity of a home study. Check with you agency to see if your most recent home study is still valid or requires updating.

  12. How do donating and adopting families find each other? Usually donating families and recipient/adopting families are matched through a clinic or agency. Sometimes donating families self-direct their donation to a couple they have chosen independent of an agency or clinic.

    While independently arranging an embryo donation match may appear to be less expensive, the parties will be responsible for arranging for legal services, clinic communications, donor/recipient screening, embryo transportation etc. All of these services must be secured independently and coordinated by either the donor or adopter.

  13. How are placing and adopting families matched?

    The matching process includes the following steps:

    1. Both donating and adopting parents provide the adoption agency or attorney with information about themselves and indicate the type of adopting/donating family they desire.

    2. Donating parents indicate their preferences regarding the age, income, post-birth work plans, religion, prior marriages, existing children in the family, and race of the adopting families as well as their desire for future contact.

    3. Assuming an adopting family matches these criteria, their introductory letter, biography, and photographs are sent to the donating parents for consideration and possible selection.

    4. The donating parents' profile information (introductory letter, biography and photographs), and medical health history are sent to the adopting family for their consideration and possible selection.

    There are additional ways for donating and adopting parents to be matched. Some fertility clinics will facilitate the matching process, or matches sometimes come about through word of mouth or by searching the Internet. When considering these options, keep in mind that an attorney or agency can be beneficial in mediating communication between the parties, to provide the safeguards that a traditional adoption offers, and to offer education and assistance throughout the process.

  14. How much do our families have to know about each other - if anything? Open adoption encompasses a wide spectrum of contact. There is usually no requirement that families meet, exchange last names or other identifying information, but at a minimum, each family will select each other through the presentation of an introductory letter, biography, and small selection of photographs that they each have personally prepared.

    All such adoptions are considered open. Whether a family wants more contact (via e-mail, telephone, photographs, and letters, sent either directly or through an adoption agency, attorney, or other intermediary) or less contact, families with similar levels of desired contact are able to be matched with one another.

    Open adoption does not mean co-parenting. The adopting couple is the child's parents.

  15. What type of information will we receive about the donating parents and their embryos? You will receive a medical health history, a family profile including information about the parents of the embryos and possibly pictures. Your doctor will receive the embryology reports, freezing and thawing protocols and all infectious disease screening results. If the embryos were created with an egg and/ or sperm donor, you will receive as much information as possible on the donor(s).

  16. What happens after a match is made?

    A home study will have been completed before a match is made. The adopting family will, with assistance from the agency representative, have determined if their clinic of choice will accept embryos from another clinic and if that clinic is willing to perform a frozen embryo transfer (FET) using those embryos.

    The agency will help them with any testing or screening procedures required of them or the donating family. The agency will coordinate the legal contracts. The agency will coordinate the physical transfer of the embryos from one clinic to another.

    The medical procedure, frozen embryo transfer, will be coordinated with the adopting couple's physician. The number of embryos to be thawed and transferred should be mutually agreed upon.

  17. What is the risk that the donating parents might change their minds? The legal agreements signed by both the donating and adopting parties mitigate the risk of the donor parents changing their minds regarding their donation.

    The donating family contractually transfers their ownership and parental rights by signing a relinquishment prior to the embryos being shipped to the adopting family's clinic. The contract agreement and relinquishment forms are legally binding between the two families. Once the embryos have been transferred, the donating parents have no legal claim to any resulting children, nor any responsibility for them.

  18. Could the children from the embryo donation inadvertently meet their siblings and reproduce? This is a common question asked by embryo, sperm and egg donors. The risk is negligible according to published guidelines and basic statistics. If one couple donates cryo-preserved embryos, the chance of accidentally meeting and mating with a sibling is extremely unlikely.

    Donating your embryos to someone in a different state will further minimize the risk. Donating your embryos in an open embryo adoption is the best alternative to virtually eliminate this risk.

