embryo donation

If you're considering egg donation as a path to parenthood, you likely have many questions about what comes after the medical procedures are behind you and you're raising your child. Among these, one significant question is whether, when, and how to tell your child about their donor-conceived origins. At Cofertility, we believe in providing complete transparency about the entire family-building journey, including the important decisions you'll face after your child is born.

A growing body of research has explored how parents navigate disclosure decisions across different family types, countries, and situations. This article summarizes the findings from a 2024 comprehensive review of research on how parents approach telling their children about donor conception. We'll examine current trends in disclosure, factors that influence parents' decisions, strategies for talking with children, and resources that can help you feel prepared for these conversations.

How disclosure has changed

Over the past decade, there has been a clear trend toward greater openness about donor conception. Looking at 34 research studies across different countries, family structures, and types of donation (egg, sperm, or embryo), most parents had either already told their children about their donor-conceived origins or intended to do so in the future.

This shift toward transparency has occurred alongside changes in social attitudes and legal frameworks. Many countries have introduced laws requiring donors to be identifiable when children reach adulthood, including Sweden, the UK, Australia, New Zealand, and several others. However, even in places where anonymous donation is still permitted (like the United States, Spain, and several European countries), many parents are choosing to be open with their children.

The research shows that disclosure intentions don't always translate into action, though. In one study, 46% of sperm donation recipients and 56% of egg donation recipients intended to disclose when their child was one year old, but by age seven, only 29% of sperm donation families and 41% of egg donation families had actually begun the disclosure process. This suggests that while parents may have good intentions, they sometimes struggle with the practicalities of when and how to start these conversations.

How family structure influences disclosure

Your family structure plays a significant role in disclosure decisions. Research consistently shows that single mothers by choice and same-sex female couples are more likely to disclose than heterosexual couples. This difference exists partly because these family types need to explain the absence of a father figure, making disclosure a practical necessity rather than just a choice.

For heterosexual couples using donor eggs, disclosure may feel less challenging than for those using donor sperm, as the mother still has a biological connection through pregnancy and birth while the father has a genetic link. Families formed through embryo donation, where neither parent has a genetic connection, appear to be the least likely to disclose, although research in this area is more limited.

The specific disclosure rates found in research include:

• In one UK study, 54.8% of single mothers had disclosed compared to 36.2% of heterosexual partnered mothers.
• In another study, 96.6% of lesbian couples had disclosed by the time their child was 9 years old.
• Across multiple studies, 43-51% of heterosexual parents using donor eggs had disclosed to their children.

Similarly, multiple studies from France and the US have found that disclosure rates among trans parents is exceptionally high, with one French study finding that 100% of transgender men partnered with cisgender women had disclosed their use of donor sperm to their children by early childhood and another survey of trans male–cis female couples planning donor conception found that 95% intended to share both the child’s donor origin and the father’s transgender identity.

Key factors that influence disclosure decisions

Research has identified several important factors that affect parents' choices about disclosure:

Personal values and beliefs

Parents who believe children have a fundamental right to know about their genetic origins are more likely to disclose. In multiple studies, this was the primary reason given for telling children about their donor-conceived status.

Other values that guide disclosure include:

• The desire to be open and honest with children
• Not wanting the burden of family secrets
• Fear that the child may find out accidentally from someone else
• Wanting the child to feel they have "always known" rather than experiencing a shocking revelation later

Parents who choose not to disclose often express concerns about protecting their child from potential social stigma, emotional distress, or confusion about their identity. Some also worry about how disclosure might affect their relationship with their child or their child's relationship with the non-genetic parent.

Parental confidence and emotions

How confident parents feel about discussing donor conception significantly impacts disclosure. Parents who lack confidence about finding the right words, timing, or approach are more likely to delay or avoid disclosure altogether.

Unresolved emotions about infertility, including grief and shame, can also make disclosure more difficult. Studies show that mothers who haven't disclosed may experience higher levels of distress compared to those who have. Interestingly, parents who have disclosed rarely express regret about their decision, while those who delay disclosure often wish they had started earlier.

Couple dynamics and agreement

For couples, agreement between partners about disclosure is important. Disagreement can lead to uncertainty, delay, or non-disclosure. Studies show that couples who are in strong agreement about disclosure also report higher overall relationship satisfaction.

Social and cultural context

The social environment in which families live shapes their decisions. Parents who perceive their community as supportive of diverse family forms are more likely to disclose. Conversely, in communities where traditional family structures are highly valued, parents may be more reluctant to share information about donor conception.

Religious beliefs can also play a significant role. In some contexts, such as conservative religious communities, disclosure may be particularly challenging due to doctrinal positions on assisted reproduction.

Access to support and resources

Parents who receive professional counseling, join support groups, or have access to educational materials about disclosure report feeling more prepared for these conversations. In one study, half of the families who had disclosed had sought professional mental health support, compared to only a small fraction of non-disclosing families.

When and how parents disclose to their donor-conceived child

Most research suggests that earlier disclosure leads to better outcomes. Parents who begin the conversation when children are young (typically before age 7) report that children tend to accept the information more neutrally and incorporate it into their developing sense of identity without distress.

The average age at disclosure across studies ranges from 2.5 to 6.8 years old, with many parents beginning even earlier. In one study, 71.4% of parents reported they had started disclosure conversations from birth.

Parents who delay disclosure often find it increasingly difficult as children get older. In one study, the average age of children in families still intending to disclose was 11 years, despite most parents having planned to tell much earlier.

Disclosure is widely recognized as an ongoing process rather than a one-time event. Parents describe revisiting the topic as children develop, adding more details and answering questions as their child's understanding matures. Many report that their children's questions and curiosity often guide these conversations.

Practical strategies for disclosure

Research points to several effective approaches for talking with children about donor conception:

1. Use age-appropriate language and concepts: Start with simple, concrete explanations and add complexity as your child develops.
   
   
2. Utilize books and visual aids: Many parents find children's books about donor conception helpful as conversation starters. Some create personalized photo books or stories for their own children.
   
   
3. Make disclosure part of everyday family life: Rather than a formal, serious "talk," incorporate discussions about your family's creation story into regular conversations.
   
   
4. Respond to your child's cues: Children often signal when they're ready for more information through their questions. Being attentive to these cues helps parents know when to provide additional details.
   
   
5. Consider the wider context: Think about who else knows about your child's conception and how this might affect your disclosure plans. Many parents choose to tell close family members and friends to ensure consistent messages.
   

