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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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Don’t Miss Long Island IVF’s Free Donor Egg Seminar

By Tracey Minella

March 19th, 2018 at 12:13 pm

Let’s face it. Having a baby using donor eggs is just not most people’s first choice. The vast majority of women understandably want a baby with a genetic connection to both them and their partner. So, it can be hard to get past the fear that a donor egg baby may not feel like it’s really yours. And there are so many questions about the process itself and what life is like afterwards. Questions only a mom who used donor eggs can really answer.

That’s why if you are considering using an egg donor to start your family, you should come to Long Island IVF’s free “New Beginnings Through Donor Egg” seminar tomorrow night, March 20, 2018 at our Melville office, from 7:00-9:30 pm. Pre-register here now. You will not only meet our compassionate and experienced Donor Egg Team, but you’ll get to meet one of our many successful and happy donor egg recipient moms. Bring your partner or a friend or come alone. We’re waiting to meet you.

One of our recipient moms is going to share her story of how she was able to become a mom because of our donor egg program. She’s going to tell you the challenges she faced, how she came to accept the idea of using an egg donor, and what life is like now that she is a mother.

She’s going to answer all those questions you have right now, because it wasn’t so long ago that she was in your shoes and had the very same questions and concerns.

We understand that if you are considering donor eggs, you are likely at a difficult crossroads in your fertility journey–one that was likely arrived at after a long, hard road of treatments and sometimes devastating losses. You’re probably on the fence. A bit hesitant.

Come down and get those questions answered, even if you think you aren’t ready to act on the information just yet. Hear a success story. Learn if using young, healthy eggs might be the missing piece for your IVF success. Get educated and empowered about this powerful family-building option.

Women whose eggs have been compromised by advanced age, premature ovarian failure, failed IVF treatment, cancer, or poor egg quality should consider donor egg therapy. Decades of happy moms agree that using donor eggs was the best decision they ever made and many wish they’d come around to the idea sooner. In addition, gay men wanting biological children also need the help of an egg donor.

Victoria Loveland, RN & Donor Egg Nursing Coordinator, Aviva Zigelman, LCSW & Donor Egg Program Director, and Long Island IVF partner and reproductive endocrinologist Steven Brenner, MD will all be there to answer your questions. You can even speak to them privately if you’re more comfortable.

Long Island IVF offers several different egg donation options, including:

  • Sole Recipient Fresh Egg Donation,
  • Shared Recipient Fresh Egg Donation, and
  • Frozen Egg Donation.

Each option offers its own unique benefits, costs, and other considerations. We have young, healthy, pre-screened, anonymous egg donors representing multiple ethnicities ready to help build your family. Or you can use a known donor if you prefer.

This seminar is generally intimate, low-key and not overly-crowded.

Location: Long Island IVF 8 Corporate Center Drive, Suite 101, Melville, NY

Date: Tuesday March 20, 2018

Time: 7:00 pm- 9:30 pm

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Will you be there? If you’d like to attend but can’t, please call anyway and ask for Vicky Loveland, so we can make other arrangements to help you.

 

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Groundhog’s Day–The Infertility Movie

By Tracey Minella

February 2nd, 2018 at 2:04 pm

image: wpclipart.com

Groundhog’s Day for infertility patients is about more than just pulling a sleeping rodent out of a hole to find out the forecast. Infertility patients relate more to Groundhog’s Day, the Movie. Remember how Bill Murray’s character was trapped reliving Groundhog’s Day all over again? Every. Single. Day? And how he desperately tried to tweak things each day in order change the outcome and finally get the thing he wanted that was always just out of his reach?

Well, that’s essentially the life of the infertility patient on their journey—especially if the baby quest is dragging out like a long, dreary winter with no hope of spring in sight. Day after day of blood work, ultrasounds, injections that blend into each other. And a frustrating hell of repetitive negative pee sticks month after disappointing month.

So, if you need extra support, Long Island IVF offers it. Our innovative Mind-Body Program, which includes group and individual counseling, may help you cope.

Or register here and come down for our free “Rekindling the Romance in the Face of Infertility” workshop on February 8th. All are welcome—no need to be a patient.

Here on Long Island for the second straight year, two local groundhogs can’t seem to agree on whether we’re going to have to suffer through more ugliness or be blessed with an early spring.

So, what do we do?

We have faith that the outcome we wish for is going to be the one we actually get. And we look forward to the morning when we will wake up from this difficult repetitiveness to a new day where the shadow of infertility is no longer in sight.

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Who Will Carry the Baby in LGBT Family-Building? (Part One): For Gay Men

By Tracey Minella

January 26th, 2018 at 3:58 pm

In family-building for heterosexual couples, this is not generally a question. But in LGBT family-building, single gay men or gay couples who want a baby that shares a genetic connection with them, the first question to answer is: Who will carry the baby?

Except in cases where a single gay man or both partners in a gay couple have male factor infertility, sperm is usually readily available for baby-making purposes. But the need for a woman’s egg– as well as a uterus in which the baby will grow– is obvious. Fortunately, there are donor programs at Long Island IVF.

In general, and depending on where they live, gay men can choose either a surrogate OR an egg donor and gestational carrier to carry the baby. Both of these options involve another woman carrying the pregnancy for the single gay man or gay couple as intended parent(s), so it helps to understand the difference, even though surrogacy is not legal in New York State.