  19. What if an adoptive family completes their family and still has embryos remaining?

    This is a matter which should be addressed in the legal contracts signed by both parties. The donor may not want to have the embryos returned to them after the adopter has completed their family building. In this case, the adopter determines the disposition of the embryos based on what was legally agreed to in their contract.

    Some contracts will specify a period of time in which the embryos must be thawed and transferred by the adopter. If more time is needed, another relinquishment will be requested from the donor.

    If the adopting parents have remaining embryos that they will not be transferring at a later time, a best practice is to have the embryos returned to the original donating family. The original family may then determine if the embryos may be adopted by another family. This gives the original donor control over who gives birth to genetic siblings of their children.

Expenses Associated with Embryo Adoption

  1. Is embryo adoption expensive? Embryo adoption is a low-cost adoption alternative when compared to domestic and international adoption, repeated IVF cycles and the cost of donor eggs. The embryo donor does not receive payment for their embryos. The most exciting aspect of embryo adoption is that you have the opportunity to give birth to your adopted child!

    In the United States the adoption of children in the foster care system is generally the least expensive form of adoption but it is difficult to adopt infants in this program.

  2. What costs are involved with embryo adoption?

    Embryo adoption costs are primarily paid by the adopting family. Generally the donating family does not receive payment for their donation nor should they expect the recipient family to cover any of the IVF expenses they incurred. Embryo storage costs prior to the match are also the responsibility of the donor family. The recipient family may be asked to pay for storage fees after the match is made.

    Agency Fee*
    *Additional travel expenses may be incurred for centralized programs.
    $2,500-$10,000 May or may not include legal fees, embryo shipping, matching services,
    counseling, additional medical screening
    Home Study/FamilyAssessment $1,000-$2,500 Costs vary by state
    Clinic Frozen Embryo Transfer (FET) $2,500-$5,000 Costs vary by clinic
    TOTAL $6,000-$17,500 Generally less expensive than domestic or international adoption

  3. What does an embryo adoption program fee typically cover? An embryo adoption program's fees typically cover the completion of a home study for families who need one, matching of the adopting family with a donating family, maintenance of files, facilitation of communication between donating and adopting families, preparation of contracts, relinquishments and other legal paperwork, counseling for both sides, coordination of communication between clinics and doctors to ensure that requirements are met for the transfer of the embryos between states, and management and direction of shipping of the embryos. Medical and incidental expenses are generally not included.

  4. Do agency program fees include the medical expenses? This depends on the program you are working with. If medical expenses are included in the fee, generally you will need to work with a specified fertility clinic. If medical expenses are not included, adopting parents are able to choose their fertility clinic and doctor, and need to pay the clinic to thaw and transfer the embryos as well as any other associated medical costs connected with the transfer. When choosing a fertility clinic, be sure to compare like services included in various quotes and the costs of subsequent transfers and embryo storage.

  5. What additional out-of-pocket expenses can an adopting family expect? Costs which may not be covered by an embryo adoption program include the rental of a dry shipper for embryo's travel and additional lab tests for a donating family or storage fees incurred by the donor family after the match is completed.

  6. Does the adopting family help with any of the fees incurred by the donating family in creating the embryos?

    Typically, adopting families do not reimburse the donor for any expenses that accrued prior to having been matched with a donating family. Adopting families do often reimburse donating families for any expenses incurred after they are matched. This includes storage and shipping fees, legal costs, and any fees associated with medical or psychological screening.

    These may be included in the overall program fee if done through an agency. Any sort of direct compensation for the embryos themselves is under the legal jurisdiction of each state, and interested parties should seek legal advice to determine the applicable laws in their states. In general, such payments are not recommended by the American Society for Reproductive Medicine (ASRM) or the American Medical Association (AMA) on ethical grounds.

    Once donating and adopting families have selected one another, the embryos are shipped to the adopting family's clinic, where the adopting family then becomes responsible for storage costs incurred. Depending on how many embryos a donating family has, if an adopting family completes their family with embryos still remaining, there may be a chance that those remaining embryos would once again become the donating family's responsibility for storage fees and selection of another family.

