Embryo Donation / Embryo Adoption

Have you thought about adopting a baby, but long for the experience of being pregnant, or want to control the intrauterine environment? Join us for this fascinating discussion about embryo donation/adoption with Dr. Craig Sweet with Embryo Donation International, Mark Mellinger with the National Embryo Donation Center, and Beth Button with the Snowflakes Embryo Adoption Program.

In this episode, we discuss:

• The IVF process.
• Remaining embryos.
• Donating to another person.
• How to find embryos available for donation?
• What is the medical process of embryo donation/embryo adoption?
• What is the success rate of having a baby through a donated embryo? What factors influence the success rate?
• What percentage of donated embryos are created via donor egg or sperm?
• What information is available about the embryos and the donors?
• Can you have twins via embryo donation if that is your preference?
• Does it matter how long they’ve been frozen?
• Are pregnancies conceived through donated embryos considered high-risk?
• Are there long-term health risks for children conceived via frozen embryos?
• What is the legal process for embryo donation/embryo adoption? 
  • Academy of Adoption & Assisted Reproduction Attorneys
• Is there a matching process? Do you have a choice regarding what embryos you receive?
• Do the people who donate the embryo continue to have a legal connection to the child? Do they have legal rights to see the child, contact the child, or take the child back?
• Openness after the birth? What is the relationship between the embryo donor and the person who receives the embryo and the child conceived? 
• Is the contact information shared between both parties?
• How much does embryo donation/embryo adoption cost?
• What factors influence the cost?
• Can you use your local infertility clinic to perform the transfer?
• LGBTQ+ and single parents
• What should you consider when choosing a clinic or organization to facilitate embryo donation/ adoption?
• How to talk with children conceived through embryo donation/embryo adoption about their conception?

Transcript

Please pardon any errors, this is an automatic transcript.
Dawn Davenport  0:00  
Welcome everyone to Creating a Family. Let's talk about foster, adoptive and kinship care. We're so glad to have you here. I'm Dawn Davenport. I am the director of Creating a Family the nonprofit, and I'm also the host of this podcast. Today we're going to be talking about embryo donation and embryo adoption. It's a topic that we haven't covered recently, and that's been a mistake, because it is something that I think our audience is very interested in, so I'm glad we're covering it today. Our guests to talk about this are going to be Dr Craig Sweet. He is a board certified reproductive endocrinologist, and as well as infertility specialist. He also is obstetrics and gynecology. His private practice is specialist in reproductive medicine and surgery in Fort Myers, Florida. He is the founder and medical director of embryo donations International, whose goal is to increase the number of frozen embryos donated while reducing the number that are discarded or abandoned. We also have Beth Button. She is the executive director of Snowflakes Embryo Adoption program, a division of Night Light Christian adoptions. Snowflake was founded in 1997 to provide an option for those with remaining embryos to choose a vetted family to adopt those embryos and give them an opportunity to be born. Snowflake serves both embryo placing and embryo adopting families. Mark Mellinger is Marketing and Development Director for the National embryo Donation Center. NEDC is a national nonprofit organization whose mission is to protect the lives and dignity of human embryos by promoting, facilitating and educating about embryo donation and adoption. All right, I'm going to begin with a topic of terminology. What do we call it? You've already heard me say, embryo donation, embryo adoption. So which is it? Is it embryo a donation? Is it embryo adoption? And does it matter? Let me start by talking about the IVF process. I just want to get everybody on the same page here in IVF, a patient, infertility patient, is given medication and drugs to force her ovaries to produce many eggs. Those eggs are retrieved and they are fertilized with sperm. The goal of IVF, as it's currently practiced here in the US, is to create as many embryos as possible, because that increases the chance that the infertility patient will go home with a baby, and also, hopefully embryos, so that they she does not have to go through the ovary stimulating process. Again, she's able to have a siblings if they so choose, if she so chooses for her child. So that's the process. It is not unusual for a patient to have remaining embryos, because we've tried to create as many embryos as possible to both save money and increase the goal, which is to have a baby. If you have remaining embryos, you have a couple of options. One, you can discard the embryos, just follow them and discard them. Or a surprising number of families that I have interviewed, and I've interviewed and a lot of families who have made have are making this decision. A surprising number of them, surprising to me, anyway, is number of families who choose to use the embryos, even though they have reached the family size they thought they wanted, let's say they thought they wanted two children, but they have three remaining embryos, a surprising number that I have talked with will try to transplant, because they feel like that's the easiest way to use up these embryos, and They feel an obligation to these embryos, another option that families have. Well, let me mention one that really isn't very available, and that is donating to research in the past. That was an option. It really isn't much of an option anymore for families. It is possible sometimes to donate to your infertility clinic, and they can use the embryos with their embryologists for things that they're doing and so that could be used for research there, but for the most part, that's not an option. So now we come to the last option, and that is, they can donate their embryos to a another family, another person who is wanting to create a family. Many times, these are infertility patients who haven't been successful, but it doesn't have to be, and that's what we're going to be talking about today, is the option of donating your embryos to another person or another family. The American Society of Reproductive Medicine is clear that the preferred term to use to describe this process is embryo donation. However, when people are searching online to get information about this process, we have found that people, very often, are searching for the term embryo adoption. Also some organizations and some of the ones we're going to be speaking with today, use an adoption model for the placing of these. Embryos plus our audience, quite frankly, is often thinking in terms of adoption, and is thinking about this as an option under that category. So it's hard because the term adoption is problematic, but it also is descriptive. So we're going to be using embryo donation as our preferred term, but we're going to be including embryo adoption as necessary for both clarity as well as just to help our audience. So with all of that baggage dealt with, let's move on now to get to the meat of what people are really interested in. The first question that we get, and probably the most common question that we get is, How do you find embryos? Okay, yes, so I'm interested, but where do I go to find embryos? And Dr, sweet, I'll start with you. Where should people go if they're considering this option?