Resources to support disclosure

Parents consistently express a desire for support and guidance around disclosure. Fortunately, several resources exist:

• Professional counseling: A fertility therapist or psychologist with experience in supporting families with donor-conceived children can help. 
• Support groups: Organizations like Resolve provide opportunities to connect with other families formed through donor conception.
• Books and educational materials: Resources like the "Our Story" series published by the Donor Conception Network can help frame conversations with children.
• Digital tools: New resources like the Tool to Empower Parental Telling and Talking (TELL Tool) have been developed to guide parents through disclosure decisions.

At Cofertility, we understand that the question of disclosure may feel daunting, but you don't have to navigate these decisions alone. We're committed to supporting intended parents through all aspects of the family-building process, including these important conversations about origins and identity.

Final thoughts

The research shows a clear trend toward greater openness about donor conception across all family types. While disclosure decisions remain personal and should be tailored to your unique family situation, the evidence suggests that early, age-appropriate disclosure generally leads to the best outcomes for children and families.

What emerges most clearly from the research is that disclosure is a process that unfolds over time, not a one-time event. Parents who approach these conversations with confidence, openness, and a willingness to follow their child's lead report the most positive experiences.

Whatever path you choose, remember that your love for your child and your thoughtful consideration of these complex themes are the foundation for your family's well-being. With preparation, support, and resources, you can navigate disclosure in a way that strengthens your family bonds and helps your child develop a healthy sense of identity and belonging.

Read more:

• How Cofertility Can Transform Your Donor-Conceived Child's Origin Story
• Will My Donor Conceived Child Want To Meet Their Egg Donor?
• The Parent-Child Relationship in Families Created Using Egg Donation
• Nine Tips For Raising A Donor Conceived Child

Third-party reproduction refers to conceiving a child with the help of someone other than the intended parent(s). For instance, egg donation is used when an intended parent cannot produce viable eggs. The eggs are fertilized via IVF, and the embryo is transferred to the intended mother or a gestational carrier. Embryo donation refers to when individuals or couples donate their unused embryos to another intended parent(s). 

Understanding the psychological implications of egg donation and embryo donation is crucial for all parties involved (parents, donors, children) because they can have lasting emotional, ethical, and relational effects. Parents using donated eggs or embryos may struggle with grief over not having a genetic connection to their child and may worry about bonding with a child who is not genetically related to them. Some parents may feel uncertain about whether or how to tell their child about their origins. For donors, the psychological implication of donating can be just as complex. Even if a donor initially sees their role as purely medical, they may later experience unexpected emotions about the genetic connection to a child they may never meet. And if the resulting child seeks them out later in life, the donor might need to navigate complex relationships. Children conceived through donation may also have questions about their origins and genetic background.

This article explores the key differences between egg and embryo donation—from biological and legal considerations to emotional and psychological impacts. Whether you're weighing your options or looking for clarity about the path that feels right for you, this guide will help you make an informed and empowered decision.

What is egg donation?

Egg donation is a process where a woman (the donor) provides her eggs to another person or couple (the recipient) who is unable to conceive on their own. Before a woman can become a donor, she undergoes comprehensive evaluations that include  medical screening, psychological evaluation, along with legal counseling. Once selected to donate, the donor undergoes hormonal treatments before undergoing a medical procedure performed under sedation to retrieve the eggs. These eggs are then fertilized and transferred to the intended mother or gestational carrier. 

Types of egg donation: known vs anonymous

The main difference between known and anonymous egg donation lies in the level of contact and information shared between the donor and the intended parents, and potentially the child in the future. With anonymous egg donation, the donor and intended parents do not know each other's identities and the fertility clinic or egg donation agency facilitates the process. Intended parents usually receive non-identifying details (e.g., physical traits, education, medical history) and the donor has no social relationship with the child. With known egg donation the donor and intended parents know each other’s identities and may even meet and form some sort of relationship. Some agreements may also allow for future updates or communication with the child.

Who is a candidate for receiving donor eggs?

According to the American Society for Reproductive Medicine, a candidate for receiving donor eggs is typically someone who cannot conceive with their own eggs due to medical, genetic, or age-related factors, is LGBTQ+, and or a single parent.

What is embryo donation?

Embryo donation is the process in which embryos created through IVF by one couple or individual are donated to another person or couple to achieve pregnancy. These embryos are typically unused from previous IVF cycles and are given to recipients who cannot conceive using their own gametes. Embryo donation provides both egg and sperm contributions, making the resulting child genetically unrelated to the recipient(s).

Legal status of embryos

The legal status of donated embryos varies by country, state, and fertility clinic policies, but generally, embryo donation is treated like tissue donation. The donating individuals legally relinquish all rights to the embryo through a contract and the recipients assume full parental rights.

Who is a candidate for receiving embryo donation

Similar to egg donation, embryo donation is an option for individuals or couples who cannot conceive using their own eggs and/or sperm due to medical, genetic, or age-related factors, is LGBTQ+, and/or a single parent.

Key differences between embryo and egg donation

With embryo donation, the resulting child has no genetic link to either parent, as the embryo comes from a completely different couple.  With egg donation, since the child is biologically related to one parent, it can influence family conversations about genetics and identity. But with embryo donation some parents may struggle with explaining the child's origins since neither parent shares genetic ties, making disclosure and identity exploration more complex.

Choosing egg or embryo donation is a deeply personal decision that can bring up a range of emotions. Anxiety is one of those emotions and is a natural part of fertility treatments and donor conception. To cope with anxieties, recipients can benefit from therapy or support groups for individuals using donor conception. Mindfulness and stress management techniques such as meditation and journaling can also be helpful. Open conversations with loved ones is key to reducing isolation. Writing letters to the future child can help process emotions and prepare for potential conversations down the road. 

Summing it up

Both egg donation and embryo donation provide paths to parenthood for those struggling with infertility. And both paths come with complex emotional and psychological considerations. In both cases, many recipients may grieve the biological connection they hoped to have with their child. Questions about their child’s future identity and how to explain their origins can add to emotional uncertainty. Some parents also experience imposter syndrome, wondering if they will feel like the child’s "real" parent or if they will even be able to bond. However, many parents find that love and connection transcend genetics, making the experience of raising a child just as fulfilling.

Find an amazing egg donor at Cofertility

At Cofertility, our program is unique. After meeting with hundreds of intended parents, egg donors, and donor-conceived people, we decided on an egg donation model that we think best serves everyone involved: egg sharing.

