Adoption & surrogacy
Only a small number of infertile couples need to consider adoption and surrogacy. These two options are not an easy means of achieving parenthood – both involve considerable emotional and psychological stress, as well as administrative hurdles, for the infertile couple.
ADOPTION
Adoption is the complete legal transfer of care of a child from the birth mother (or birth parents) to the adoptive parents. Most couples who consider adoption are those whose fertility treatments have failed, or who are unable to proceed with possible treatments (often for financial or religious reasons). Most of these couples would like to adopt a baby, but this is rarely possible. The introduction and widespread use of the contraceptive pill, ease of access to legal abortion and the greater acceptance of single motherhood have all contributed to a reduction in the number of babies put forward for adoption. The Adoption Register for England and Wales (2003) presented information this year showing that 3,200 children were adopted between August 2001 and March 2003, and of these only a small proportion (3 per cent) were babies or less than one year of age. Adopting a young child with mental or physical disabilities may be easier, or an older child with special emotional needs. However, these children often need constant attention and can present problems for a childless couple who have no prior parenting experience.
The agencies responsible for adoption always consider the benefit for the child as their first priority, not the needs of the potential adoptive parents. A couple will be expected to have come to terms with their infertility before being considered as adoptive parents. This is to minimise the risk that the adopted child will be seen as a substitute, rather than an individual in their own right, and is one of the reasons why the process of adoption can take many months, sometimes up to two or three years.
Finding an adoption agency
There are about 200 adoption agencies in the UK. Most adoptions are arranged through local authority social services departments or through voluntary agencies such as the Catholic Children’s Society or the National Children’s Home. Information is also available from the British Agencies for Adoption and Fostering (BAAF).
Criteria for adoptive patents
There is wide regional variation in the criteria used to select potential adoptive parents. Most agencies still apply an upper age limit, usually between 34 and 40 years for both parents. Those who do not impose an upper age limit will take account of the general health of the potential adoptive parents instead. These criteria are basically for reassurance that the prospective couple will be able to provide effective parenting for a child until adulthood.
Most agencies expect a couple to be married if they want to adopt a baby. This may not be necessary for the adoption of an older child. Potential parents will be expected to have no criminal record and to be against any form of corporal punishment. Most agencies will expect both parents to have normal reading and writing abilities; this is not only so that they can deal with the large volume of literature and paperwork involved in adoption, but also so that they can support a child who may have been deprived or have learning difficulties.
The adoption process
You should write to an adoption agency with details about yourselves: your ages, how long you have been married, your race and religion, and any special skills or experience you may have. Most local authority adoption services will hold information meetings for potential parents. If the agency has vacancies on its waiting list, you will be asked to complete some formal application forms and will be allocated an adoption worker who will complete an assessment on you.
The assessment will include a police check for any past criminal record, a Social Services check for any entry on their ‘at risk’ register, obtaining confidential references from friends or colleagues, a medical report from your GP and any fertility clinic you have attended, and a number of home visits. The home visits give you the opportunity to discuss all aspects of adoption and enable the adoption worker to prepare a report that will be considered by an Adoption Panel. The report will include details of your family, your current relationship, and any previous relationships and lifestyle and activities, as well as exploring your feelings about your infertility, your attitudes to discipline and your expectations for your own future and that of any adopted child.
In addition to the assessment, the adoption agency will want to be certain that you are adequately prepared to take on the parenting of a child. You will usually have to attend an information and training course with other prospective couples, at evening or weekend sessions. Adoption is now a much more open process than in the past and the course will include issues such as what information to discuss with the child, and keeping records or mementoes of the birth family to maintain the child’s identity if needed at a later age. Sometimes, the birth parents may ask to maintain links with their child, even after the legal transfer of care is complete. Adopted children are allowed to see their birth certificate when they reach the age of 18. Some may try to trace their genetic parents at this stage. The training course is intended to prepare prospective parents for these potentially difficult situations.
If a couple is selected by the Adoption Panel, they will go on to a waiting list for a child. There will often be some delay before a suitable child is found. The child will need to have lived with the potential adoptive parents for at least three months before they can apply to the court for an adoption order. The formal court hearing is usually brief, and the adoptive parents will be told the court’s decision straight away. Once the adoption order is granted, it cannot be reversed. The child becomes a member of your family, usually takes your surname, and will inherit from you as though you were his or her birth parents.