Speaker 1  5:57  
There's lots of sources now, so one might be an IVF program. Their own IVF program may have some embryos. For a lot of the programs throughout the country, I think slightly over two thirds suggests that they do embryo donation, although a number of them do very, very few. So one of the problems with going to your nearby program is that they might not have very many embryos to choose from, so that that's a slight disadvantage. People are finding themselves online. I know there's some various groups out there, so I think that happens. And then, of course, you've got the matching organizations, and those have certainly proliferated over the last 10 years. And otherwise, you know some of the free, full service organizations like NADC and national embryo Donation Center and embryo donation International, we tend to have larger quantities of embryos for patients to consider,

Dawn Davenport  6:56  
right and snowflakes as well. All of those are sources. You did a good job of summarizing the availability. One thing to note when going to if you are not an infertility patient at a clinic, many clinics will not accept people into their embryo donation program if they are not currently a patient. Now, obviously a lot of the people listening to this will be patients at a clinic, or have formerly been a patient at a clinic. So those are things just to think about. All right, that's a good summary of where embryos are available. And Dr sweets, that you are the only reproductive endocrinologist here, can you walk us through the medical process for going through how do we place embryos? What is it medically, what is entailed in going through using someone else's embryo to become pregnant? So there's

Speaker 1  7:46  
two parts of this. The first is the side of the donor, and then there's the side of the recipient. Did you want me to start with one versus the the other?

Dawn Davenport  7:57  
Yeah, no, start with a donor. I was, I was thinking of the recipient, but honestly, that's your Yeah, we should start with the, you know, chicken and egg type of situation here. Let's start with the donor. That is obviously the obvious place to begin. So

Speaker 1  8:10  
I can speak for our program, and then maybe a little in general. So if somebody has excess embryos, and they are making this very challenging, it's a very difficult decision to consider donating to patients in need. One of the first things that we need to do is to take a look at the characteristics of the donors. If they have certain medical issues or genetic concerns. Then it becomes really less likely, not impossible, but a little less likely, at least, my program will find a happy home for those embryos. So there can be some level of screening, looking at the donors, past, medical history, family history, and then genetic concerns. Once you get through that, then also what's the quality of the embryos, and how many embryos are there. And again, I'm really only speaking from my program, we tend not to take single embryos, because recipients want to have more than just one chance at having a child, just one embryo. So the number and the quality of the embryos makes a difference. So once that gets for us, we look at that and we go, these are great embryos. We think recipients will really want to have them. Then they go through, usually a genetics counseling session, some of the organizations, especially the ones that are we're talking with here, mental health, professional counseling, attorney or some sort of mediation process. So there's legal and other steps involved, and eventually those embryos can be then donated to a program or to a patient or in adoption, adoption to a patient that's on the the donor side. I think that's fairly simplistic, but that it usually takes a few months to get through all of these steps, at least in. My program here the recipient side, likewise, we need to make sure that they're really good candidates for pregnancy. It's like anybody else that comes into an infertility clinic. You know, if she has lupus and kidney disease, it's not a good idea that she gets pregnant, because it's really going to hurt her, probably put her into renal failure. So we take a look at the patients. In addition, many of the recipients have failed in the past, and their reasons why they failed. And so we need to look carefully at those reasons, or we're going to fail placing donated embryos inside them too. So we have to make sure that you know, if they're pre diabetic, they're getting treated if, if their tubes are blocked, that they're being operated on or receptive some medical issues. If fibroids are present, if we think that they may be potentially impairing success, we need to get them removed. So there's some preparation on on that individual, we look to see, okay, is this a good candidate? And then after that, the individuals go through a physical exam and ultrasound and cavity evaluation, and we make sure that, again, it's a happy home for these donated embryos. And when I say a home, I'm talking about the uterus most well, home for nine months. So that works, yes, yeah, the nine month, I call it the condo. So is the condo ready for occupancy, or does it need to be tweaked a little bit? And so those things go through. And then once everything is done, and then mental health professional evaluation is desired, or counseling session, any legal steps that are necessary, especially in open models, we we always get the attorneys involved, and then they finally get to receive their embryos. And again, that takes a couple few months to go through that entire process.

Dawn Davenport  11:54  
And the process for receiving the embryo is what placing an embryo inside of a woman's uterus. What is entailed?

Speaker 1  12:02  
Okay? So there are generally two recipes out there, and the success rates are the same. So one is a natural cycle. Those are not done very often, and especially with embryo donation. A lot of the embryo recipients don't necessarily live close by, and so a natural cycle means we trap when a woman is ovulating, and then figure out exactly when the embryo would have been coming in on its own, and place it then for implantation. They're great. The success rates between these two recipes, they are the same. So it doesn't there's no one is not better than the next. The most common recipe involves what we call a medicated cycle, or replacement cycle. So we give a woman the hormones that the ovaries would normally be producing. So we give estrogen to thicken the lining and to prepare it for implantation, and progesterone to support the pregnancy in the early stages, and so we give those hormones the replacement cycle tends to work better for longer distance patients, because we can really lock in exactly when we're going to do the transfer natural cycles. We're kind of waiting for the woman to ovulate, so we don't know exactly when things are going to go.

