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Who Will Carry the Baby in LGBT Family-Building? (Part Three): For Transgenders

By Tracey Minella

April 4th, 2018 at 9:37 am

 

Eggs with symbol of transgender, female and male gender symbols

At Long Island IVF, we take pride in our history of building families for the LGBT community. While gays and lesbians have historically made up the majority of LGBT cases, recent years have brought transgender people and their family-building options into the spotlight.

For the third and final part in this series on “Who Will Carry the Baby in LGBT Family-building?”, we’re going to examine the options that transgender couples and individuals have for starting their families.

In many ways, building a transgender family is very similar to building other families in that many of the same assisted reproductive technologies are utilized, such as in vitro fertilization, egg-freezing, donor sperm and more, depending on the needs of the transgender individual or couple. Yet, in some ways, the transitioning factor of the transgender lifestyle can bring some unique challenges to transgender family-building.

Before diving in to the several different scenarios that transgender individuals and couples who want to build families may face, a basic understanding of some of the methodologies that may be used is necessary.

As we all know, biology requires an egg, a sperm, and a uterus to make a baby. When gay men want a family, they generally have the sperm requirement covered between the two of them, but they need to find an egg donor to donate the egg and a gestational carrier to carry the pregnancy in her uterus for the intended parent(s). When lesbians want a baby, they often have the egg and uterus requirements covered between the two of them but need donor sperm (which is relatively inexpensive to procure).

But when a transgender person wants a child that is genetically-connected to them, things can become a bit more complicated—especially depending on where they are in the transitioning process.

So, it’s imperative that anyone even remotely considering have a baby that’s genetically-tied to them at some point in the future see a reproductive endocrinologist as soon as possible and prior to proceeding with any transitional hormonal treatments. Failure to do so may negatively impact your ability to have a biological child.

When assisted reproductive technology is needed to help people conceive, it often involves either intrauterine insemination (“IUI”) or in vitro fertilization (“IVF”). So, let’s summarize what IUI, IVF, Egg-freezing, and egg donation entail.

For an IUI, at the time of ovulation, sperm is deposited via catheter into the uterus of a woman (who generally took oral or injectable hormonal medications to encourage ovulation of a couple of mature eggs) in the hope that fertilization will occur naturally and a pregnancy will result.

IVF is more involved and expensive than IUI but has a higher statistical success rate per cycle. It involves a woman taking hormonal injections for a couple of weeks to encourage the production of multiple eggs (rather than the one that would normally be produced each month) and being monitored closely through blood work and ultrasounds. Then when the time is right and just prior to them being ovulated, the eggs are retrieved from the ovaries through a fine needle aspiration under light sedation. The eggs are then mixed with sperm in a petri dish and incubate in the lab in the hope fertilization will take place, or in cases where sperm quality is an issue, sperm may be injected into the eggs in a procedure called intracytoplasmic sperm injection (“ICSI”) to assist in fertilization. A few days later, 1-2 resulting embryos are generally transferred vaginally via catheter into the uterus in the hope of implantation and a resulting healthy pregnancy. The unused embryos are often frozen, or cryopreserved, for future use. Sometimes, no embryos are transferred back in the fresh cycle and all are frozen for use in a future cycle.

When women undergo egg-freezing, the procedure is identical to IVF described above except that after the retrieval, mature eggs are frozen prior to being fertilized and no transfer takes place in that cycle. At some future date, the eggs can be thawed as needed and fertilized in the lab, then resulting embryos can be transferred to the woman’s uterus (or another woman’s uterus, if need be) in the hope a pregnancy will occur.

When a woman is an egg donor, she, too undergoes the procedure identical to IVF described above except that after the retrieval, her participation is over and all of the eggs are turned over to the parties who are the intended recipients for freezing and/or fertilization in accordance with their agreement.

Now that the procedures have been explained, let’s examine how transgender individuals and couples can take advantage of the available technologies. Again, we stress the need to see a reproductive endocrinologist before transitioning and beginning hormonal treatment.

We’ve broken the options down by the gender the person was biologically born into and the gender they are attracted to, so readers can skip ahead to which of the four sections best applies to them.