Here’s how it works: our unique model empowers women to take control of their own reproductive health while giving you the gift of a lifetime. Our donors aren’t doing it for cash – they keep half the eggs retrieved for their own future use, and donate half to your family.

We aim to be the best egg-sharing program, providing an experience that honors, respects, and uplifts everyone involved. Here’s what sets us apart:

• Human-centered. We didn’t like the status quo in egg donation. So we’re doing things differently, starting with our human-centered matching platform.
• Donor empowerment. Our model empowers donors to preserve their own fertility, while lifting you up on your own journey. It’s a win-win.
• Diversity: We’re proud of the fact that the donors on our platform are as diverse as the intended parents seeking to match with them. We work with intended parents to understand their own cultural values — including regional nuances — in hopes of finding them the perfect match.
• Baby guarantee. We truly want to help you bring your baby home, and we will re-match you for free until that happens.
• Lifetime support: Historically, other egg donation options have treated egg donor matching as a one-and-done experience. Beyond matching, beyond a pregnancy, beyond a birth…we believe in supporting the donor-conceived family for life. Our resources and education provide intended parents with the guidance they need to raise happy, healthy kids and celebrate their origin stories.

We are obsessed with improving the family-building journey — today or in the future — and are in an endless pursuit to make these experiences more positive. Create a free account to get started today!

The choice between fresh and frozen embryo transfer is a key decision in the IVF process. While both approaches have proven successful, recent research shows shifting success rates and evolving recommendations. This article looks at the differences between fresh and frozen transfers, their respective benefits and limitations, and how to determine which option might be right for you.

What's the difference between a fresh and frozen embryo transfer?

During IVF, fertility medications help the ovaries produce multiple eggs, which are then retrieved and fertilized with sperm in a laboratory. Over several days, these fertilized eggs develop into embryos, growing from a single cell to a complex structure of hundreds of cells called a blastocyst. At this point, your doctor will either proceed with a fresh transfer of the embryo to your uterus (or the uterus of a gestational carrier) or freeze the embryos for a later transfer.

In a fresh embryo transfer, the embryo is transferred to the uterus immediately after fertilization and development in the lab, typically 3-5 days after egg retrieval. The process aligns with your natural cycle and the hormonal stimulation used for egg retrieval.

Frozen embryo transfer (FET), on the other hand, involves freezing embryos immediately after they reach the blastocyst stage. They're then thawed and transferred in a subsequent cycle, which can be weeks or years later. This allows families the chance to do genetic testing on the embryos. 

Can you do a fresh embryo transfer from frozen eggs?

Yes, you can do a fresh embryo transfer using frozen eggs. This is common when working with frozen donor eggs or when using your own previously frozen eggs. In this scenario, the frozen eggs are thawed and fertilized with sperm. The resulting embryos are cultured in the lab and transferred to the uterus without ever being frozen. This is considered a fresh embryo transfer because the embryo itself was never frozen, even though the eggs started out frozen.

How we define “fresh” vs. “frozen” transfers can be confusing. The "fresh vs. frozen" designation refers specifically to whether the embryo was frozen, not the eggs or sperm used to create it. 

Here's a simple way to think about it:

• If the embryo was frozen at any point before transfer = Frozen embryo transfer
• If the embryo was never frozen before transfer = Fresh embryo transfer

This classification stays the same whether you're using fresh or frozen eggs, donor or own eggs, or fresh or frozen sperm. The key factor is whether the embryo itself was frozen.

When using frozen eggs, you have two main options:

1. Thaw the eggs, create embryos, freeze them, and transfer in a subsequent cycle
2. Synchronize the egg thawing with either a natural or medicated cycle, allowing embryo transfer without an additional freeze

The key factor in determining your approach will be the synchronization of embryo development with optimal endometrial receptivity, which your clinic will carefully plan based on your specific circumstances.

Success rates between fresh and frozen embryo transfers

A clinical study from 2024 looked at whether there's any real difference between doing a fresh embryo transfer versus freezing all embryos and doing a frozen transfer later. They specifically looked at cases where genetic testing (PGT-A) of the embryos wasn't done, studying over 8,000 patients having their first IVF transfer.

The key finding was simple: both approaches worked equally well. Live birth rates were about the same - 44% for fresh transfers and 46% for frozen transfers. This held true across different age groups and even when patients had different levels of estrogen during their IVF cycles.

The researchers concluded that doctors and patients can choose either approach for a first IVF cycle. However, they note that certain situations might still favor freezing all embryos, like when there's a risk of ovarian hyperstimulation syndrome (OHSS) or when hormone levels aren't optimal. The choice should be based on each patient's specific situation after a thorough discussion with their doctor.

An interesting point about cost was mentioned too - different healthcare systems saw different cost implications. In some places, fresh transfers were more economical, while in others, the frozen approach made more financial sense.

However, ethnicity may play a role in outcomes. In 2016, I wrote a paper comparing South Asian and Caucasian women undergoing frozen embryo transfers and found interesting differences. While first-time frozen transfer cycles showed similar success rates (43% live birth rate for both groups), South Asian women who had previously undergone fresh transfers had significantly lower live birth rates compared to Caucasian women (21% vs. 37%). The study included 196 Caucasian and 117 South Asian women, with South Asian women being generally younger (34.9 vs. 37.1 years) and more likely to be nulliparous (59% vs. 43%).

Benefits of frozen embryo transfer

• Time for genetic testing: A frozen transfer allows time for preimplantation genetic testing (PGT), which can screen embryos for chromosomal abnormalities before transfer.
• Lower risk of OHSS: Ovarian hyperstimulation syndrome is a potential complication of fertility medications. Although today the overall risk is very low, if you are both the one retrieving eggs and having embryos transferred to your uterus, doing a FET can reduce this risk.
• Scheduling flexibility: You can plan the transfer around your schedule, and take time to prepare your body optimally for pregnancy.
• Storage for future family building: Extra embryos can be stored for future transfers if you want more children later.

Benefits of fresh embryo transfer

• Faster timeline: Since there's no waiting period between egg retrieval and transfer, you could potentially achieve pregnancy sooner.
• Lower initial costs: Without freezing and storage fees, the upfront costs are typically lower.
• Fewer procedures: The embryo doesn't go through the freeze-thaw process, which some patients prefer.
• Slightly better outcomes: Research has shown that for some people with diminished ovarian reserve, fresh embryo transfer may be beneficial. However, for most people, frozen embryo transfer outcomes are better.