Dawn Davenport  13:19  
Let me pause here to remind you that we need your questions because we have the weekend wisdom podcast that allows us to answer your questions. So we need you to send us your questions. You can send them to us at info, at creating a family.org you can use your first name if you want. We can use where you're from, or we can use none of the above. So send us your questions to info at creating a family.org. And now back to the show. All right, maybe the $64 million question is, how successful? What is a success rate for having a baby through a donated embryo? Beth, I know that snowflakes tracks that. So what is the success rate that you guys see? Yeah. So

Speaker 2  14:07  
up until, I guess, for the year of 2024 Our success rate was 59% that was the transfer to pregnancy success rate,

Dawn Davenport  14:16  
yeah, which is how I to pregnancy, not live, birth. You're saying, right? Exactly. Okay, gotcha. Okay, excellent. And mark what factors influence success. Which success is we're defining right now as pregnancy. Others might define it as live baby, but let's just say pregnancy,

Speaker 3  14:35  
well, to some degree, it's a little bit of a mystery. Dr, sweet and Beth would both affirm that there is something inherently mysterious and uncontrollable about the pregnancy, the outcome of the attempted pregnancy process, right? So we, we don't always know, but a major factor, and I think, think Dr sweet would. Agree with this is the age of the genetic mother who provided the egg the her age at the time that she provided the egg, if you're looking for the biggest factor as to whether there will be a successful pregnancy, and it's a potentially controllable variable. That's the big one that we always point to, younger is going to be better in those cases.

Dawn Davenport  15:29  
Yeah, let me ask each of you in your organizations. At some point in the past, I had read that a large percentage, a higher percentage of donated embryos came from donated egg and sperm. Is that still the case? Let me ask. I'm going to ask each of you, Dr, sweet, I'll start with you. So

Speaker 1  15:48  
I think we've got somewhere around 680 embryos available, and when we track that, actually 40% of those embryos came from donated material itself. So 32% were from egg donor cycles, 7% were from sperm donor cycles, and 1% are a combination of egg and sperm donations. So it's that's a much higher number than in the percentage of cycles that are done in the country that use donor eggs or donor sperm, and

Dawn Davenport  16:21  
there's interesting speculation as to why that is, but what I'm a particular let me I should probably have mentioned the reason that is important is, as Mark said earlier, that the age of the woman donating the egg is one of the prime factors in success for implantation, and then pregnancy and donors for donor egg are almost universally in their 20s, quite young. So Beth in snowflakes program. I think you guys probably also track this. So what do you see as far as whether or not donor egg or donor sperm will use primarily donor egg,

Speaker 2  17:00  
right? So, you know, obviously it varies even from day to day, because we're receiving those donations regularly, but it's usually right around half give or take, a few percentage points that are created with donor gametes. And you know, it makes sense, because people who are doing IVF generally there is an infertility diagnosis on one side or the other. So we do tell our adopters to not be surprised, you know, and to really give consideration to whether they're willing to match with embryos created with donor gamings. And

Dawn Davenport  17:33  
Mark, I'm guessing your percentages is probably similar. I

Speaker 3  17:36  
was gonna Yep, she took the words right out of my mouth. It's about half that are donor communities. Yeah,

Dawn Davenport  17:42  
I think that's something that a lot of people don't realize when they're when they're thinking about this. Well, that leads us to the next question, and Mark, I'll start with you on this one, how much information is available about the genetic parents of these embryos? So you're thinking about embryo donation. You found you found embryos. What do you know about the people whose genetics help create these embryos? Generally,

Speaker 3  18:09  
with the NADC, you're going to know quite a bit, because we ask the male and female who created the embryos to provide height, weight, hair, color, ethnicity. So how it works with us is we have a database that recipient families who are who are doing the adoption side or recipient side of the embryo donation process people want to add to their families. We have a database that they are able to look through once they've cleared a couple of milestones, and are a decent way into our program. So what that database consists of is a series of cover boxes that'll provide that basic demographic information. For starters, height, weight, hair, color, ethnicity, things of that nature, a picture of either the couple who created the embryos or children who have resulted. And then, if somebody has interest finds a particular profile compelling, they can click on that, and they can find out a lot more information, genetic health history, which that varies, especially on the older profiles, the health information is is less complete than it generally is on newer profiles. But to the best of our ability and their ability, they being the donating side, the donors have provided, in almost every case, very good genetic and health history, and we also allow them to dig deeper into some of those demographic characteristics, even even down to things that people may not think are that important, like favorite band, favorite movie, vocation, education level, they may be trivial to some people, but to recipient families who are. Going through and looking for a connection, we found that those factors matter and in additional pictures as well, if those are available. So that's the sort of information that they get. It's it's a lot.

Dawn Davenport  20:11  
Craig, does that change if a donor was used in the creation of the embryos?

