The rise of the matching paradigm linked infertility tightly to adoption. Because families made socially were supposed to look like families made by blood, taking in children born to others emerged as a solution for childless heterosexuals seeking to approximate, emotionally and legally, the family they could not produce themselves. Although childless couples have probably always been interested in adoption, the practice of giving preference to infertile couples evolved only in the twentieth century and was most pronounced around 1950. By then, infertility was so closely tied to adoption that applying to raise someone else’s child was considered an admission of reproductive failure. Adoption and “sterility,” as infertility was typically called before the 1960s, were practically synonymous.

There were also practical reasons for the close association between infertility and adoption. At a time when demand exceeded supply for healthy white infants, many professionals believed that limiting the pool of potential adopters to infertile couples was the fairest method of allocating children. It was not unusual for agencies to exclude from consideration couples who had or were capable of having children of their “own,” even if they had experienced multiple miscarriages or were suffering from “secondary” infertility (the inability to conceive after having one child).

In the era before reproductive technologies such as in vitro fertilization, infertility usually meant one of two things: permanent childlessness or adoption. In addition to being a qualification for adoptive parenthood, infertility was treated as a sensitive barometer of marital adjustment, a predictor of parental success, and a quality in need of interpretation. Because not being able to have children was considered just as abnormal as giving them away, infertility was at once a logical feature of adoption and a source of potential problems in new families and psychopathology in adopted children. The first major theoretical treatment of adoption, Shared Fate (1964), made infertility the key to understanding adoption’s social significance and cultural context.

At midcentury, much was made of the difference between “organic” infertility, which had a clear physiological explanation, and “psychogenic” infertility, which did not. The first was a tragic consequence of reproductively uncooperative bodies. The second was caused by the mind, and that made it far more sinister. Psychogenic infertility implied that men and women might be terrified of parenthood or hostile to it without knowing it. Women, in particular, were suspected of frigidity that might do serious harm to children. One of the primary goals of home studies was to explore the psychology of infertility. What did it mean to applicants for adoption? Had they tried hard to overcome it? Had their pain and anger about it been resolved? Such insistent probing surely added to the burden of grief and self-blame already felt by many infertile couples.

The belief that adoption might cure infertility by inducing pregnancy endured throughout the twentieth century and into the twenty-first in spite of empirical evidence to the contrary. It has been sustained by desperation, anecdote, and Freudian theories that blamed infertility on resistance and speculated that adoption could dissolve unconscious barriers to conception and pregnancy. The fact that little or no credible evidence existed to prove this suggests that therapeutic perspectives on adoption were—and still are—powerful.

Special needs adoptions, African-American adoptions, single parent adoptions, lesbian and gay adoptions, and other adoptions that expanded the borders of family belonging began gradually to untie the knot between infertility and adoption. If more kinds of children were adoptable, then more kinds of families were needed to adopt them. Demographic patterns suggest that working-class families, older adopters, and parents with children of their “own” were often more tolerant of difference and more open to “making room for one more” than childless infertile couples, who still desired healthy, white infants.

Its close association with infertility exposes a poignant feature of modern adoption. Adoption has been a last resort, a way to make families only after the normal, preferred, method of biogenectic reproduction has been tried and failed.