Questions to ask your doctor

This decision shouldn't be made alone. Your doctor knows your specific medical history, test results, and circumstances. They can help guide you toward the option that makes the most sense for your situation. What works best for one patient might not be ideal for another, which is why it's important to have an open discussion with your healthcare team about your specific case.

To make an informed decision, consider asking:

• Based on my age and health history, which approach do you recommend?
• What are my personal success rates likely to be with each method?
• How might my hormone levels affect success rates?
• What are the cost differences for my specific situation?
• If we choose fresh transfer, can we freeze any remaining embryos?
• What's your clinic's success rate with each method?

Making your decision

While we outlined various factors that might influence the choice between fresh and frozen transfer, it's important to remember one key point: The research shows that both approaches work well, with very similar success rates. This means that of all the many decisions you'll face during your fertility journey, this isn't one you need to stress about - both paths can lead to success.

The decision between the two approaches should be based on medical evidence, personal circumstances, and careful consultation with your fertility clinic. As technology advances and success rates continue to improve, both options remain valid paths to building your family.

Starting with a fertilized egg, embryo development is a complex biological phenomenon that has fascinated scientists for centuries. With advances in assisted reproductive technology (ART), particularly in vitro fertilization (IVF), our understanding of embryo development has expanded dramatically — contributing to the birth of 91,771 ART-conceived babies in 2022! 

This article walks through the step-by-step processes involved in unassisted and assisted embryo development, highlighting underlying biological events, how IVF works, and the factors influencing fertilization success. Let’s jump in.

It starts with the egg 

Ovulation is the starting point of embryo development. It is the part of the menstrual cycle when one ovary releases a mature egg. Once it is released, the egg moves down into one of the fallopian tubes, where it can survive for about 24 hours. This can result in pregnancy if the egg gets fertilized by sperm during that time – if it doesn’t get fertilized, the egg will break down and eventually will shed along with the lining of the uterus when you have your period.  This typically occurs around the 14th day in a 28-day cycle, though not for everyone. The day of ovulation varies based on cycle length, anything ranging 21 - 35 days is considered normal. Hormones such as luteinizing hormone (LH) and follicle-stimulating hormone (FSH) play critical roles in inducing ovulation. These hormones are always in your body, but your FSH levels fluctuate throughout the menstrual cycle, typically peaking just before LH levels peak to trigger ovulation.

During an egg freezing / IVF cycle, understanding the timing of your menstrual cycle is important as it influences the scheduling of your treatment. Ovulation is carefully controlled through the administration of hormonal drugs that stimulate the ovaries to produce multiple eggs and bring them to peak maturity. The development of these eggs is monitored through regular ultrasounds and blood tests, which are crucial to ensure the specific medication protocol you are given is personalized to you. Once the eggs are mature, they are retrieved surgically under anesthesia.

Then, the eggs are fertilized 

Fertilization marks a pivotal stage of embryo development. During unassisted embryo fertilization, it occurs in the fallopian tubes and begins when a sperm cell breaks through the outer layer of the egg, the zona pellucida. This penetration triggers reactions that prevent other sperm from entering the egg. Then, the nuclei of the sperm merge with the nuclei of the egg, combining their genetic material to form a zygote, the earliest stage of the embryo.

During IVF, fertilization takes place in a lab setting, using the retrieved eggs and sperm. An embryologist combines each egg with sperm, under a controlled, microscopic watch to monitor daily development. Ideally, the same response occurs as during an unassisted fertilization process. To enhance success rates, especially in cases of male factor infertility and low sperm counts, a single sperm is injected directly into the egg using a technique called intracytoplasmic sperm injection (ICSI). 

The early embryo develops through cleavage 

Once the fertilized egg has created a zygote, it then begins a series of rapid divisions in a process known as cleavage. This stage of embryo development involves the embryo splitting without growing in size, essentially forming a compact ball of cells. Cleavage is vital as it transforms the single-cell zygote into a multicellular entity, setting the foundation for further differentiation and growth. Both in unassisted conception and IVF, studies have shown the quality and speed of these divisions can be an early indicator of the embryo's health and viability.

The blastocyst forms 

About five days after fertilization, the developing embryo hopefully(!) reaches the blastocyst stage. This is when the embryo is made up of two parts: a cluster of cells inside that will develop into the baby (called the inner cell mass) and a shell on the outside that will help form the placenta (called the trophoblast). 

During unassisted conception, the blastocyst travels from the fallopian tube to the uterus throughout this five day period. During IVF, however, the blastocyst first develops within the lab and then is frozen. At this point, many families opt for genetic testing of the embryo. 

Preimplantation genetic testing for aneuploidy (PGT-A) allows families to know whether embryos possess the right number of chromosomes. A “euploid” embryo is genetically healthy enough to transfer. Embryos with chromosomal additions or deletions are considered aneuploid. Mosaics are somewhere in between and we’re still learning more about their potential. 

PGT-M (preimplantation genetic testing for monogenic disorders), on the other hand, takes place if there is a specific genetic diagnosis for which both reproductive partners are carriers. This technology allows embryologists to identify embryos possessing those specific genetic abnormalities. That way, parents can choose to avoid transferring one of these embryos if it would put the future child at risk. 

A healthy embryo is transferred and grows in the uterus

Your PGT results (should you choose to pursue that testing), combined with the grades given to each of your blastocyst embryos, will both factor into your and your doctor’s decision on which embryo would be best suited for transfer. 

During IVF, an embryo transfer procedure is done with great care under ultrasound guidance to optimize the placement of the embryo(s) within the uterine cavity, enhancing the chances of successful implantation. The timing of this transfer is crucial and is carefully synchronized with the recipient's menstrual cycle to ensure the uterine lining is optimally receptive. 

Implantation and fetal development

Ideally, the hope is that the transferred blastocyst will attach itself to the uterine wall— a process known as implantation. During implantation, the outer layer of the blastocyst, known as the trophoblast, connects itself to the uterine lining. As we mentioned, timing is everything — implantation success is influenced by the hormonal balance of the body and the receptivity of the uterine lining, which needs to be thick enough to “accept” the embryo. This will eventually grow into placenta, and will be an essential connection for the transfer of nutrients and oxygen to the embryo as it develops into a fetus and, ultimately, a baby. 

