The Fertility Issues Same-Sex Couples Face When Trying to Conceive

Starting a family is a big step for everyone, but having a child is more difficult when both partners are of the same sex. When a couple is gay or lesbian, they are missing at least one essential piece of the conception puzzle.

“To conceive, you need a sperm, an egg and a uterus,” says Amanda Adeleye, MD, assistant professor of obstetrics and gynecology and reproductive endocrinologist at the University of Chicago Medicine. In the absence of any of these, couples need help – often a fertility clinic.

A gay couple’s journey to pregnancy

Same-sex couples start with semen, which either partner can bring. What they’re missing is an egg and a uterus, which usually don’t come from the same woman. “The general consensus is that it is unethical to do this, and it poses too many potential problems for the couple because the infant carries the woman’s genetic material,” says Jennifer L. Eaton, MD, director of the Division of Reproductive Endocrinology and Infertility. at Women & Infants Hospital and Warren Alpert Medical School at Brown University in Providence, RI.

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Instead, most same-sex couples use a donor egg and a gestational carrier, or surrogate, who could be a friend, family member, or woman the couple finds through a agency. Mark Leondires, MD, and her husband had two different surrogates, one for each of their two children.

Gestational carriers must undergo a “rigorous screening process,” says Leondires, who is also the founder and medical director of Reproductive Medicine Associates of Connecticut (RMACT). There is a battery of tests to make sure that her uterus is healthy enough to carry a pregnancy, that she does not have an infectious disease, and that she is emotionally ready to undergo the process.

The ideal gestational carrier should be between the ages of 21 and 45, in good health, and have had at least one child of their own. That last part is important, says Eaton. “We know they are capable of carrying a pregnancy to term and that they have already had a healthy baby.” She adds, “Studies have shown that women who have given birth to their own children are less likely to feel an attachment to the baby they are carrying for someone else.”

The couple also choose donor eggs, which usually arrive frozen from an egg bank. The eggs are thawed, fertilized with sperm through in vitro fertilization (IVF), cultured in the laboratory, and then transferred to the uterus of the gestational carrier.

A lesbian couple’s journey to pregnancy

Female couples enter the process with eggs and a uterus, but they have an important decision to make. Who will carry the pregnancy and who will provide the egg? The answer comes down to a combination of personal choice and biology.

Lorie Mason was already 42 when she and his wife, Shannon, began the process of having their first child. They decided that Shannon, who is almost 8 years younger, would use her egg and carry the pregnancy. “I should have done all of these fertility treatments,” Lorie Mason says.

From there, couples can decide to buy sperm from a donor through a bank, or ask a friend or family member. Lorie Mason says they searched for their donor for months, a process she likened to buying a home. “We were looking for a person of Polish origin because I wanted to integrate him into my culture. And blue eyes, because I have blue eyes. We obviously wanted someone who had no serious illness in their extended family, ”she says. They also wanted an open process, to give their children the opportunity to meet their donor one day.

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The easiest and most cost-effective way for lesbian couples to conceive is intrauterine insemination (IUI), in which the fertility clinic places the donor’s sperm directly into the uterus of the partner who carries it. The clinic can either time the IUI to coincide with a woman’s natural ovulation or induce ovulation with medication.

However, IUI does not always work. The couple went through seven unsuccessful cycles. In the end, they turned to in vitro fertilization (IVF), which took the first try.

When both partners want to be a part of the process, they can use reciprocal IVF. A partner delivers the egg, which is fertilized by IVF. The other partner receives the embryo and carries the pregnancy. But because IVF is expensive and more invasive, “it’s usually not the first route couples will take,” says Suneeta Senapati, MD, assistant professor of obstetrics and gynecology at the University Hospital. of Pennsylvania and Third Party Director. reproduction at Penn Fertility Care.

The obstacles

The road to parenthood is filled with obstacles for same-sex parents. Two decades ago, many same-sex couples had to give up having their own children because fertility options were not available to them. “It was our ‘cross to bear,’” says Leondires.