Speaker 1  20:16  
No, not really, but so with an egg donor, for example, they will certainly have undergone preconception genetic screening, screening for various genetic diseases like carrier states for cystic fibrosis and spinal muscular atrophy. And then on an egg donor side, you usually get a lot of information the demographics. We're just talking about, the characteristics of the individual family histories. Some of them will even go through genetic counseling to make sure that they're good to go. So you get a lot of information, and I agree, some of the older embryos that we have, we have a decent amount of information. We don't have the same amount that we have with our current donors, which is, I think, much more efficient and better

Dawn Davenport  21:02  
both you and Mark have mentioned older donors. That begs the question, does it matter how long an embryo has been frozen? And again, I'll toss this one to you. Dr, sweet,

Speaker 1  21:13  
the answer would appear to be no. In fact, I think NADC has got the record, isn't it like 30 or 31 years? Is that,

Speaker 3  21:20  
yeah, that's No, that's right. Dr, sweet. We had a pair of twins born through our program, through an embryo adoption donation that was facilitated through our program. I guess it was a little more than a couple years ago, and these, these twins, who are now healthy, two year olds, were frozen for almost 30 years. It's amazing.

Dawn Davenport  21:41  
That is amazing, because the cryopreservation techniques have changed and improved so much in the last 30 years. You know, you mentioned twins. Frustratingly, perhaps we do certainly hear people talk about and ask, can I have twins if I'm using donated embryos? Beth? How do y'all answer that question?

Speaker 2  22:02  
Definitely, it's a possibility. In fact, we prepare families that there is a good possibility they could become pregnant with multiples, but a lot of that is really a conversation with their physician, because doctors are looking at, you know, the age of the woman who's going to be carrying the baby, even her stature, you know, is it wise to transfer more than one embryo at a time? And you know, there's not going to be a topi all the time. There's not going to be another optimum, you know, there's not a physician that's going to transfer. Certainly. Hope not. Yes, we very much. Hope not. But yeah, a lot of doctors are hesitant to transfer even three at a time. So we have families coming to us saying, Oh, I really want twins. And we say, you know, that's a conversation you have with your physician, right?

Dawn Davenport  22:51  
I mean, the American Society of Reproductive Medicine has for a long time tried to stress we as a society underestimate and certainly don't talk about the risks of of multiple birth and specific twins. I think we all know that if you were the Octomom, or if you were talking about eight or six or five or four, that there's going to be risk, but we tend to downplay the risks associated with multiple births that involve just two. So yeah,

Speaker 1  23:18  
not as much anymore. So I'd like to give you some good news, and that is, according to the national data, we're looking at 94% singleton so the multiple rates have definitely dropped, and the overall delivery rate, according to the national data, you got pregnancy, but then you have the losses. So the delivery rate has ranged for years, between 39 and 46% that's kind of the range. Most recent is a 45% delivery rate. And we're only transferring, and this has been the last four years, nationally, an average of 1.2 embryos per frozen donor embryo transfer. So we've really, over the years, we've dropped the number. We're transferring. We have dropped the multiple rates significantly, and we have maintained the delivery rate. And that has been a bit of a dance. There it has

Dawn Davenport  24:13  
been. And you know what it's that has been a it's been a long time. It's been a lot of effort from a lot of reproductive endocrinologists and researchers to get that done. So, yeah, that's why it drives me a little crazy when I know that you've been trying for children for a long time, and the idea of a ready made. You know, I want two kids. Let's get it over with. I get that, I truly do. But as Beth said, Talk with your doctor, and hopefully your doctor is going to be encouraging you, depending, of course, on the quality of the embryos to transfer just one. Are there long term health risks associated for children conceived via frozen, frozen embryos, regardless of whether they are donated? I don't, not sure that it would make a difference. This is probably more of a medical question mark I'm going to ask. You and see if you have, if you know the data on that. If not, we will turn back to Dr sweet.

Speaker 3  25:06  
Yeah, no, I'll give you the somewhat informed, layman's response, and then happy for Dr sweet to add his expertise to that. My understanding, based upon the research that I have seen, and I'm happy to be corrected, is that from any assisted reproductive technology procedure, there is a slightly elevated risk of the child having birth defects or chromosomal abnormalities. So if you're considering doing IVF or embryo donation adoption. I think that's something of which, especially if, if you as the receiving family are struggling with infertility, especially in those cases, yes, there is a slightly elevated risk. I think it's maybe 1% I don't think, I don't think it's very elevated. But anybody going through embryo donation adoption, to my understanding, will have a slightly elevated risk for birth defects or chromosomal abnormalities.

Dawn Davenport  26:13  
And that's list that has nothing to do with it being donated. The embryo being donated, it has to do with the cryopreservation and the and the manipulation beforehand. Dr, sweet, any thoughts on that?

Speaker 1  26:24  
So every pregnancy, no matter how it is conceived, has about a 3% incidence of a malformation. Most of them are minor, but some of them are major malformation. When it comes to the IVF world, especially when there is severe male factor, that is the sperm counts really low. On that side of the equation is there might be, and I agree with Mark, it's about a one or 2% increase in slight anomalies. These are now major anomalies. These are minor ones. Genetically, no, I wouldn't say there are increased incidents of chromosomal abnormalities, but we're talking very small numbers. I think what's, what might be even more important to bring up, though, is the average age of the embryo recipient is older than the vast majority of individuals going through IVF. So like an average age for an average IVF patients, 3637 to receive donated eggs. It's usually about 40, but at least in our program, I'd love to hear about the others. We get a peaking right around 43 and 44 that seems to be our greatest number, and those women are at a greater risk for pregnancy complications. They come in with hypertension, maybe pre diabetes and a host of other medical issues, so they tend to have a little bit more of a rocky course in the pregnancy. So they're high risk, and just purely because of their age, and that can have an effect, especially if the child is born prematurely, but there could be some difficulties with the child

Dawn Davenport  28:02  
before we continue, I have a favor to ask. We have a goal to increase the number of reviews that this podcast has. I hope you will agree with me that it's one of the best out there, and we need more reviews, just to put it frankly. So please, will you go whatever app you're using to listen to this podcast. There is a way to rate and review this podcast. Please, please, please, give us a star rating. Won't take you more than less than a minute. Or if you're feeling generous with your time, write us a review. Either one. We would be so appreciative. And now I'll let you get back to this interview. Okay, we've talked about the medical but embryo donation embryo adoption is also a legal process. Beth. What is the legal process for embryo donation or adoption?

