HOW WE GOT HERE — AND WHERE WE ARE GOING

The eternal stars shine out again, so soon as it is dark enough.

— Thomas Carlyle

In this chapter, you will learn

• How fertility issues affect all US families, even those with biological children

• How in vitro fertilization (IVF) has helped couples conceive while also creating unintended consequences that should be considered

• How your personal journey, like mine, is one that will necessarily expose you to the moral question of what should happen to embryos that are not immediately transferred to a mother's uterus

• How this book will coach you through the process of embryo adoption from start to finish

I don't make a habit of discussing reproductive health with friends and family, much less casual acquaintances. I have a hard enough time discussing such matters with my wife. But I am making an exception for you because you, having opened this book, are interested in building a family. You are interested in having babies. You are probably curious to know what embryo adoption is and whether your own family should seriously consider it.

As someone whose family has taken the embryo adoption journey, I want to help you answer those questions, as well as some you probably haven't thought of. I am holding my daughter in my arms as I write this. (Cradling a baby in the crook of my elbows while typing is one of the few fine arts I have mastered.) As you can imagine, she is well worth every effort. To begin this journey, you must know where other couples have been before you — and where you are going.

Even before we were married, Julie and I had thought about adoption. We didn't know where those thoughts would lead us, and it took us a decade to find out.

Before I share some of the research that will help explain how embryo adoption developed, it would probably help you to understand my family's unique perspective. You deserve to know our circumstances because they are potentially unlike your own. All of us approach the concept of family in different ways.

Julie and I are both proud graduates of the University of Missouri. Our relationship blossomed on campus, at church, and during outings in her tri-tone ramshackle pickup truck. We enjoyed Tiger Stripe ice cream, Mizzou football games (with low expectations of victory, of course), and the sight of the six columns that once upheld Academic Hall in the center of The Quad.

As an aspiringly chaste Christian couple, sex never took a prominent place in conversation around the dinner table, with a few exceptions. Julie holds degrees in animal science and reproductive physiology, so our conversations occasionally veered to include a survey of the unusual mating habits of opossums, raccoons, and other of God's bizarre mammals.

Unusual? Certainly.

Intriguing? Without question.

Relevant to mankind? Not particularly.

As our wedding day approached, the topic of human children took on a more serious tone. We both come from families of four children each and agreed that would be a reasonable amount for our own household. Two would be acceptable. We didn't consider only one child simply because we felt the need for increased socialization and — perhaps more selfishly — another person to bear some of the constant nagging and incessant neediness of little people. I jest (slightly).

We discussed adoption and even foster children, if only briefly. We had some personal experience: my cousin, adopted from South Korea, is a gem. I knew firsthand the joy of family defined beyond the simple boundaries of genetics.

But here is where our lives might diverge from your own. Many couples we have encountered seek information about adoption because they are unable to conceive. If this describes you, rest assured you are not alone. More than six million US couples of child-bearing age — roughly one in ten of such couples — struggle with infertility, according to the American Pregnancy Association.

Julie and I are thankful we never faced infertility. In fact, after three years of marriage, we welcomed our oldest son, Micah; our next son, Titus, the following November; and our third son, Ezra, two years later. We discovered that with each additional child, our acquaintances became emboldened and inquired, cheekily, whether we understand the basics of abstinence. This, of course, stirred my competitive spirit to the point of wanting to continue having children simply to deepen our friends' discomfort. But I digress. It is not a good idea to welcome little people into the world simply to prove you can. It is only a good idea if you have the wherewithal to bring children into the world because it enriches your family and becomes a moral obligation you will gladly bear.

The Bible says Elijah heard God's calling as a still, small voice. We heard no such voice on our journey to adoption. Yet we certainly felt the effects of God's commands to care for one of our world's most vulnerable groups of people — children, including those not yet carried to term — and to do so through adoption. That is the point at which our daughter, Phoebe, entered the picture. She screamed her little lungs out, taking her first breaths in the operating room two days before our tenth wedding anniversary. This was all because of another precious family's experience with infertility and the consequences of a life-creating technology known as in vitro fertilization (IVF).

