Building a family can be overwhelming for any couple, but when you are in a same-sex relationship, there are added factors that make the navigation more challenging. With today’s technology, however, this is no longer a ‘possibility,’ but rather a ‘choice,’ same-sex couples can now make. Reproductive technology, along with various choices, and several resources, allow your partner and you to begin building a family.
How Same-Sex Couples Can Begin a Family With Artificial Intrauterine Insemination
To begin your journey into parenthood, you and your partner will decide who will carry your child. If both of you are open to the idea of becoming pregnant, talk to your doctor at All Women’s Care to determine which of you is the best candidate.
A fertility workup will be performed, including blood work, on the third day of your menstrual cycle to test hormone levels. There is also a test of your HSG to determine the health of your fallopian tubes and uterus. When it has been decided which of you is the better candidate to carry your child, it then time to choose how you will become pregnant. There are different procedures you can use:
Artificial Intrauterine Insemination with Donor Sperm
Artificial insemination is an assisted reproductive technology that will use the sperm from a known friend or anonymous donor. If you have chosen to go with an anonymous donor, some policies must be followed according to the FDA, as well as ASRM requirements. If you have decided to use donated sperm, you want to be sure the establishment which provides this donation is registered with the FDA and has followed ASRM guidelines.
- FDA regulates human reproductive tissue, including eggs and sperm. Donated reproductive tissue, including sperm and eggs, are regulated through the FDA as human cells and tissue-based products. Any clinic or establishment that conducts one or more manufacturing steps for these tissues, storage of them, processing, labeling, or distribution or packaging has to register with the FDA and list their tissues under the rules outlined in Title 21 Code of Federal Regulations, Part 1271.
- ASRM are guidelines used in the United States for those who donate their sperm. The donor should be of legal age, and under the age of forty. Increased male age of sperm is associated with an increase of aneuploid sperm. Aneuploidy is the presence of abnormal chromosomes in a cell. Extra or missing chromosomes are a common cause of some genetic disorders.
Careful coordination is needed to prepare for intrauterine insemination:
- Sperm donation
The process of Intrauterine Insemination begins with the sperm being washed, processed, and concentrated before they are ready to be placed in your uterus. There are non-sperm elements in a man’s semen that cause reactions in a woman’s body. There are also times a women’s immune system thinks the sperm is an invading germ and will dispatch a natural defense to destroy the sperm as if it were a virus or bacteria.
The donation will be cleansed in a manner that separates highly active, healthy sperm from the lower quality sperm and other elements found in the sample. There is a higher success rate for pregnancy if a small, highly concentrated sample of healthy sperm is used in the insemination.
- Monitoring Ovulation
The timing of intrauterine insemination is crucial, so it is necessary to monitor for signs of impending ovulation. There are at-home urine ovulation predictor kits you can use to detect when your body begins producing a surge of luteinizing hormones. There is also an imaging method your doctor at All Women’s Care can use so the doctor can visualize your egg growth and ovaries. This imaging is a transvaginal ultrasound. Your doctor may suggest you take an injection of human chorionic gonadotropin to make you ovulate one or more eggs at the right time.
- Choosing the optimal time
Most intrauterine inseminations are done one or two days after it is detected that you have ovulated. Your doctor at All Women’s Care will have scheduled the timing of your procedure according to the ovulation monitoring.
What to Expect With Intrauterine Insemination
When you have your intrauterine insemination, the procedure should take from fifteen to twenty minutes, and typically be performed at All Women’s Care Clinic. The procedure itself takes only a minute or two and will not require any form of medication or pain reliever.
While you are lying on the examination table, you will be in a position just as when you have a Pap test. You will be on your back with your legs in the stirrups. The doctor will use a speculum to open your vagina walls. The procedure itself consists of:
- Attaching a vial that holds the sample or donation of healthy sperm to the end of thin, long tube or catheter
- The doctor will insert the tube into your vagina, through the cervical opening, and into your uterus
- They will then push the sperm sample out of the tube and into your uterus
- The catheter and speculum are then removed
Once the catheter and speculum are removed, the physician will ask you to lie on your back for a short time. You will then be able to dress and go about your regular daily routine. For one or two days following the insemination, you may experience some light spotting.
