I tell friends I found two loves during medical school: My husband was the first and the field of infertility, my current specialty, was the second. It was clear the two were not mutually exclusive; I’d need help from a doctor like myself to have a child with my husband one day.
As a reproductive endocrinologist at the Marlton office of Reproductive Medicine Associates of New Jersey (RMANJ), I’m often asked — both by patients and friends — what the process entails. My answer? It depends on your situation, but there is a path to parenthood for everyone.
The first thing many LGBTQ folks will tackle before entering into assisted-reproductive care is the associated cost. IVF can be expensive, and insurance coverage for gay, lesbian and trans couples is limited at best. This is because insurance ties benefits based on the definition of infertility — the inability to get pregnant naturally after a set amount of time. Gay, lesbian and trans couples simply can’t meet this requirement, and thus are at a disadvantage from the get-go.
Lesbians, for example, must usually pay out of pocket for six to 12 rounds of intrauterine insemination (IUI) — or when sperm is placed inside a woman’s uterus to facilitate fertilization — before they can be considered infertile and receive insurance benefits. Single men and gay male couples, however, have trouble meeting the infertility requirement at all, and usually end up paying out of pocket for all services.
The good news is that many companies are beginning to adopt more progressive health-insurance policies that provide infertility coverage for LGBTQ couples, and advocacy groups are actively pushing for changes to state-insurance laws.
For many couples, cost is a big challenge, but never a complete deterrent; many couples I meet see the cost as a necessary means to an end.
So how does it work?
If you are a lesbian couple, your first choice is whether to use a known or anonymous sperm donor. Once you’ve decided that, both IUI and IVF are available for pregnancy. In an IUI, the woman who is going to carry the pregnancy will take medication to help her ovulate, and doctors will place thawed sperm into her uterus. If that doesn’t work, IVF is an option, and allows both women to take part in the pregnancy. One of the partners can use her eggs to be fertilized with sperm (after the eggs are retrieved through a simple outpatient procedure), while the other partner can have the newly created embryo transferred into her uterus and carry the baby to term. Through this co-IVF process, both women can participate in the pregnancy.
Gay male couples can also begin their family through IVF. They will need to find a known or anonymous egg donor, as well as a gestational surrogate to carry their child. Once an egg donor is chosen, one or both of the male partners can provide a semen sample to fertilize the donor eggs during IVF. The resulting embryo can then be transferred to the surrogate.
If you are a member of the trans community and froze your eggs or sperm before transitioning, you can use the sperm and eggs to conceive either with a partner or with a donor through IVF. And if you didn’t freeze your eggs or sperm before transitioning, treatment is still available depending on your specific situation.
What about if you are single or just not ready to start a family yet? Freezing is your best bet. Egg freezing is available for women and trans men who have not completed their transition. The process is simple and involves taking hormonal medication over several weeks before having your eggs removed and frozen.
For men and trans women, the process is even simpler: Give several sperm samples for freezing. You can also have a child on your own with the help of a donor.
So, rest assured, whether you are gay, lesbian or trans, there are promising options to start your family.
Dr. Daniel Kaser, M.D., FACOG, is director of Third Party Reproduction and LGBTQ Services at Reproductive Medicine Associates of New Jersey, the state’s largest infertility clinic.