1Q. What is the simplest way to conceive for lesbian couples?
A. The least invasive and least expensive way for a lesbian couple to achieve pregnancy is through a donor sperm intrauterine insemination cycle. You select a donor from a high quality sperm bank or use a known donor, and time insemination through monitoring of a natural cycle or through use of the oral medication to improve ovulation.
2Q. Can we use fresh sperm of a friend or relative, instead of frozen sperm?
A. Federal regulations strictly prohibit the use of fresh sperm for insemination, because of the risk of transmitting infectious diseases through the sperm. All sperm used for insemination, with the exception of intimate partners, has to be frozen and quarantined for at least six months. The sperm donor has to be tested, both before freezing and before thawing the sperm, and must be negative for HIV I and II, syphilis, gonorrhea, Chlamydia, CMV, Hepatitis B and C as well as Human T-cell lymphotropic virus (HTLV) on both occasions.
3Q. Can we use frozen quarantined sperm of a friend or relative?
A. If you prefer using a known donor you certainly may do so, but there are a few additional steps involved with this type of cycle. With a known donor, by law, the sperm has to be frozen and quarantined for at least six months. The sperm donor has to be tested, both before freezing and before thawing the sperm, and must be negative for HIV I and II, syphilis, gonorrhea, Chlamydia, Cytomegalovirus (CMV), Hepatitis B and C as well as Human T-cell lymphotropic virus (HTLV) on both occasions. Frozen sperm obtained from sperm banks is known to be resilient and the required donor screening has already been completed. With a known donor the sperm quality is unknown and might not be resilient enough to adequately withstand the freeze and subsequent thaw. Furthermore, the cost of the testing, freezing and storing of the sperm is not covered by insurance so it would be out of pocket for you. And although the benefits of using the sperm of a family member or close friend are undeniable, both legal and social issues may complicate such an arrangement.
4Q. Will my donor insemination cycles be covered by insurance?
A. Most insurance companies will cover inseminations, but they do not usually cover the cost of the donor sperm. There are, however, 2 potential stumbling blocks: some insurance companies require proof of infertility. Infertility is defined as “unprotected sexual intercourse for six months (above age 35 years) or one year for younger women” and will not cover inseminations before the above criteria are fulfilled. This may be problematic for single women and same sex female partners. The second problem is exclusion of fertility services in your medical insurance.
Parenting for Lesbian Couples: IVF
5Q. I have done 4 cycles of donor sperm insemination, without success. Is it time to move on to In Vitro Fertilization (IVF)?
A. The success with donor sperm insemination is the highest for the first 3-4 cycles and the rate of conception starts falling significantly after 3 cycles and dramatically after 6 failed insemination cycles. Some insurance companies require at least 3 trials with insemination before allowing IVF. Others require insemination cycles with injectable medications before allowing IVF. Because of the much higher success with IVF, compared to insemination, it may be best to start with IVF under certain circumstances.
6Q. I would like to become pregnant first, but my partner would like to follow within a year or two, but she is 39 years old and I am 34 years old, is it advisable to wait?
A. Female fertility potential is age-dependent and decreases after age 35. For that reason, we would recommend your 39-year-old partner to try first and not wait several more years before trying to achieve pregnancy. But if you wish to carry the first child then there are options for you. For example, if you underwent an IVF cycle with your eggs and donor sperm and had leftover embryos to freeze, your partner could have an embryo transfer done when she is ready to conceive, if she is unable to conceive on her own. The children would be full siblings (since the frozen embryos would be created from your younger, presumably healthier, eggs) but she would be the birth mother to the subsequent child. Alternately you could donate eggs to her, rather than frozen embryos. Another scenario is that your partner can undergo an IVF cycle and embryo banking now, to obtain eggs, and create and freeze embryos until the time she is ready to become pregnant.
Parenting for Gay Men:
7Q. My partner and I are in a stable relationship. Both of us would like to have children, and if possible, continue our genetic lineage. What are our options?
A. There are several options available which maximize the preservation of your and your partner’s genetic lineage. The most obvious solution is to use an egg donor and, through in vitro fertilization (IVF), inseminate the eggs with sperm from both you and your partner. For example if there are 8 mature eggs, 4 could be inseminated with your sperm and 4 with your partner’s sperm creating fully realized genetic embryos for each of you. The embryo(s) would be transferred into the uterus of a gestational carrier (not the egg donor) carrier who would carry the pregnancy. Whose embryos are transferred would be decided by you and any subsequent embryos can be frozen for future use.
8Q. We are ready to have children and already made contact with a lawyer who is trying to find a gestational carrier for us. What else needs to be done from the medical point of view?
A. Federal regulations for safe cell and tissue donation apply to your situation. Namely, either you, your partner, or both of you will need to freeze and store sperm for future use. Within a week of sperm deposit you need to undergo infectious disease testing according to FDA regulations. The sperm has to be quarantined for at least 6 months and the sperm depositor (one or both of the intended parents) has to be retested at the 6-month mark. The sperm may be used only once a negative infectious panel is verified. The egg donor undergoes similar testing; however, the 6 month quarantine does not apply to eggs, so the embryos can be transferred fresh to the gestational carrier. Since there are potentially 4 parties involved in creating a baby, each of them has a unique role and in turn specific responsibilities. We are well versed in this and can walk you through, step by step.
9Q. What effect does the gestational carrier have on the genetic composition of a baby?
A. If the embryos transferred into the gestational carrier’s uterus originate from an egg donor and the sperm of one of the intended parents, the gestational carrier has zero contribution to the genetic make-up of the baby. Thus she is solely providing a nourishing environment to the baby.