Two weeks after the insemination has been performed, you can take an at-home pregnancy test. It is essential to wait a full two weeks as testing too early can result in:
- False-positive results
If you’ve used medication for inducing ovulation like HCG, this medication can still be in your body and could indicate a positive answer to a pregnancy test when you actually are not pregnant
- False-negative results
Pregnancy hormones are not yet at measurable levels before the end of two weeks, and the test may tell you that you are not pregnant, when in fact you are
The physician at All Women’s Care may schedule an appointment for you to return a couple weeks after you’ve taken an at-home test to have your blood tested. Blood tests can detect pregnancy hormones more efficiently after fertilization. If you have not become pregnant, they may suggest having the second insemination done.
In-Vitro Fertilization for Same-Sex Couples
In-Vitro fertilization is performed by removing the eggs from the chosen partner and fertilizing them in the lab. The fertilized eggs can then be placed into the selected partner to go through the pregnancy. The partner who contributes the eggs can also be the parent that goes through pregnancy and childbirth, or the eggs can be retrieved from one partner and placed in the other partner once fertilized. This option might be chosen when both partners want a part in creating the life of their child. The eggs can be retrieved from one partner, and placed in the other to carry and deliver the baby (Reciprocal In Vitro Fertilization). This is one reason same-sex partners choose this method; you may have other personal or health reasons determining your choice.
The retrieved eggs are fertilized in the lab with the donor’s sperm, which is the ‘in-vitro’ process. To complete the in-vitro fertilization, there are several steps involved:
- Stimulating the Ovaries
The ovaries of the partner carrying the baby will have her ovaries stimulated with injectable fertility medication. This medication is a purified concentrate of the same hormones your body makes. The concentrate will administer a higher dosage than your body generally creates, so the growth of follicles is stimulated. The follicles are the pocket of fluid that contains your eggs. Your physician at All Women’s Care will monitor the development of your follicles using blood estrogen tests as well as vaginal ultrasound.
- Retrieve the Eggs
When your doctor determines there are a sufficient number of follicles, and that they have matured, you will receive a ‘trigger’ injection of HCG to complete the egg development. It will take approximately thirty-six hours before the eggs can be moved from the ovaries through transvaginal ultrasound-guided needle aspiration. The procedure takes about fifteen to thirty minutes, during which time you will be sedated. You will be allowed to return home anywhere from one to two hours after the retrieval.
Once the eggs have been retrieved, they are fertilized in a lab using the donor’s sperm. After fertilization, they then go into an incubator. In most cases, ICSI is done. ICSI is a procedure where a single sperm is injected into each egg by a high-level trained embryologist. The day after this injection, the embryologist evaluates the eggs for maturation that would mimic the normal fertilization process. They will use standardized reporting and grading to identify which embryos are ideal for cryopreservation and transfer. Depending on the case, assisted hatching may also be performed during the fertilization stage.
Embryology is the part of biology that studies the prenatal development of fertilization and gametes and the development of fetuses and embryos. Clinical embryologists are responsible for retrieving eggs and helping with the in vitro fertilization, running tests on the eggs, and maintaining clinical records. These specialists often work in fertility clinics and hospitals.
Cryopreservation is the process of storing and cooling tissues, cells, and organs at very low temperatures. This process will maintain its viability. The technology of storing and cooling these cells, and fertilized eggs in the case of the in vitro process, permits a high rate of survival of the eggs upon thawing.
- Assisted Hatching
Assisted hatching helps the embryo with a natural hatching process and increases the positive chances of successful implantation and pregnancy. Assisted hatching is generally recommended if there have been unexplained in vitro failures in the patient’s history.
- Transfer of the Embryo
Three to five days after the fertilization process, the best embryos are transferred directly into your uterus. This is done with the use of a small catheter in a brief procedure that will not require sedation. The American Society for Reproductive Medicine’s Guidelines (ASRM) recommends a number of embryos are transferred based on the quality of the eggs and the age of the patient. Any remaining fertilized eggs can be cryopreserved for future use should they be needed.