Adopting a child from abroad
Some couples consider adopting a child from abroad. This may be because they have passed the upper age limit for local agencies in the UK, because they only feel able to accept a baby or child under the age of one year and are encountering difficulties with this in this country, or because they are moved by media attention on children who are the victims of crises or emergencies abroad. Adoption from overseas may not necessarily be in the interests of the child, can be complicated and expensive and, despite the time, cost and emotional trauma involved, may still be unsuccessful. The procedures and requirements vary from country to country.
The cost of adoption
For adoptions within the UK, the costs involved are small. Local authority adoption agencies do not charge a fee, although voluntary agencies may request a donation, as they are usually charities. Potential adoptive parents are usually required to pay a small fee for medical and police certificates. There will also be legal fees at the time of the court hearing for an adoption order, but these are also small. After an adoption order has been granted, you will be entitled to claim child benefit and any additional benefits that may be available if your child has any qualifying special needs.
If you are thinking of adopting a child from abroad, the costs can be much higher. A home study and assessment will be needed, as for a UK adoption, but you will be charged for this. The fee may be as high as £2,000 to £3,000. In addition to travelling and accommodation costs for the country from which you hope to adopt, you are likely to face high charges for local legal advice, documentation and certificates, emigration papers and possibly a donation if the child is in the care of a charitable organisation. You may need the services of an interpreter, and may also have to pay fees for translating various documents, forms and reports. The total costs of adopting from abroad can vary from £5,000 to £25,000.
SURROGACY
Surrogacy is where a host mother (the surrogate) carries a pregnancy for another couple (the commissioning or recipient couple) and gives up the baby to them after the birth. There are two main types of surrogacy. IVF surrogacy is where the pregnancy is carried by the host mother after IVF using sperm and eggs from the commissioning couple. The pregnancy has no genetic link to the host mother and this is sometimes referred to as ‘womb leasing’ or ‘straight surrogacy’. Variations of IVF surrogacy are where donated sperm, donated eggs or both are used.
‘Natural’ surrogacy is where the host mother donates her own eggs as well as carrying the pregnancy. In this situation, the surrogate is the genetic mother of the child. The pregnancy may be achieved by artificial insemination using sperm from the male partner of the commissioning couple, by intercourse with the male partner of the commissioning couple (rarely) or by artificial insemination using donor sperm.
The main indications for surrogacy are where the female partner of the commissioning couple has been born without a uterus, where she has had to have a hysterectomy or where she has a medical condition that would be life threatening if she were to carry a pregnancy herself. Very rarely, surrogacy may be considered for couples who have had repeated miscarriages or who have had many failures to achieve a pregnancy from embryo transfer after IVF.
IVF surrogacy is only possible through clinics that are licensed to provide IVF by the Human Fertilisation and Embryology Authority (HFEA). A recent national survey showed that only 29 of the 115 licensed clinics in the UK provided this type of surrogacy and that only about 60 cycles of IVF surrogacy were being undertaken each year. Eggs from the female partner of the commissioning couple can be used only for IVF surrogacy if she is under the age of 35 years – the same condition that applies to egg donation.
‘Natural’ surrogacy is not regulated in the UK unless it involves the use of donor sperm, rather than sperm from the male partner of the commissioning couple. It is most frequently arranged by private agreement, without the involvement of a fertility clinic.
Although surrogacy is legally allowed in the UK, it is illegal for host mothers to be paid for their services by the commissioning couple. However, the commissioning couple are allowed to refund any expenses incurred by the host mother. Fertility clinics are not permitted to recruit or advertise for potential host mothers directly, and commissioning couples must find their own surrogate host independently. This may be a relative, a close friend or a volunteer who has met the commissioning couple through an introduction agency such as COTS (Childlessness Overcome Through Surrogacy).
Surrogacy raises major ethical issues and potential concerns, not least of which is the media interest and wide publicity if a host mother feels unable to give up the child. Although this occurs only rarely, it emphasises the importance of careful and extensive counselling of the commissioning couple and the host mother and her family before beginning treatment. It is also important for the commissioning couple and the host mother to have taken legal advice in advance, and to consider the need for insurance cover for any potential complications.
After the baby has been born, the commissioning couple usually take over his or her care almost immediately. It will frequently have been agreed in advance that they are present at the birth. The commissioning parents need to apply to the courts for ‘Parental Orders’ within six months of the birth to become the legal parents of the child. This requires the full agreement of the host mother.