  1. Born female but identifies as male–Attracted to females:

If you were born female but identify as male and are attracted to females and you want to have a genetically-linked baby someday, you will need to use the eggs you were born with to make that connection. You may or may not want to also use the uterus you were born with, but the genetic connection comes from the eggs, not the uterus. Usually, those females who identify as male are not interested in carrying a pregnancy before transitioning.

Here are your options:

  • Have an IUI using donor sperm (provided you have no egg, uterine, or tubal issues) and carry the baby yourself before transitioning;
  • Have IVF using donor sperm (provided you have no egg or uterine issues) and carry the baby yourself before transitioning;
  • Have IVF using donor sperm before transitioning (provided you have no egg issues) and freeze all the embryos for future use. They can be transferred to your uterus or a partner’s uterus before transitioning or to a partner’s uterus after transitioning.
  • Have your eggs frozen for future use (provided you have no egg issues). They can be thawed and fertilized with donor sperm as needed and transferred to your uterus or a partner’s uterus before transitioning or to a partner’s uterus after transitioning.

Many of these transgender couples find that using the eggs of the partner born female who identifies as male and having them transferred to the uterus of the partner who was born female and identifies as such allows both partners to be invested in the pregnancy—one provides the egg and the other carries the pregnancy and is the birth mother. In fact, many lesbians elect to do something similar and have one partner carry the pregnancy using the eggs of the other partner for the same reason.

 

  1. Born female but identifies as male–Attracted to males:

If you were born female but identify as male and are attracted to males and you want to have a biological child someday, you will also need to use the eggs you were born with to make that connection. You may or may not want to also use the uterus you were born with, but the genetic connection comes from the eggs, not the uterus. Again, many females who identify as males are not often interested in carrying a pregnancy prior to transitioning.

If your goal is transitioning to male and partnering with a male, your family-building options would be very similar to those of a gay couple. However, you have a potentially-huge advantage in being able to use your own eggs and possibly your own uterus if desired.

Here are your options:

  • Have an IUI using donor or a partner’s sperm (provided you have no egg, uterine, or tubal issues) and carry the baby yourself before transitioning;
  • Have IVF using donor or a partner’s sperm (provided you have no egg or uterine issues) and carry the baby yourself before transitioning;
  • Have IVF using donor or partner’s sperm before transitioning (provided you have no egg issues) and freeze all the embryos for future use. They can be transferred to your uterus or a gestational carrier’s uterus before transitioning or to a gestational carrier’s uterus before or after transitioning;
  • Have your eggs frozen for future use (provided you have no egg issues). They can be thawed and fertilized with donor or a partner’s sperm as needed and transferred to your uterus or a gestational carrier’s uterus before transitioning or to a gestational carrier’s uterus after transitioning.

Many of these transgender couples find that using the eggs of the partner born female who identifies as male and having them fertilized with the sperm of the partner who was born male and identifies as such and then transferring them to the uterus of a gestational carrier not only saves them the expense of an egg donor but allows them both to have a biological connection to the baby. Before hormonal treatment/transitioning occurs, it is possible the partner with the uterus may even be able to carry the pregnancy, though most don’t pursue that option. One of the biggest obstacles to gay family-building is the cost of an egg donor and a gestational carrier. These transgender couples may be able to build their families without incurring one or both of those costs.

  1. Born male but identifies as female–Attracted to females:

If you were born male but identify as female and are attracted to females and you want to have a biological child someday, you will need to use your sperm to make that connection. As much as transition surgery can do for one who identifies as a female, it unfortunately cannot create a functional uterus in which a baby can be carried (at this time, anyway). But the genetic connection to your baby comes from the use of your sperm.

If your goal is transitioning to female and partnering with a female, your family-building options would be very similar to those of a lesbian couple. However, you have the wonderful possible advantage of being able to use your own sperm to create a baby.

Here are your options:

  • Have your sperm frozen for future use in IUI and/or IVF procedures before transitioning or beginning hormonal treatment! Multiple times. Samples can be thawed and used to fertilize your partner’s eggs via IUI or IVF as indicated (or an egg donor’s eggs via IVF, if needed) and transferred to your partner’s uterus (or a gestational carrier’s uterus if needed). You may need to undergo IVF with your partner if you have a sperm issue which ICSI (described above) may overcome.
  • Have your partner do an IUI using your sperm (provided she has no egg, uterine, or tubal issues and your sperm is of acceptable quality);
  • Have your partner do IVF using your sperm (provided she has no egg or uterine issues and use ICSI if sperm quality is an issue);
  • Have your partner do IVF using your sperm (provided she has no egg issues) and freeze all the embryos for future use. They can be transferred to a gestational carrier’s uterus if your partner has uterine issues;
  • Have IVF with donor egg using your sperm if your partner has egg issues and freeze the embryos for future use. They can be transferred into your partner’s uterus (if no uterine issues) or a gestational carrier’s uterus.

