Sunday, March 31, 2013

Bad Blood

On Friday I went to my primary care doc, to have some blood tests completed for the donor egg pre-cycle screening. Since I am completely out of fertility coverage through my insurance ($5000 doesn't get you very far when you've done 8 medicated cycles and 3 IVFs), I thought I'd try to see if insurance would cover it if done through my regular doctor.

Side note: I recently received a bill for over $700 for two measly ultrasounds. This is what happens when your insurance benefits for fertility run out. They don't TELL you, they just hit you with the bills later. This was particularly infuriating because I can see on my billing statement that my own insurance only pays $150 for ultrasounds. So why should I have to pay $350, as a self-pay patient? WTF. I called the hospital system to see about this, and why I should have to pay more than twice what my insurance would have to pay, and was told they will give me a 50% discount. To be honest, they should give more than that, since the insurance only pays $150, why should I pay $175? But, I am grateful to save $350 so I will take it. Still... WTF?

Okay, back to my doctor's visit. I went to the lab area to get my blood drawn for everything under the sun, thanks to the fact that all my bloodwork is one year and one month, and it has to be within one year. Sigh. So I roll up my sleeve and show the phlebotomist my one good vein, the only one that has ever been used, in my right elbow. Well, she wasn't able to get anything from it. Remember when I went to my fertility clinic for my pregnancy test three weeks ago, and they couldn't get anything (did I write about that? can't remember. it was awful)? Same story. Apparently my one good vein is covered in scar tissue due to the many, many blood draws that I have had in the past year. The needle goes in, but the scar tissue prevents blood from being accessible.

So, she tried other places, but I have really tiny veins. I must have been there for half an hour. Finally, she goes for my left hand and smacks it a few times (ouch!). At last, a vein pops up. But it's a hand vein and not an elbow vein, so it was slooooooow. She had to label the blood vials "special handling" so that the lab doesn't waste a single drop, since we didn't get as much as usual.

O.M.G. All I can say is, thank god I am doing donor egg, with a minimum of blood draws needed. IVF requires so many. From now on, I won't be able to donate blood, and any blood draws will need to come from my hand, which is way more of a pain than the crook of the elbow. My blood is slow and my veins suck, and it's just all really upsetting and reminds me of how much I have been through in the past year. Nobody tells you that your veins will be destroyed from IVF.

Sorry for so much complaining. I came home covered in bandaids and wraps on Friday, but the good news was that on my way home, the clinic in Atlanta called. I have a phone consult set up with the doctor on April 24th! I am very much looking forward to it- now I just need to spend the next 3 1/2 weeks gathering up all our medical records and writing down my questions. But, glad to be moving forward.

Thursday, March 28, 2013

Decision Made

We did it. We decided on RBA, and I submitted the initial paperwork last night and this morning.

I feel terrified at the amount of money we are about to pay. We sat down to think of how we can save money but we didn't come up with any good ideas. We already drive old cars, don't eat out too much other than maybe one moderately priced dinner a weekend, and we don't have cable or drink coffee out each morning. We pack lunches and I cook a lot. Anyway, we have the money, it's just scary to let go of 2/3 of our savings from the past five years or so.

But, what's done is done. If we're going to have a child, this is what it takes.

I'm spending hours and hours every day dealing with getting our medical records and updated testing, and organizing it all, and figuring out what needs to be done next. Luckily it's a three day weekend so I am looking forward to relaxing soon too.

Tuesday, March 26, 2013

Answers to Questions from Last Post

  1. How much info do we get about the donor? Atlanta said 20-25 page PDF including genetic info, and baby photos, but what else? If there are future health concerns, can the donor be contacted by the clinic? Answer: I checked with RBA and they said yes, they keep the donors on file and as long as their contact info remains the same, they can contact them if anything were needed in the future. Their contract also points out that laws may change in the future regarding privacy, and recipients may be allowed to find out more info in the future if legal details were to be amended.
  2. If we miscarry or have to terminate, does the refund apply? I read somewhere that success is considered a live baby so miscarriage/termination is included, but I can't remember where I read that, or for which clinic. Answer: Yes, both refer to "live birth" so you can try again until then or until you meet the maximum of 5 (RBA) or 6 (Shady Grove) cycles. 
  3. I'd like to know the % of 5 day versus 3 day transfers, and twinning rates? Answer: SG has complex charts to show this, but basically, from 2% if you do a SET on day 5 to 46% if you do a double blast transfer on day 5. RBA has about a 45% twin rate but if I did the guarantee program, I would feel less pressured to do a 3 day or a double transfer so I would hopefully be able to avoid twins.
  4. I want to compare chances of having frozens left over with a successful cycle? Answer: With the 1:3 program at SG, 52% of participants have frozen embryos left over, with an average number of two embryos. At RBA, about 50% have frozens left over, and I don't know the average number of embryos. 
Other random things learned:
I do not know how many donors are in the database at Shady Grove, but RBA currently has 56 donors (I think Shady Grove has more). But, they are adding a huge backload right now, and expect to have 100 by the end of April or beginning of May. It will likely take us that long to get our screening done and the consult with the physician, so the timing will work out well for us. 