Legal Requirements for Embryo Adoption

  1. What are the most significant legal issues associated with embryo adoption?

    The most significant legal issue associated with embryo donation and adoption relates to, 1.) the unsettled nature of embryo adoption law, and 2.) the contractual agreements used to legally bind donor and recipient couples.

    First, both the donor and recipient couples should acknowledge that the law of embryo donation and adoption is unsettled. There are no federal or state laws specifically governing the adoption of embryos although some states do have laws generally related to embryo donation and or assisted reproductive technology.

    Second, the embryo donation and adoption process involves adoption and agreement and relinquishment forms, which are legal contracts between the donor and recipient couples. These forms formalize the genetic parental relinquishment of their parental rights prior to the embryo being transferred to the receiving mother. Once transferred, the embryos belong to the adopting parents. Parties involved should also note that embryos have a special legal status that is yet to be clearly defined. While many courts are reluctant to classify embryos as property, they also do not characterize them as human beings. As a result, embryo adoption programs may differ in how they define embryos in their legal agreements. Some may refer to embryo donation as a transfer of property while others may incorporate traditional adoption language into their legal documents.

  2. What laws govern embryo adoption? In the United States embryos are considered property, not people and therefore the 'owners' [the donor] of the embryos transfer the ownership to the recipient family via contract law.

    In Georgia legislation was passed in May 2009 granting embryo adopting parents the right to finalize their adoption in the court.

    In Louisiana embryos are considered 'juridical persons' which means: Entity (such as a firm) other than a natural person (human being) created by law and recognized as a legal entity having distinct identity, legal personality, and duties and rights. Also called artificial person, juridical entity, juristic person, or legal person.

  3. Is it legal for the donor to request reimbursement for their IVF expenses as part of their donation?

    The term 'donation' implies that the embryos are being given, without charge, to the recipient. Since the inception of embryo adoption through adoption agencies, donors have not received compensation for their embryo donation.

    When a couple determines to pursue IVF treatments, they are making that choice as a direct benefit to themselves. Most often, a couple with remaining embryos has them because excess embryos were created as a part of their IVF treatment. They have now completed their family building and are choosing a disposition for their remaining embryos.

    Any sort of direct compensation for the embryos themselves is under the legal jurisdiction of each state, and interested parties should seek legal advice to determine the applicable laws in their states. In general, such payments are NOT recommended by the American Society for Reproductive Medicine (ASRM) or the American Medical Association (AMA) on ethical grounds.

  4. Legally, what is the relationship between the adoptive parents and any child born following embryo adoption? At the time of birth the adoptive couple is fully recognized as the legal parents to any children who are born. The mother who physically gives birth is recognized as the legal mother and the man to whom she is married at the time of pregnancy and birth is recognized as the legal father of the child(ren). These individuals are noted as the legal mother and legal father on the birth certificate(s).

The Medical Side of Embryo Adoption

  1. What is involved in Frozen Embryo Transfer (FET)? The frozen embryo transfer (FET) procedure is the same whether the patient is using her own or donated embryos. The process can be done during an un-medicated/natural cycle, but medicated cycles are more common as they provide more control in the timing of the transfer. Sometimes, a mock cycle is done to test the effects of the medicine on the body.

    If this is successful, the cycle is done again and the embryos are transferred. Potential medications used in the cycle include: antibiotics, oral contraceptives, prenatal vitamins/calcium supplements, pituitary suppressors, baby aspirin, estrogen supplements, and progesterone.

    Understanding the FET process may be an important part of your selection of a fertility clinic.

  2. What are the protocols for a frozen embryo transfer?

    Hormone preparation for FET
    Using hormones to prepare the uterus is the most common way in which a frozen embryo transfer is performed. The first step is to suppress the pituitary gland. This is necessary to reduce the chances of ovulation occurring unexpectedly. Typically, Lupron is used for pituitary suppression. For most women, this will require approximately two weeks of daily Lupron injections.