Speaker 2  28:51  
So embryos are considered property in the United States rather than children. So instead of finalizing an adoption in court like you would do with an already born child. The transfer of ownership takes place through a contract, and snowflakes does provide that legal document for each party to sign, and once that's been executed, that ownership is then transferred from one party to the other All

Dawn Davenport  29:21  
right, and I'm assuming that any DC and embryo donation international all are handling the legal aspects of the process. Is that correct mark, and then is that correct? Dr, sweet, for us, definitely. Yeah. And Dr sweet, are you also embryo donation international handling some of the legal aspects Well, we

Speaker 1  29:43  
encourage them, and we have attorneys that we call upon when we have a patient that wants them in an open model. You know the disclosed model or the identified model, depending on what word you want to use these days, since it's really kind of alphabet soup. Is those all required? Require. We require attorneys involved. When there is an open process, when there's a non identified or non disclosed, or what used to be called Anonymous, then we encourage it, but we don't necessarily mandate it there. I don't know how that differs from others, right?

Dawn Davenport  30:17  
And if you're working through your clinic, it is generally up to the you, the recipient, to make certain that they find an attorney. And there are attorneys that specialize in reproductive medicine and so reproductive processes. So that is something that you would the American Society of reproduct No. Quad A, see, I'll put that in the show notes. Quad A is the American

Speaker 1  30:42  
Association of adoption attorneys, American Association of assisted reproductive technology attorneys. Arda,

Dawn Davenport  30:47  
yeah, exactly, but it's not quite a is no longer adoption attorneys. It's assisted reproductive and adoptive attorneys. So it's a more complicated name now, all right, so is there a match process? Another way to say it is, do you have a choice regarding what embryos you receive? Mark, I'll start with you, and then I know I think each of your organizations probably handles it differently. So Mark, let's start with you.

Speaker 3  31:14  
Yes at the end. EDC, you do. You can choose to go either open or closed. Open means you will have some limited contact with the donating family. Closed means you won't you'll still get information, but it'll be in a non identifying way. So if you were to go through the NEDC and you were doing a closed adoption. And then the embryos that you select are the embryos that you will try with. If you go through an open process with the NEDC, to simplify it, both sides essentially have to sign them on each other. In other words, you go through what we the process of what we call an open donation agreement, or ODA, where the receiving family and donating family go back and forth on the phone with a social worker who serves as a mediator, separately with the mediator over a period of weeks, and what You're hoping to do is come to a written agreement called an open donation agreement, that's going to spell out what type of contact you'll have, how frequently it will happen through the child's first 18 years of life. So you're looking for mutual levels of comfortability and fit in the case of Noda, and usually, usually they work out just fine. Sometimes they don't, and the two sides can't reach a mutual level of comfortability and fit. And in that case, those embryos that have been selected, then the couple would have to go to a different set of embryos. So in that case, you don't have complete control and choice, but you still have a good degree of both.

Dawn Davenport  33:06  
So somebody comes in and they are presented with the options of embryos, and perhaps that match what they are looking for, and they select, and then it depends on the process. Beth with night light, how does the matching process. Do people that come in and say, we're interested in an embryo that that has these characteristics are, is this quality or whatever? Is that an option?

Speaker 2  33:32  
Yes. So we use what we call a mutual matching process, and it's very similar to the model that's used in our domestic infant adoption program, and pretty much any infant adoption program, which is we are receiving preferences from both parties. As far as you know, the number of embryos they want to adopt, the ethnicity, the amount of communication and openness they hope to have. And then on the placing family side kind of similar, you know, they they can state preferences regarding the education level of the adopting family, age, whether they might already have children in the home or not. And so we're presenting matches based on those factors, and we present a profile of the adopting family to the placing family first, if they accept that match, then we present their profile to the adopting family, so they're both receiving information about one another at the same time, the adopting family is also receiving the health history and the medical information that we have on that family, as well as the embryos and If donor gametes were used, that's when I'll also see those donor profiles that were collected by the facility that created the embryos. Okay, so once they have both agreed to the match, then we would move forward and discuss what type of communication they're going to have with one another. We do encourage at least some level of. Openness, even if that's just, you know, one email year, because it's been pretty well established through research that that benefits not only the child or children involved, but even the adopting and placing parents. So once they've agreed on that communication agreement, then they move into that contract space that I mentioned before, where they're actually signing the legal contracts to transfer the custody

Dawn Davenport  35:25  
Beth, do the people who donate the embryos continue to have a legal connection to the child? Do they have the legal right to see the child, contact the child, or even take the child back, which is, of course, the fear that the recipient families often feel,

