Infertility, defined as the inability to conceive after 1 year of unprotected intercourse, is recognized as a medical condition. In the United States, infertility is a growing problem: over the last several decades, age-related infertility has become increasingly prevalent as a relatively larger portion of women has deferred childbearing due to effective birth
control methods, safe and legal abortions, better access to college education, and greater participation in the labor market (Angrist and Evans 1999; Buckles 2008; Caucutt, Guner, and Knowles 2002; Goldin and Katz 2002; Kane and Staiger 1996).
Individuals with fertility problems who want to have children have two main alternatives: adoption and infertility treatment. (1) Chandra et al. (2005) use data from the 2002 National Survey of Family Growth (NSFG) to show that about 57% of women who received infertility treatment also considered adoption or actively sought to adopt a child. Infertility is an important factor in determining the demand for adoption. Married childless couples are more likely to seek adoption, and adoption is more prevalent among women who have used infertility services (Bernal et al. 2008; Chandra et al. 2005). Our calculations using the 2002 NSFG show that, among the women who are seeking to adopt, a third have also sought medical assistance to get pregnant. Some individuals choose to pursue infertility treatments and child adoption concurrently. Among women who are currently pursuing medical help to get pregnant, about 7% are also concurrently seeking to adopt an unrelated child. Conversely, among those who are seeking to adopt an unrelated child, about 20% are also pursuing medical help to get pregnant. (2) The extent to which individuals view child adoption and infertility treatment as alternatives is an empirical question with important economic, social, and public health implications. In this article, we investigate the substitutability between assisted reproductive technology (ART) and child adoption. To the best of our knowledge, no prior study in the literature provides a formal empirical investigation of these two alternative paths to parenthood.
The main motivation for this study is the recently increasing trend in ART use in the United States. Since the beginning of the 1980s, diagnostic and treatment options for infertility have advanced dramatically in effectiveness and availability. As a result, Americans have been utilizing more and more ART, mostly in the form of in vitro fertilization (IVF). In 1995, an estimated 6.7 million women had impaired fecundity, of which 42% had received some form of infertility services (Stephen and Chandra 2000). In 2002, an estimated 7.3 million women had fecundity problems, and about 45% had received some form of medical assistance (Chandra et al. 2005). The most commonly used infertility services are noninvasive methods such as medical advice, infertility testing, and ovulation drugs. IVF is characterized as "a last resort" that is generally pursued only after other diagnostic problems are solved and less invasive approaches have failed (Staniec and Webb 2007). ART, including IVF, is used by less than 2. Van Den Akker (2001) analyzes whether individuals in the United Kingdom first pursue IVF, adoption, or both simultaneously, among other options. He concludes that first actions varied greatly depending on whether the individuals suffered from female or male subfertility, or both. 1% of women, but the number of children conceived through ART is quite high. The Centers for Disease Control and Prevention (CDC) reports indicate that the number of babies conceived using ART has more than doubled from 20,840 in 1996 to 54,656 in 2006 (CDC 2008).
In addition to the increased effectiveness and availability of ART, improved access due to infertility insurance coverage has contributed to the upward trend in ART utilization. In the late 1980s and early 1990s, some states enacted health insurance mandates for infertility treatment. …