Choosing how to grow your family is a deeply personal decision. For couples facing infertility or other challenges, two common paths to parenthood are surrogacy vs. adoption. Both options can be rewarding and life-changing, but they differ in significant ways. In this article, we will break down the key differences between surrogacy and adoption, discuss related topics like adoption arrangements, costs, infertility causes and treatments, and the importance of counseling and planning.
Surrogacy vs. Adoption
Surrogacy is an arrangement in which a woman (the surrogate) carries a pregnancy for the intended parent(s). In gestational surrogacy, the pregnancy is achieved via IVF using the eggs and/or sperm of the intended parents or donors, meaning the child can be biologically related to one or both intended parents. Adoption, on the other hand, is a legal process where prospective parents become the permanent parents of a child born to someone else. In adoption, there is no genetic link between the child and the adoptive parents. Aside from genetics, there are other key differences in process and experience:
- Pregnancy and Birth: Surrogacy entails a planned medical process and a surrogate pregnancy. Adoption involves taking custody of an already-born child.
- Legal Process: Surrogacy contracts are established before birth to outline parental rights, while in adoption, the transfer of parental rights is finalized after the birth.
- Parental Control and Involvement: Intended parents in a surrogacy often have more say during the pregnancy compared to adoptive parents, who may have little control during the birth mother’s pregnancy.
- Emotional Considerations: In adoption, birth parents may experience complex emotions and have the option to change their mind until legal consents are signed, adding some uncertainty for adoptive parents. In surrogacy, a binding contract and the surrogate’s commitment provide more assurance that the baby will go to the intended parents after birth.
Each hopeful parent or couple must weigh these differences against their own situation and values to decide which path is best for their family.
Open vs. Closed Adoption
When considering adoption, one important factor is the level of contact and information shared between the birth family and the adoptive family. This is often described as open vs. closed adoption. An open adoption typically means there is some form of ongoing relationship or communication: for example, the adoptive parents and birth parents might meet, exchange updates, or even have occasional visits. By contrast, a closed adoption means no identifying information is shared, and there is no contact between the birth parent(s) and the child or adoptive family after the adoption is finalized.
Open adoption has become far more common in modern practice. The vast majority of U.S. adoptions today are at least semi-open, with only a small percentage being fully closed. Only about 5% of modern adoptions are closed, with the rest involving some level of openness. Open adoption can benefit all parties in many cases. The child can know their origin and get questions answered, birth parents can have peace of mind about the child’s well-being, and adoptive parents have access to medical history and can foster a sense of identity for the child. However, open adoption also requires clear boundaries and trust, and the degree of openness varies widely, case by case.
Surrogacy for Same-Sex Couples
Surrogacy has become a crucial family-building option for LGBTQ individuals and couples, particularly male same-sex couples. In surrogacy for same-sex couples, a gestational surrogate can carry a baby for two men, allowing at least one parent to have a biological link to the child. By contrast, adoption is also an option for same-sex couples and single LGBTQ parents, but it does not provide a genetic connection. The ability to have a child who is biologically related to them is a major reason why many gay couples opt for surrogacy.
The Financial Aspects: Costs of Surrogacy vs. Adoption
One of the most practical differences to consider is the costs of surrogacy compared to the costs of adoption. Both processes can be expensive and involve many line items, but surrogacy is generally the more costly route due to the medical procedures and compensation involved. When you pursue surrogacy, intended parents typically pay for fertility clinic procedures, all of the surrogate’s pregnancy-related medical expenses, legal fees for drafting the surrogacy contract and establishing parentage, and usually a surrogate compensation for the woman who carries the baby. In contrast, adoption costs usually include agency fees, legal fees for the adoption process, and often cover the birth mother’s pregnancy-related expenses, but adoptive parents do not pay the birth mother a fee beyond covering expenses. Because of these differences, surrogacy often ends up more expensive than adoption.