    The second step in a frozen embryo transfer cycle is to use hormones to duplicate the changes that normally occur in the uterus during a regular menstrual cycle. This requires the use of two hormone medications: estrogen and progesterone.

    Estrogen preparation for FET
    During a normal menstrual cycle, estrogen is produced by the developing follicle. This estrogen acts on the uterus to thicken and mature the uterine lining. Estrogen is given in a FET cycle for the same reason. There are many different ways that estrogen can be given in a frozen embryo transfer cycle:

    • Estrogen pills — Estrace, Premarin
    • Estrogen patches — Estraderm, Climera
    • Estrogen injections — Delestrogen (estradiol valerate), Depogen (estradiol cypionate)
    • Vaginal estrogen — Vagifem, Femring

    There is no data that any one method works better than another and a method is usually chosen based on physician preference.

    During the time when estrogen is given, the woman will come to the office periodically to be monitored. A transvaginal ultrasound is performed to determine the thickness of the uterine lining and a blood test is performed to look at the level of estrogen in the blood. On occasion, if the lining is not thickening as it should, the dose or type of estrogen must be increased or prolonged. The length of time the estrogen can be given is very flexible. During this phase, for example, the duration of estrogen may be prolonged to delay the day of embryo transfer to accommodate the patient's schedule.

    The monitoring in a thaw cycle is very flexible. Unlike a fresh IVF cycle during which the required days for monitoring are determined by the growth of the follicles in the ovary, in an FET cycle, the days can be adjusted at any time. Thus, a frozen embryo transfer cycle is much less stressful on the patient.

    Progesterone in an FET cycle
    Once the uterine lining has been thickened sufficiently, progesterone is added. Once the progesterone is added, the Lupron may be stopped. Progesterone matures the uterine lining and makes it receptive to an embryo to implant. Once the progesterone is begun, there is a certain window of implantationduring which the embryo must be transferred. The stage of the embryo must match the stage of development of the uterus. Therefore, the only factor that locks the patient into performing the transfer on a certain day is starting the progesterone. Once the progesterone is begun, if the embryo transfer is not performed on a certain day, the cycle must be cancelled and a new preparation with hormones must be begun after allowing a period to occur.

    There are many different types of progesterone that can be used in a frozen embryo transfer cycle. Some of the more common methods include:

    • Progesterone pills — Prometrium
    • Progesterone injections
    • Progesterone vaginal suppositories
    • Progesterone vaginal gels — Crinone, Procheive

    There is considerable uncertainty in the medical literature concerning which type of progesterone is the best for FET cycles. Again, the choice of progesterone for an FET cycle is up to the discretion of the physician. A few things, however, most experts would agree on. Progesterone given by mouth is unreliable due to variable absorption and subsequent metabolism in the liver.

    Once the uterine lining is adequately thickened with estrogen, the progesterone is usually started on a particular day to allow for scheduling of the embryo thaw and embryo transfer.

  3. What is the timeline for an FET (Frozen Embryo Transfer)? One of the benefits of having a Frozen Embryo Transfer (FET) an embryo adoption is that no egg retrieval is required because the embryos are already in existence. Couples participating in FETs can skip right to preparing her body for pregnancy by building up the lining of her uterus. As a result of having the embryo ready, once her lining is optimal, the embryo (or embryos) can be transferred. This shortens the overall timeline considerably for a couple undergoing a FET over a fresh embryo cycle.

  4. Will the drug regimen be the same for embryo adoption with fresh embryo transfers? No, it will not be the same. There are fewer drugs needed because the ovaries need no additional stimulation to produce several eggs at ovulation. There will still be estrogen treatment to begin to prep the uterine lining for around two weeks. Following that, the patient will get both estrogen and progesterone to build up the uterine lining for implantation.

  5. Can a natural cycle be used for the frozen embryo transfer?

    FET during a natural cycle
    If a woman has regular, ovulatory menstrual cycles, a frozen embryo transfer can be performed without the use of hormone preparation. Several studies have shown that the pregnancy rates in natural FET cycles are equivalent to that of hormone prepared cycles. In practice however, these cycles are much more difficult logistically to perform.