Speaker 2  35:41  
of course, yeah, it's definitely a fear with domestic infant adoption, and it's a very there's a good reason for that, because different states do have like that relinquishment period where an expectant or birth parent can change their mind. That is not the case with this. The contracts are very secure. We've never had a placing family even attempt to get custody back, but if they did, you know, they don't have the legal standing for that. It's just not a possibility for them to to have that so, so yeah, any communication they have is really just agreed upon between the parties, and it's, a good faith, trust that they're putting in the other party that they'll abide by what they agreed to. As far as communication,

Dawn Davenport  36:27  
it's generally not legally enforceable, as you say. It's a correct it's a good faith. All right. Dr, sweet. And then I'm going to go around the around the panel here. How much does embryo donation, embryo adoption cost if you can speak to clinics, then, which is, may not be fair, because you may not know, but if you could speak to if you're going to your your infertility clinic, if you have a feel for the cost from an infertility clinic standpoint, noting that infertility clinics provide, generally speaking, far less services. Frozen embryo transfer is sometimes all that they do. And then, if you could talk directly as to embryo donation International, okay,

Speaker 1  37:10  
so first, I hate to punt it, but it really does vary. So I'll give you some examples. If an individual goes to their local IVF program, and they have embryos there, they may end up paying mostly for just a frozen embryo transfer, and that's in the 567, $1,000 range. If one works with a matching organization that is an organization that's bringing embryo donors and recipients together, they usually have a very separate fee, and that can be, I've seen fees go 510, $12,000 just for the matching process there. So that can get kind of tacked on if you do end up involving mental health professionals and attorneys, and that kind of brings the cost up a little bit too, increasing the cost doesn't increase the delivery rates. It's just that's because of the complexity that it comes in. I can tell you, with our program, we don't charge a matching fee, and I didn't get a chance to talk about how our donors, how our recipients, choose the embryos. But the fees for us, it's about 11,000 for an anonymous and non disclosed we have an intermediate model, which is called approved, and that's just, I think another five or 800 and then an open model, wherever you got the attorneys, you got everybody involved, we think those prices come up to about 16,000 and that scenario fees, It's the added individuals into the process,

Dawn Davenport  38:41  
right? And one of the factors, and I will come back to you're right, I did not get you to talk about matching. And I will come back to you on that. One of the fees you had, did not throw in when talking about clinics, is you would absolutely have to hire an attorney. So and

Speaker 1  38:57  
whatever you do, you've got to find doctors that are going to do this. So there's always a transfer fee, right, right? It's always going to be there in

Dawn Davenport  39:08  
Yeah, all right. So mark for those using NADC. What is the cost?

Speaker 3  39:14  
Yeah. Well, first of all, just if you're looking at the overall landscape, I concur that I think the view that Dr sweet gave you is pretty accurate for the NEDC. We give a total estimated cost of somewhere between 11,012 and a half $1,000 now that's not all money you pay to the NEDC. In fact, the vast majority of it would not be money that you pay to the NEDC. The biggest cost, as Dr sweet said, is always going to be the medical fee or the transfer fee, which is going to be, you know, four to $5,000 maybe $6,000 in some places, with the with the NADC, I think it's right in the ballpark of 4000 for the clinic that we use other factors in that. That would be we do require either a home study or we work with snowflakes on an embryo adoption alternative to a home study called the snowflakes family evaluation, which a lot of our folks will go through. So you know that those it costs money to do either of those if you go with a home study and need to have it reviewed by a social worker that can increase the cost if you go open and need an open donation agreement worked out that can raise the cost. And there, there is a fee. There are a couple fees that you pay to the NDC, like, like an application fee and just, just a program fee, which is about $3,500 for the first time you're coming through, and it's 2495 if you're coming through for a sibling. So generally, we think that's going to land in that 11 to $13,000 range. I tell people, budget. You know, with that doesn't include travel and lodging. You do have to come to Knoxville if you go with the NEDC. So I tell people, if you budget for, you know, $15,000 for a first frozen embryo transfer with the NEDC, I can't see it going over that.

Dawn Davenport  41:10  
All right. Beth with snowflakes, what is the cost?

Speaker 2  41:13  
Yeah. So first, I appreciate, Don that you had mentioned that, you know, a clinic model is not, does not include all of the services that you're going to get, you know, from an agency. So our fee is $8,500 that includes everything from responding to that family when they first inquire, to reviewing their application to assisting them with we also require a home study or family evaluation all the way through, you know, communication, agreement, matching contracts, even shipping. We actually coordinate the shipment of the embryos from the clinic or storage facility where the placing family has stored the embryos to the clinic the adopting family will use so there isn't a higher fee. If they have an open communication agreement, it's just, it's all inclusive. And they also receive, generally, unless it's a very large set of, say, 10 or more, embryos, they will receive each of the embryos that the placing family has. So if they have two embryos, they'll receive both of those. If they have eight, they'll receive all of those. And so they're not having to pay this fee every time they want to have a frozen embryo transfer. And then, yeah, we're working with them even through the post adoption phase if maybe there needs to be some mediation when it comes to communication, if there's some misunderstanding or hurt feelings, or whatever we're walking them through that we're helping them prepare for how to discuss with their child the unique way that they joined their family, and how to discuss that even with their friends and extended family members. So that fee does not include the medical procedure, so just going to ask that question, yeah, we work with about 40 plus, really more than that, if you consider some additional locations that some clinics have, but we have a network of over 40 clinics we have partnered with across the US. This allows them, you know, to not have those travel expenses most times, because most families will have a clinic within a couple hours. But obviously those clinics set their own fees, so whatever they're charging for that frozen embryo transfer, you know, we don't have control over that, and so we just ask them to do their research into that, and obviously to factor that in when they're budgeting, you know, what this cost is going to be for them? Something

Dawn Davenport  43:40  
that just came up was that it sounds like with snowflakes, the recipient families choose their own clinic to do the frozen embryo transfer and mark you mentioned at the National embryo donation center that families come to Knoxville, which is where you guys are located, and Have the transfer done there. All right, Craig, what about? And I'm going to come back, actually, I'll ask you two questions. Let's talk about, do people have to come to Fort Myers if they're using embryo donation International, or can they use a local clinic? And then we'll, we'll segue into your talking about your matching process. But answer first the where they do the transfer.

