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

By Tracey Minella

February 28th, 2018 at 12:25 pm

 

image: shutterstock

At Long Island IVF, we take pride in building families for the LGBT community. And the first question in LGBT family-building is the same whether you are a single gay man, a gay couple, a lesbian couple, or a single lesbian: Who will carry the baby?

Don’t jump to the seemingly obvious conclusion that a single woman or a lesbian couple necessarily has a uterus—or two—that would be suitable for carrying a pregnancy. Things are not always that simple. That’s why if the idea of having a baby now or someday is something you’re considering, it might be wise to see a reproductive endocrinologist for a baseline fertility evaluation now to catch any “red flags” that could compromise your fertility.

One (or both females) may have uterine or other medical issues that either prohibit her or them from carrying a pregnancy or would make attempting to do so unsafe or unadvisable. In addition, there may be non-medical factors that make a woman an uninterested, unwilling, or otherwise a poor candidate for baby-carrying. When that happens, a gestational carrier would be needed to carry the baby for the intended parent(s). That’s assuming there are healthy eggs.

In addition to a uterus in which to carry the pregnancy, the single woman or lesbian couple needs to produce healthy eggs. Again, it may be easy to assume that a woman—or especially two women—would have that requirement covered. And they generally do. But if premature ovarian failure, poor egg-quality, or another medical condition precludes the use of the intended parent’s eggs, an egg donor may be required.

In the vast majority of cases, a lesbian couple will not need a gestational carrier to overcome uterine issues. And, depending on their age, most lesbian couples won’t need an egg donor. The availability of two female reproductive systems instead of one basically gives lesbian couples a second chance at overcoming many fertility obstacles one might face. But there is one thing all lesbians do need for family-building.

Lesbians have the obvious need for donor sperm. Fortunately, obtaining that missing biological piece is far easier and cheaper for them than obtaining donor eggs is for their gay male friends. Pre-screened donor sperm is readily available and relatively inexpensive. A single woman or lesbian couple generally selects an anonymous donor after reviewing the profiles of available sperm donors. Frozen specimens from the sperm donor would be shipped to the reproductive endocrinologist’s lab so they may be thawed and used at the time they are needed for conception.

Although sperm donation from a known individual or friend is possible, that option comes with additional complexities related to medical pre-screening, a mandated quarantine period and re-testing period as well as psycho-social and legal considerations, which need to be considered. These additional elements may complicate as well as add time to the process.

In many cases, where no tubal or other fertility issues have been identified, the partner wishing to carry the pregnancy –or the partner who wants to carry a pregnancy first–would be monitored for ovulation and, at that time, inseminated with the donor sperm through an intrauterine insemination (“IUI”).

Here’s how an intrauterine insemination (“IUI”) works: The woman who wants to carry the baby is carefully monitored through blood work and ultrasounds to determine when she is ready to ovulate and her insemination is scheduled to coincide with ovulation. She can do a natural cycle, without added hormones, or she can do a medicated cycle in which oral or injectable hormones are added to the protocol. For the IUI, the donor’s specimen is thawed and deposited into the woman’s uterus via a thin, flexible catheter during a fast and simple office visit at the time of ovulation.

Through careful monitoring and minimal or no ovarian stimulation, the risk of a high-order multiple pregnancy in IUI can generally be reduced but not eliminated. Since the egg(s) remain inside the woman’s body in IUI and are therefore capable of being ovulated (rather than being retrieved from the body as in IVF), there may be a greater chance for multiple eggs becoming fertilized and multiple pregnancies implanting with an IUI than there is in the more-controlled IVF procedure.

If the lesbian partner (or the single woman) who wants to carry the pregnancy doesn’t become pregnant after a few IUI cycles, she might want to consider undergoing in vitro fertilization (“IVF”) — or in the case of a lesbian couple they might decide that the other partner will carry the pregnancy instead. In the event neither partner is willing or able to conceive or maintain a pregnancy for health or other reasons, the lesbian couple or single woman would still have the option of using donor eggs and/or a gestational carrier as mentioned above.

Here’s how IVF typically works for lesbians: The woman whose eggs are being used to create the baby will receive hormonal injections, blood work, and ultrasound monitoring over a period of weeks that is designed for her to produce multiple egg-containing follicles rather than the one egg she would generally produce naturally each month. When the time is right based on close monitoring, the eggs are retrieved by the reproductive endocrinologist transvaginally–using a needle aspiration procedure–and combined with the donor sperm in the hope that fertilization occurs. If it does, generally one or two embryos will later be transferred back into the woman’s uterus in the hope of a pregnancy implanting and developing. In IVF, the hope is to produce many more eggs than in IUI because they are being retrieved instead of ovulated. The excess embryos can be frozen for future use. Sometimes, enough eggs can be retrieved in a single IVF cycle to create a couple’s entire family—which can be built over time through successive pregnancies.

Sometimes, one partner in a lesbian couple will become pregnant first and then the other will follow. Sometimes only one partner may want to carry all of the couple’s pregnancies. Other times, both may attempt pregnancy at the same time.

But there is another exciting family-building option for lesbian couples that is rapidly gaining popularity: reciprocal IVF.

Because reciprocal IVF involves one of the women in a lesbian couple undergoing IVF, it is a more expensive treatment option than a relatively simple IUI cycle, but it’s increasingly popular because it allows both partners to be involved in the creation, pregnancy, and birth of the baby.

This is how reciprocal IVF works: One partner undergoes a typical IVF cycle, including routine hormonal injections, blood work, ultrasound monitoring, and the egg retrieval. Those eggs would be fertilized using donor sperm. Now, here is the twist: After fertilization, instead of the resulting embryos being transferred into the partner the eggs were retrieved from, they get transferred into the uterus of the other partner. If the embryo implants and a pregnancy occurs, one partner is the genetic mother of the baby growing inside the uterus of the other partner who gets to carry the pregnancy and experience childbirth!

If you are interested in LGBT 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.

We are proud to partner with the LGBT Network to provide information, education, support, and access to the most advanced traditional and holistic assisted reproductive technologies. All while understanding, respecting, and being sensitive to the unique needs of the LGBT community.

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. Please follow us on Facebook or Twitter for info on our upcoming free events.

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