Lesbian and Gay Family Building Using Assisted Reproductive Technologies (ART)

Samuel Pang, MD  Board Certified Reproductive Endocrinologist and Fertility Specialist

Reproductive Science Center of New England Medical Director and Director, Donor Egg Program

Historically, lesbians who have not had children through prior heterosexual relationships have utilized donor sperm insemination to have children. Similarly, gay men who have not had children through prior heterosexual relationships may adopt children, or create co-parenting arrangements with a lesbian couple or single woman. With the availability of assisted reproductive technologies (ART), more gay and lesbian couples are utilizing ART to have children. Gay men may have genetic offspring by doing in vitro fertilization (IVF) with donor eggs and gestational surrogacy. While most lesbians continue to use alternative insemination with donor sperm to have children, some opt to do reciprocal IVF, where one partner provides the eggs which are inseminated with donor sperm, and the resulting embryo is transferred into the uterus of the other partner who gestates the pregnancy. Reciprocal IVF allows both women in the relationship to be part of the process of having their child(ren) together.

Male couples who want genetic child(ren) can use of the same ART that enable infertile heterosexual couples to have babies. The cost is comparable to adoption. Success depends on many factors, including the health and fertility of those involved in the insemination, pregnancy and birth of the child, but also the skill and experience of the reproductive endocrinologist and embryologist facilitating the reproductive process.

ART options for male couples all involve working with eggs, sperm and embryos outside of the body. The primary procedure for male couples is IVF with Donor Eggs and Gestational Surrogacy. This requires the use of an egg donor and a gestational surrogate.  These roles may be provided by their female relatives or close friends.   If an appropriate family member or close friend is not available to be an egg donor, an anonymous egg donor may be used. These are women who donate their eggs through a fee-based agreement facilitated by an agency. Anonymous egg donors are remunerated for their time, effort, inconvenience and time lost from work. They are not being paid for “selling” their eggs. Recently, another source for donor eggs has become available.  With the ability to successfully freeze unfertilized eggs, using frozen donor eggs from a frozen donor egg bank has become another source for donor eggs.

Ideally, egg donors are healthy women between the ages of 21 – 30 years. All egg donors complete a detailed questionnaire, providing among other information, known familial genetic diseases which will be traced, as extensively as possible for at least two generations. There is, of course, a risk that potential donors may fail to reveal some aspect of their family history. All egg donors are also screened for sexually transmitted infections such as HIV, hepatitis, syphilis, gonorrhea and chlamydia, according to FDA regulations.

If a relative or friend is not participating as a gestational surrogate, male couples will need to engage an agency that screens and facilitates finding gestational surrogates.  Legal contracts need to be drafted between intended parents and gestational surrogates.  Most agencies offer in-house legal counsel. Others contract with an independent attorney who specializes in reproductive law.

Successful pregnancy for lesbian couples through ART also depends on many factors including the health and fertility of the sperm donor, the lesbian partner who is providing her eggs, and the partner who will carry the pregnancy and give birth.

ART options are available for lesbian couples, some of which involve working with sperm, eggs and embryos outside of the body. The primary aspects of family building for lesbian couples are donor sperm, intra-uterine insemination (IUI), IVF and reciprocal IVF.

Women who do not have infertility may conceive through IUI. Ovulation is monitored and, at the appropriate time, donor sperm is injected into the uterus using a small catheter.  Use of fertility medications may or may not be necessary in conjunction with IUI, depending on the individual’s situation.

The concept of reciprocal IVF is that one woman provides the eggs which are inseminated with donor sperm and her spouse or partner carries the pregnancy and gives birth. Taken one step further, after the first baby is born, the two women have the opportunity to switch roles to have their second baby, if that is what they choose to do.  Lesbian couples who do not have infertility may choose reciprocal IVF to build their family. Reciprocal IVF enables both partners in the relationship to be physically involved in the conception of their child and is a very appealing concept to some lesbian couples, but may not be the choice for other couples. There are less expensive and less medically intrusive ways to conceive, so reciprocal IVF is generally chosen by couples who desire the bonding that this experience provides, who can afford the cost of doing reciprocal IVF, and who are willing to undergo the medical procedures which are necessary in order to have their baby this way.

For more information about GLBTQ family building options, please visit www.gayivf.com and join the Facebook community at www.facebook.com/gayivf. To schedule a consultation with Dr. Pang, please call 800.858.4832.

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