Most single IVF transfers do not result in a live birth. The International Committee for Monitoring Assisted Reproductive Technology’s world report for treatment performed in 2017 and 2018 — 2.9 to 3.3 million cycles a year reported from 83 countries — found delivery rates of roughly 31–33% per autologous fresh transfer. Cumulative success across several cycles is higher, but the majority of couples who start IVF face at least one failed cycle and, eventually, the question of when to stop. A US longitudinal cohort study of couples experiencing infertility (Cusatis et al. 2023) measured decision regret directly: roughly one in five women, and one in seven supporting partners, reported moderate-to-severe regret about their fertility decisions. Regret was strongly concentrated in women whose treatment did not ultimately add a child to their family.
The adoption pathway shows a markedly different regret structure. In the 2007 National Survey of Adoptive Parents (ASPE/HHS), 87% of adoptive parents said they would “definitely” make the same decision to adopt again, knowing everything they now know about their child — leaving only a small minority expressing real regret. Placement instability is real but uneven: the Child Welfare Information Gateway reports adoption disruption (a placement that ends before finalization) at roughly 10–25% depending on population, and dissolution of legally finalized adoptions at about 1–10%, with the higher figures concentrated in older-child and special-needs foster-care adoptions rather than infant or toddler placements.
The critical framing issue is that IVF and adoption are rarely strict alternatives — most couples pursuing family formation consider IVF first, then adoption if IVF fails. The decision at the margin is usually not “IVF or adoption?” but “should we do another IVF cycle, or pivot to adoption?” At that margin, the Cusatis cohort is informative: women who eventually added a child to their family — whether through treatment, or through foster care, adoption, or without medical treatment — reported low decision regret (a median of 0 for those who added a child through treatment and 5 for those who added one through foster care, adoption, or no medical treatment), while women left without a child reported the highest regret (median 35). Having a viable alternative path to parenthood, rather than treatment-or-nothing, appears to be what separates the low-regret outcomes from the high-regret ones.