As a reproductive endocrinologist and fertility specialist, my day-to-day work, and indeed my passion, is to help individuals and couples alike start or grow their families through fertility treatment. As a gay physician, a particularly satisfying aspect of my job is working with LGBT patients who otherwise may not be able to have their own biological children. With the landmark Supreme Court case Obergefell v. Hodges, which protects the fundamental right to same-sex marriage, taking effect just over a year ago, a natural progression from working to ensure the legal status of gay marriage to improving access to options for gay parenting has begun.
It wasn’t until I began having these same conversations with my husband, Dana — also a physician — that I fully appreciated just how foreign these waters must be to members of our community. Adoption and foster parenting are well-known and viable parenting options for LGBT individuals and couples, but what if you want to have your own biological children?
Gay men have the option of egg or embryo donation combined with gestational surrogacy. While it’s only possible to use the sperm from one man to fertilize any given egg, many gay couples often choose to do a split insemination, in which half of the eggs are put with one man’s sperm and the other half are put with the other man’s sperm. They can then choose to implant two embryos (one from each father), or to transfer just one and freeze the others for later use. This process requires a considerable investment of time, energy and money, not only for the medical treatment, but also for the legal contracts for the involved parties.
Lesbian women often choose sperm insemination, either with an anonymous donor or a friend, at home or at a fertility center. While an at-home insemination may at first seem convenient and preferred, I encourage gay women to complete this process at the practice for several reasons. Working with a team of physicians and nurses can help you through the process of donor selection by discussing the option of genetic testing; reducing the possibility of contracting an infectious disease; telling you about the sperm quality and concentration; ensuring the insemination occurs at the correct time and location to optimize pregnancy rates; and finally, preventing future legal issues with the donor over parenting rights and obligations.
In vitro fertilization (IVF) is an option for women with fertility issues, as the conditions associated with infertility do not discriminate between gay and straight. IVF also allows partners to share in the process of pregnancy through an approach called co-IVF or reciprocal IVF. Here, eggs are extracted from one woman, inseminated with donor sperm to create an embryo, and then the embryo is transferred back to the other woman’s womb to carry the pregnancy. Many of the lesbian couples I speak with choose this shared path — we have even had patients come back for a second child and reverse who provides the egg and who carries the pregnancy.
Dana and I are still navigating what it might mean to start our own family. Of course, we’d be thrilled to have children, but like for all couples, much consideration must be given to the time and financial commitment of doing so. Would one of us take leave or become a stay-at-home dad? What is the process of second-parent adoption like? Are we prepared to respond to the inevitable biases our family will experience?
We still have a ways to go to make LGBT parenting widely available and are starting this effort by improving access to care, lobbying to make insurance plans equitable and non-discriminatory, and celebrating success stories in our own community. The most important thing is that we, as members of the LGBT community, now have the freedom to choose how and when we’d like to build our own families. As a gay reproductive specialist, I personally will work hard to support those choices and ensure these conversations continue to evolve.
Dr. Daniel Kaser is a board-certified obstetrician and gynecologist at Reproductive Medicine Associates of New Jersey, a nationally recognized Leader in Healthcare Equality by the Human Rights Campaign. He specializes in third-party reproduction (use of donor sperm, donor egg and donor embryo, along with gestational surrogacy) and leads the practice’s LGBT-focused program in the Marlton and Hamilton offices. He and his husband of six years, Dana, reside in Center City Philadelphia.