Fertility Treatment Options for Women
Congratulations on making the decision to become parents as a lesbian couple! As a lesbian couple, where do you start?
The first question to ask is: do you want to proceed with a genetically linked child or adoption?
If you decide to move forward with a genetically linked child, there are some different family building options a lesbian couple can proceed with.
Lesbian Family Planning Options
Option 1- Artificial Insemination
Artificial insemination (AI) is a process that is used to place sperm into a woman’s reproductive tract using means other than sexual intercourse. The procedure involves concentrating semen into a small volume and placing it into the uterus (intrauterine insemination, or IUI) or the cervix (intracervical insemination, or ICI).
In order to begin artificial insemination, you need to see your primary care physician. Be sure to be up-to-date on all health care maintenance, including Pap smear, and mammogram if recommended. It is important to track your cycle each month as you must also have a regular menstrual cycle to complete a natural cycle insemination with success. This cycle tracking is how insemination is timed. Some OB/GYNs will require a basic fertility evaluation, including a hysterosalpingogram and documentation of ovulation.
A HYSTEROSALPINGOGRAM (HSG) is a short X-ray procedure used to evaluate the status of a woman’s fallopian tubes, the two structures that carry eggs from the ovaries to the uterus. It is also used to make sure that the uterine cavity has a normal shape and size and to identify uterine malformations, adhesions, polyps or fibroids. These types of problems may cause painful menstrual periods or repeated miscarriages. It is possible that they may be damaged from a known/unknown infection or previous surgery.
Documentation of ovulation can be done by testing your blood for the presence of high levels of progesterone which is a hormone required for pregnancy and secreted by the ovary.
For women over 35 the completion of a basic fertility workup should be considered to evaluate their reproductive age. Here are some tests given:
- When a woman is undergoing a fertility work-up, Menstrual Cycle Day 3 is the day she has blood work done to check the levels of three important substances: follicle stimulating hormone (FSH) and estradiol (E2).
- FSH is secreted by the pituitary (a gland in the brain) throughout the menstrual cycle, but on day 3 it should be low indicating good fertility.
- Estradiol (E2) is a complimentary hormone which is secreted by the ovary and correlates proper time of the FSH test.
- Anti-Mullerian Hormone (AMH) may also be tested. This blood test is now able to tell women, more easily than ever before, about their potential to become pregnant. The AMH test is used to measure ovarian reserve, the quality and quantity of your eggs. This result helps doctors determine your chances of becoming pregnant now and in the future. This can be done at any point in the menstrual cycle.
To complete the process, you are required to meet with a board- certified Reproductive Endocrinologist. At this meeting with a fertility specialist, you will discuss donor insemination. A known donor can be a family member or friend, but requires careful consideration and consultation with an attorney to protect parental rights and to be sure that all adults are invested in the emotional development the child to be. An anonymous donor can be found through a sperm bank. As the name implies, parents do not know the donor, including his name or medical history. However, recipients can choose a sperm donor based on basic characteristics such as family history, race, academic achievements, looks and other factors. This is considered by many the safest way to choose a donor as these donors have been screened for infectious diseases, genetic risk factors, and been counseled on their release of parental rights.
Many sperm banks offer a known sperm donor option. This is a sperm donor who is willing to be known to the parents and child, who has been screened by the sperm bank. Sperm is shipped to your physician frozen and is thawed the day of insemination.
After a donor is chosen, you can then proceed into natural cycle insemination or, if recommended by your physician, superovulation and insemination. The focus of this treatment path is to properly time and deliver sperm into the female reproductive tract. Superovulation therapy uses medication to release more than one egg in a month to increase the chances for pregnancy. This can dramatically increase a woman’s per cycle chance of pregnancy. Ovulation medicine is used to induce ovulation. Then, at the appropriate time, the sperm are introduced into the vagina, cervix (intracervical insemination), or uterus (intrauterine insemination). These procedures are very low risk, take about 5-10 minutes and are done in the office
Option 2- IVF with One Person’s Egg and Uterus
In-vitro fertilization (IVF) is a process that involves stimulating ovaries to develop multiple eggs. This is achieved with injectable medications.To move forward with IVF you should see a board certified Reproductive Endocrinologist. She/he will complete a panel of pre-pregnancy screening tests, genetic tests, and infectious disease tests. The goal of IVF is to produce a large number of growing follicles, then to retrieve the eggs from inside the follicles through a short surgical procedure performed in the office. The eggs are then inseminated with designated donor sperm in the laboratory in order to create embryos that can then be transferred to the endometrial cavity (the uterus) of the recipient. To complete IVF using one person’s egg and uterus, the same screening listed above is required to continue with the process. A uterine assessment with a saline sonogram is also required to investigate the health of the implantation site.
Over 5 million children have been born from in vitro fertilization. IVF is considered safe for women, and one of the most successful fertility treatment options available. IVF stimulation requires injectable medication, and also a procedure known as an egg retrieval under sedation.
Option 3- Reciprocal IVF
With reciprocal in vitro fertilization, one woman donates her eggs to her partner, and her partner carries the pregnancy. For female couples this is a way that both can participate in the process of bringing a child into their home. One woman donates egg and goes through superovulation with fertility medicines to produce multiple eggs and undergoes egg retrieval. After egg retrieval eggs are combined with the designated donor sperm in the IVF laboratory. Her partner who is choosing to become pregnant, goes on medication to prepare her uterus. Then when the timing is optimal 1-2 embryos are transferred into her uterus.
For the person who carries, the same screening as above is required, along with a uterine assessment with a saline sonogram to investigate the health of the implantation site. Estradiol will be taken to thicken the lining. The carrier will also be required to take progesterone to prepare the uterine lining for the embryo transfer, the process in which an embryo is placed into the uterus during a simple painless procedure under ultrasound guidance. Progesterone is required to maintain the uterine lining in which the embryo grows and develops. The embryo transfer should occur on a set day under a controlled condition, and is a 15’ low risk, very little discomfort procedure. Success rates with reciprocal IVF vary with the age of the women. If successful, women are discharged to their OB-GYN in about six weeks.
In summary there are three routes to pregnancy for women: artificial insemination, IVF using their eggs and uterus, or IVF using their partner's eggs and their uterus. Success rates vary based on individual circumstances. A very important part of the journey is to pick out a sperm donor. There are many choices in this regard and I recommend you meet with an experienced reproductive mental health professional to help you with this decision. This decision is a lifelong one for you and your child. Overall, success rates for woman remain very high for women under the age of 40, but age is a significant predictor for success. I recommend you work with a board certified Reproductive Endocrinologist to assure that your pathway to pregnancy is successful, safe, and time-efficient.
Good luck in your family building journey, take the time to get educated, and stay hopeful.