- Test for Pregnancy
You will continue the progesterone regimen until you return to the clinic for a blood pregnancy test. The pregnancy test will be scheduled ten to twelve days after the transfer of the embryos. If it comes back positive, a second test will be scheduled two to four days later to confirm. Two to four weeks after you’ve had the in vitro fertilization, and you’ve had positive tests confirming the pregnancy, including an ultrasound, you will continue care with All Women’s Care for all your obstetrical care.
In Vitro Fertilization is a more expensive procedure than intrauterine insemination, but there is a higher success rate with in vitro. In vitro fertilization also allows for the option to perform genetic testing. Your doctor will talk with you about the possibility, if it is necessary, for performing genetic testing on your embryos before implantation.
- Preimplantation Genetic Diagnosis (PGD)
Preimplantation genetic diagnosis is a technique for identifying genetic defects in embryos created for in vitro fertilization before they are implanted into a woman’s uterus. This test is suggested if one or both genetic parents have a known genetic abnormality, or in some cases when using donor sperm to rule out the possibility of there being a genetic abnormality present. This test will confirm or rule out the presence of an abnormal chromosome count.
In Vitro Fertilization with Donor Eggs
Same-sex couples know they will have to locate a sperm donor. This donor can be someone you know, such as a good friend, or by going to a sperm bank. Some couples also choose to use donor eggs as well. If you and your partner do not feel strongly about being genetically tied to your child, but one would like to go through the experience of pregnancy, a donor egg might be your answer for starting a family.
Other reasons you and your partner may pursue a donor egg, is that both of you may have an egg quality issue either due to your age or you are experiencing Diminished Ovarian Reserve or Premature Ovarian Failure. No matter what your reasons are for needing a donor egg, you can have eggs donated from a friend, relative or, go to a donor egg bank.
- Premature Ovarian Failure
Premature ovarian failure is the loss of the function of your ovaries in which they normally behave. The loss occurs at around forty-years of age and results in your ovaries not producing enough estrogen. Without estrogen, your body does not release eggs regularly.
- Diminished Ovarian Reserve
A diminished ovarian reserve happens when a woman’s ovaries lose their reproductive potential. This loss can cause infertility. Ovarian reserve refers to a woman’s quality and quantity of her eggs. Diminished ovarian reserve represents those factors that are decreasing.
How Same-Sex Couples Can Have a Child, Just Not Yet
Same-sex couples who want to begin a family have several options with today’s technology. One option is to use donor eggs or eggs from one of the partners. It is a fact of nature that the older a woman gets, the more her fertility will decline. For this reason, you and your partner may want to consider freezing eggs or embryos for later when you are more prepared to begin your family.
The process of freezing eggs is very similar to the in vitro fertilization process as far as how the eggs will be retrieved. The difference would be once the eggs are retrieved, they are not fertilized, and are instead frozen with a process called vitrification.
Vitrification is ‘fast freezing’ and will instantly preserve your eggs and reduce the chance of ice crystals forming on them. This process presents less risk to the egg when it is unthawed. When eggs are frozen from you when you are at a younger age, it decreases the risks of the embryos having chromosomal abnormalities.
In the future, when you and your partner are ready to begin your family, the eggs can be fertilized through in vitro fertilization. Another option to this process is having the eggs fertilized and then freezing embryos for later pregnancy.
Same-Sex Couple Having a Baby Through Surrogacy
When you and your partner have decided to begin a family, but neither of you is willing or able to carry the child through pregnancy, surrogacy is an option for you to have a child. This monumental experience can be complicated with these milestones to overcome:
The first step in surrogacy is perhaps the most significant one, deciding on surrogacy, and who will donate the eggs. Eggs can be harvested from one or both of you, depending on each of your health history. In some instances, one female partner can contribute her eggs, and along with a sperm donor, they can then have a surrogate carry the child through delivery. Talk with your physician at All Women’s Care to help with the decision on how you should harvest eggs for the surrogate.
