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Frequently Asked Questions
Family Building Resources
My partner and I started trying 6 months ago to get pregnant and we are getting a little worried.
When do we see a doctor?
Anne: It depends on how old you are: The ASRM - Association of Reproductive Medicine - defines infertility as the inability to achieve pregnancy after 12 months of trying. Only 60% of couples are actually pregnant after 6 months of concerted efforts. However, you might want to be sure you know when you are ovulating by using an ovulation predictor kit and then give it another 6 months. *If you are 35 or older (for women) the ASRM recommends seeking medical advice after only 6 months of trying to conceive.
Is InVitro Fertilization (IVF) always successful and how expensive is it?
Anne: Success rates for IVF have improved since it first became available in the early 80’s. Since that time over 5 million babies have been born world wide using this technology. However, it is not always successful. Many factors influence success rates. Among them: age of patients, diet, weight, cause of infertility, other medical factors, etc.
“Success” is measured differently and by various factors, so when you research clinics, it is important to be aware of this, and look carefully at the statistics. According to the CDC and SART (Society for Assisted Reproductive Technology) in the 2014 National Summary, for women under 35, live birth rates ranged from 37%-46% per cycle , depending on whether donor or non-donor eggs were used and whether the embryos were fresh or frozen. This rate dropped to 10 - 32% per cycle for ages 41-42, again depending on the above factors. To view this report, go to: https://www.cdc.gov/art/pdf/2014-report/art-2014-national-summary-report.pdf. Your doctor is the best person to ask about your chances of conception with IVF since s/he will have the full picture of your situation.
We are not able to have biological children and have decided to adopt.
But we have no idea where to begin.
Anne: Adoption can be a little overwhelming with so many things to consider, and a jumble of internet stories ranging from the perfect match of a baby into a family, to adoption scams. In 2015 approximately 135,000 children were adopted into US families, of which about 5500 were international adoptions. However, it is also important to realize that the landscape of adoption has changed dramatically in recent years; in 1970 approximately 175,000 children were adopted, and the trend has been downward ever since, with fewer babies available in this country, as well as abroad (see question below addressing this in detail). This makes adoption a more expensive process and a longer process then ever before. However, with a good plan and persistence, adoption is a viable way to build your family.
Here are some basic questions to begin asking yourselves:
1. Do we want to adopt a baby from the US or do we want to adopt internationally?
2. How do we feel about race, gender, special needs of a child, and drug use of a birth mother?
3. Do we want a baby, a toddler, or an older child?
4. How long are we willing to work at this?
5. How much money do we have to spend?
Once you have settled on domestic or international adoption, a good next step is to begin doing some of your own research.
If you are committed to international adoption, take a look at the US State Department website which has a wealth of information on intercountry adoptions, which can be helpful in narrowing your search as to which countries. Here is a good link: https://travel.state.gov/content/adoptionsabroad/en/about-us/our-role.html. You will have to have your home study done by a local licensed agency, and then you will choose an organization that does international adoptions in the country from which you would most like to adopt. There are many of them around the US.
If you have opted for domestic adoption, you will first need to choose the type of adoption service you would like to use. Options include:
• Large national licensed adoption agencies • Smaller local licensed adoption agencies • Adoption Law Centers • Private attorneys • Adoption Facilitators
There are pros and cons to each choice and it is good to read about these various options. Each of these entities will support you through the process. With so many choices and decisions, it can be helpful to engage an adoption coach or counselor to objectively help you navigate everything and to have as part of your support system as you go through the process.
I’m a woman in my early 30’s, and I know I want kids, I’m just not sure when..
Are there steps I should start taking now?
Anne: Meeting with your OB/GYN and talking about your plans is a good first step. If there is any reason to believe your fertility might be compromised they may run some tests or refer you to a Reproductive Endocrinologist to do a complete fertility evaluation which will look at your ovulation patterns, ovarian reserve, etc. Depending on your age, freezing your eggs for when it is the exact right time is an option, but it is costly and a medical procedure not to be taken lightly. Since you want kids soon, assessing your fertility first is a good first step. For more on egg freezing, see question below.
We are a gay couple who wants to have kids, what are our options?