Many of these transgender couples find that using the sperm of the partner born male who identifies as female to fertilize the eggs of the partner who was born female and identifies as such either through IUI or IVF allows them both to have a biological connection to the baby. As long as the one partner’s eggs and uterus are fine, and the other partner’s sperm is fine, IUI or IVF could be the pathway to parenthood without the need for sperm or egg donors or a gestational carrier.

 

  1. Born male but identifies as female–Attracted to males:

If you were born male but identify as female and are attracted to males and you want to have a biological child someday, you only have your sperm to use to make that genetic connection. At least until science makes a uterine transplant possible in a transgender individual. But the genetic connection to your baby comes from the use of your sperm.

If your goal is transitioning to female and partnering with a male, your family-building options would be very similar to those of a gay couple. You have presumably got the sperm issue covered between the two of you but need both an egg donor and a gestational carrier in order to have a baby.

Here are your options:

  • Freeze your sperm before beginning hormonal treatment or transitioning! Multiple times. Multiple vials. It’s relatively inexpensive, especially in comparison to egg-freezing. There is virtually no reason not to do this for security– you can’t change your mind later. If an analysis determines your sperm has some issues (i.e. factors like its volume, shape, speed), ask your doctor if you should freeze even more. As discussed earlier, if you have a sperm issue ICSI (see above) during IVF may overcome it.
  • Have IVF using your sperm from before transitioning and using an egg donor and a gestational carrier. Your egg donor can be anonymous or known to you. She will undergo IVF (as previously explained above) but at the point of the egg retrieval, she turns the eggs over to you and she’s done. The eggs are then mixed with your sperm and/or your partner’s sperm for fertilization. After fertilization, the resulting embryos are frozen, to be implanted in the uterus of a gestational carrier. A gestational carrier is a woman (one different than the egg donor) who agrees to carry the baby for you, the intended parent(s). At the birth, the baby is turned over to you pursuant to your contract.

Many of these transgender couples find that using the sperm of both the partner that was born male who identifies as female and also the sperm of the partner born male who identifies as such to fertilize the eggs of the egg donor allows them both to potentially have a biological connection to their babies, though not currently both being connected to a single baby at the same time. For example, embryos fertilized by one partner’s sperm might be transferred into a gestational carrier first and then in a later pregnancy attempt, embryos fertilized with the other partner’s sperm are transferred. If successful, this gives each dad a biological connection to the child fathered with their sperm.

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Fortunately, there are donor programs at Long Island IVF to help transgender, homosexual and heterosexual folks with any donor egg, donor sperm, or egg donor needs.

Whether you are a gay man, lesbian, or transgender—single or married—if you are interested in family-building, Long Island IVF has decades of experience helping the community become parents.  Please contact us today for more information or to schedule an initial consultation. In addition, follow us on social media for info on our many free upcoming events.

We are proud to partner with the LGBT Network to provide the community with information, education, support, and access to the most advanced traditional and holistic assisted reproductive technologies. We also understand, respect, and are sensitive to the unique needs of the LGBT community when it comes to building its families.

This year, Long Island IVF is celebrating a milestone–our 30th anniversary. If you are ready for parenthood, we would love the opportunity to assist you with your own milestone.

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Important Infertility Insurance Coverage Issues for the LGBT Community in New York

By Tracey Minella

June 22nd, 2017 at 8:31 am

From Stonewall to date, the LGBT community has always had to fight for rights equal to those of the heterosexual community, often in an atmosphere of “us against them”. Persistence has always paid off…eventually. As we’ve seen from winning battles on openly serving in the military with the repeal of “Don’t ask. Don’t tell” and the legalization of same-sex marriage (#LoveWins), we can move mountains as a community united.

 

The latest major gay rights fight involves insurance coverage for infertility treatment in New York.