The heart is the first organ to develop within an embryo — by the sixth week of pregnancy, the embryo may have developed an actual heartbeat, which can be measured on ultrasound.

Factors influencing embryo development success

Several factors affect the success of both unassisted and assisted embryo development:

1. Age and quality of eggs: Older women tend to have fewer eggs, and the quality of eggs decreases with age, affecting fertilization rates and embryo development. Utilizing donor eggs can significantly improve outcomes in IVF treatments.
2. Sperm quality: Parameters such as sperm count, motility, and morphology are crucial in both unassisted and assisted fertilization processes.
3. Clinic and lab quality: Not all fertility clinics are created equal, and the same goes for labs. If you have not yet begun the IVF process, ask your clinic about their blastocyst development success rates (it’s key to use this language, as opposed to fertilization rate, for example) and feel free to call other local clinics and do the same. 
4. Embryonic development: The ability of an embryo to reach the blastocyst stage is a key indicator of its viability and potential for successful pregnancy.

A recent study examined a few reasons why embryo growth may stall — in summary, this is largely due to chromosomal fragility and abnormalities. If possible, we recommend undergoing genetic carrier screening before pursuing IVF so as to make the experience as successful as possible and ideally provide a healthy pregnancy. 

Summing it up

In conclusion, the path from egg to blastocyst formation is pretty incredible and requires the completion of several successful steps even before a transfer attempt. As technological capabilities expand within the field of embryology, so too does the potential to assist those facing challenges in unassisted conception. 

If you’re interested in working with an egg donor to help create embryos and start or grow your family, click here to browse our platform with tons of egg donors eager to help. 

FAQs about embryo development

What percentage of fertilized embryos make it to day 5?

About one-half of fertilized embryos continue developing to become a day 5 blastocyst. When an embryo is created using donor eggs, this stat jumps to 60%. 

How long does it take for an embryo to develop after IVF?

In IVF, embryos are typically cultured in the laboratory for 5-6 days to reach the blastocyst stage, which is considered optimal for transfer. However, occasionally embryos may be transferred earlier, at the cleavage stage (day 3). 

Where does the embryo develop?

In unassisted conception, the embryo develops in the uterus. After fertilization, the embryo travels down the fallopian tube and reaches the uterus, where it undergoes several stages of development starting from a zygote to a blastocyst. Successful implantation into the uterine wall is essential for the continued growth and development of the embryo.

While the implantation process remains the same for an embryo’s development during IVF, the actual fertilization process for assisted conception takes place within a lab, where an embryologist combines an egg with sperm under close watch. Only once the embryo has spent 5 days developing into a blastocyst is it transferred into the recipient’s uterus, or may be frozen for a future embryo transfer cycle. 

What is the first organ to develop in the embryo?

The first organ to develop in the embryo is the heart. The heart begins as a simple tube-like structure and starts beating and pumping blood by around the 22nd day after conception, which is essential for the circulation of nutrients and oxygen to the developing embryo.

When does an embryo develop a heartbeat?

An embryo typically develops a heartbeat by the end of the fifth week of pregnancy, which is about three weeks after fertilization. This milestone can often be seen during an early ultrasound scan, and is a crucial indicator of the embryo's viability.

What is preimplantation genetic testing (PGT)?

PGT is a process that screens embryos created through IVF for specific genetic conditions or chromosomal abnormalities. This can help increase the chances of a healthy pregnancy and reduce the risk of miscarriage. Read more about PGT testing here.

Does using frozen eggs affect embryo development?

Research suggests that eggs frozen through vitrification have similar success rates to fresh eggs in IVF. However, the success rates of utilizing frozen eggs still depends on the age of the egg when it was frozen. The younger the egg(s), the greater its potential for successful fertilization and development into a healthy embryo.

The embryo transfer is an exciting and pivotal time in the in vitro fertilization (IVF) process. It’s when the embryo is transferred to the uterus of the intended mother or a gestational carrier, in hopes that it snuggles in for nine months and becomes the child you’ve always dreamt of.

You may be wondering if you should transfer one (single embryo transfer, or SET) or two (double embryo transfer, or DET) embryos, to increase your chances of a happy, healthy baby.  

This article will dissect the complexities of this decision-making process, taking into consideration both personal choices, and also help answer this question to intended parents using donor eggs.

First off, what is an embryo transfer?

Understanding what an embryo transfer entails is important to appreciating the decision-making process between single or double embryo transfer.

After an egg, or eggs, are fertilized with sperm, an embryo develops in a controlled laboratory environment for a few days under the careful watch of a trained embryologist. If and when the embryo reaches a particular developmental stage (ie. blastocyst stage), it is suitable for transfer.

Now, at this point, some families opt to do PGT testing, which looks to see if the embryo contains the correct amount of chromosomes. Embryos with the right number of chromosomes — 46 — are considered “euploid,” and those with extra chromosomes or chromosome deletions are considered “aneuploid.” PGT is a way to screen for genetic disorders in embryos created through IVF before they are transferred to the uterus. Read more about PGT testing.

All embryos are then “graded” by the embryologist to evaluate their quality and chances of developmental success into a healthy pregnancy. Based on this assessment, your fertility doctor will recommend the order and number of embryos to be transferred. This is the stage where the choice between a single embryo transfer or a double embryo transfer is usually made.

Finally, the selected embryo(s) is transferred to the uterus via a thin catheter, typically under ultrasound guidance. If the embryo implants in the uterine lining, it may lead to pregnancy.

Embryo transfers and the history of IVF

When IVF was in its infancy, following the birth of the first IVF baby, Louise Brown, in 1978, the process was distinctly different from what it is today. In the early days, IVF involved the transfer of fresh embryos, without the technological advancements available now. This is because we didn’t have the technology to freeze and preserve embryos for genetic testing or future transfer.

At the time, this approach was taken to increase the likelihood of pregnancy, compensating for the uncertainties around embryo viability. However, this practice led to a higher incidence of multiple pregnancies (pregnancies of twins, triplets, or more), with associated health risks for both mothers and children.

With the development of cryopreservation techniques, it became possible to freeze embryos for later use, allowing for more flexibility and planning in the transfer process. This technology also enabled better timing for embryo transfer, and gave patients a break between the egg retrieval and embryo transfer. 

Simultaneously, genetic testing of embryos significantly increased the success rates of IVF, even with the transfer of a single embryo.

