With the legalization of same-sex marriage, and the increasing availability of state-of-the-art fertilization techniques, in addition to computerized egg and sperm donor banks, the introduction of babies into same-sex relationships has created a cottage industry to accommodate their needs. Up-to-date information is the key to any successful family plan, with a few basics provided here to get the process started.
For Gay Men:
You may already know that the path to parenthood for gay men requires the involvement of a surrogate or gestational carrier and an egg donor. In this process, you use an egg from a donor and sperm from either male partner or a sperm donor to create an embryo, which is then placed inside the uterus of a gestational carrier to attempt to achieve a pregnancy.
You should begin this process by first checking with your insurance carrier to determine whether or not you need a referral from your primary care physician to see a reproductive endocrinologist (a physician who is specially trained in reproductive medicine).
In Vitro Fertilization
For gay men, family building necessitates the need for In Vitro Fertilization (IVF) with an egg donor and a gestational carrier.
IVF is a process which consists of a series of coordinated steps. First, the egg donor takes a medication (usually birth control pills) that will keep her from ovulating prematurely. She then administers fertility medications in order to maximize the amount of eggs (follicles) that grow that month. The donor will be seen in the office for a series of blood tests and ultrasounds to assess her response and assure that we are stimulating her safely.
Once it is determined by ultrasound that the majority of her follicles are mature, she administers an injection that completes the maturation process and will cause ovulation to occur. The eggs are removed from the ovary via an intravaginal procedure called the “egg retrieval” that is performed in an OR suite of a fertilization specialist. They are then fertilized with sperm and embryos (fertilized eggs) are created and allowed to grow in the laboratory to the blastocyst stage. A blastocyst is an embryo at the stage at which it implants in the uterus, so visualization at this stage, most physicians feel, is important in the embryo selection process.
At this point, the embryos may be frozen if genetic testing is desired or they are replaced as fresh embryos via an intrauterine catheter. If frozen, they will be thawed and then replaced into the uterus of the gestational carrier. After transfer, any remaining, viable blastocysts can be frozen for later use if desired. A pregnancy can be detected 11 to 12 days after the embryo transfer.
Surrogacy
A surrogate is a woman who agrees to help another individual or couple have a baby by achieving a pregnancy using her own egg and carrying a pregnancy to term. A gestational carrier is a woman who performs the same service using an embryo created with another woman’s egg. As a result, while a surrogate has a biological link to the baby, a gestational carrier does not.
In some cases, gay men choose a woman they know to be their carrier. Others are able to find a surrogate mother by using agencies or attorneys that specialize in this service, or even via websites that link prospective parents with women who want to be carriers. In these agreements, the gestational carrier is usually paid a negotiated fee and is also reimbursed for related out of pocket expenses.
Couples and solo parents-to-be have a few options when it comes to choosing a gestational carrier. In some cases, they choose to use a friend or relative as a gestational carrier. Many agencies are also now available to help identify women willing to serve as gestational carriers. Ideally, gestational carriers are women who have had a previous uncomplicated pregnancy and delivery, and who are medically and emotionally healthy as well as financially stable.
There are many important legal issues associated with the use of a surrogate or gestational carrier, and the laws governing these relationships can differ from state to state. As a result, it is very important to work with a knowledgeable attorney when choosing this option. Your attorney will draft contracts, provide legal counsel and coordinate the termination of parental rights for the surrogate or the gestational carrier and egg donor. Egg and sperm donors should also make sure that they understand and address any legal issues associated with their services.
Egg Donors
Gay men have two options when starting a family using the donor egg program. You can use either known or anonymous egg donation. The egg donor program should involve a comprehensive screening process, including medical and psychological evaluation and testing for genetic markers and infectious diseases. Potential donors also should undergo various tests to confirm that they are in good medical health, including a physical exam, as well as laboratory and genetic testing. All egg donor candidates should provide comprehensive details about their medical and family histories and lifestyle habits, which are assessed to determine their suitability and to identify any potential risks for medical or genetic health problems.
A comprehensive list of egg donor agencies is available at https://www.fertilitysourcecompanies.com/egg-donation.
HIV Positive
The Special Program of Assisted Reproduction (SPAR) is the only program in the world that uses highly sensitive PCR tests for HIV in semen to minimize the risk of transmitting the infection to the child or gestational surrogate during assisted reproduction. Testing the semen sample directly is advocated as it has been shown that the amount of HIV virus in a blood sample is not representative of the presence of the virus in the semen sample.
Data collected by this team of researchers has found that approximately two-thirds of semen specimens produced by healthy, HIV infected men have an undetectable amount of HIV virus. Sperm from such specimens are safer for use in assisted reproduction than “washed sperm” from untested specimens, or from specimens that test positive for the virus. Men whose sperm tests negative for the virus can have their sample frozen for later use.