 

The subject of mandated infertility insurance coverage in New York State has been in the news lately, but before addressing an important pending bill that could positively impact the infertility insurance rights of all New Yorkers– heterosexual and non-heterosexual– we must examine and understand the existing obstacles to LGBT infertility treatment coverage.

 

Currently, New York State has a mandate which requires coverage for infertility treatments. It’s one of only 15 states to do so, which sounds promising, but it’s not. With so many existing definitions, restrictions, qualifications, and loopholes, the mandate in its current form does very little to benefit New York’s infertile heterosexual couples– and does even less for non-heterosexual couples or single women who need advanced reproductive technologies in order to start their families.

 

Some of the major problems with the current New York State infertility coverage mandate include:

 

  • It does not cover in vitro fertilization (“IVF”), but only applies to intrauterine inseminations (“IUIs) and other low-level/less successful infertility treatments, which are also riskier in terms of causing a multiple pregnancy (twins, triplets, etc.);
  • Small group employers can opt out of having to provide this coverage;
  • Insurance carriers may impose certain restrictions and rules that impact the employees’ ability to access the benefits.

 

Some insurance carriers that do offer IVF require both heterosexual and non-heterosexual couples to undergo 6-12 unsuccessful IUI cycles before moving on to IVF treatment (6 IUIs if the woman is over 35, or 12 IUIs if under 35, though some require less).

 

In addition to the above multiple-failed-IUIs prerequisite for IVF coverage, the employee must satisfy the insurance carrier’s definition of “infertility”. “Insurance companies define ‘infertility’ as the inability to conceive after one year of frequent, unprotected heterosexual intercourse, or six months if patient is over the age of 35”.

 

Applying this definition to heterosexual couples merely costs them 6-12 months of time before moving onto IVF treatment—provided they can somehow prove they’re doing it often enough and without protection. And while up to a year of time wasted really is a big deal to all infertile folks, the impact on non-heterosexuals and single women is far worse.

 

When applying this definition to a same-sex couple or a single woman, they not only lose valuable time, but they also lose money that a heterosexual couple would not. Because for same-sex couples or single women to meet the current definition of “infertility”, they would have to undergo six or 12 months of IUI with donor sperm treatments — in many cases, at their own expense –just to prove their infertility so that they could qualify for covered infertility treatments.

 

This issue was thrust into public view when two lesbian couples in New Jersey filed a federal lawsuit alleging that the language of the New Jersey insurance mandate “discriminates based on sex and sexual orientation”.

 

There is also disparity among insurance companies with respect to requiring authorizations for IUIs, requiring IUIs with donor sperm prior to approving infertility treatment, and coverage for the cost of donor sperm or thawing the sperm. In addition, companies offer different levels of coverage, which may be dependent upon copayments, deductibles and other restrictions on certain services like embryo cryopreservation, embryo storage, Pre-implantation Genetic Diagnosis or Pre-implantation Genetic Screening (“PGD” or “PGS”) of embryos, and more. To further complicate matters, even within the same insurance company, there are different individual plans that are chosen by the employer which provide different benefits coverage and different qualifications or benefits structure.

 

That’s why Long Island IVF assigns each patient a personal financial counselor to help guide them through the complicated insurance process to maximize any benefits to which they may be entitled.

 

Despite the obstacles that currently exist, there is good news to report and even more promising change on the horizon.

 

As a result of New York Governor Cuomo’s mandate to New York State insurance companies, they may no longer exclude same-sex prospective parents or single prospective parents from infertility coverage. While this is a victory, the sticking point for true reform and open access to appropriate infertility coverage for both heterosexual and non-heterosexual patients requires a redefinition of “infertility” and direct access to IVF.

 

There have already been noticeable changes in policies and the provision of coverage for IUIs with donor sperm in same-sex couples, presumably collectively-driven by Gov. Cuomo’s mandate, along with the New Jersey lawsuit, and forward-thinking, large-scale employers like Facebook and Google now offering high-end infertility insurance coverage for egg-freezing services. But the bottom line is that until a patient meets the “infertility” definition, they still have to self-pay.

 

That’s why we need the definition of ‘infertility’ to change. And we need access to IVF, which is the more successful treatment in terms of a singleton birth outcome.

 

And it is within our grasp right now.

