A Child of Your Own: At What Cost?
Tara Yoder
Biology Senior Seminar
14-Nov 05
Thesis: Adopting or fostering children is a healthier, more socially responsible option than fertility treatments for infertile couples.
With each passing year new technologies are developed, giving Americans more and more choices about how they wish to live. One currently advancing field is reproductive technologies. Infertility is a reality facing 1 in every 6 couples in the United States (Kilner, 2000). Today’s culture is inundated with medical or surgical solutions to their problems, and many infertile couples put a large emphasis on having a child “of their own.” These couples now have a whole host of options to get such a child, ranging from drugs that stimulate ovulation, to hiring a surrogate. They often seem not to even consider the obvious alternative to these sometimes painful and always expensive procedures: adoption.
Every day, embryos are created that are often frozen for indeterminate periods of time, or merely discarded. Some people opt to use the unwanted embryos of other couples using in-vitro fertilization (IVF), as a sort of prenatal adoption. In 2003, 1.2 million children were born to unmarried women, making up 34.6% of the total births in the United States for that year. Approximately 14,000 of those children were relinquished for adoption (NAIC, 2005). The couples considering fertility treatments are most likely financially capable, and could therefore provide stable homes to children who otherwise may not have such an option. In a way, aiding infertile couples also contributes to the problem of infertility; if the problem is one of genetics, then the children may also be unable to conceive (Genetics, 2005).
II. Assisted Reproductive Technologies (ARTs)
Infertility is a problem that faces couples, not individuals It can be a very stressful event, and it affects approximately 15% of couples trying to have children. The definition of infertility is “the inability of a heterosexual couple to produce a pregnancy after one year of regular intercourse.” Before a couple will be considered for treatment, they must meet those requirements. Two types exist; primary infertility is the inability to conceive without any previous successful pregnancies, and secondary infertility is infertility after one or more pregnancies that have been carried to term. (Stangel, 1980) Generally, the two have different causes, since in secondary infertility the process has already happened successfully.
There are many variables to account for when treating infertility. It could be a problem existing in just the male or female, or both parties could be infertile. Approximately 50-55% of infertility problems occur in the female counterpart, the most common of which is anovulation, or the failure of the ovaries to release viable eggs (Stangel, 1980). This has many possible causes, including hormonal deficiencies or malformation of the fallopian tubes. This is frequently treated by ovulation induction using drugs such as clomiphene citrate or exogenous follicle stimulating hormone (FSH) (Timiras, 2005).
The male is the problem 45-50% of the time. Similarly to the female, this is most often the inability of the testes to produce viable sperm, which are both motile and normally shaped. Another common problem is a low sperm count, or too low of a number of sperm being produced to fertilize a normal woman. Both of these can be determined by a semen analysis (Stangel, 1980). This is sometimes caused by overheating of the male anatomy, which can be fixed simply by wearing boxers instead of briefs, or in other ways. Artificial insemination (AI) of the female with a concentrated sample of the male’s semen is another treatment. (Goldfarb, 2005)
The last general cause of infertility is problems between the male-female interaction (Stangel, 1980). This could be a problem with the actual act of intercourse, which can be fixed with sex therapy. It could also be because of the failure of the sperm to make it to the egg alive. The mucus produced by the female or the semen produced by the male are sometimes inhospitable to the sperm. This can be remedied in some cases by the use of antibiotics.
Depending on the severity and number of problems for the couples, there are other options available. AI is used in response to low sperm counts, to bypass a toxic cervical mucus, male sterility, or genetic concerns. The latter refers to a heritable disease or trait the male has that is unwanted in the child. In those cases, anonymous or directed donor sperm may be used. The sperm can be fresh or frozen, and it can be either an intrauterine or intravaginal AI. (Timiras, 2005) AI is one of the least costly ARTs, at about $250 per attempt (Fidelman, 2002). If sperm from the husband is used, the result is a genetically related child.
In-vitro fertilization (IVF) is the oldest ART aside from AI. It is a more complicated procedure than AI, involving four steps. It is also more costly, ranging from $7,000 to $9,000, plus $1,500 to 3,000 for the drugs alone. First, hyperovulation is induced, and the eggs are retrieved. A sperm specimen is either retrieved from the husband, or from a donor. Donor eggs may also be used, although this increases the expense to between $10,000 and $60,000. IVF of between 4 and 12 eggs is next, followed by the transfer of 3-5 of the resulting embryos. The remaining embryos are disposed of or frozen. Many other options are available to infertile couples; the list is long. Some of the remaining procedures are gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT), microsurgical epididymal sperm aspiration (MESA), intracytoplasmic sperm injection (ICSI), and cytoplasmic transfer (Timiras, 2005).
One of the most drastic and controversial solutions to infertility is surrogacy. In this procedure, IVF is performed on a designated woman. This woman is essentially acting as a substitute womb for the desired child. Some couples create their own embryos, using ova and sperm from the man and woman, if the woman is unable to carry a pregnancy to term due to a defect with, or the absence of, her uterus. Others use already created embryos that would otherwise be discarded, viewing it as a sort of prenatal adoption similar to the situation mentioned earlier. Still others create embryos from donor eggs and sperm (Stangel, 1980).