Other facts of concern about Shady Grove: by going with Shady Grove, there is a chance of cancellation that isn't an issue with frozen eggs at RBA. According to their stats, in the 1:3 program, there is a 4% chance of cancellation if you are recipient one, 8% if you are recipient two, and 19% if you are recipient three. I'd likely be number 2 or 3 since I am a newbie, so that 19% is something to be seriously considered. 

And a concern about RBA: the refund program is not as great as I first thought. I was tipped off by this blog. I asked for RBA's contract and sure enough, the refund is not the whole amount, but the total minus $3K per cycle completed. Also, if you only do one cycle, you forfeit a fee of $16,500. It's strange, but it's in writing. So, worst case scenario, we would lose $15K if we did all five cycles, and $6K or $9K if we did two or three cycles. It's not as good as Shady Grove's but I am somewhat reassured by their high success rates that we wouldn't do more than three cycles anyway, for a max loss of $9K.

I hope that we have time to sit together tonight and make a decision, though I think it's pretty clear how I am leaning. The downsides to RBA remain: the need for both of us to travel to Atlanta is more of a pain than DC, the need for me to miss work for a week rather than just three days (not a huge issue- I have plenty of leave), and the refund program is not as good as Shady Grove's. However, the upside of not needing another HSG (which I think Shady Grove requires, and of which I am terrified, having been traumatized by my first one) and having a significantly higher success rate, as well as being able to start any time and not worry about timing and cancellations, all lead me to the important question: WHAT IS MY END GOAL? My end goal is to get pregnant as soon as I can, with a reasonable refund so we can pursue adoption if this doesn't work. To that end, I think RBA will make the most sense. But I will report back soon, once more things are decided and are set in motion.

Wednesday, March 20, 2013

More Research on Donor Egg Options

Here is a summary of what I have found out. In the past I have not used identifying information for clinics, but at this point I am sharing it, in case this helps anyone else out there:

Shady Grove (in Maryland):
They have four programs for donor egg. You can split one woman's egg between three recipients, two recipients, or keep them all yourself. Their success rates are good, at 46-47%, though the chances of having frozens left over varies depending on the option you choose. Their chart explains it all. Prices are $14K for the 1/3 program for just one cycle, or $30,500 for up to six cycles and a 100% refund if no pregnancy. This is the option we are leaning towards- splitting three ways but paying double to have the six cycles and refund. The 1/2 program is $18K for one cycle, or $39K for the six cycle refund program. The 1/1 option is $29K or $55K for the refund. They guarantee a minimum of 4 mature eggs per cycle. They also offer a frozen cycle through Donor Egg Bank USA. I don't have price info but they say it's similar to the 1/2 cycle cost.  I think if I did frozens I would just go to the place in Atlanta, which has a higher success rate with frozens. 

My Egg Bank (in Atlanta) (part of RBA):
This might be the one I am leaning towards. It's $16,500 for one cycle, but we are interested in their guarantee/refund plan which offers up to 5 cycles or your money back and is $30K. It would mean staying in Atlanta for 5-6 days (they have deals on hotels). Since all the eggs are frozen, you can start anytime you want. They guarantee a minimum of 6 mature eggs per cycle. Their success rates are impressive to me, at 60% for SET and 70% for two embryo transfer. I want to find out the % of people who have frozens left over, in comparison to Shady Grove's numbers. 