    In the section above, it was stated that there is a precise window of implantation for transferring frozen embryos. This must be maintained in a natural FET cycle as well. This requires precise determination of the time of ovulation. This can be done by using a home ovulation predictor kit. However, as anyone who has ever used these kits knows, it is sometimes difficult to read them accurately. Although the instructions accompanying the ovulation kits usually recommended that women test the urine once each morning, for FET cycles it is recommended that testing is done in the morning and evening. It is also possible to monitor natural cycles using blood tests and ultrasounds.

    Unfortunately, during a natural cycle, the day of ovulation is not as controlled.

  6. What is the success rate for thawing embryos? The success rate for thawing frozen embryos will vary by clinic - from 50 - 75%. Each clinic reports on its own statistics to the U.S. Center for Disease Control (CDC). It is advisable to discuss these statistics (found at CDC Fertility Clinic Statistics) with any clinic being considered for the frozen embryo transfer (FET) process.

    One family adopted embryos from two different families. One embryo was adopted from one family, and five embryos were adopted from a second family. The time came to transport the embryos to the adopting family's clinic via Fed Ex. The adopting mother was prepped for her embryo transfer and the physician doing the frozen embryo transfer asked for the five embryos to be sent to the clinic. The one embryo from the first family remained frozen at the original IVF clinic.

    The physician felt the statistics were better with five, so he wanted the five for the transfer. Unfortunately, when the five embryos were thawed, none survived. Because the doctor had a patient prepped for transfer with no embryos, he called to have the one embryo sent over. Fed Ex priority overnight delivered the one embryo the next day, and the transfer occurred. Against statistical evidence, two weeks later the pregnancy test was positive! Nine months later a beautiful baby was born from that one embryo. The truth is it only takes one embryo for a successful pregnancy.

    In another instance a doctor reprimanded his patient for adopting a set of embryos. The doctor thought the embryos were very poor quality and he could not believe she had adopted these embryos on her own free will. The doctor did not want to proceed with the transfer. The adopting parents proceeded against his advice. Nine months later, the mother gave birth to their son.

  7. What is the success rate of frozen embryo transfers (FETs)? The success rate for embryos transferred during FETs is the same to slightly better than those implanted from fresh cycles of IVF. In some cases, success is more likely because the womans uterus and body have not just had surgery for egg retrieval. Also, because the uterus and body will not have to be stimulated for egg production, her body is more receptive to pregnancy and will not have any residual effects of the drugs used to stimulate the ovaries that can be harmful to a pregnancy. In some ways, FETs are more successful. For example, babies from frozen embryos had higher birth weights than babies born from fresh embryos.

  8. How many embryos should an adopting family transfer per cycle? Adopting families should limit the number of embryos transferred to the number that they are willing to carry to term in the event that all the embryos implant. Some embryo adoption programs specifically require their adopting families to agree to transfer all thawed and viable embryos and to not selectively reduce the number of embryos that have begun developing. Due to the high-risk nature of a multiple pregnancy, most doctors recommend limiting the number of embryos transferred to no more than three embryos at a time. This is something adopting families should discuss with their doctor prior to their scheduled embryo transfer. The ASRM also provides members with transfer guidelines based on the woman's age.

  9. How long can embryos be used after they are frozen? Frozen embryos do not have a determined 'shelf-life'. In September 2010, a baby was born in New Zealand from an embryo which had been frozen for twenty years. There are quite a number of other instances where embryos which have been stored over 10 or more years have resulted in successful pregnancies.

  10. What is the likelihood of having twins or triplets with frozen embryo transfer? Multiple births are less common with frozen embryo cycles than with fresh embryo transfers. But this in no way guarantees that an adopting family will not have multiples. Adopting families should consult the Society for Reproductive Technology, ASRM, the Center for Disease Control, and their fertility clinic for statistics regarding multiples birth rates and the number of embryos to be transferred in any given frozen embryo transfer (FET) cycle.