Infertility has shaped the lives of many US families, including our own.

Although Julie and I have never experienced infertility directly, our respective families had acute encounters with it. Today, despite many advances in medical science and technology that have made childbirth safer, tremendous challenges persist.

Our family's fertility experiences are not unusual, but I feel they are important to the conversation. Let me share two examples. First, my mother suffered a miscarriage before I was born. It is not something we have discussed in detail, but knowing my tenderhearted mother and father, I can imagine the experience must have been devastating. I thank God they continued to build their family, welcoming me and then my two brothers and sister. It is fair to say few experiences have brought my mother greater joy than the art of parenting and nurturing, which she and my father mastered through some incredibly trying times, including job losses, financial hardship, and angst-addled teenagers.

My wife's parents also faced fertility challenges, prompting them to consult their doctor. Through medicine and modern technology, my mother-in-law gave birth not only to one set of twins — my wife and her brother — but a second set of twins six years later.

Both of our families began raising children in the mid1980s, within a decade of the first successful birth of a baby from IVF in 1978. Five years later, technology had advanced to the point that the first baby from a frozen embryo transfer had been born. Whereas scientists initially focused on fertility treatments for women, later breakthroughs such as intracytoplasmic sperm injection (ICSI) overcame barriers to male infertility and increased pregnancy rates dramatically. IVF has allowed couples to bypass fertility challenges associated with sperm, ovulation, fallopian tubes, uteruses, or other issues to deliver more than seven million babies worldwide.

How Rats in a Laboratory Challenged Us to Define When Life Begins

So while Julie and I didn't directly encounter the impact of IVF on the families around us, we could certainly empathize with families craving the opportunity to raise their own children. To see their sweet smiles. To hear their laughter.

In her laboratory work as a master's student, Julie spent countless hours studying endometriosis, a disease that causes the uterine lining to push outside of the womb, creating inflammation and resulting in infertility. The condition affects roughly one in ten US women. Worst of all, there is no known cause or cure. It is yet another fertility challenge in an era where the zeitgeist suggests anything is possible as long as we put our best scientific minds and technology on the case. For some families, the aspiration of children and the reality of an empty crib are all too real.

Julie never worked with real-life prospective moms. Instead, she and her colleagues focused their research on rats, using the animals to study how the condition passes from generation to generation. She sought to understand the factors that predispose a person to having endometriosis. And she watched generation after generation give birth and die, starting at the early stage of embryo development.

She valued her work and the important knowledge it provided scientists seeking to help families struggling with endometriosis. Yet it also raised a key ethical question: What is the value of an embryo? What some view as a clump of cells is actually a living creature. What is our responsibility to it?

Although rare, IVF creates a beacon of hope for families. Yet its high cost, physical toll, and moral questions cannot be ignored.

As Carlyle's quotation at the chapter's beginning suggests, we sometimes must face the darkness before discovering the light of opportunity. In the case of infertility, IVF is often a last resort for couples seeking a child, and it can appear to offer a bright beacon of hope. The purpose of this book is to show couples, regardless of their infertility experience, that there is every reason to be hopeful because many couples that use IVF to build their families save their remaining embryos for the future. And some of those embryos might join your family one day.

Before you pursue adoption, though, it is important to understand the emotions and the economics that created these children in the first place. For the sake of context, you should know IVF isn't particularly common. In fact, with approximately 1.7 percent of US births attributed to assisted reproductive technology, the Centers for Disease Control and Prevention (CDC) deems it rare, even though demand has doubled in the past decade.

This is not a coincidence. The amount of money couples must spend on IVF is considerable. The chart I've included in the next paragraph features CDC statistics from 2013, the most recent year for which data are available. They show the average cost to patients and insurers. My belief is that these numbers do not reflect another important cost: the loss of embryo babies that are never transferred or placed for adoption.

In 2004, Italy attempted to limit couples to creating only three embryos, all of which had to be transferred. The country also banned human embryo freezing because it can threaten the life of these children. A court ruling later reversed some of the parliament's decisions. But Italy's bold statement highlighted the important point that all human embryos should have the chance to be brought to term. By curbing the creation of embryos never intended to be used, Italy encouraged couples to move away from IVF and toward adoption. I envision a world in which one day, there are no more frozen embryos to adopt because all of those in storage have loving homes, and more couples are pursuing adoption.

