Pathways to Parenthood

For some people, when they decide they would like to have a child, they dispose of the birth control and have unprotected sex. These actions can lead to a “spontaneous conception” which means a pregnancy is conceive without other interventions. Spontaneous conception is one approach to having a child, but there are numerous other paths to parenthood. Below is an exploration of the different ways families can come together. The reason someone or a couple may choose one path over another can be due to biological factors or preferences. Click below to learn more! 

  • IVF is a multiple step process. Egg and sperm are retrieved by specialized doctors, reproductive endocrinologists. Egg retrieval takes weeks, careful planning, and medications. A person with ovaries usually has one egg that could potentially be fertilized by a sperm per month. However, for IVF, the goal is to retrieve as many eggs as possible in order to increase the chance of being successful. In order to produce more eggs more frequently than once a month, the person with the ovaries is given medication. Once enough eggs are ready to be retrieved, the individual goes into their doctor’s office for egg retrieval. The number of viable eggs collected ranges from 0-30. Sperm retrieval can occur around this time. Once the eggs and sperm are retrieved, the sperm will fertilize the eggs in a lab setting. It is important to know that not every egg will be successfully fertilized, but for the ones that are, they will become embryos. Select embryos, usually 1-2, will then be transferred in the uterus of the person that will carry the pregnancy. However, not every embryo will implant. For the one(s) that do, they may result as a baby!

  • IUI is a fertility treatment that places sperm in the uterus in order to get it as close to the mature egg as possible. IUI is used to facilitate pregnancy for many reasons:

    -for individuals or couples using sperm donation

    -for males who may have blockages or surgeries that impede sperm delivery

    -for couples with unexplained fertility

    -for females with cervical scar tissue or differently shaped uterus/cervix

  • Some people know for most or all of their lives they would like to adopt a child. Sometimes adoption is chosen after the diagnosis of infertility or after fostering a child. Adoption is legally taking the parental rights and responsibilities of a child who may not have another guardian able to take on those rights and responsibilities or a guardian who forfeited the rights. Sometimes the process starts with getting in contact with an American or International adoption agency. Other times a child is adopted by another family member. People need to qualify to be able to proceed with the adoption process. Once they are approved, then they may be put on a waiting list and wait for their child.

  • Surrogacy is when a person with a uterus carries a pregnancy not with the intention to raise the resulting child, but for a couple or individual, who are the intended parents, to raise the child. This option can be helpful to couples or individuals without uteruses or for a woman in which pregnancy is not recommended because she has a higher than average risk for complications if she were to carry a pregnancy. There are two main kinds of surrogacy.

    -Traditional Surrogacy: a person with a uterus carries the pregnancy AND donates their egg cells to be fertilized with the desired sperm

    -Gestational Surrogacy: a person with a uterus ONLY carries the pregnancy and does not contribute any of their genetic material/egg cells. *This has been the preferred and more common option.

    There are surrogacy agencies where individuals who want to be surrogates, sign up and individuals seeking surrogates can connect with them. Sometimes family members such as mothers or sisters are the surrogate for their relative. There are many crucial, legal documents that are signed and need to be mediated by lawyers in order to make sure each party is protected.

  • Sometimes, egg or sperm donation is needed to complete one’s family. Egg donation needs to be done in conjunction with IVF. Sperm donation can also be done with IVF as well as IUI. The egg or sperm donor can be from an anonymous person, a friend, or family member. This option may be for:

    -single individuals

    -same sex couples

    -a couple who are carriers of the same genetic condition may choose a donor who is not a carrier of the genetic condition

    -couple in which either the egg or sperm quality is less than ideal

    -women, who are older and want to avoid having many embryos with too many or too few chromosomes

    -a couple in which one member has an autosomal dominant condition

    -a couple in which the female may have Turner syndrome or the male has Klinefelter syndrome

  • Sometimes, a couple create more embryos than they ever intend to implant. For those embryos, they could indefinitely be frozen, donated to research, discarded, or donated to another couple. Embryo donation has some similarities to adoption, yet cost, qualifications, and legal terms can differ. If someone wants to use an embryo donated from another couple, then they will need to undergo some of the steps involved with IVF but not all of them. A surrogate can carry the donated embryo or the intended mother. For intended mothers, who are carrying the donated embryo, they are experiencing the bond that can come from being pregnant as well as having control over the substances the growing baby is exposed to which is not always the case in adoption. This option may be for:

    -couples with unexplained fertility

    -couples who are carriers of the same genetic condition

    -couple who are of the same sex

    -individuals without the other half of the needed genetic contribution

  • Reciprocal or Co-IVF is an option for female partners or partners who both have uteruses and ovaries. This option allows for both partners to be involved with the creation of their family. One partner contributes the egg cells to be fertilized with the desired sperm and the other partner carries the pregnancy. IVF is needed in this option as well.

  • This option is for a couple who are both male and want to be have genetic links to the family they are creating. For the Split-cycle IVF, both partner contribute a sperm sample to be fertilized with the same egg donor. Then the embryos can be selected to be transferred to the surrogate’s uterus. The plan could be to have one embryo from one partner transferred first and then subsequently an embryo from the other partner.

  • One option for fertility preservation is egg freezing, also referred to cryopreservation. This option harvests a female’s eggs, freezes those eggs usually through a process called vitrification, and stores the eggs until a later time. Those eggs can then be fertilized, implanted, and become a potential pregnancy. Egg freezing can be for individuals, who are delaying their childbearing for social situations, or can be for individuals undergoing chemotherapy and treatment for cancer. Cancer treatment can damage the egg quantity and quality, so before treatment, if a person desires children who are genetically related, then egg freezing can be considered.

Preimplantation Genetic Testing

Preimplantation Genetic Testing (PGT) is a genetic test for embryos created with in-vitro fertilization (IVF). An embryologist will take about 5 cells from the embryo when the embryo is 5 or 6 days old. Those cells are sent to a genetic testing lab to perform one or two of the available PGT tests.

  • This is the most common test performed on the embryo. PGT-A assesses the embryo for aneuploidy. Aneuploidy means there are too many or too few chromosomes. PGT-A can be considered for anyone undergoing IVF because anyone can have an embryo or embryos with aneuploidy. However, as a woman ages, the chance for aneuploidy increases. If an embryo has too many or too few chromosomes, then this can lead to implantation failure, miscarriage, or a child with intellectual disability and/or birth defects.

  • This PGT is for a couple in which one member has a structural rearrangement (also known as a balanced rearrangement or translocation) within their chromosomes. This means they have all the chromosomes they need, but those chromosomes are arranged in a way that when go on to have a pregnancy, they may give too many or too few chromosomes which can lead to aneuploidy in the embryo. An aneuploid embryo, if transferred, can lead to implantation failure, miscarriage, or a child with intellectual disability and/or birth defects. PGT-SR assesses the chromosomes for the embryo, with particular focus on the potential chromosome imbalances that can result from the parent’s structural rearrangement.

  • PGT-M assesses the embryos for monogenic (also known as single gene conditions) conditions. A monogenic condition is caused by one gene that is nonfunctional. Cystic fibrosis is one example of a monogenic condition. If a couple is known carriers of condition or if someone has a personal diagnosis, then they could have PGT-M to detect which embryos may have the condition and which do not. Then only the embryos without the condition can be transferred.