    The Centers for Disease Control (CDC) also maintains data submitted by U.S. clinics regarding the number of embryo transfers, success rates and incidents of multiple births. You may see this data displayed for each unique clinic on the CDC web site.

  11. Are there any risks to pregnancy inherent in using donated embryos for the Frozen Embryo Transfer (FET)? A pregnancy using donated embryos does not involve any special or increased factors of risk. It is important to consider the age and any medical conditions of the donating parents and to discuss this and all other pertinent details with the obstetrician. A recent study published in the journal Fertility and Sterility actually found that the pregnancy success rate for women adopting embryos is equal to or greater than the success rate for women using their own embryos in IVF treatments. Women who use their own embryos will have a 32% chance of delivering to term, whereas women using adopted frozen embryos will have a 35% chance of delivering to term.

  12. Can we choose our own fertility clinic for the frozen embryo transfer (FET)? Several embryo adoption programs will allow you to choose the fertility clinic you wish to work with for your medical procedures. Others will require that you use a particular clinic. Most clinics with donor programs will require you to use their clinic. Understand your priorities and then select the right program for you.

  13. What questions should an adopting family ask when looking for a fertility clinic?
    • Is the clinic willing to accept embryos from another clinic for a frozen embryo transfer (FET)?

    • How much does it cost for a FET, including necessary prescriptions?

    • Does the clinic have any testing or screening requirements? Are there any other conditions involved in accepting and transferring the embryos?

    • What are the in-house statistics regarding thawing and transfer of embryos?

    • What paperwork is required by the clinic? How long will it take the clinic to process the paperwork?

    • What are the short-term and long-term storage fees at the clinic?

    • Check the Center for Disease Control statistics on the clinic to see not only their pregnancy rate, but also their live birth rate, and multiple birth rate. Triplet and more pregnancies are another form of IVF mistake.

    • Ask the clinic about their labeling protocol for embryos. (They should use at least two, and preferably more, unique identifiers such as bar-coding, color-coding, name, number, etc.)

    • Ask the clinic what safeguards are used to make sure that the correct embryos are used for each procedure. (For example, more than one person doing the identification of both the embryo and the patient)

    • Check to see if there have been any complaints or disciplinary actions against your doctor. You have a couple of options: a.)Search medical board and the state name in your favorite search engine to find the Medical Board for your state. b.)Use a commercial service to provide a report on your doctor.

    • Ask the clinic if a nurse is available to work with you individually if needed to make certain you understand how to administer the medication. Not all mistakes in infertility treatment are by the clinic itself. Infertility medications can be confusing to administer.

    • Does the clinic have a specific policy of disclosing all mistakes or errors to a patient?

    • During your procedure, ask questions. 'Have you double checked to make sure these are my embryos?' 'May I see the storage vial for the embryos before the FET?'

    This is not a comprehensive list of questions. Adopting families may have to educate a clinic about embryo adoption and/or donation with assistance from their chosen agency representative.

  14. How concerned do we need to be about the 'quality' of the donor embryos? Our clinic seems to have some very strict requirements.

    The 'quality' of human embryos is determined by a variety of factors. The reality is that healthy children have been born from very 'low quality' embryos and children with birth defects have been born from 'very high quality' embryos.

    Prenatal genetic testing (PGD) removes cells from embryos prior to transfer into the womb to test for disease and other chromosomal deficiencies. Some people go as far as testing to determine the sex of the embryo because of their preferences.

    Fertility clinics do have to follow FDA rules and regulations regarding human reproductive tissue.

    Keep in mind that the embryos that are donated have already produced children for the donor family. They are donating them because they want to give their remaining embryos a chance at life and they want to help another couple achieve pregnancy and children.

    There have been children born from embryos that have been frozen more than twelve years. There have been children born from embryos that were deemed to have defects 'incompatible' with life. There have been children born from embryos that were frozen and thawed and frozen and thawed again!