In a surrogacy arrangement, the woman surrogate uses her own egg to become pregnant with the gay intended parent father’s sperm. Just to be clear –and to the relief of all involved –the pair does not have sexual relations to establish the pregnancy. Instead, a semen specimen is collected from the gay man who intends to be the biological father, and it’s processed and frozen in advance. The surrogate will be monitored for ovulation (when the egg is released from the ovary and the limited window for conception begins). At that time, in a fast and simple office visit, the father’s specimen is thawed and deposited into her uterus via a thin catheter– through a procedure called an intrauterine insemination, or (“IUI”).

If the IUI is successful, the surrogate carries the pregnancy to term, and gives the newborn to the gay father(s) upon birth, thereafter relinquishing her parental rights (in the manner dictated by that particular state’s laws). The newborn is genetically-linked to both the surrogate birth mother and the gay father. Again, this is not an option in New York.

Those of a certain age may remember the infamous New Jersey “Baby M” case of the mid-80s, which thrust the validity of surrogacy agreements into the national limelight. The birth mother, who was genetically-connected to the baby, changed her mind and wanted to keep the baby instead of turning her over to the biological father and his wife, who were the intended parents pursuant to a surrogacy contract.

A long legal battle ensued, and in a nutshell, the court ruled that the paid surrogacy agreement was invalid and against public policy, and that the birth mother and the biological father were the baby’s legal parents. Further, the case was remanded to Family Court for a judge to decide which parent would be awarded legal custody of the baby, using the “best interests of the child” standard that’s used in regular child custody cases. Custody was given to the father, but the mother was awarded visitation rights. *

Times have changed.

While surrogacy in some form is legal in some states, the advancements in reproductive medicine that followed in the decades since Baby M have now made the use of gestational carriers and donor eggs not only medically possible and popular, but also often the only legal way to have someone carry a baby for you.

Gestational carrier with donor egg is the alternative option to surrogacy for a gay man or gay couple to have a genetically-linked baby and it’s the only legal option in New York State. It involves finding two different women to help you– an egg donor and a gestational carrier. That’s how it’s different from surrogacy.

First, the egg donor only provides the eggs, not the uterus. She could be someone you know (like a sister or friend) or could be an anonymous donor who you select after reviewing an extensive profile of donor egg candidates. At Long Island IVF, we have pre-screened donor egg candidates ready to help you build your family.

Lady #2 is the gestational carrier. She only provides the uterus, not the eggs. She can be someone you know, or someone you don’t yet know but who you select through an agency. In most cases, you will get to know and develop a relationship with the gestational carrier.

With the gestational carrier and donor eggs option, the woman chosen to be the egg donor undergoes what is essentially an in vitro fertilization or (“IVF”) procedure up to the point of the egg retrieval. That means she will receive hormonal injections, bloodwork, and ultrasound monitoring of her ovaries (and the developing follicles/eggs inside them) over a period of a few weeks. The purpose of the treatment is for her to produce multiple egg-containing follicles rather than the one egg she would normally produce that month.

When the time is right, the eggs are retrieved prior to ovulation by a reproductive endocrinologist using a transvaginal needle aspiration procedure and injected with the sperm from the gay man (or men) intended parent(s) in the hope that fertilization occurs.

placed in a petri dish with sperm from the gay man (or men) intended parent(s) in the hope that fertilization occurs.

The resulting fertilized eggs, now known as embryos, will be frozen (a/k/a cryopreserved) until such time as they are ready to be thawed and transferred into the waiting uterus of the chosen gestational carrier. [Note that if pre-genetic screening (“PGS”) is elected, it is done prior to the freezing of the embryos.]

The thawed embryos—generally one or two– are placed into the gestational carrier’s uterus through a thin catheter in a fast and simple procedure performed by the reproductive endocrinologist, aptly called “the transfer”. The intention is for an embryo to implant in the uterine wall and a healthy pregnancy to result. If the gestational carrier gets pregnant, she turns the baby –who unlike in surrogacy has no genetic connection to her – –over to the gay man (or men) who is the intended parent(s).

In accordance with applicable state laws, these women are generally well-compensated for their time and effort. Because of the need for gay men to involve two different women in the process, costs are higher than what lesbians and straight couples using assisted reproductive technology typically incur. However, the good news is that a single egg donor cycle may produce enough eggs that gay male intended parents may be able to build their families through more than one pregnancy using just the eggs retrieved from that initial cycle. So, future pregnancy attempts would require the compensating the gestational carrier, but not the egg donor.

Here is how that could work: They might transfer 1-2 embryos into the gestational carrier on the first try (leaving the rest frozen), and if successful, they have a baby (or two). Then maybe a year or more later, they transfer another 1-2 embryos into the same (or another) gestational carrier, and if successful, they have another baby (or two). And so on, until all the embryos are used or they no longer want to use the embryos for additional children.

While there would be the expense of the gestational carrier for each birth (as well as for the medical treatment expenses for the gestational carrier to undergo a frozen cycle), there would be no additional egg donor costs– until you exhausted your supply of embryos from the first egg donor. As exciting and promising as this process is, each case is different and no program can guarantee a baby in the end for any couple. That said, we do have patients who have successfully used embryos retrieved from a single IVF cycle to build their multi-children families—a child at a time—in separate births spaced a few years apart.  So, there is reason to consider this wonderful family-building option that wasn’t available—especially to gay men—all that long ago.

[The second part on this topic on who will carry the baby—for lesbian singles and couples—will be posted next month.]

If you are a gay man or lesbian—single or married– 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.

 

*Source: https://en.wikipedia.org/wiki/Baby_M

 

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