But it makes her feel better about the surgery and the pregnancy, which Randall brought up to her in the opening moments of the show — one of the strongest scenes in an episode full of strong scenes. Randall is rightly very hurt that Kate would say he can't pass on a piece of their dad, but he comes at Kate from a place of getting on her a bit about adoption. Randall has some very personal issues with her choosing a dangerous surgery over adoption and he's not wrong because there are risks, but Kate is also right when she says she shouldn't have to defend wanting a biological child and pointing out Randall had two biological children before he adopted. He also shouldn't make the money an issue — adoption is basically as expensive as IVF, so it's not like it's really the cheaper option.