Family Planning Options for Lesbians and Trans-Males
Helping members of the LGBTQ community pursue family building has been such an integral part of my practice for several years now. Just the other day one of my lesbian patients told me “Growing up as a gay woman in the US, I never thought I’d have children.” Fortunately, we have come a long way since the advent of assisted reproductive technology and there are now numerous therapeutic options available to individuals who identify as LGBTQ.
One assisted reproductive option available to lesbian (or trans-male) couples, is reciprocal IVF also known as CO-IVF. This procedure is unique in that it allows for both members of a couple to biologically participate. As a general overview, this process entails one member of the couple undergoing controlled ovarian stimulation followed by retrieval of their eggs. The eggs are then fertilized using donor sperm to create embryos. An embryo created this way is then transferred into the uterus of their partner who will carry the pregnancy to term.
To accomplish the goal of a single embryo transfer that will hopefully lead to a successful pregnancy, a lesbian or trans-male couple must complete several integral steps:
- Initial testing: This includes blood work, ultrasound, and physical exam of both individuals
- Selection of donor sperm: The couple can choose to use either anonymous donor sperm or designated (known) donor sperm
- In vitro fertilization (IVF): This process assumes use of injectable recombinant hormones of the pituitary gland for approximately 7 to 10 days in order to achieve multi-follicular growth and maturation of multiple eggs. A patient will likely have 5 to 7 visits to their clinic for monitoring, ultrasounds, and blood work as they continue to prime their body for the egg retrieval.
- Egg retrieval: Once the follicles have reached a certain size (IVF centers may vary on their size criteria), a patient is scheduled for an egg retrieval. This is a brief procedure performed under sedation and is not painful. Under vaginal ultrasound guidance, a surgeon will introduce a very slim needle though the side wall of the vagina into each egg of each ovary. This needle collects the eggs into vials that are then given to the embryologist. Most patients will wake up about 5 to 10 minutes after the procedure, spend 30 to 40 minutes in the recovery room as they wait for the anesthesia to wear off, and then go home. The majority of patients will not experience pain following the procedure, but rather some pressure or bloating. Some may feel menstrual-like cramping and can take ibuprofen or Tylenol as needed.
- Fertilization: Approximately 5 hours following the retrieval, the embryologists prepare the collected eggs for fertilization with the selected donor sperm. Eggs become known as embryos once they are fertilized by sperm.
- Embryo culture: Embryos are cultured in the embryology lab for the next 5 to 7 days until they reach the more mature blastocyst stage. At this stage, an embryo can be transferred into the other partner’s uterus or tested for genetic abnormalities using preimplantation genetic testing and frozen for future use.
- Embryo transfer: This process entails preparation of the other partner’s uterine lining (also known as the endometrium) with estrogen tablets, and then progesterone administration in order to optimize implantation success. Once their uterine lining reaches a certain thickness and quality which usually takes about 2 to 3 weeks, an embryo will be thawed and transferred using a very slim, rubber straw (also known as a catheter) into the uterus. This procedure is painless, and does not require anesthesia. After two weeks, we ask that you take a pregnancy test to confirm if the embryo has implanted.
While this article provides a general overview of Co-IVF, there are many details that warrant further discussion with your physician. Consider the following questions before starting your fertility journey using Co-IVF:
- Whose eggs will be used to create embryos?
- Will anonymous or donor sperm be used to create embryos?
- Who will undergo embryo transfer and carry the pregnancy?
While your plan may change based on what your physician advises, knowing the answers to these basic questions and having a general sense of the Co-IVF process will help you feel more at east and in control of your fertility journey.