    What is believed to be flawed by some may become a life-filled baby girl or boy.

  15. What if pregnancy is not achieved after using all of a donating family's embryos? If a match between adopting and placing families does not result in a pregnancy after thawing and/or transferring all of their embryos, another match can usually be facilitated by your agency with another donating family.

    Your original fee may cover the cost of new match or there may be additional fees assessed. This may include a nominal fee to cover counseling for the new donor couple, new paperwork and embryo transportation.

    We strongly recommend that you clearly understand what is and is not included in the program you are considering, as each embryo adoption program is different.

  16. Have there been any reported psychological problems found in children born through embryo donation?

    Issues and concerns have yet to be identified and there are no long-term studies available. Similar psychological issues associated with adopting domestically or internationally may arise with embryo adopted children.

    Working with an experienced adoption agency will help you understand the unique needs of an adopted child and help equip you to meet those needs. Additionally, a reputable agency will be available to you for future counseling as your children mature.

  17. What counseling should be offered to the donor family as well as to the adoptive family? Counseling is an important component of the services that should be offered in an embryo adoption and, in fact, is specifically included in the American Society for Reproductive Medicine's (ASRM's) guidelines for donating embryos. The type of counseling services made available and offered in an embryo adoption situation should be similar to the counseling services offered for traditional adoptions. For example, local area donating families should be provided with counseling services at no charge. Counseling for local adopting families should be included in their program fees. Referrals should be made for families outside of the geographical area serviced by the agency, clinic, or attorney.

  18. What are the current FDA requirements for blood tests?

    The U.S. Food and Drug Administration (FDA) has published regulations regarding human tissue donation that effects embryo donation and adoption. On May 25, 2004, the FDA published final rules addressing donor testing/ screening and good tissue practice. The FDA subsequently issued an interim final rule on May 25, 2005, which amended certain sections of those regulations. For additional information on the rule, see the FDA's web site Question and Answer section at: http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/TissueSafety/ucm095440.htm

    Previously, the FDA rules exempted sexually intimate partners engaged in reproductive treatment, from infectious disease testing prior to the creation of their embryos, which were intended for the couple's own use. The interim final rule expanded this exemption, which now permits couples who were not originally screened for infectious disease to donate their cryopreserved embryos to other couples. The regulations do suggest that attempts to test these donor couples should be made before the embryos are transferred to the recipient, but, when testing is not possible, the recipient should at least be advised of the potential communicable disease risk. Given that FDA regulations may change, you should be sure to understand what screening and testing requirements are in effect at the time of your donation.

    When issuing the interim final rule, the FDA stated; "We are now adding a new exemption from screening and testing in Sec. 1271.90(a)(4) for cryo preserved embryos that, while originally exempt from the donor eligibility requirement because the donors were sexually intimate partners, are later intended for directed or anonymous donation. When possible, appropriate measures should be taken to screen and test the semen and acolyte donors before transfer of the embryo to a recipient. This change reflects the fact that sexually intimate partners may decide to donate their cryopreserved embryos long after their fertility treatments are completed. Because the embryos were intended for use in a sexually intimate relationship the donors would not have been required to be screened and tested for communicable disease agents at the time that oocytes and semen were recovered. The new provision recommends that appropriate measures be taken to screen and test the semen and oocyte donors before transfer of the embryo to the recipient, when possible.

    The current FDA mandated blood tests include:

    • HIV 1 & 2

    • HTLV I/II

    • Hepatitis B Surface Antigen

    • Hepatitis B Core Antibody (IgG/IgM)

    • Hepatitis C Antibody

    • RPR (Syphillis)

    • CMV IgG/IgM

    • Gonorrhea/Chlamydia Culture

    • Blood Typing

    • Rh Factor

  19. A local clinic has agreed to receive frozen storage embryos from another clinic, however, they insist that the donating family follow FDA regulations regarding blood work. What does this mean?

