Choices for Lesbian Couples

Depending on each partner’s age, health, and desire to carry a child, you may have a plethora of options to expand your family.

Nearly 35% of female spousal couples in the U.S. are raising children45

Options

Before you agree to undergo any kind of treatment, take some time to talk to your healthcare provider about its likelihood of success and its risks. You may also wish to inquire about a timeline for each type of treatment.

If fertility testing reveals an ovulatory problem, a doctor may prescribe fertility medications. A fertility specialist, also known as a Reproductive Endocrinologist, may recommend prescription medications to treat ovulatory disorders, which are given in the form of oral medications or injections.

This may be used in combination with intrauterine insemination (IUI), described as a type of artificial insemination.

AI is a procedure in which the healthcare provider inserts the male partner’s or donor’s sperm directly into a woman’s reproductive tract. A common AI procedure is intrauterine insemination (IUI), in which the healthcare provider inserts sperm directly into the uterus near the time of ovulation. The healthcare provider may also consider cervical insemination, when semen is released through a soft catheter to the cervical opening.47

ART is the umbrella term for a variety of medical procedures used to bring eggs and sperm together without sexual intercourse.

  • In vitro fertilization (IVF) is the most common ART procedure. During IVF, medications are often used to stimulate the development and release of a woman’s eggs. The eggs and sperm are then collected and placed together in a laboratory dish to fertilize.48 If the eggs are successfully fertilized, one or some of the resulting embryos are transferred into a woman’s uterus. The goal is that one of the fertilized eggs will implant and begin to develop. Any embryos not transferred may be frozen for later use
  • In reciprocal IVF, also known as IVF with embryo transfer, the procedure is performed using the eggs of one partner and the womb of the other. For lesbian couples, reciprocal IVF can help both women feel an equal biological tie to the child49
  • Intracytoplasmic sperm injection (ICSI) is used in conjunction with IVF, in which a laboratory technician, using a microscope, attempts to inject a single sperm directly into each egg. ICSI is often used if the male has very low sperm count, low sperm motility, or poor-quality sperm.50 If fertilization occurs after ICSI, one or some of the resulting embryos may be transferred into the uterus

For lesbian couples, egg donation involves one woman (a donor) “donating” her eggs to another woman. IVF is performed in the usual manner, except that the donor receives fertility medications to stimulate the production of multiple eggs in her ovaries. The eggs are then fertilized in a laboratory and depending on the doctor’s experience and the woman’s medical situation, one or some of any resulting embryos may be transferred into the recipient’s uterus.

For women utilizing donor sperm, it’s important to know that anonymous sperm donation is regulated by the U.S. Food and Drug Administration (FDA). Sperm donors are required to be tested for certain infections and also may need to meet other criteria as determined by the sperm bank.51

Cryopreservation, also known as “freezing,” involves storing embryos at a very low temperature so they can be thawed and used later. Many fertility clinics now offer this option, and some clinics have begun to offer egg freezing as well.

Surrogacy agencies are available to recruit, screen, and educate the surrogate mother, refer partners to established egg donor agencies and fertility centers, and provide legal advice. The agency can also give emotional guidance and support during the treatment process.

There are two types of surrogacy:

  • In traditional surrogacy, the woman who’ll carry the pregnancy contributes her own eggs to be fertilized with the sperm and will share a genetic link to the child. In this case, conception is achieved through intrauterine insemination (IUI), in which a healthcare provider places sperm directly into the uterus through the cervix using a catheter52
  • In gestational surrogacy, eggs (from a donor or the other partner) and donor sperm are used to make embryos that are transferred into the surrogate’s uterus. In this case, the surrogate has no genetic bond to the child. When donor eggs are used, the healthcare provider will recommend using in vitro fertilization (IVF), during which the eggs and sperm are collected and placed together in a laboratory dish to fertilize53


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46

RESOLVE, Ovulation Induction, 2013

47

RESOLVE, IUI, 2013

48

RESOLVE, IVF/ART, 2013

49

Pelka S. J Homosex. 2009;56:195-217.

50

University of California San Francisco Medical Center, Intracytoplasmic Sperm Injection, Accessed 2016

51

U.S. Food and Drug Administration (2010) What You Should Know – Reproductive Tissue Donation