From foster adoption to hiring a surrogate, discover the latest options for building your family.

cute baby reaching
Credit: Alexandra Grablewski

Adding another child to your family used to be a simple affair--you could either do it the old-fashioned way or head to the local orphanage or adoption agency to find a child who needs a good home.

But 21st century family building gives potential parents a whole new world of options, including adopting an embryo and hiring a gestational carrier (a surrogate) from almost anywhere around the world. Here's a rundown of the options available to you, if you're looking to expand your family this year--and the "old-fashioned" way won't work for you.

1. Assisted Reproductive TechnologyWhat It Is: Cutting-edge science has been helping many couples with fertility issues conceive and give birth to a child. Examples of this include fertility drugs, using donor sperm or eggs, and in vitro fertilization (IVF), where the mother's egg and father's sperm are united in a lab, then implanted in the mother's uterus.

The Pros: For couples with fertility issues, the technology can lead to a successful pregnancy.

The Cons: Treatment success rates vary wildly--and even after trying several different types of fertility treatments, some couples still don't achieve a healthy pregnancy. Treatments can run into the tens of thousands of dollars, and many health insurance companies offer only limited coverage.

2. Domestic Adoption

Prospective parents use an adoption agency or adoption attorney to seek out a birth family that is interested in making an adoption plan for their son or daughter. Most often, the children are adopted as newborns, and families maintain some ties to the birth family through open adoption.

The Pros: You may get to care for your new child from the first moments after birth. Most domestic adoptions are now at least partially open, so you will have some information about the birth parents and their medical backgrounds that you can share with your child.

The Cons: The timing of your adoption can be uncertain, as you could be picked by a birth mother tomorrow--or two years from now. Sometimes, the birth mother decides to keep her child after he's born, which can be devastating.

More Ways to Grow Your Family

3. Foster AdoptionWhat It Is: Children whose families cannot properly care for them are placed in the care of foster families temporarily. If the biological families cannot stabilize their situation, the birth parents permanently lose the rights to their children and they become available for adoption.

The Pros: Children in a wide range of ages are available, making it an ideal choice for couples that would rather adopt an older child. The fees for a foster adoption are often extremely low or there may be no fee.

The Cons: Foster programs try to keep biological families intact, so if a child's birth family situation stabilizes, the child may be placed back with them. Some children may have been abused or neglected in their past, and will need special care and guidance to help them become strong, healthy adults. "Many of the children do come with a history," Mantell says. "You have to be prepared to do some real therapeutic parenting--and some people are prepared, some people are not."

4. International AdoptionWhat it is: Potential parents put together a stack of paperwork to show their ability to be good parents, including interviews with social workers, background checks, and letters of reference. The completed dossiers are sent to the country of their choice, and families may wait months or years for a referral of a child.

In most cases, the families must travel to the country for several weeks to complete their adoption and bring their child home.

Children adopted internationally are often more than a year old when they come home, and some may arrive with developmental delays or other special needs as a result of the deprivations of institutional care in an orphanage.

The Pros: For parents who want to adopt but don't want to deal with the pain of repeated failed domestic adoptions, international adoption often provides a safer and more predictable process for becoming parents. Parents who aren't interested in an open adoption may prefer international adoption, where birth family information and contact are often limited or nonexistent.

The Cons: International adoption numbers have declined as countries have closed to U.S. families, but the interest in it has not--and this has led to longer wait times for referrals for many families. Many countries have rules that can make it challenging for people to adopt, and prohibit adoptions to gay couples or single parents, families with health issues, or those who fail to meet other criteria. "International adoption has become so much harder," Mantell says. "Some countries require families to travel three times before the process is complete--and a lot of people just don't have the option to do that."

5. SurrogacyWhat it is: A woman agrees to become pregnant for a couple that is unable to do so--often for a substantial fee. The couple and the surrogate sign a legal contract, after which the surrogate is either implanted with the couple's embryos (gestational surrogacy), or artificially inseminated with sperm (traditional surrogacy). When the surrogate gives birth, the child is given to the couple.

With celebrities like Sarah Jessica Parker and Nicole Kidman recently using gestational carriers to grow their families, surrogacy has come into the limelight. "People usually choose surrogacy because the woman can't carry a pregnancy for a medical reason, or it's two guys," Mantell says.

In the past, most American couples hired a surrogate within the U.S., but some families have started seeking surrogates elsewhere in the world--India, for example.

The Pros: This procedure allows couples to have children that share genes with them, even if a woman isn't able to carry a pregnancy to term herself.

The Cons: Some states have laws prohibiting surrogacy; others have very little case law surrounding it, making it a bit of a legal gray area. It can be expensive, from $25,000 to well over $100,000. And some ethicists are concerned that it exploits the surrogates, who tend to be women who come from lower-income households.

6. Embryo AdoptionWhat It Is: During fertility treatments, clinics create multiple embryos for each couple, and store some for use in additional cycles. When a couple decides that their family is complete, they often feel conflicted about what to do with the remaining embryos. Some agencies are beginning to help match couples that have stored (but do not need) embryos with infertile couples that want to use them to achieve pregnancy.

The Pros: Embryo adoption allows moms-to-be to experience pregnancy. Couples can often get some health and medical background on the family that is donating their embryos, so they'll have valuable information for their child. Embryo adoption can be less expensive than other types of adoption.

The Cons: Embryo adoption works only if a woman's body can manage a healthy pregnancy. Pregnancy rates at clinics that perform implantation via embryo adoption vary, but range from 37 percent to 47 percent. Some couples bristle at the home study and other background checks that some embryo adoption agencies require.

Parents Magazine