 

As this article is being written, a bill that would revolutionize the infertility insurance law in New York for the benefit of heterosexuals, same-sex couples, and single women is awaiting consideration by the Senate after having passed in the Assembly this week.

 

The Senate Bill S.3148A known as the “Fair Access to Fertility Treatment Act”, or (“FAFTA”), if enacted, would not only mandate coverage for IVF treatment, but it would change the application of the definition of “infertility” to:

 

“a disease or condition characterized by the incapacity to impregnate another person or to conceive, as diagnosed or determined (I) by a physician licensed to practice medicine in this state, or (II) by the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse in the case of a female 35 years of age or older.”

 

According to Long Island IVF co-founder and reproductive endocrinologist, Dr. Daniel Kenigsberg, who has been advocating for the passage of the FAFTA bill, “the current mandate’s specific exclusion of coverage for IVF has resulted in much emotional and financial cost spent on inferior or inappropriate treatments which ARE covered by the mandate when, for over 50% of infertile couples, IVF was the best or only treatment.” He further notes that “IVF is far safer in terms of reducing multiple pregnancy risk than less successful and often inferior treatments like ovulation induction and intrauterine insemination (IUI). There has been waste and needless sacrifice for insured couples denied IVF.”

 

It is time for both the heterosexual and the LGBT communities to get active and push our respective representatives to pass this legislation. You can find your local senator here or can access their phone number here. Armed with Senate Bill number S. 3148A, a simple phone call expressing your support of the bill may make all the difference. It takes less than one minute to help support this latest gay rights fight for fair access to appropriate infertility treatment and insurance coverage. Do it now.

 

There has never been a better time for non-heterosexuals to fulfill their dream of parenthood. If you would like more information on the many available LGBT family-building options, we encourage you to join Long Island IVF and our partner, The LGBT Network, on June 29, 2017 for a special free seminar entitled “Building Families in the LGBT Community”. Pre-register here.

 

This progressive legislation not only opens the door to IVF access for all, but it changes the definition of infertility to one that encompasses everyone, regardless of sex or sexual orientation. Instead of “us against them” it’s “one for all”. Its passage would put everybody suffering from the disease of infertility one giant step closer to our common dream of parenthood– and maybe, just maybe, a step closer to us all being one united community.

 

 

 

 

 

 

 

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Balancing Breast Cancer and Fertility Preservation

By Steven Brenner MD

October 9th, 2016 at 5:22 pm

 

Dr. Steven Brenner


A diagnosis of breast cancer is one of the most challenging health issues a person could face.  This diagnosis is even more devastating to the woman who desires to have children the future.  Treatments for the breast cancer may have harmful effects on the woman’s ability to conceive by adversely affecting the health of her eggs.  In addition, the hormonal treatments frequently used to help an individual conceive have the potential to worsen the breast cancer.

There is often turmoil surrounding the diagnosis of breast cancer.  The individual, her family and physicians are appropriately focused on getting rapid effective treatment and survival.  The issue of fertility may not be thought of until a chemotherapeutic plan is just about to start or has already been initiated.

Since there are fertility preserving options for the individuals facing breast cancer treatment, these options should be considered.  If time allows eggs or embryos may be frozen for future use.  The use of such procedures depends on many factors, primarily, will such treatment have a negative effect on the woman’s disease.  If in the patient’s and oncologist’s judgment fertility preservation is an option it should occur rapidly to allow for the timely treatment of the breast cancer.

The key is for the oncologist and patient to be aware and discuss the potential for fertility conservation treatment prior to the start of chemotherapy.  This opportunity for discussion may be lost in the unrest that surrounds the diagnosis.  Breast cancer awareness month, October, 2016, creates a platform to raise these issues and help both individuals and health care providers come more cognizant of available treatments and the importance of timing these treatments to maximize future fertility.

Long Island IVF offers women facing cancer the fertility preservation options of elective embryo- or egg-freezing prior to undergoing chemotherapy. This enables the woman to safeguard some of her eggs from the adverse effects of chemotherapy by retrieving and freezing them before she begins her cancer treatment. Her frozen eggs or embryos will be there for her use in family-building once her cancer battle is behind her. For more information, please contact our office at 877-838-BABY.

 

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Would you consider fertility preservation or mention the option to a friend facing a cancer diagnosis?

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