Carolina Conceptions (in Raleigh):
They are local which is easier, and have a good success rate between the other two clinics- at 57.1% according to SART figures. They have around 50 donors so a smaller pool, but no wait because many are ready to go. The last weekend of each month they offer a free look at the donor database (check their website). It costs around $15K for 1 cycle split between 2 recipients. It costs $25-29K for a cycle not shared. You get a 3/4 refund if the donor backs out, and $3K back if no embryos are available for transfer due to egg quality issues (the numbers are higher for the non-shared cycle). They do not have a refund program, so we are not going to go with them. 

They have great success rates, the best of all options: 68.4% according to SART. But they told me a one and a half year wait. I cannot wait that long so I'm not pursuing this option.

International egg donor options:
Ummm. I have found plenty about going to Cancun and doing it for cheap, but this scares me. I wish I knew someone who had done it. 

Private agency for egg donors:
A friend through the RESOLVE group did this- she worked with a private agency and then did the process all at Duke. I don't know much about this, but she chose it because she wanted a non-anonymous donation- she wanted her potential child to be able to contact the donor when s/he turns 18. I am meeting with her for coffee on Friday and will get more details. She got 11 embryos but is unhappy because only 3 were great quality. She chose to freeze them because she had some other health issues pop up- not sure about the details. She told me if she could do it again, she'd go with the Atlanta place, though I don't know any more than that. Will get more info Friday.

The questions I still want to ask of the two finalists and compare the answers (Shady Grove and Atlanta frozens): 
  1. How much info do we get about the donor? Atlanta said 20-25 page PDF including genetic info, and baby photos, but what else? If there are future health concerns, can the donor be contacted by the clinic? Update: I checked with RBA and they said yes, they keep the donors on file and as long as their contact info remains the same, they can contact them if anything were needed in the future. Their contract also points out that laws may change in the future regarding privacy, and recipients may be allowed to find out more info in the future if legal details were to be amended. 
  2. If we miscarry or have to terminate, does the refund apply? I read somewhere that success is considered a live baby so miscarriage/termination is included, but I can't remember where I read that, or for which clinic. Update: Yes, both refer to "live birth" so you can try again until then or until you meet the maximum of 5 (RBA) or 6 (Shady Grove) cycles. 
  3. I'd like to know the % of 5 day versus 3 day transfers, and twinning rates? Update: SG has complex charts to show this, but basically, from 2% if you do a SET on day 5 to 46% if you do a double blast transfer on day 5. RBA has about a 45% twin rate but if I did the guarantee program, I would feel less pressured to do a 3 day or a double transfer so I would hopefully be able to avoid twins.
  4. I want to compare chances of having frozens left over with a successful cycle?
That's the info I have gathered so far. My goal is to make a decision in the next month and be on our way to making a baby by my 33rd birthday at the end of June. Moving ahead! 

Monday, March 18, 2013

Next Step: Donor Eggs

Today we met with my doctor for what I think of as the obligatory "WTF" appointment. I brought in a list of questions but did not get very far, as he immediately launched into his analysis of why this cycle sucked so bad, why the previous two sucked even more, and what he thinks we should try next. I have to say, even though I am so disappointed in the results, I was overall happy with this clinic, and really do respect and trust this particular doctor. He was clear and informative in his discussion with us today, and honest and sensitive in his manner.

This is what he said: he thinks it's an egg problem. I have impaired function due to my left ovary not working as a result of the endo and/or the endo surgery, and although my AMH is okay, I am a low responder to the drug stimulation. However, I was able to get five mature eggs. But the embryologist reported that of the five eggs, three were just bad. They "degenerated at injection." So, when they injected the sperm using ICSI, the eggs basically collapsed or died. Dr. M believes this is an egg quality problem. The other two that fertilized were okay, but stopped growing, which is why we only had four-cell embryos, so that wasn't good either. The quality of one was bad, and one was pretty good- but only four cell so not ideal.

To sum it up, my eggs are probably bad. We don't know why, but there is something wrong with their quality. He said we could try a 4th round of IVF- he has seen women get pregnant before. But he does not think I have very good chances, and knowing we are paying out of pocket, he did say that donor egg may be the better use of our money.

I agree. I don't have the financial or the emotional strength to go through another difficult cycle. Sadly, I am done with my own eggs. Donor egg it is.