Typical adoption costs in the U.S. can range widely: for a domestic infant adoption through an agency, it might range from about $20,000 up to $50,000, depending on the agency and what expenses are covered. International adoptions or private attorney adoptions have their own ranges. Surrogacy, however, tends to be significantly higher. In the United States, a full gestational surrogacy journey can easily cost over $100,000. Many sources estimate an average total of around $120,000 to $150,000 for one completed surrogacy cycle and birth. The average total cost for a surrogacy journey in the USA ranges from about $120,000 to $180,000. This figure includes everything.
Causes of Infertility and Signs to Watch
Many individuals and couples begin considering surrogacy or adoption as a result of fertility struggles. Understanding the causes of infertility can help frame why some turn to these family-building options. Infertility is medically defined as the inability to conceive a child after a certain period of regular, unprotected intercourse. It’s a common issue. By some estimates, about 1 in 8 couples (around 12-15%) experience difficulty getting pregnant or carrying a pregnancy to term. Infertility can stem from factors affecting the woman, the man, or a combination of both partners.
Female infertility can have many causes. Some of the most common include ovulation disorders, age-related decline in egg quantity and quality, tubal blockages or damage, endometriosis affecting the uterus or ovaries, uterine abnormalities, or hormonal imbalances such as thyroid disorders or hyperprolactinemia. There are also cases of “diminished ovarian reserve” or primary ovarian insufficiency, where a woman’s egg supply runs low or menopause-like changes happen earlier than normal. Female infertility signs are not always obvious, because many women with fertility issues have no outward symptoms other than not getting pregnant. However, certain signs can point to possible problems: very irregular menstrual cycles or absent periods can indicate ovulation problems. Extremely painful periods could be a sign of endometriosis. Chronic pelvic pain or pain during intercourse might also hint at endometriosis or pelvic adhesions. Unusual nipple discharge could signify a hormonal issue like elevated prolactin. The main symptom of infertility in women is simply the failure to conceive within the expected timeframe. This is why many doctors recommend seeing a specialist if pregnancy doesn’t happen after a year of trying.
On the male side, infertility often comes down to issues with sperm. The causes might include low sperm count, poor sperm motility (swimming ability), abnormal sperm shape (morphology), or blockages in the male reproductive tract that prevent sperm from being ejaculated. These issues can result from genetic factors. Unlike women, men typically don’t have obvious “symptoms” like cycle changes. Male infertility is usually discovered through a semen analysis in a lab. Sometimes there are signs, such as difficulty with sexual function, ejaculatory issues, or signs of hormonal problems, but many men with low sperm counts wouldn’t know it without a test.
Infertility Treatment Options and Solutions
For those diagnosed with fertility issues, there are many fertility preservation methods available today. Below are the major categories of fertility treatments, including considerations for male-factor and female-factor issues:
- Medications and Ovulation Induction: If a woman has trouble ovulating (releasing eggs), medications can often help. Drugs like clomiphene citrate (Clomid) or letrozole can stimulate ovulation. These are often used as a first-line treatment for conditions like PCOS. In some cases, injectable hormones are used to stimulate the ovaries more aggressively to produce multiple eggs. Ovulation induction is usually combined with timed intercourse or intrauterine insemination. For men, there are fewer medication options, but if there’s a hormonal imbalance, certain medications or hormone shots can improve sperm production. Male infertility treatment might also involve medications if there is an infection to clear or a specific condition affecting sperm that is medically manageable.
- Intrauterine Insemination (IUI): IUI is a procedure where concentrated, prepared sperm are placed directly into the woman’s uterus around the time of ovulation. It gives sperm a head start by bypassing the cervix and placing them closer to the egg. IUI is often used in cases of mild male factor infertility, unexplained infertility, or situations where donor sperm is being used. It’s less invasive and cheaper than IVF. The woman may take ovulation meds to increase the number of eggs available in each cycle.
- In Vitro Fertilization (IVF): IVF is the cornerstone of assisted reproductive technology. It involves stimulating the ovaries with hormones to produce multiple eggs, retrieving those eggs with a minor surgical procedure, fertilizing the eggs with sperm in a lab dish, and then transferring one or more resulting embryos into the uterus. IVF bypasses a lot of natural steps, which is why it works for many causes of infertility. A big advantage is that IVF allows for genetic testing of embryos before transfer, and one can also freeze extra embryos for future use. Many couples will move to IVF if other treatments haven’t worked. For some conditions, doctors may recommend IVF right away as the most effective solution.