Even now, gay and lesbian couples face emotional, financial and legal hurdles. Freemasons were jealous of their straight friends who appeared to get pregnant with little effort. Having their two children “was a lot of work, very emotional and expensive,” says Shannon Mason. “It’s something we can tell our children,” adds Lorie Mason. “You weren’t a mistake. We wanted to have you.

Access to a clinic

It can be difficult to find a fertility clinic that works with gay and lesbian couples. One study found that only half of fertility clinic websites had LGBTQ-related content on their pages. Clinics in the Midwest and South were less likely to be inclusive than clinics in the Northeast and West.

It is important to use a clinic experienced in the procedures used by lesbian and gay couples to conceive. “There are very specific protocols that must be put in place when using non-paired eggs and sperm,” Senapati explains.

Cost

Every part of the fertility process costs money, starting with the eggs or sperm that couples will need. Women have the advantage of already having an egg and a uterus, but a single vial of sperm can cost almost $ 1,000. And if a lesbian couple wants genetically related children or is worried that they won’t get pregnant the first time, they may have to buy multiple vials from the same donor in advance.

The IUI costs between $ 300 and $ 1,000 per trial, and the chances of getting pregnant in each cycle are only 15% to 20%, even without fertility issues. IVF costs an average of $ 12,000 to $ 15,000 per attempt, not including medications. Fortunately, for Lorie and Shannon Mason, they were able to enroll in a clinical trial that paid for their IVF. “But even the drugs cost $ 3,000,” Lorie Mason says.

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For men, the additional cost of the surrogate – up to $ 150,000 for the agency plus IVF – can be prohibitive. And it may take several embryo transfers to achieve pregnancy.

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Even though same-sex couples are fortunate enough to have health insurance that covers infertility treatments like IVF and IUI, they may not be eligible. Insurance coverage often does not take effect until the couple have had unprotected sex for at least 12 months without conceiving, which excludes gay and lesbian couples.

A few nonprofits offer grants or scholarships to help offset the costs of fertility treatments, including the Cade Foundation (cadefoundation.org), the Baby Quest Foundation (babyquestfoundation.org), and Journey to Parenthood (journeytoparenthood.org) ). Organizations like the American Society of Reproductive Medicine (asrm.org) and Resolve (resolution.org) can also help couples find funding and other resources.

Legal obstacles

When a same-sex couple has a child, the partner who is not the genetic parent will need legal documentation to have rights to the child. In most states, the person who gives birth to the child is considered the legal parent, which means that the gestational carrier must give up their parental rights in order for the process to move forward. Because of the legal challenges involved, “We recommend that couples meet with a lawyer who specializes in reproduction,” Senapati says.

Emotional issues

Conceiving a child can be a stressful and sometimes frustrating process for same-sex couples. Even in the best of circumstances, fertility treatments may not work the first time.

As women reach their late 30s and beyond, the less likely they are to conceive in any given cycle. “It takes a lot of cycles and a lot of time, emotional determination, persistence and strength to get there,” says Taraneh Nazem, MD, reproductive endocrinologist and infertility specialist at RMA of New York.

Acceptance can be another problem. Although non-traditional families are becoming more and more common, sometimes friends and families are not immediately on board. “There are scenarios where people may not have the support they would like, or they feel very lonely in this process,” Senapati says.

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A visit with a reproductive psychologist can be invaluable before trying to conceive. “We met a mental health professional with experience in third-party reproduction, who guided us through the decision-making,” says Leondires. A psychologist can also help you decide how to one day tell your child about their origin story.

Another place couples can turn to is an online or in-person support group, says Nazem. “Support groups are essential in this process – knowing that you are not the only one who has had to break down barriers or overcome challenges.”

In numbers

114,000 – The number of same-sex couples raising children in the United States.

24% – Number of couples of women raising children.

8% – Number of male couples raising children.

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