Surrogacy may be an option that you have to pursue either for health reasons being neither of you will be able to carry a child, or it could be a personal choice, where neither of you wants to experience a pregnancy. Whatever your reasons, your doctor at All Women’s Care will help you through the many stages involved with this choice.
Choosing/Matching a Surrogate
The matching stage of surrogacy can be an exciting time. You and your partner will choose a woman who will help you create a family. A surrogate can be a friend or family member from either of your families, or All Women’s Care can put you in touch with women who are willing to help you create the family you’ve been dreaming about. When a match is presented, you will meet with each other and discuss any questions either of you have, and if interested, you will be officially matched.
When an individual or family are unable to have children on their own, they have an option of turning to surrogacy. Surrogate mothers are women who are able to carry a child and do so for those who are unable to conceive and carry a child to term themselves.
There are different forms of surrogacy:
- Gestational Surrogacy
With gestational surrogacy, a surrogate mother will undergo in vitro fertilization with donor sperm, and in some cases, with both donor sperm and eggs. There are cases where the same-sex female parent will use her own eggs and donor sperm to implant into a surrogate, so her partner and she are able to have a genetically related child.
- Traditional Surrogacy
In traditional surrogacy, the surrogate mother is the biological parent of the child. Donor sperm and the surrogate’s eggs are used to impregnate the surrogate for the same-sex couple wanting to begin a family. Women who do not have viable eggs and same-sex couples are often interested in this form of surrogacy.
Legal Work and Medical Screening
The surrogate will need to go to All Women’s Care for her medical screening. If you are doing a traditional surrogacy, and the surrogate will use her own eggs, All Women’s Care will walk you through the process of preparing her for egg retrieval to have them fertilized with the donor sperm. This process was explained above in the in vitro fertilization information.
If you are using your eggs and donor sperm for gestational surrogacy, you will need to follow in vitro steps to prepare your body and eggs for retrieval. You will also follow the procedures for in vitro fertilization, except the implantation will be into the surrogate and not you.
Depending on the form of surrogacy you are using, there are legal steps to follow as well as the medical ones. If you are using the traditional form of surrogacy, the surrogate mother will have to sign away parental rights after birth. Check with your lawyer on how this process will be performed. There may include other legal matters to settle between you and your chosen surrogate that will need to be completed. Check with your lawyer and All Women’s Care for the process and whom to contact for help in legal matters.
When it is time, the surrogate will go to the in vitro clinic for an embryo transfer. As a same-sex couple preparing to start a family, you and your partner may want to be present at this milestone, and spend some time with the surrogate.
Once the fertilization is complete, the surrogate will return home. She can choose to visit her personal clinic or continue her care with All Women’s Care.
The pregnancy stage will be the hardest and longest in the process of surrogacy. As the intended parents, you can continue to develop a strong bond with your surrogate as she shares updates on the pregnancy and development of your baby.
Ultrasounds taken during pregnancy are a significantly important piece of the baby’s growth, and you should be part of these to get your first glimpse of your child. The twenty-week ultrasound will be the most significant milestone.
During the pregnancy, you can finish up any legal paperwork that needs to be in place prior to the birth of your child, as well as begin setting up the nursery.
Delivery and Parenthood
The moment the baby arrives, you finally get to meet your child and hold them for the first time. When the doctor medically clears the baby to go home, you and your partner will embark on your dream of having a family.
Same-Sex Couples Having a Family
Families and babies come in all shapes and sizes. No longer does a ‘traditional’ family have to be the only choice for people to become parents. Gay and lesbian couples are now offered numerous opportunities on how they can build their families with the help of fertility treatments. Your dream of having a family can now become a reality for you and your partner. All Women’s Care is here for you when you are ready to begin your journey to parenthood.
Find Fertility Help for Same-Sex Couples Near Me
If you and your partner have decided to become parents, call All Women’s Care to discuss the many options available to help you become a family. Call us today at 213-250-9461 and schedule an appointment to speak to our expert OB-GYN and learn about the different treatments available to you. We provide high-quality and individualized care to women with state-of-the-art technology and are ready to help you achieve parenthood.