- Surgical interventions: Sometimes, treating infertility involves surgery. For example, removing uterine fibroids or polyps can improve fertility for some women. Unblocking fallopian tubes or removing scar tissue might be attempted via laparoscopy. In men, surgery can correct a varicocele or retrieve sperm directly from the testicles if none are present in the ejaculate. These approaches can either fix the issue or at least obtain the necessary reproductive cells for use in IVF.
- Third-Party Reproduction: If the primary issue is the quality or availability of eggs or sperm, some couples turn to donor gametes. Egg donation is common for women who have a low ovarian reserve or genetic concerns; a donor’s eggs are used to create embryos and then transferred to the woman’s uterus or a surrogate. Sperm donation is an option if the male partner has no viable sperm or if a single woman or lesbian couple is trying to conceive. Embryo donation is another avenue. And of course, surrogacy is a form of third-party reproduction used when a woman cannot carry a pregnancy or a male same-sex couple is building a family.
With the wide range of infertility solutions, it is advisable for couples to consult a reproductive endocrinologist who can run the appropriate tests and recommend a tailored plan. Some couples may conceive with relatively simple interventions, while others may find that IVF or third-party assistance is needed.
The Role of Family Planning Counseling and Support
Facing infertility or deciding between surrogacy and adoption is not only a medical or logistical choice. It’s an emotional journey as well. This is where family planning counseling and psychological support come into play. Counseling can be extremely valuable for individuals and couples as they navigate the stress, grief, and complex decisions that often accompany fertility challenges and alternative family building.
Choosing a Fertility Clinic and Next Steps
If you decide to pursue medical treatment or surrogacy, an important practical consideration will be selecting the right clinic and professionals to guide you. There are hundreds of reproductive clinics and fertility centers across the United States, so doing some research is key. Many of the top fertility centers publish their success rates and are transparent about their services and costs. Look for clinics that are members of SART or those that have good success rates for cases similar to yours. You may also want a clinic that offers comprehensive services so you have continuity of care.
It’s often helpful to read reviews or get personal recommendations, though individual experiences can vary. Consider scheduling initial consultations with more than one clinic to compare approaches. Many clinics now make it convenient to get started. You can even book fertility specialists online for an introductory appointment. In that first meeting, ask questions about the clinic’s experience with cases like yours. Evaluate how the staff makes you feel. You’ll be going through an emotional journey, so you want a team that is compassionate and communicative.
You’ll be forming a partnership with your fertility clinic or agency. For surrogacy, besides the medical clinic, you’ll also engage with a surrogacy agency or attorney to manage the matching and legal process. Choose reputable professionals. For instance, IVF Center Hawaii is an example of a specialized fertility clinic that offers advanced reproductive technologies and personalized care, serving patients who need IVF. Working with established centers like that can provide confidence that all aspects will be handled properly and with experience.
Educate yourselves, lean on supportive friends or family, and maintain good communication with your partner. Whether you end up pursuing additional IVF cycles, deciding on a surrogate, or filling out adoption paperwork, remember that there is no one “right” way to build a family. Only the right way for your family. By gathering knowledge and support, and with a bit of luck, you will find the path that leads you to the child you’ve been dreaming of. Every journey is unique, but the end goal is the same: welcoming a new member into your family with love.
Sources
- American Adoptions – “Open vs. Closed Adoption: What is the Difference?” americanadoptions.com
- American Surrogacy – “Adoption vs. Surrogacy for Gay Couples [Pros and Cons]” americansurrogacy.com
- Surrogacy4All – “The Complete Cost Breakdown of Surrogacy in the USA (2025 Updated Guide)” surrogacy4all.com
- Cleveland Clinic – “Unexplained Infertility: Tests, Diagnosis & Treatment” my.clevelandclinic.org
- CBS News (60 Minutes) – “Egg freezing popularity increasing among young women to preserve their fertility” cbsnews.com