Children Delivered Estimated Cost

1 $26,922
2 $115,238
3+ $434,668

Keep in mind that a good portion of IVF cycles are conducted to help families plan for the future — a future that might eventually overlap with your own. For example, in 2016, approximately 25 percent of cases involved the creation of embryos or eggs destined to be frozen for future cycles.

I will delve into our own placing family's story later in the book. But just imagine for a moment that you are going through IVF — or perhaps you have experienced this directly. Imagine the hours of work and thought you have put into saving for an IVF cycle. You and your spouse are desperate for children. Your doctor and his or her staff will create the best possible embryos using your sperm and eggs. But there is a high financial cost, many cycles result in remaining embryos that do not survive, and there is no guarantee of a baby.

Now imagine you have successfully delivered one or even multiple babies created using IVF. In some cases, it might take six to nine cycles, which can challenge even the most resilient couple physically and emotionally. Then, you still must choose how to handle the remaining embryos, which, from a Christian perspective, are human lives.

Doctors' ability to create and preserve viable human embryos has improved dramatically. In November 2017, a couple welcomed a particularly noteworthy embryo baby, frozen using cryopreservation for 24 years — the longest period on record. On average, families will pay between $200 and $800 annually for embryo cryopreservation. As I will share later in this book, even this is no guarantee these children will survive the thawing process.

You and your placing family will encounter these risks if you enter into an embryo adoption contract. Consider the devastating news families received in early 2018 after learning clinics in Ohio and California had experienced technical malfunctions, resulting in the overheating of storage tanks that destroyed thousands of their embryos and eggs. Couples have welcomed many babies through IVF, but the process can also create a rollercoaster of emotions that last years into the future.

Your Mission for This Book: Consider Reproductive Choices and Their Lasting Consequences

There is not a little full-circle irony in the fact that I am authoring the first chapter of a book about the genesis of life while holding my embryo baby. The late-afternoon sun is slanting through the shades of our basement, glinting off her light-red hair. It curls in the back, a trait partly attributable to the beautiful genetics of her placing family and partly to the fact she has been passed from cradling arm to cradling arm, creating a matted effect not quite ready for the runway.

I am sitting in the cool of the basement on this spring afternoon to avoid the heat of the sun. Julie and the boys are outside with friends, jumping in and out of a plastic pool rimmed in lime green and filled with grass clippings from a recent mow. We live on about eight acres. The cottonwood has been drifting on the breeze, stirring allergies and giving the illusion of a gentle pillow fight from on high. Phoebe is asleep on my chest, her pink owl-emblazoned onesie with daisies lifting every few seconds to catch a sweet, sustaining breath.

Julie and I have four happy, healthy children. We have reached our optimal family size. At each stage of our family planning journey, we made choices that included following biological, as well as adoptive, processes that brought us here. As Christians, we trust God's providence played a critical role throughout.

In a similar sense, Julie and I threw in our lot in with adoption well before we even dreamed up Phoebe's future. We had a choice to make, and you will too. It will not be the easiest choice. It will not be a choice everyone understands, respects, or admires. You might even question your judgment at times. If you stay true to your moral compass, I can assure you the outcome will be favorable, regardless of what the months and years ahead might hold. We made a conscious choice to forego what for us was the easy choice of having another biological child in favor of a little girl who had been, for all practical purposes, frozen in time since just after we were married.

Buckle up and prepare yourself for the adoption journey ahead.

In reading this chapter, you now know more than I ever did about the history of IVF and assisted reproductive technology. You know that hundreds of thousands of US families take tremendous risks — of finance, of health, and of emotional well-being — to bring their own biological children into the world. And you've also discovered that tens of thousands of those embryos are made specifically to be frozen for a future date. For many, I hope, that future date intersects with your family's personal destiny. To get to that point, you need to learn the process, identify shortcuts, and plan for the long road ahead. It might sound daunting, but rest assured, it is totally worth the journey.

Let me explain where we are headed.