But- this is where the appointment went downhill. This clinic has excellent success rates for donor egg- 68.4% in last year's SART numbers. This is amazing, compared to much lower numbers at most other clinics. BUT the bad news: there is a year and a half wait for a donor. Either this clinic attracts many couples because of it's great success rates, or it has such stringent requirements that it doesn't take too many donors, but either way, we are not waiting a year and a half. I began crying when he said that. I just couldn't help it. I felt... crushed. To go through one surgery, two painful x-rays, and three IVFs, all of which failed, and then to be told I need to wait another two years--- no. Cannot do it. I don't know that I would be sane and not checked into the loony bin if I had to wait that long, suspended in time, waiting for just a chance to become pregnant. Nope, not for us.

But when I got home things started to seem more possible. I called the big clinic in Maryland and they have plenty of donors available. Their success rate is not as good as my current clinic's, but it's not bad, at 50% success per donor egg cycle. No wait needed at all. They are very, very expensive, but we will do what it takes to reach success. They also have refund programs. Because of our not 100% confidence that B's sperm isn't totally the problem, I think we need to do a refund program. It doubles the price, but I just don't think I can handle the stress without a refund option. What if nothing fertilizes, or only a few? Then we'd be out another $15K? No.

We also have an appointment at CC, a local clinic that says they have available donors (and a good success rate of 57.1%), and they have a refund program. Perhaps they will have better prices since they are not next to a large, expensive city. Our appointment is not till the end of next week, so I won't have any more info till then. [UPDATE: CC no longer has a refund program so we are not considering them.]

Another option is to use a private egg donor agency, which is what someone in my support group did. But that gets very expensive. She also mentioned the agencies give you more info about the donors- but that is not a big concern for me. Agencies also allow future contact once the child is 18. I'm not sure how I feel about that, but I don't feel strongly about it. I can't say how a child will feel, but if B's sperm is used and I carry the child, I would hope that a child would feel more connected than, say, traditional adoption. But, I don't know. This is a strange grey area and pretty new. I should think about these issues some more.

Anyway, this woman in my group said if she could do it over again, she would consider using frozen eggs: "If I was to start all over, I think I would go with RBA in Atlanta (Reproductive Biology Associates, I think.)  They are the ones who pioneered egg freezing.  So, their "in house" donor pool isn't the 2 women who volunteer to give their eggs while you are at the top of the waitlist but a huge bank of frozen eggs.  Their success rates are fantastic, they offer a guarantee program and they are supposed to be one of the cheapest options."   So this is something I would like to investigate as well.

So, we have some options. The big clinic in Maryland that has available donors and costs a lot and has decent but not great success rates. The local clinic here that has better success rates and I don't know much else about yet. Using a private agency or the frozen eggs from Atlanta.

Options, options. I am feeling exhausted by it all, but committed. After all we have been through, perhaps this is our answer.

Sunday, March 17, 2013

Options After IVF Failure

The last week has been tough.

I'm not even sure how to describe it. I've been really busy with a work-related conference and haven't had time to think over things too much, but when I do, it's not good. Yesterday was Saturday and I think I cried about five times. B and I are getting along fine, and he's been more supportive, but I think he just doesn't know exactly what to do. I'm not real good at telling him, because I don't know what to do myself.

One thing I have been thinking a lot about is next steps. What do you do after three failed IVFs? If I'd had even one great embryo, I might be willing to consider another round, with the third and final protocol available. However, it doesn't seem a wise use of money or time, considering the low yield, poor fertilization, and less than ideal quality of embryos.

So we are left with the following options:

1. Traditional adoption: sometimes I do feel drawn to adopt, and wonder if this is where I really was meant to end up. The physical process of pregnancy has never particularly appealed to me, and I am more interested in being a parent than in being pregnant. However, my concerns about the prenatal environment are strong. I worry about the long term effect of drinking and drug use on a child. Although I know plenty of adopted kids turn out okay, both B and I can list so many cases of adopted kids being messed up, and it often seems separate from their upbringing or other parental influences. Of course, what is nature and what is nurture, and how much is genetics versus the hormonal development in utero? There are no clear answers. But on a practical note, I get shaky inside when I think of doing a homestudy, compiling a website or portfolio about us, and paying $30K for this process. After the trauma of years of infertility and failed IVFs, I don't know how well I can stand up to all of this right now. Being examined and judged? It just turns me off completely, and I feel that my bitterness about the unfairness of life and fertility will be increased through this process. I am just not ready. If someone handed me a child, wonderful. But the rigors of adoption? Not appealing.