Anne: In addition to adoption, many gay couples today are choosing surrogacy, also called using a “gestational carrier”, as a way to build their families. Assuming at least one partner has viable sperm, surrogacy gives couples a chance to contribute their genetic material to their offspring, as well as choose their egg donor. It also offers the opportunity to be part of the pregnancy in a more intimate way than what adoption usually provides. Even if neither partner has viable sperm, sperm donation or embryo donation, is also an option. However, surrogacy is quite costly. Estimates range from $90,000 to $150,000, which is beyond many couples means. Adoption, as we have discussed above, can also be expensive, but not nearly as much, and actually very little if it is an adoption through the state department of health and human services.
Will my insurance pay for our fertility treatments?
Anne: If you live in the state of Maine, most likely your insurance will not cover it. Some employers have special additional coverage, and in some cases if corporate offices are out of state, some coverage might exist. However, only 17 states have some mandated form of coverage for infertility treatments and fertility drugs. Ask your MD to explore what coverage might exist within your insurance policy, they are very good at navigating policies. You might be surprised.
How do I find a good fertility clinic?
Anne: Choosing the right clinic is very important. You want one in which you feel 100% confident and are comfortable with. SART (Society for Assisted Reproductive Technologies) began tracking statistics of clinics in 2010. So you can look up success rates. Next, It’s a good idea to visit a few clinics to just see how they feel to you. If you can swing it financially, setting up a few initial consultations with the clinic’s Reproductive Endocrinologist, can give you clarity around which clinic you like best. Asking friends for their recommendations can be helpful, while keeping in mind experiences are very subjective. RESOLVE offers an excellent list of questions to ask clinics once you narrow down your search. They can be found HERE.
We’ve heard it takes a long time to adopt, but why is that, since there are so many
children out there who need a good home?
Anne: Many factors have impacted the declining number of children available for adoption in the US and abroad in the past decades. Teen pregnancies have actually decreased over the past 20 years with the availability of birth control and access to abortion. In 1991 there were 60 births per every 1000 teens age 15-19, versus only 26 births for every 1000 teens in 2013 ( CDC). Additionally, our society has de-stigmatized teen parenthood to a great extent, thus many teens are choosing to parent their babies. Plus extended families are stepping up to support raising children of younger parents. Additionally, within the social service system, there has been a significant effort to keep children with extended families when parents are not capable of parenting themselves. Thus, kinship fostering and adoption has grown. All of these factors have led to a decline in adaptable children in the US. On the international front, adoption sits upon the shifting sands of international politics, internal policy changes and a growing desire to keep children within their home countries.
So while yes, there are many children who need good homes, systems, both domestic and international, are changing how they respond to these needs plus, re-calibrated cultural values are also at play.
How does egg freezing work and should I be thinking about it since I want kids,
but have no partner in sight?
Anne: Egg freezing has been available to the public now since 2012 when the ASRM lifted its experimental status, thus making it another form of ART helping intended parents conceive. In 2014 , of all the ART cycles tracked nationally, 17% were done with the sole intent to freeze all of the harvested eggs for future use. So it is becoming much more common. However it is a medical process involving medication and a surgical procedure, so it is important to understand the benefits and risks. Just like in IVF, with egg freezing, the woman undergoes ovarian stimulation by hormone injections, so that instead of just having one ripe egg, she has many. A series of sonograms determines ripeness of the follicles and at the right time, via a surgical procedure under mild sedation, the eggs are retrieved, frozen and then stored. The process of ovarian stimulation itself carries a small risk such as hyper stimulation of the ovaries. The drugs also can be difficult for some women to tolerate. And as with any surgical procedure, there are risks involved, though relatively minor.
The ASRM guidelines suggest that the best time to freeze eggs is when women are in their 20’s to early 30’s, and no later than 38. One retrieval cycle may not be enough as statistics show that for women under age 38, one frozen egg yields a pregnancy only 2-12 % of the time. Most clinics recommend freezing and storing 15-25 eggs depending on various factors. Costs per freezing cycle ranges from $7500- $10,000, though some clinics have multiple cycle programs which help reduce costs. There are also annual storage costs.
Most important to consider is that freezing ones eggs does not guarantee a pregnancy down the road, though young eggs certainly have a higher rate of producing a pregnancy than older eggs. Technology has improved vastly with freezing and thawing eggs, but that is only part of the process of conception. When a woman is ready to use her eggs, they have to be thawed, fertilized with her partner’s or a donor’s sperm, and then be transferred into her uterus, or in some cases, into a gestational carrier. Just because the eggs were frozen when the woman was much younger, there are still a number of steps to go to reach pregnancy. It’s important to be fully aware of the benefits and risks and weigh all factors thoughtfully.
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