Speaker 1  44:20  
So for EDI, for patients who want to receive their embryos, they come here. And there's all sorts of reasons for that. Beyond that, if you're going to go someplace to get donated embryos, you might as well come to paradise here in southwest Florida,

Dawn Davenport  44:35  
Spoken like a true Floridian, there you go. So

Speaker 1  44:38  
at this point in time, we are not working with any organizations, although we are hoping to expand towards the end of this year. So right now, people do have to travel, and generally they have to travel twice. So they come here for a physical exam, maybe their intake, ultrasound, hysteroscopy. Make sure that condo. Was ready, and then they'll go back home, get their uterus all ready to go with partnering with other organizations near their home. Then they travel for their embryo transfer, and then head back, hopefully pregnant.

Dawn Davenport  45:14  
All right, now tell us about the matching process. I apologize for having skipped, you

Speaker 1  45:18  
know, that's all right. It's just, you know, it's a little complicated. I'd like to think it's a little elegant, but it is a little complicated. On the donor side, the donors control everything. They make a decision of what type of donation they're going to do. Maybe it will be anonymous, or maybe it will be with the approved model, where we involved a mental health professional, or maybe it's an open process. So the donors drive this process. They make a decision. In addition, in our program, sometimes the donors are going to want to have certain recipients only potentially receive their embryos. So maybe you have a heterosexual, Christian married couple, and they only want a heterosexual, Christian married couple receiving their embryos. Maybe we have a same sex couple and they only want a same sex couple receiving their embryos. We call those conditional donation stipulations. It's like race, religion, marital status, sexual orientation, highest education in the home, and then geographic. A lot of the concerns that donors have is that they donate to their local clinic, that they're afraid they're going to see their kids in the mall or at school, or they're afraid that their children will marry their children, and so donating to a distant facility sometimes kind of builds that that process up. In addition, the donors have to decide if they're going to involve themselves in what we call the identity disclosure program. So that's a process where we bring the identity open later in the years, and that's a great program, and that's becoming really popular. So there are a bunch of decisions that the donor makes, the recipient has to put up with the decisions. So the recipient decides she'll take any type of donation process, or maybe she only wants the approved model, maybe she only wants to receive embryos for which contact is possible in the future. That's that identity disclosure program, but the characteristics of the recipient have to match the characteristics of the donor in order for her to even see the embryos. Then they're given profiles, multiple profiles, and the recipients, then they make the choice of which embryos they want. That's how it works with us. Again, a little complicated. I apologize there. Yeah,

Dawn Davenport  47:39  
no. Thank you. Let me pause here and ask you, did you know that you can sign up for a newsletter if you're enjoying the information you get from creating a family. We have a free monthly e newsletter. It is a terrific resource. We curate the best of what we've seen that month. So join us at creating a family.org/newsletter. Thanks. Now I'll let you get back to this interview. I want to circle back to something that Beth mentioned, and what do you tell and Beth, I'll start with you, but talking with children about how they how they joined your family. Obviously, here at creating a family, we think it is crucial that children know and it's talked about early and often. It is not a secret. How do you counsel families on talking with their children about the uniqueness of embryo donation or adoption?

Speaker 2  48:35  
Well, very similar to what you just said, Don we encourage them to start from day one, as early as when that child is in their womb, just practicing telling that story. And you know, there are, fortunately, many children's books. Now, you know, there's lots of children's books about adoption and even donor conception, but now there are books specific to embryo adoption and donation. And so we, you know, we provide lists of those books for families. We do still have occasionally. We had one this week, call and say, Well, you know, I researched your program, and I see that we have to tell our child about their adoption, and we don't want to do that. And so, you know, we provide education. I mean, first of all, it's not even possible. She Exactly. So even if you wanted to have that mindset like it was in the old days, you know, it's not possible to hide that from your child. And you know, what people don't realize is that you're basically establishing mistrust if your parents are going to lie to you about something this significant, you know, what else are they lying to you about? So you know, most of our families through the education that they're required to do as part of this process, if they're not there when at the outset, they generally are there by the time they have finished that education and they understand. How important that is to their child's well being.

Dawn Davenport  50:03  
Listen to some of the interviews we've done over the years with donor conceived people who were not told. It's,

Unknown Speaker  50:11  
it's heartbreaking. It is and it's, it's

Dawn Davenport  50:13  
not, it's not the fact that they were donor conceived that is concerning to them. It's the fact that their parents did not tell them that becomes it's, you know, the old thing, it's the cover up, not the line. So, yeah, that that's big. All right. So I'm going to give each of you a chance now to talk about what you think people should consider when choosing a clinic or organization to facilitate embryo donation or adoption. Mark, let's start with you.