2. Using donor eggs: hmmmm. This is probably our first choice at the moment. Using donor eggs is usually an option for older women who cannot conceive using traditional IVF/ICSI. I seem to be an anomaly, being only 32 years old and not having premature ovarian failure. On paper, my AMH and FSH are fine (well, low for a 32 year old but not at all low for a fertility patient). This raises the perpetual question of whether it really is my eggs that are the problem, and not B's sperm that accounts for our poor embryo quality and fertilization rate. For this reason, I am not sure using donor eggs is for us. It is VERY expensive- but it would be amazing if we could get enough embryos for this cycle and for a second child in the future. We are meeting with my doctor tomorrow and I intend to try to see how good of an option he thinks this is for us. Even if he does encourage us to try it, we are only willing to do one of the refund programs. There is no way we are going to spend $22K-ish and have a failure. There are refund program where you can get 70% back if no pregnancy occurs. This seems a reasonable option, though of course I am terrified that we will get great eggs, and then have crappy fertilization. At least then we'd have some answers, I guess. This option does appeal to me in that we can use B's sperm and I would carry the child. We can control the prenatal environment, and we'd both have a biological tie to the child- his would be genetic, and mine wouldn't be genetic, but I would carry the child, and be able to breastfeed. It's so expensive- we would seriously be impacted financially, but we can do it if we are up for the risk.

3. Using donated embryos: a third option, and the cheapest but perhaps the lowest odds of success. Since I wrote about this at length in my March 5th entry, I won't go too into depth again. We are still interested in this option, but we're feeling overwhelmed at the details of actually arranging it. Using the self-match website brings up so many questions about logistics, and my clinic doesn't have any embryos available. The clinic in Cary that advertises "available embryos" actually has a one year wait. We do have an appointment in two weeks at a clinic in Raleigh that also says they have embryos available, but I'm half expecting that to be untrue as well. However, we will go, and see what they say. The low cost is appealing, but we also know the success rates aren't the 60% that donor egg carries. The women will generally be older, so there are lower odds, and they are leftover embryos so not as ideal as fresh ones from a donor who is in her early 20s. Anyway, it's still an option, and probably #2 on our list of most desired paths to take.

Overall, I am feeling very emotional, and I cry often, but I am doing what I can to take care of myself: spending plenty of time alone because I am not yet ready to talk to people about this, eating well, sleeping enough, and getting good exercise. Yesterday we walked in the woods again for over two hours, and today I plan to go to one of my favorite classes at the gym. Later, I'll make one of my favorite meals, tofu broccoli lasagna. All I can do is keep trying to be kinder to myself than I am used to, and being realistic about the fact that I need to keep moving forward.

IVF failure wasn't supposed to happen, not to me, not now. But I hope that one of these three options brings me to peace and brings me a baby. I know I am meant to be a parent and not to live child-free. I just have to keep figuring out how to get there.

Monday, March 11, 2013

This is what a broken heart feels like

On Saturday morning, bright and early, B and I woke up. Normally we'll sleep till 9 on weekends, or sometimes later. But not this morning. We were up and in the bathroom before 7 am.

The test was negative. As I suspected and expected it to be.

We went back to bed but it was hopeless to go back to sleep. All things considering, we had an okay day after that. We took a long walk in the woods, a nap on the couch together, and met friends in Raleigh for dinner. Another friend came over later that night and we shared a bottle of wine.

Sunday was not so good. Sometimes the first day isn't so bad, but then the shock wears off and it becomes more real.. the lack of hope. Sunday I did yardwork and then we went for another long walk. However, we had a horrible fight in the woods. I was asking to mourn the loss of our last opportunity to have a biological child, and he just wanted to try to get me to think more positively about our other options and life in general. He also said he would like more support for the stress he is under at school.

Bullshit. That is such bullshit. This blog is not a forum to complain about my marriage, but I am still very upset with him. I know infertility can cause many couples to become unhappy with each other, and can break apart some marriages even. I know all this, and we've been doing okay over the past two years. But for some reason, this time I really wanted to mourn, and I wanted him to do it with me. And he couldn't, or wouldn't.

This turned into a 7 hour fight. Well, most of that was not actually fighting, it was him hiding upstairs and doing homework, and me crying and being miserable everywhere else. We did make up before bed, kind of.  He did bring home veggies and chocolate to try to make up, but my anger and sadness were overwhelming.