Although there have not been any cases of infection by utilizing this technology, your gestational carrier needs to be thoroughly counseled for the theoretical risk so that she has the information necessary to make an informed decision to proceed with the cycle. Should she decide to proceed, the current SPAR protocol is for her to be tested for HIV antibodies at 3 weeks, 3 months and 6 months following each cycle.
For Lesbians
Lesbians have a considerably easier process to examine when contemplating having a family if one or both of the partners is fertile. Getting started is easy. The first step is to check with your insurance carrier to determine whether you need a referral from your primary care practitioner to seek treatment from a reproductive endocrinologist.
Treatment Options
There are three routes to pregnancy for women: artificial insemination, IVF using their eggs and uterus, or IVF using their partner’s eggs and their uterus. Success rates vary based on individual circumstances. Overall, success rates remain very high for women under the age of 40. However, age is a significant factor for determining your success. A board-certified Reproductive Endocrinologist will help assure you that your pathway to pregnancy is successful, safe and time-efficient.
Artificial Insemination
Artificial insemination (AI) is a process that is used to place sperm into a woman’s reproductive tract using means other than sexual intercourse. The procedure involves concentrating semen into a small volume and placing it into the uterus (intrauterine insemination, or IUI) or the cervix (intracervical insemination, or ICI).
In order to begin artificial insemination, you need to see your primary care physician. Be sure to be up-to-date on all health care maintenance, including Pap smear, and mammogram if recommended. It is important to track your cycle each month as you must also have a regular menstrual cycle to complete a natural cycle insemination with success. This cycle tracking is how insemination is timed.
IVR with One Person’s Egg and Uterus
In-vitro fertilization (IVF) is a process that involves stimulating ovaries to develop multiple eggs. This is achieved with injectable medications. To move forward with IVF, you should see a board-certified Reproductive Endocrinologist. The doctor will complete a panel of pre-pregnancy tests for screening, genetics and infectious diseases. The goal of IVF is to produce a large number of growing follicles, then to retrieve the eggs from inside the follicles through a short surgical procedure performed in the office. The eggs are then inseminated with designated donor sperm in the laboratory to create embryos that can then be transferred to the endometrial cavity (the uterus) of the recipient. To complete IVF using one person’s egg and uterus, the same screening listed above is required to continue with the process.
Over 5 million children have been born from in vitro fertilization. IVF is considered safe for women, and one of the most successful fertility treatment options available. IVF stimulation requires injectable medication, and also a procedure known as an egg retrieval under sedation.
Reciprocal IVF
With reciprocal in vitro fertilization, one woman donates her eggs to her partner, and her partner carries the pregnancy. For female couples this is a way that both can participate in the process of bringing a child into their home. One woman donates the egg and goes through super ovulation with fertility medicines, producing multiple eggs for retrieval. After egg retrieval, eggs are combined with the designated donor sperm in the IVF laboratory. Her partner, who is choosing to become pregnant, goes on medication to prepare her uterus. Then when the timing is optimal, 1-2 embryos are transferred into her uterus.
The embryo transfer should occur on a set day under a controlled condition, with very little discomfort. Success rates with reciprocal IVF vary with the age of the women.
Sperm Donors
For many women, the use of sperm from a donor is an option that can make pregnancy possible. As with egg donation, in some cases women can use a male friend as a sperm donor, or they can use the services of a sperm bank. Once the sperm is available, based on the woman’s health and other factors pregnancy is usually achieved using intracervical, intrauterine or intravaginal insemination. Donor sperm can also be used in an IVF procedure to create an embryo that is then implanted into the woman’s uterus. With IVF women can also have the option of using a donor egg to achieve a pregnancy.
Anonymous sperm donation is regulated by the U.S. Food and Drug Administration (FDA). Anonymous sperm donors are required to be tested for certain infections and may also need to meet other screening criteria. While these same regulations may not apply when a friend serves as a sperm donor, the American Society for Reproductive Medicine (ASRM) recommends that all sperm donors including known donors undergo the same initial and periodic screening and testing process used in anonymous donation.
For Transgender
For transgender individuals considering a transition, it is important to cryopreserve sperm or egg specimens prior to hormonal therapy or surgery. For transgender females, you need to develop a plan that involves using the patient’s own sperm, or donor sperm and eggs, and a gestational carrier. For transgender males, you need to develop a treatment plan that involves use of a patient’s own eggs, or donor eggs and sperm, as well as a gestational carrier.
For a more in depth look at treatment options, check out this recent blog post written by Dr. Leondires on Fertility Preservation for the Transgender Community.
Legal Issues
Some of the legal issues associated with third party reproduction and gay parenting can differ from state to state. By working with an experienced attorney, you can help make sure that your parental rights are protected to the fullest extent of the law in any state where you choose to build your family. You can also make sure that your child’s rights are protected.
Prepared through the cooperation of and facts provided by the Reproductive Medicine Associates of Connecticut
