Anonymous donation programs are generally managed by fertility clinics and receive donated embryos to be given anonymously to whomever the clinic chooses. Known donation programs give the donating family the option of choosing the receiving family and mutually determining the level of future interaction between families. Embryo adoption programs regard embryo donation as equivalent to traditional adoption and offer corresponding assistance and services before, during and after the adoption.

However, the clients of both programs use the terms in a different and more generic way. 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 interchangably like the words lawyer and attorney.

1. In the case of traditional adoption, the birth-mother is frequently single; however, it is not uncommon for placing parents to have become divorced or for a single woman to choose to donate her remaining embryos.

2. In traditional adoption, the mother is frequently very young. A woman placing her born child for adoption is very often placing her firstborn, is not experienced and therefore unaware of the demands of parenting, and may change her mind and choose to keep her baby for emotional reasons. She may be hopeful that by keeping the child, a marriage with the child's father may occur, or she may plan to rely on family and friends for support. Conversely, in an embryo adoption, the placing parents are typically older, are already raising at least one child and so understand the demands of parenting a child or children, and fully understand that they do not want to add to their family.

3. Placing families often have the luxury of more time than a pregnant woman has in reaching a decision to place their embryos for adoption.

An adoptive homestudy 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 homestudy 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 homestudy also educates the parents of the best way to addresss and answer these questions with sensitivity to the needs of the child.

The homestudy 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

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.

• 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. If the adopting family is selected, then 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 without an attorney or agency. Some IVF clinics will facilitate the matching process, or matches sometimes come about through word-of-mouth or by searching the Internet. Miracles Waiting, Inc. maintains a website (www.miracleswaiting.org) where parents can post profiles as either donor or adopters. These profiles allow an interested party to find a profile that fits their criteria and make contact through email. When considering these options, keep in mind that an experienced attorney or agency can be beneficial in mediating communication between parties, can provide the safeguards that traditional adoption offers, and offers education and assistance throughout the process.

• What are the most significant legal issues associated with embryo adoption? The most significant legal issue associated with embryo donation and adoption relates to, first, the unsettled nature of embryo adoption law, and second, 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.

• Does embryo adoption have to be open? 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.

• 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).

• 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.

• What is the risk that the donating parents might change their minds? There is no more risk than with any legal contract. The donating family contractually transfers their ownership rights by signing a relinquishment prior to the embryos being shipped to the adopting family's clinic.

• What does an embryo adoption program fee typically cover? An embryo program's fees typically cover the completion of a homestudy 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.

• Does the program fee include 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.

• 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.

• Does the adopting family help with any of the fees owed by the donating parents? Typically, adopting families do not pick up any costs prior to having been matched with a donating family. Adopting families do often reimburse donating families for any expenses incurred during or 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 experienced agency. Any sort of direct compensation for the embryos themselves is under the legal jurisdiction of each state, and interested partieis should seeks legal advice to determine the applicable laws in their states. In general, such payments are not recommended by the American Society of Reproductive Medicine or the American Medical Association 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.

• Who handles the coordination of the embryos' travel? 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 tranferred to another clinic. The donor should also find out what the clinic used to transport the embryos; often clinics use glass ampoules 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 donor's clinic and have the embryos transferred without the shipping of embryos. Check with the clinic first to find out if they accept patients for this procedure.

• 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 an FET, including necessary medications? Does the clinic have any testing or screening requirements? Are there any other conditions involved in accepting and transferring the 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? Do they store embryos on-site or off-site? If off-site what additional fees or procedures must be followed in order to have the embryos at the clinic for FETs?

  Adoption families may find that they have to educate a clinic about embryo donation and adoption.

• A local clinic has agreed to receive frozen storage embryos from other clinics, 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, Hepatits B Core Antibody (IgG/IgM), Hepatitis C Antibody, RPR (Syphilis), CMV IgG/IgM, Gonorrhea/Chlamydia culture, Blood typing, 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 where already performed, the standard practices of the physician and clinic, and any specific resk factors associated with the patient, such as age. Adopting parents should consult with their physician to find out what testing is required.

  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 into 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.

• What is involved in Frozen Embryo Transfer (FET)? The FET procedure is the same whether the patient is using her own or donated embryos. The process can be done during an unmedicated 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.

• What is the success rate for thawing and viability of embryos? The success rate for thawing frozen embryos will vary by clinic - from 50 - 75%. Each clinic reports on their 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 FET process.

• 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 attach. 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.

• What is the likelihood of a multiple pregnancy 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.

• 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; however, it is important to consider the age and any medical conditions of the donating parents and to discuss all pertinent details with your physician.

  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 32% chance of delivering to term, whereas women using adopted frozen embryos will have a 35% chance of delivering to term.

• What if an adoptive family gets pregnant and there are still embryos remaining? All donated embryos will be released to the adoptive parents via a relinquishment agreement. The agreement will specify a period of time in which they must thaw and transfer as many embryos as are needed. If more time is needed, another relinquishment will be requested.

  If the adopting parents have remaining embryos that they will not be transfering at a later time, the embryos are returned to the original donating family and become their responsibility.

  The original family may then determine if the embryos may be adopted by another family.

• 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 with another donating family. This would normally include a nominal fee to cover counseling for the next couple, new paperwork and embryo travel. However, you should check with the program you are considering, as each embryo adoption program is different.

• How do we get started? Continue to look through our website to gain more information on embryo donation and adoption and to hear from other people who have donated or adopted. The Personal Experiences section includes individual testimonies. Our Videos inform about the frozen embryo situation and portray the decision making process for donating and adopting families. There is also a list of Articles regarding embryo donation and adoption. Under Finding Help you can find a national resource list of Fertility Clinics, Adoption Agencies and Law Offices.

  Please feel free to email or call us with any questions or simply to discuss your situation. Contact Us at 970-663-6799 or email at Info@EmbryoAdoption.org.