Surrogacy can cost $70,000 or more. This includes legal fees, compensation of as much as $25,000 for the surrogate, and medical expenses (Fretwell, 2005). Usually a contract is signed by the surrogate and the married couple, but the legal system does not have very rigid rules regarding such transactions (Kilner et. al., 2000). The situation is fraught with possible complications. Who has the right to decide when to abort a fetus? What happens if the couple no longer wants the child after it is conceived? And more importantly, is the implication present that these women are becoming viewed merely as wombs?
In the case of embryos that are not genetically related to the husband and/or wife, the desire for a child “of their own” is not fulfilled. Why do they use this as opposed to adoption? Other than financially, the creation of the child is in no way connected to the couple, unless the surrogate is close to them. Five people contribute to the making of a child (donor male and female, married couple, and surrogate mother), when two people could make a difference in a child’s life. Which is more socially responsible?
Sometimes couples are advised by friends or colleagues to adopt as a treatment for their infertility. They claim to know couples who have adopted and then later gotten pregnant. Adoption should not be a treatment; it should only be done after careful consideration for individual circumstances.
According to data from the 1995 National Survey of Family Growth (NSFG), the adoptions of unrelated children processed yearly were “most common among childless women, those with fertility impairments, white women, and those with higher levels of income and education. The adoption of a related child was more common among black families and families with low incomes and low levels of education.” (NAIC, 2005) It is also more common for black families to informally adopt children, without going through the legal process (Wozniak, 2002).
Adoption can be related or unrelated, national or international. National adoptions can be processed by foster care organizations, through licensed private agencies, independently, or facilitated by unlicensed agencies. There are a number of costs involved, and these types of adoptions can range anywhere from $5,000 to $40,000 or more. State laws regulate many of these costs. Adoption of children from foster care is cheaper, because the agencies often aid the families and fees are sometimes waived, especially in the case of special needs children (NAIC, 2005).
International adoption has become an increasing trend in the past 15 years, increasing from about 7,000 immigration visas granted in 1990 to nearly 23,000 in 2004. Since the mid-1990s, China has represented the most adoptions, closely followed by Russia (NAIC, 2005).
All adoptions represent a challenge. Children must be made aware of their adoption stories and helped to deal with the feelings of loss and abnormality associated with such an event. International adoptions, along with other national transracial adoptions, are trickier. When adopting a child of a different race or ethnicity, their culture must also be “adopted” (Crumbly, 1999). If handled correctly, adopted children can learn to be comfortable with their adoption story and their heritage, and grow up happy and well adjusted.
In the advancing high-tech field of medicine, increasingly more “treatments” are offered to people. Americans take advantage of this, spending more annually on healthcare than any other country in the world. When the problem is infertility, often a married couple’s desire for a child “of their own” drives them to spend excessive amounts of money, time, and energy into therapies to help them attain this goal. Thousands of children born every year are relinquished to adoption agencies (NAIC, 2005), many of them lingering in foster care systems for years. Adoption is not for everyone. However, it should be carefully considered by anyone desiring a child. Any child who is loved and cared for can be a child “of your own.”
Crumbley, Joseph. Transracial Adoption and Foster Care - Practice Issues for Professionals. Washington D.C.: CWLA Press. 1999.
Fidelman, Charlie. Boomers Try to Beat Clock. Montreal Gazette. 27 May, 2002. Accessed at: <http://www.asklenore.info/infertility/additionalreading/gazette_may2002.html>
Fretwell, Laura. Angel Matcher.17 Nov. 2005. <http://www.angelmatcher.com/projected_surrogacy_costs>
Genetics Home Reference. 4 Nov. 2005. U.S. National Library of Medicine (NLM). 14 Nov. 2005. <http://ghr.nlm.nih.gov/info=inheritance>
Goldfarb, Lenore. 7 Nov. 2005. <http://www.asklenore.info/infertility/infertility.html>
Kilner, John; Cunningham, Paige; and Hager, W. David. The Reproductive Revolution - A Christian Appraisal of Sexuality, Reproductive Technologies, and the Family. Grand Rapids, MI: Cambridge. 2000.
National Adoption Information Clearinghouse (NAIC) - Gateways to Information: Protecting Children, Strengthening Families. 4 Oct. 2005. US Dept of Health and Human Services. 15 Oct. 2005. <http://naic.acf.hhs.gov>
Stangel, John, M.D. Fertility and Conception - An Essential Guide for Childless Couples. New York and Scarborough, Ontario: New American Library. 1980.
Timiras, Paola, Ph. D. Fall, 2005. Material Background: Treating Infertility - New Reproductive Technologies. University of California at Berkeley . 7 Nov 2005. <http://mcb.berkeley.edu/courses/mcb135e/>
Wozniak, Danielle. They’re All My Children - Foster Mothering in America. New York and London: New York University Press. 2002.