Speaker 3  50:40  
Well, I mean, I think you just have to think and think about a lot of factors. First of all, do you trust them? You need to know your parameters when you're when you're setting out you. You need to have that defined in your mind. What what is important to me going into this process, is it that I go with some program that I trust medically? Is it that I go with a program that fits my values? Because the embryo donation and adoption programs, as Dr sweet accurately mentioned, have proliferated over the last decade, run the gamut from from extremely liberal to extremely conservative. Some like us, our religion we are we're Christian, and we don't make any any bones about that. So you need to think of those. And we would also say to anybody pursuing or thinking about pursuing assistive reproductive technology, infertility treatment, know your limits. Know how far you're you are willing to go based upon your personal values, and don't let the clinic make that decision for you. Don't let them pressure you into doing things you don't want to do. You won't have to worry about that with our partner clinic at the NADC,

Dawn Davenport  51:58  
I'll ask each of you this question after the and that is, do you place with LGBTQ families or single families?

Speaker 3  52:05  
We do not, no, because we hold to the Orthodox Christian understanding of marriage, you know, which is one man and one woman for life. And that is, that is not a policy that is against anybody. We love everybody. We just believe that it's a strongly held religious conviction that God says there are certain lines you don't cross, and we want to honor him. So we believe that, you know, marriage and family within a heterosexual, married context is one of those lines that you don't cross. No animus toward anybody, but that's our rule.

Dawn Davenport  52:42  
Okay, all right. Dr, sweet, what do you think people need to consider when choosing a clinic or an organization?

Speaker 1  52:49  
I think what Mark is saying is right, to me, a lot of the programs are doing a very good job, and they need to have some experience. But I think, above all, one of the most important things from a recipient side is probably making sure that who they're working with has a good selection, that they have a good set of options. If you go to a local program, they've got only four sets, and they really don't fit and they you really are not thrilled with them. And you go to any DC or snowflakes or EDI embryo donation International, where we have a plethora of embryos available, I think there's a better selection process. So yeah, you look for experience and skill and research and all those, and where the heart is and where their passion is, all those things. But I do think selection becomes very important for the

Dawn Davenport  53:40  
recipient, and do you place with LGBTQ families and single parents? Absolutely,

Speaker 1  53:45  
we do. Okay. We do not discriminate in any way. We do have an age cutoff, which is common for all IVF procedures, which is 55 you know, I think they got to be a little crazy to wait that long, but we do have a few patients like that, but we don't discriminate. It's interesting. We allow the donors to kind of say, Hey, I only want certain types of people to receive these embryos. So we do allow the donors because we think they have that right, but, but EDI itself and re donation International, we do not discriminate in any way.

Dawn Davenport  54:19  
All right, Beth, what are the things that you think people wanting to use embryo donation are adopted? What should they consider when choosing a clinic? I mean an organization, not necessarily a clinic. I

Speaker 2  54:33  
echo, you know what Mark and Dr sweet both said, I would say one thing that's maybe unique about our program versus, say, a clinic Donation Program, is we really encourage people to think long term. And so many people that are doing fertility treatments of any kind, whether it's IVF, IUI or embryo donation, you know, it's a very short term goal. They want a baby. They have been through this roller coaster, this. Horrible loss they have felt, which infertility is a huge loss, and we recognize that, and they just want a baby by any means. And so sometimes, you know they're not thinking through some of the other nuances that we try to counsel people through the things we've already discussed about, how are you going to talk to your child about this and why it's important to be open, and why it's important to consider having communication with the other family. And just, you know, we really pride ourselves on being and I've really tried to make it clear that we are child centric. So whereas an infertility patient, you know, they're a customer or a patient where the clinic is trying to meet their demand and fix what's broken, which is, we want a baby. They're trying to provide that to them. We're trying to go beyond that. Yes, we need adopting families to provide the opportunity for life for these frozen embryos. But we also want you to understand all of these nuances that are important so that you're making sure that you're invested in the well being of your child. So, you know the things that come along with that experience? You know we do have the experience we have, you know, the large number of embryos available for adoption, but we really want people to understand. We want them to be able to process the grief they've had with infertility. We want them to recognize that, and we want them to understand, you know, what kind of supports they need to just be successful and to protect their children's well being.

Dawn Davenport  56:40  
Does snowflakes place with LGBTQ families and single parents?

Speaker 2  56:46  
We do? We allow single women to adopt. We also allow couples or adopters to use a gestational carrier if they're not able to carry a pregnancy. We do not exclude LGBTQ families. However, what we share with them, and really with any family who we feel, you know, might be difficult to match, and that is based, again, on replacing parent preferences. What they're looking for in adopting family, we will, you know, advise them that this might not be the best organization for you to come to, because, you know, the majority of our placing families are looking for a married heterosexual couple. We do have quite a few who are willing to place with single women. But when it comes to, you know, the LGBTQ population, not as many. So we will tell people that we will make recommendations for other organizations where they might be more successful. But we have had couples who have said, we like you. We're going to take our chances if we have to wait a little bit longer to be matched. So be it, and we have been able to match those families as well.

Dawn Davenport  58:00  
Well. Thank you so much. Beth button with snowflakes embryo adoption program. Mark Mellinger with the National embryo Donation Center and Dr Craig sweet with embryos donation international for talking with us today about embryo donation and embryo adoption, we truly appreciate your input, your wisdom and your knowledge. So thank you. Applause.