Many countries in the world have legalized same-sex marriages, marking a significant step forward in embracing our increasingly diverse society. The next exciting question is: can gay and lesbian couples also have a child of their own? It is not difficult to imagine a future where the answer is a definitive yes, and we are approaching that day with significant medical innovations in the field called ‘Assisted Reproductive Technology (ART)’.
What current technologies do we have that let same-sex couples have their own children? In this blog, we will explore the exciting options currently available for gay and lesbian couples.
Fertility Services for Lesbian Couples
The most common way to conceive for lesbian couples is to use donor sperm. This can be donated by someone you know, or from a de-identified donor.
If you choose the latter, you will be given a database of donors to choose from, including donors’ physical attributes, ethnicity, and medical history. Finding the donor this way may appeal to couples who prefer no emotional ties to the donor. At the same time, it can be daunting and expensive as there are limited supplies in most fertility clinics. Zeta Fertility provides matchmaking services to support you on this journey, tailored to your preferences.
After acquiring donor sperm, it can be used for either artificial insemination (IUI) or in-vitro fertilization (IVF). These are the same procedures used in heterosexual couples who have difficulty conceiving and are common procedures performed in fertility clinics.
IUI is generally the more natural, cheaper and preferred method for people who do not have serious fertility problems. It involves inserting prepared semen through the cervix and into the uterus, close to a stimulated or monitored ovulation time.
IVF is a technology that allows conception outside the female body, where an individual sperm is injected directly into the egg. This requires prior removal of the eggs from a woman’s ovary. Upon successful in-vitro fertilization, the embryo is grown in the laboratory for approximately 5 days. If an embryo is deemed high quality, based on genetic testings and embryologists’ observations, it will be transferred back to the woman’s uterus.
Partner IVF / Reciprocal IVF
Partner IVF or reciprocal IVF is a special type of IVF for lesbian couples who wish to involve both partners in having a baby. In this procedure, one partner provides the eggs to be fertilized with donor sperm (genetic mother), whilst the other carries the pregnancy (birth mother). This is a popular option among lesbian couples because it lets both partners develop a biological connection to the child.
The Steps involved in partner IVF are:
- Both partners take the oral contraceptive pill to synchronize their menstrual cycles.
- The partner providing the eggs will also be prescribed ovary-stimulating medications to promote the growth of egg-containing follicles. The other partner carrying the pregnancy will be prescribed with medications that encourage the development of the endometrium, which is the lining of the uterus that supports an embryo.
- Once the ovarian stimulation process is complete, mature eggs are retrieved from one partner and fertilized with the donor sperm.
- The fertilized eggs are developed in the laboratory and they divide into multiple cells. These cells are now referred to as embryos. The embryos are carefully monitored for their growth each day. After a few days, quality control tests such as a preimplantation genetic test are performed to select high-quality embryos best for transfer.
- Usually, only the highest-quality embryo is transferred back into the uterus. In this case, the embryo is transferred to the other partner who did not provide the eggs. Other embryos may be frozen for future use.
Fertility Services for Gay Couples
Surrogacy is usually involved for gay couples to have a child. This requires finding a surrogate woman who agrees to conceive and carry out the pregnancy for the gay couple, who will raise the child after birth. Surrogacy is a rather complicated process and you may consider finding a surrogate agency to assist in this process.
The egg can come from the surrogate herself in the case of a traditional surrogacy or can come from a known or unknown egg donor in the case of gestational surrogacy.
In traditional surrogacy, the surrogate provides her own eggs and is, therefore, the biological mother of the child. Conception can be achieved via IUI or IVF in a fertility clinic, using sperm provided from either partner in the gay couple.
In gestational surrogacy, the egg is provided from a different egg donor and fertilized with the provided sperm via IVF. The fertilized egg grows into an embryo in the laboratory and is then transferred into the surrogate’s uterus, who will carry out the pregnancy. In this case, the surrogate is not the biological mother of the child.
Surrogacy should be conducted in a framework of ethical considerations and adequate education1. In New England, there are two important legal steps. First, a contract needs to be signed between the surrogate and the intended parents, taking care of financial responsibilities, parental rights and obligations, and other after-birth plans. Between 12 and 20 weeks of gestation, a pre-birth court order is prepared to grant parental rights for the intended parents. Gay couples are advised to contact an attorney to carry out these legal steps.
While each fertility clinic may have slight variations in their own process, here are the common steps that you could expect:
1. The first step is to consult a fertility specialist. In New England, there are a number of fertility clinics that could help you.
2. During your consultation with the specialist, he or she will get to know you and discuss your preferred way to conceive. Both partners will be asked about your circumstances and medical history. You will get an understanding of the best conception approach and the steps involved.
3. You and your partner may be asked to have a series of blood tests performed as a routine screening procedure. These tests will help your fertility specialist decide which conception plan is the best and what precautions need to be taken into consideration.
4. Before the conception procedure begins, you and your partner will also be required to attend a counseling session, which allow you to discuss in-depth the procedures, emotional responsibilities and address other personal concerns.
5. If you decide to proceed with the conception plan, a fertility coordinator will usually take you through the personalized plan devised by your fertility specialist. You will be advised on how to take medications, manage your treatment cycle and other important tasks. This applies to lesbian couples in particular.
6. When all forms are signed in a final review and you are ready, your conception cycle can officially start according to the conception plan. Before that, you can take some time to optimize your lifestyle and mental state as they can also influence your egg/sperm quality2.
“A framework for ethical surrogacy for intended parents”. http://www.menhavingbabies.org/advocacy/ethical-surrogacy/
“Making fertility-friendly lifestyle choices”, Harvard Medical School. https://www.health.harvard.edu/womens-health/making-fertility-friendly-lifestyle-choices