Guided by these advancements, the American Society for Reproductive Medicine (ASRM) now recommends elective single embryo transfer (eSET) in most cases, especially for women under the age of 35 with a favorable prognosis. This shift towards eSET reflects a growing emphasis on minimizing the risks associated with multiple pregnancies without compromising success rates.

So how many embryos should I transfer?

The decision regarding the number of embryos to transfer should weight the potential success rate against the risks associated with multiple pregnancies. Factors such as age, the quality of the embryos, previous IVF attempts, and individual patient preferences play an important role in this decision.

Let’s go through the pros and cons of each option:

Elective single embryo transfer (eSET)

Pros:

• Reduced risk of multiple births: eSET almost eliminates the chance of a multiple pregnancy (twins, triplets, etc.), thus reducing the associated health risks for both the mother and the babies.

Cons:

• Possibly lower success rates: Some studies have shown that eSET may yield a slightly lower live birth rate compared to double embryo transfer.

Double embryo transfer (DET)

Pros:

• Potentially higher success rates: By transferring two embryos, DET may improve the chances of pregnancy, especially when there are concerns about embryo quality.
• Chance to have twins: If you always wanted twins, transferring two embryos gives you a better chance of that dream.

Cons:

• Riskier pregnancy and birth: DET significantly increases the risk of twins or higher-order multiples, leading to more complicated pregnancies and a higher chance of preterm births and low birth weight.

It’s important to discuss this with your fertility doctor and get their input. Because ASRM usually recommends a single embryo be transferred, in most cases fertility doctors will recommend just that.  

How many donor egg embryos should I transfer?

When donor eggs are utilized, a couple other factors need to be considered. Donor eggs are from younger women who have gone through extensive medical screening, and thus, embryo quality tends to be higher. Because of this, it increases the chances of success, even if the mother is older, or if she experienced failed IVF in the past. In donor egg cases, eSET is generally preferred to minimize the risk of multiple pregnancies while maintaining a satisfactory success rate.

Summing it up

If you are wondering if eSET or DET is right for you, talk to your fertility doctor. They can help talk you through the pros and cons, and help select an approach that best fits your needs.

For those using donor eggs, the generally higher quality might lean the decision towards eSET, while personal preferences and specific medical situations might suggest otherwise. By carefully considering the nuanced pros and cons, you can make a well-informed choice in your pursuit of parenthood. We wish you all the best!

Embryo grading plays a critical role in assisted reproductive technology (ART), providing valuable insights into the quality of embryos and their potential of developing into a healthy pregnancy. But — and I speak from personal experience — embryo grading can also be one of the most complicated aspects of ART (an already complex process!) to navigate. In my case, I actually had one fertility clinic — where I did my retrieval cycles — disagree with my new clinic about which embryo was the best quality to transfer. When transfer day came and the embryologist read aloud which embryo they’d be using, imagine my surprise when it was a different embryo than the one I expected. 

Thankfully, my (very patient) reproductive endocrinologist walked me through my clinic’s data on various embryo grades and the success rates of each. And luckily, this embryo transfer resulted in the healthy birth of my son. But, since we all don’t know what we don’t know, the goal of this article is to ensure that you are armed with all the facts about embryo grading. We’ll discuss how different embryo grades influence the chances of success in ART procedures, including IVF. That way, you can ask the right questions, make more informed decisions, and maximize your prospects of achieving a successful pregnancy — with donor eggs or your own. Let’s jump in. 

What is embryo grading?

Embryo grading involves the visual assessment of morphological characteristics of an embryo by a trained embryologist, to evaluate the quality of embryos and their chances of developmental success into a healthy pregnancy. In other words, embryo grading is important because it can give you an idea of your odds of success prior to transferring that embryo. It can also provide insight into whether or not another IVF cycle might be beneficial, with or without adjustments to the treatment protocol.  

During the embryo grading process, embryologists evaluate factors such as cell number, cell symmetry, fragmentation, and the appearance of the zona pellucida. These assessments are typically conducted at the embryo’s cleavage stage (day 2 or 3 of development) and the blastocyst stage (day 5 or 6 of development) following fertilization, for embryos that have made it to this point. 

Understanding different embryo grades and their significance

Embryo grading systems provide a framework for embryologists to assign ratings based on specific morphological features. And while these systems are standardized, the grading system used can vary depending on the clinic. Embryo grading systems are equally applicable in donor egg IVF cycles, enabling the evaluation of embryos derived from donor eggs. 

Some commonly used embryo grading systems include: 

Gardner's blastocyst grading system 

The Gardner embryo grading system (sometimes referred to as the Gardner and Schoolcraft system) is widely used, and takes into account three main factors: expansion grade, inner cell mass (ICM) grade, and trophectoderm (TE) grade. Here's a breakdown of each component:

Expansion grade 

The expansion grade refers to how much the embryo has grown and expanded in the culture medium. It is usually assessed on a scale from 1 to 6. Here's what each grade means:

• Grade 1: The embryo is not expanded or only slightly expanded.
• Grade 2: The embryo has started to expand, with a small fluid-filled cavity called a blastocoel.
• Grade 3: The embryo has further expanded, and the blastocoel is larger.
• Grade 4: The embryo is even more expanded, with a significant blastocoel.
• Grade 5: The embryo has expanded further, with the blastocoel filling most of the embryo.
• Grade 6: The embryo has fully expanded, with a large blastocoel and thinning of the outer layer.

A higher expansion grade generally indicates better developmental potential.

Inner Cell Mass (ICM) grade

The ICM is a cluster of cells inside the embryo that will eventually develop into the fetus. It is graded based on its appearance and overall quality. Here's a simplified breakdown of ICM grades:

• Grade A: The ICM is tightly packed, with many cells and high density.
• Grade B: The ICM is looser or slightly less dense than Grade A, but still considered good quality.
• Grade C: The ICM is fragmented or has fewer cells, indicating lower quality.

Embryos with a higher ICM grade have a higher likelihood of successful implantation and pregnancy.

Trophectoderm (TE) grade

The trophectoderm is the outer layer of cells that will develop into the placenta. It is also graded based on its appearance and overall quality. Here's a simplified breakdown of TE grades:

• Grade A: The TE is tightly packed, forming a cohesive layer.
• Grade B: The TE is slightly looser or has minor irregularities but is still considered good quality.
• Grade C: The TE is fragmented or has more significant irregularities, indicating lower quality.

Embryos with a higher TE grade generally have a higher chance of successful implantation and pregnancy.

