No matter the sexual orientation or gender identity of either partner, our physicians and clinic staff are committed to helping you on your fertility journey with a personalized treatment plan and compassionate care. Let’s get started!
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Fertility Options for Biologically Female Same-Sex Couples
Fertility Options for Biologically Male Same-Sex Couples
Successful pregnancy depends on many factors, so an initial workup will be performed prior to treatment. This will help us evaluate the potential for conception, and select the optimal treatment plan. The evaluation begins with a detailed review of the patient’s gynecologic and medical history to assess overall health and fertility. Our initial consultations are done via telehealth to allow our patients more flexibility in scheduling. During this consultation, the physician will discuss diagnostic testing and potential treatment options.
The initial in-person evaluation will include a physical exam and pelvic ultrasound of the uterus and ovaries. Frequently the woman’s egg reserve or egg count is checked with a blood test called anti-müllerian hormone or AMH. Additionally, the woman’s antral follicle count (AFC) is performed to determine the number of small follicles in each ovary. Both of these tests predict whether a woman has a robust, average or low egg supply.
We will obtain preconceptual lab work, including a prenatal panel, thyroid and vitamin D on the woman who plans to conceive the pregnancy.
Depending on past gynecologic history, a detailed evaluation of the uterus and fallopian tubes is commonly performed at the outset. The two tests used to evaluate the uterus and fallopian tubes are hysterosalpingogram (HSG) and hysteroscopy. Both of these tests are important, and complement one another to allow a thorough evaluation of the pelvic structures. Both are performed in the office setting with minimal discomfort.
Intrauterine insemination (IUI) is a simple artificial insemination process and a commonly-used treatment option for same-sex female couples. The majority of pregnancies occur in the first few cycles of IUI.
A small, flexible tube is placed through the cervix, which deposits the processed semen sample into the womb. Minimal to mild cramping is associated with IUI. See Figure 4.1.
Figure 4.1 IUI with donor sperm.
Natural Cycle Donor IUIIf the female undergoing treatment has predictable menstrual cycles, the insemination is typically performed in a natural cycle without the use of fertility medications. This minimizes the risk of multiple pregnancy (twins) and yields pregnancy rates close to the age-matched fertile population. The IUI is timed with ultrasound and the use of an ovulation predictor kit.
Clomiphene Citrate (Clomid) Donor IUIFor females with irregular cycles and normal to high egg counts, natural cycle donor IUI is not an option. Clomiphene citrate or Clomid is a fertility tablet which may be used to stimulate ovulation. Clomid increases the risk of a multiple birth (twins).
In vitro fertilization (IVF) with donor sperm offers the highest chance for pregnancy and the lowest risk of a multiple birth. After a single cycle of IVF, many patients (though not all) will have extra frozen embryos which may be used for subsequent pregnancies.
With IVF, eggs are fertilized outside the body, in the laboratory. The embryo created in this process is transferred to the uterus. Embryos which are not transferred may be frozen for use at a future date.
Some couples may opt to begin with IVF rather than donor IUI because of the higher rate of pregnancy, potentially shorter duration to conceive, control over multiple birth, and the potential to have extra embryos to expand their family in the future.
Figure 4.2 IVF process.
An increasing number of same sex female couples are choosing to undergo Reciprocal IVF. This option allows both women to be involved in the process. Figure 4.3 shows how one partner, the “egg mom,” provides the eggs, which are fertilized with donor sperm outside of the body, in the laboratory. The resulting embryos are frozen at the blastocyst stage, then one embryo is transferred to the other partner, the “birth mom,” who will carry the pregnancy to delivery. This allows both partners to have an intimate link to their offspring.
In this scenario, the evaluation is split between the two females. The partner who is going to undergo the egg retrieval has an assessment of her egg count and the partner who carries the pregnancy has her uterus evaluated.
Figure 4.3 Reciprocal IVF with donor sperm.
Many same-sex female couples are candidates for a simplified IVF process pioneered by CARE Fertility known as effortless IVF®.
This revolutionary technique simplifies the IVF process. Daily fertility injections over 10-12 days stimulate the ovaries, but only two ultrasounds are needed. No blood tests are required. Due to the ease and affordability of the process and the higher success rates compared to IUI, a growing number of same-sex female couples are choosing effortless IVF as their first-line treatment option. effortless IVF can be used for Reciprocal IVF or IVF for the woman carrying her own pregnancy.
Donor sperm is obtained from commercial sperm banks. One of our andrology staff members will be happy to assist you in the ordering process. One vial of donor sperm is needed for each treatment cycle, and CARE Fertility has large liquid nitrogen storage tanks on site.
Both the egg donor and gestational carrier are selected by the couple and we take it from there.
Donor Egg. Donor eggs may be obtained from an egg donor who undergoes stimulation of her ovaries for the sole use of the same-sex male couple. Alternatively, donor eggs may be obtained from a commercial donor egg bank. The couple has the option to use sperm from one or both partners.
Gestational Carrier/Surrogacy. The gestational carrier undergoes a thorough evaluation with a focus on her uterus. The couple and gestational carrier complete a formal legal agreement through a gestational carrier agency prior to the transfer process. The gestational carrier takes oral estrogen and progesterone injections to prepare her womb or uterus for the frozen embryo transfer.