    Current ASRM/FDA recommended blood tests include: HIV I & II, HTLV I & II, Hepatitis B surface antigen, Hepatitis B Core Antibody (IgG/IgM), Hepatitis C Antibody, RPR (Syphilis), CMV IgG/IgM, Gonorrhea/Chlamydia culture, Blood Typing, and Rh factor.

    The FDA requires that parents who create embryos on or after May 25, 2005 must have their blood screened twice for infectious diseases. The first screen is done at the time of collection/creation and the second screen must be done at least six months later. This is to ensure that no infectious diseases were contracted during the month or two preceding the collection, which would not have shown up on the first screen.

    Parents who created embryos before May 25, 2005 are recommended to have this second screening done, but there is no FDA requirement. However, most clinics who agree to accept embryos from other clinics will require a second screening, even if they embryos were created far before May 25, 2005. If an egg or sperm donor was used in the creation of the embryos before May 25, 2005, the original screening results are sufficient. It is not necessary to locate him or her for additional blood testing.

    If the embryos were created prior to May 25, 2005, and the donating parents are not able or willing to complete additional blood testing, a waiver can be signed by the adoptive parents stating that they are aware of the lack of testing and choose to accept any risks.

    Fees for the screens are covered by the adopting parents, although donating parents may have to pay initially and then be reimbursed.

    Some clinics may also require some tests or screens for the recipients. This is contingent on what tests were already performed, the standard practices of the doctor and clinic, and any specific risk factors associated with the patient, such as age. Adopting parents should consult with their doctor to find out what testing needs to be done.

    In addition, adopting parents may be required to meet with a psychologist to discuss their feelings towards embryo donation/adoption and whether they are fully aware of what it will entail to enter such an agreement. Clinics that do not require counseling may require some type of consultation to ensure that both parents have been informed and give their consent.

  20. Who handles the coordination of the physical transportation of the embryos between clinics?

    If you are working with a private embryo adoption provider, the agency or attorney should coordinate travel for the embryos between the two clinics. Otherwise, the donor will need to discuss with the fertility clinic what paperwork is required to have the embryos released and transferred to another clinic. The donor should also find out what the clinic uses to transport the embryos; often, clinics use glass ampules or plastic straws that hold up to six embryos. They must be held in temperature-controlled containers in order to preserve them in a frozen state. The embryos can then be shipped overnight via air courier.

    In some cases, the recipient may be able to travel to the donors' clinic and have the embryos transferred without the shipping expenses. Recipients need to first find out how they can be become patients at the clinic and whether the transfer can be performed there.

  21. What if our clinic doesn't have a dry shipper? The agency or attorney with whom you are working should be able to coordinate the rental of an appropriate shipping container for you.

Understanding Emotions and Embryo Adoption

  1. What emotional issues should those considering embryo adoption be aware of? There are emotional impacts on both the individual and the couple; personal, financial, sexual, and spiritual concerns. Keeping in mind that the hoped-for end result is the birth of a child, coming to conclusions regarding how you will educate that child about their origins is also important. Finding a counselor who has in-depth experience with the psychological impacts of infertility is a good first step. Many couples who choose embryo adoption have already been faced with infertility. Even for those families who choose embryo adoption without having experienced infertility. Choosing to parent through embryo donation involves a leap of faith that you will be able to handle and assimilate with grace the multiple uncertainties that you might face. I recommend that you, as couples, learn to communicate very well about complex issues, surround yourself with others who are learning about similar issues, and find professional support that can encourage and support you in positive and wise ways. Overall, before embarking on embryo donation I suggest that you grieve the many losses involved in your infertility and that you share with and forgive each other for the misunderstandings you experienced during the treatment period. I also recommend that you recognize that becoming a parent in any way involves a leap of faith, because regardless of where your children come from or how they were conceived, parenting is both the most rewarding and the most challenging life experience you will ever have. There are no easy paths for parents and children, and if natural conception guaranteed emotional satisfaction and success, just think of all the arrogant parents there would be in the world!


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