Today didn't start off too much better. Actually, it was awful. I woke up so exhausted from not enough sleep, and went to the gym to try to feel better. Doing Zumba for an hour did help. But then I had to go to the clinic to do the obligatory blood test. I guess I was a little dehydrated, presumably from the Zumba but perhaps also from crying so much yesterday. Anyway, three nurses tried to get a vein, resulting in my being stuck five times. They even sent me away and had me drink water and come back, but nothing. No vein, no blood. At this point I was bawling. I mean, uncontrollable crying, right there in the blood lab. The main nurse finally consulted with the attending, who told me to just go on home. I guess the pee test I did at home is gonna have to suffice.

This experience was torture. My arm is full of pain from the five needles I had in my right vein, and I cried myself hoarse at the clinic, in the car, and when I got home. I called B and told him I'm on the verge of a nervous breakdown and he better damn well stop bickering with me and listen to what I need. I need someone to tell me they know how much I've been through, and that it's been HARD. I do not know anyone else who has been through three IVFs, and I am proud of myself for doing it, and I could use more acknowledgement from him. And when I say I don't need someone trying to cheer me up, but just to listen and try to empathize, that's what I want. I think he gets it now, after calling him at work today and having another little talk.

Overall, I feel that my heart has been broken, stomped on, and broken again. I know some of this is the hormones that are still in my body, and some of it is the lack of sufficient sleep I've had for three nights now. But most of it is just the plain and simple fact:  I will never have a biological child. I am 32 years old and cannot conceive, despite three IVFs with ICSI, costing more than $20,000 and two years of our lives. We will never know if it's my egg quality or his sperm's inability to fertilize, but the combo of me and him will never result in good embryos. We are done with our IVF journey.

Of course, all is not lost. I still intend to pursue embryo adoption, and traditional adoption is that does not work out. One of these days, I will be a parent, and maybe then my heart will begin healing.

Tuesday, March 5, 2013

4 More Days.. and Plan B

I had a pretty good weekend. A nice date night with B on Friday night where we tried this amazing Singapore style restaurant that we now are wondering how we didn't know about for the past 7 years! As an appetizer we had lettuce wraps that were served DIY- they give you the large lettuce leaves and a filling of tofu and onions and mushrooms, all marinated and delicious, and you get to make the wraps yourself. It was fun and tasty.  On Saturday I hung out with a friend all day- we went to the farmer's market, had a nice brunch in town, went used book shopping, etc. She is trying to get pregnant now and thinks she might already be. I have mixed feelings: of course I would be happy for her, but it's a little painful to watch someone at the beginning of their journey and remember how naiive I was, thinking of course it would be easy. I wish her none of our troubles.

On Sunday a friend came over and we did "fertility yoga." She used to teach it and I think she now trains instructors. In any case, I am not normally a big yoga fan, but it was so good to move my body for the first time in awhile. I've been abstaining from exercise for the past few weeks, to try to help with any possible implantation. But it was great to do some gentle yoga moves, with the sun pouring in and warming us both in my cheerful purple guest room (a.k.a. someday baby's room). Sunday night we had dinner with friends and none of them have kids.

So, I stayed pretty busy all weekend. I did not have time to laze around and feel sorry for myself very much. That is definitely a good thing.

As test date gets closer, I'm prepared for disappointment. I do not have my hopes up too high. Of course it would be the best thing ever if this could work, but I know the chances are not great.

However... we do have a plan B! Of course we will investigate adoption, but we are also starting to learn about embryo adoption. My main fears with adoption are: the birth mother's care of herself while pregnant (as we have heard many, if not almost all, birth mothers are using some amount of drugs or alcohol while pregnant), the massive financial cost (where on earth will we get the money needed?), and the intense process of applying, background checks, home studies (all sound so draining and we are already so weary from 3 IVFs). The lack of genetic connections with an adoptive child is not on my list of concerns. So that's why we are interested in embryo adoption. If we can have me carry the baby, we can control the environment since of course I will take good care of myself. We can avoid the financial toll since from what I read, it's not too much more than the cost of a frozen transfer (a couple of thousand versus $30K). And home studies and background checks are not always required.  I do not feel bad morally if we do not adopt a child that has already been born. A long time ago, or in another country, there was/is a need. But now, with there being years-long waiting lists and more demand than need, it's not like it was.

We still have many, many questions. But it is nice to have another option on the table.