Combining the expansion grade, ICM grade, and TE grade provides an overall assessment of the embryo's quality and potential for successful implantation and pregnancy. However, the grade of the embryo is just one piece of the puzzle. The success of embryo transfer depends on various individual factors, including your age, overall fertility health, uterine environment, and the skill of the doctor.

Society for Assisted Reproductive Technology (SART) grading system

The SART embryo grading system focuses on the evaluation of cleavage-stage embryos (day 2 or 3). It takes into account parameters such as the number and symmetry of blastomeres, the presence of fragmentation, and the appearance of the cytoplasm. Embryos are generally graded on a scale from 1 to 4:

• Grade 1: These embryos are considered of excellent quality. They have equal-sized and symmetrical blastomeres (cells) without any fragmentation. These embryos have a higher likelihood of successful implantation and pregnancy compared to lower-graded embryos.
• Grade 2: These embryos are still of good quality but may show minor asymmetry or minimal fragmentation. Although they may have slight imperfections, they still have a reasonable chance of successful implantation and pregnancy.
• Grade 3: These embryos have moderate asymmetry or fragmentation. The presence of moderate irregularities may slightly decrease their chances of successful implantation and pregnancy compared to higher-graded embryos.
• Grade 4: These embryos exhibit significant asymmetry or fragmentation. These embryos have more substantial irregularities, significantly reducing their chances of successful implantation and pregnancy compared to higher-graded embryos.

Cummins' embryo grading system:

The Cummins' grading system is another method used to assess cleavage-stage embryos. It is quite similar to the SART system, but while the SART system primarily focuses on the symmetry of blastomeres and the degree of fragmentation, the Cummins system emphasizes the size and fragmentation of those blastomeres. 

Unlike the SART grading system, through the Cummins embryo grading system, embryos are actually scored on a scale from 1 to 5 (vs. 4):

• Grade 1: Embryos that receive a Grade 1 are considered of excellent quality. They have blastomeres (cells) that are of equal size and show no fragmentation. Grade 1 embryos have a higher chance of successful implantation and pregnancy compared to lower-graded embryos.
• Grade 2: Grade 2 embryos are still considered good quality, but they may have minor imperfections. These embryos might have some minor asymmetry or minimal fragmentation, meaning that the blastomeres may not be perfectly equal in size, and there may be some small fragments. Grade 2 embryos still have a reasonable chance of successful implantation and pregnancy.
• Grade 3: Embryos with Grade 3 have moderate asymmetry or fragmentation. This means that the blastomeres may show more unevenness in size, and there may be a moderate amount of fragmentation present. Grade 3 embryos have a slightly lower chance of successful implantation and pregnancy compared to higher-graded embryos.
• Grade 4: Grade 4 embryos have significant asymmetry or fragmentation. The blastomeres may show significant variation in size, and there may be a substantial amount of fragmentation present. Grade 4 embryos have a lower chance of successful implantation and pregnancy compared to higher-graded embryos.

How important are embryo grades, anyway? 

Embryo grades provide valuable insights into the developmental potential of embryos, but they are not the sole determining factor of success. It’s important to recognize that grading systems primarily evaluate morphological characteristics and do not consider other crucial aspects, such as genetic abnormalities or the embryonic environment. 

While higher-graded embryos generally have higher implantation rates, it is not uncommon for lower-graded embryos to still result in successful pregnancies. The decision regarding embryo selection should involve a comprehensive evaluation of individual patient factors, including age, fertility history, and the number of available embryos.

How to know a "good" embryo grade

Understanding how to interpret embryo grades is vital for patients undergoing IVF. Typically, embryos with higher grades possess certain characteristics indicative of better developmental potential. For instance, in the Gardner system, high-quality blastocysts often have a fully expanded blastocoel, a tightly packed ICM with many cells, a well-formed TE with few or no fragments, and a smooth and even zona pellucida. These features suggest a greater likelihood of successful implantation and subsequent pregnancy. 

While these grading systems provide a standardized approach, there may still be some variability in interpretation between embryologists and clinics, based on that clinic’s own success rate data with embryos of different grades. Additionally, newer systems and modifications continue to emerge, aiming to improve the accuracy and reliability of embryo grading.

Understanding the grading system used by your fertility clinic and discussing it with your reproductive specialist can help you interpret and interpret the grading of your embryos more effectively. Remember, the grading system used may influence the way embryos are selected for transfer or cryopreservation.

Which embryo should I transfer first?

If you’ve made it to the point where you have more than one blastocyst embryo available to transfer, congratulations! That’s a huge weight off of your shoulders. Now, you’re likely focused on the next big decision: which embryo should I transfer first? Doctors may have different opinions on this, depending on various factors. Here are a few considerations as you and your doctor weigh this decision: 

Implantation potential

As we previously mentioned, higher graded embryos generally have a higher potential for successful implantation and pregnancy. They often exhibit better morphological characteristics and developmental quality, which can increase the chances of successful embryo implantation and subsequent pregnancy. Therefore, some clinicians may recommend transferring higher graded embryos first to maximize the likelihood of achieving a successful pregnancy.

Number of embryos

If you have a limited number of embryos available for transfer, some doctors may advise starting with the higher graded embryos. This approach aims to optimize the chances of achieving a pregnancy early in the treatment process, preserving any remaining higher graded embryos for future transfer attempts. 

Depending on how many kids you want, other doctors may advise the opposite — if you know you want two children, but you transfer a higher graded embryo earlier and get pregnant right away, that will delay your availability to potentially do another IVF cycle again should your lower-graded embryos not result in another pregnancy. Also, if you transfer a lower graded embryo and it does stick, that will only further increase your chances of a successful pregnancy down the line with another embryo, especially a higher graded one!

Patient-specific factors

Factors such as your age, fertility history, previous IVF outcomes, underlying medical conditions, and specific treatment goals should be taken into consideration. If you’ve undergone previous IVF cycles and had unsuccessful outcomes with higher graded embryos, your doctor might consider altering the approach and prioritize transferring lower graded embryos first to try something different. Although higher graded embryos generally indicate better chances of a successful pregnancy, it’s not impossible to have a baby using a lower graded embryo. They still show implantation potential and result in successful pregnancies in some cases.

We recommend talking with your REI to receive personalized guidance based on your specific situation. They can provide the most up-to-date clinical information, evaluate your individual factors, and offer recommendations tailored to your needs and timeline. 

Embryo grading for donor egg IVF cycles

With a donor egg IVF cycle, embryo grading is equally important. However, other factors, such as the intended parent or gestational carrier’s uterine environment and receptivity, still play a significant role in the success of donor egg IVF cycles. It’s also critical to understand that embryo grading is not indicative of the presence or absence of chromosomal abnormalities or specific genetic factors.

At Cofertility, the average number of mature eggs a family receives and fertilizes is 12. Some intended parents want to do two egg retrievals with the donor which is definitely possible. We also ask each of our donors whether they are open to a second cycle as part of the initial application — many report that they are!

You can see how many eggs are retrieved in the first cycle and go from there. If, for any reason, the eggs retrieved in that round do not lead to a live birth, our baby guarantee will kick in and we’ll re-match you at no additional match deposit or Cofertility coordination fee.

In conclusion

Embryo grading serves as a valuable tool in assessing the developmental potential and quality of embryos in assisted reproductive technology (ART). While higher-graded embryos generally exhibit higher implantation rates and better chances of success, embryo grade is not the end-all-be-all when it comes to predicting pregnancy outcomes. 

Grading systems primarily evaluate morphological characteristics and do not account for genetic abnormalities or the embryonic environment. Because of this, the decision regarding embryo selection should involve a comprehensive evaluation that considers multiple factors beyond just the assigned grade. Your fertility doctor can provide personalized guidance to optimize your chances of achieving a successful pregnancy based on their specific circumstances. We wish you all the best!

The path to parenthood can take many roads. There is no single “right way” to become a parent, so you may be debating which path is the right one for you. Two options include egg donation or adoption. 

If you’re asking yourself “should I adopt or find a donor?” then this article is for you. Here, we’ll explore the pros and cons of egg donation, adoption, and embryo donation to help you make the best decision for your family.

What Is egg donation?

The first child born from egg donation was reported in Australia in 1983 and the first American child born from egg donation was in February 1984. Before this medical intervention, for most, adoption was the only path to parenthood. Egg donation opened the door for more people to become parents. 

Egg donation is ideal for those who:

• Have experienced infertility
• Have high risks of passing on genetic disorders to their offspring
• Have diminished ovarian reserve or early menopause.
• Have had multiple unsuccessful IVF cycles
• Are single 
• Are in a same-sex relationship

Pros of using donor eggs

✅ High success rates – donor egg IVF offers higher pregnancy success rates than using one’s own eggs.
✅ Biological connection – the child may share a genetic link with one parent.
✅ Experience pregnancy – if you plan to carry the pregnancy, you can still go through pregnancy, childbirth, and nursing.
✅ Biological siblings – if you already have children, donor eggs can allow for genetic siblings.

Cons of using donor eggs

❌ Emotional considerations – Some may grieve the loss of a genetic link to the mother.
❌ Finding the right donor – The process of selecting an egg donor can take time.
❌ Financial costs – though with our Family by Co platform, we’ve removed cash compensation for donors from the equation. Instead, our donors freeze their eggs entirely for free when giving half of the eggs retrieved to your family.
❌ No guarantees – While donor eggs have higher success rates, there’s no guarantee an embryo will be created or result in pregnancy.

What is adoption?

Adoption is the legal process through which a person assumes the parenting responsibilities for someone else's biological child. The concept of adoption exists across cultures and countries and may be traced all the way back to 6th century AD Roman Law. During this time, if the family patriarch did not have a male heir, an heir could be adopted. This was important for the Romans because by adopting one another’s sons, the nobility ensured the wealth would stay within a few families. 

In the United States, the first modern adoption legislation, the Adoption of Children Act, was passed in Massachusetts in 1851. This act required judges to determine that adoptive parents had “sufficient ability to bring up the child” and that “it is fit and proper that such adoption should take effect.” 

Today there are different types of adoption, including:

• Domestic adoption – Adopting a child within your own country.
• International adoption – Adopting a child from another country.
• Open or semi-open adoption – The birth parent may have ongoing contact with the child.

Pros of adoption

✅ Providing a loving home – Adoption gives a child a stable and supportive family.

✅ Proven success – Studies have shown that adoptive children are less likely to abuse drugs or alcohol and more likely to graduate from high school and go on to college than those who remain in foster care. They are also more likely to have successful careers and strong relationships.

✅ Peace of mind for birth parents – Birth parents often feel reassured that their child is in a loving, caring home.

Cons of adoption

❌ Time-consuming process – Adoption can take 9–12 months or longer.
❌ Cost – Domestic infant adoptions can range from $40,000 to $70,000+.
❌ Birth parent rights – In some cases, birth parents may change their minds during pregnancy or up to 30 days after adoption.
❌ Ongoing birth parent involvement – Since most adoptions are open, there is a chance that the birth parent may want to be a part of the child’s life, and that may be difficult for some adopting parents.
❌ Not always inclusive – Different states have different laws on who can become an adoptive parent based on age, sexual orientation and even religious affiliation.

What is embryo donation?

Embryo donation is an option for individuals and couples who have not been successful with traditional infertility treatments. In this process, frozen embryos donated by others are transferred to the recipient’s uterus, offering an alternative to egg and sperm donation.

Pros of embryo donation

✅ Shorter wait times – Embryos are already created and available.
✅ Lower costs – Typically less expensive than egg donation and adoption.
✅ Experience pregnancy – You can still carry the pregnancy, give birth, and nurse your baby.

Cons of embryo donation

❌ Limited genetic history – Embryo donation is technically an adoption. You may not have access to the full medical history of the embryo’s biological parents.
❌ Matching delays – Although embryos are readily available, it can still take time to find the right match.
❌ No guarantee of success – As with any fertility treatment, pregnancy is not guaranteed.

Which one is right for me?

The decision to use medical intervention to conceive a child or to go through an adoption agency to start a family is an extremely personal one. As you can see above, all paths come with their own set of unique challenges. 

The best thing you can do is become educated in all your options. Get second and third expert opinions. Seek out legal counsel and ask questions.

When considering your options, think about:

• Genetic connection – If having a biological child is important to you, egg donation or embryo donation may be the right path.
• Pregnancy experience – If you want to carry a pregnancy, egg donation or embryo donation allows for that experience.
• Time and cost – Adoption can take longer and cost significantly more, while egg donation and embryo donation have higher success rates.
• Ethical and emotional considerations – Both processes come with their own set of emotional challenges, so it’s essential to be well-informed.

No matter what path you choose, you are not alone. Many families have navigated this journey before you—and each one has found the path that was meant for them.