Congratulations on deciding to become parents! As a same-sex female couple, there are several family-building options available to you.
The first question to ask is: Do you want to proceed with biological family building (where you and/or your partner could conceive a genetically linked child), or do you want to pursue adoption? Both are wonderful family building options, and require separate teams of family building professionals to help you achieve your goal.
What are biological family building options for lesbians?
An excellent first step for any family planning pathway is a fertility workup - this tells you and your doctor more about your personal fertility, and will help to build your plan as you move forward.
How do I understand my fertility?
Women at any age can complete a basic fertility workup to evaluate their reproductive age – which may be different from your actual calendar age. This workup includes a basic panel of tests that can determine your baseline level of fertility and your chance for a successful and healthy pregnancy.
When you are undergoing a fertility workup, your menstrual cycle is measured from the first day of your period (full flow, not spotting), so Cycle Day 3 is the third day of your period. On Day 3 you would have bloodwork done to check three important levels:
- The FSH blood test helps diagnose problems with sexual development, menstruation, and fertility. Your FSH level can be used to diagnose or evaluate polycystic ovary disease, ovarian cysts, irregular vaginal bleeding and infertility. 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.
- The LH blood test measures the amount of luteinizing hormone, which is also secreted by the pituitary gland. In women, LH levels rise mid-cycle. Then, within 24 to 36 hours, ovulation typically occurs. Higher-than-normal levels of LH can indicate several disorders, including ovarian failure and polycystic ovary disease (PCOS).
- Estradiol is the most important form of estrogen. It is primarily made in and released from the ovaries, adrenal cortex and the placenta, and it is responsible for the growth of the breasts, outer genitals, uterus, fallopian tubes and vagina. Estradiol is a complementary hormone which is secreted by the ovary and correlates proper time of the FSH test.
What is an AMH test? What is Anti-Müllerian hormone?
- An Anti-Müllerian hormone (AMH) test is used to measure ovarian reserve, which can indicate the quality and quantity of your remaining eggs. This blood test is now able to tell women, more easily than ever before, about their potential to become pregnant. Your AMH test 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.
Another way that your physician or fertility specialist may measure your fertility is by performing an HSG. A hysterosalpingogram (HSG) is a short procedure used to evaluate the status of your fallopian tubes - which carry eggs from your ovaries to the uterus. An HSG also looks at your uterus, to make sure it has a normal shape and size and to identify any other adhesions, polyps or fibroids. These problems are important to note, as they may cause painful menstrual periods or repeated miscarriages.
While you’re learning about your fertility baseline, it’s a good time to consider your family building options. If you haven’t already done so, this is also a great time to schedule a consultation with a fertility specialist, who can help you understand your fertility and plan for your future family.
Lesbian Family Planning Options
Luckily, there are many options for same-sex female couples or single moms looking to pursue biological family building. These include:
- IUI, or intrauterine insemination
- IVF, or In vitro fertilization
- Reciprocal IVF
- IVF with INVOcell
Keep scrolling for more information on each of these treatment options, information on choosing a sperm donor, and more!
What is an IUI?
Intrauterine insemination (IUI), sometimes known as assisted or artificial insemination (AI), is a process used to place sperm into a woman’s reproductive tract. The procedure involves concentrating semen into a small volume and placing it into the uterus to increase your chances of conceiving.
To begin this process, you need to see your primary care physician. Be sure to stay up to date on all health care maintenance, including your pap smear and mammogram if recommended. It is essential to track your cycle each month, as cycle tracking will help you complete the insemination at the right time. Some OB/GYNs will require a basic fertility evaluation, including a hysterosalpingogram (HSG) and documentation of ovulation, as mentioned above!
The next step in this process is to meet with a board-certified Reproductive Endocrinologist. You can learn more about what makes a practice LGBTQ-friendly here. At this meeting with your fertility specialist, you would discuss an insemination pathway, as well as your choice of sperm donors.
What is a Known Sperm Donor?
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.
What is the Difference Between a Known and Anonymous Sperm Donor?
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 essential characteristics such as family history, race, academic achievements, looks and other factors. This is considered by many to be the safest way to choose a donor, as these donors have been screened thoroughly for infectious diseases, genetic risk factors, and have been counseled on their release of parental rights.
Many sperm banks offer a known or open-door 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. It's important to remember that today, DNA programs like 23 and Me or Ancestry.com make it almost impossible to be genetically anonymous, so it is likely your child will find their donor if they are interested and of-age, regardless of your donor's anonymity.
In both anonymous and open door sperm donations, the donor's specimen is shipped to your physician frozen, then thawed the day of your insemination.
After you make your donor choice, you will then proceed into either a natural cycle with insemination or a cycle using superovulation and insemination. Superovulation uses fertility medicine, so you release more than one egg per month to increase your chances of pregnancy. This can dramatically increase your per-cycle chance of pregnancy. Your fertility care team will help guide you to decide what's right for you.
Then, at the appropriate time in your cycle, donor sperm is introduced into your uterus. This procedure is very low risk, takes about 5-10 minutes, and is done in the office.
IUI treatment is often a first step for many same-sex couples or single women with good fertility markers. Let's move on to understand how IVF treatment works for same-sex moms-to-be.
How does IVF work for a lesbian couple?
In vitro fertilization (IVF) is a family planning pathway for same-sex female couples (or single women) where only one partner wants to biologically and genetically participate in the pregnancy, and perhaps has completed IUI treatment unsuccessfully, or is struggling with their fertility. IVF treatment involves stimulating that partner’s ovaries with medications to develop multiple eggs, combining eggs with donor sperm in the laboratory to create embryos, and then placing those embryos back into the same partner’s uterus in a process known as an embryo transfer.
Over 8 million babies have now been born via in vitro fertilization. IVF is one of the most successful fertility treatment options available - but it's not the only option available for same-sex female couples. Keep reading to learn about IVF options for female partners who both want to participate in conception or pregnancy.
What is Reciprocal IVF?
In a reciprocal IVF cycle, one partner’s eggs are used to create embryos, and then the other partner carries the pregnancy and delivers the child. For same-sex female couples, this is a way that both partners can contribute to the family building process uniquely. The first partner will take fertility medicines to produce multiple eggs, and undergo the egg retrieval. Only this partner will be genetically linked to the future child.
Those eggs are then combined with designated donor sperm in the IVF laboratory, while the partner who is choosing to become pregnant goes on medication to prepare their uterus. Then, when the timing is optimal, embryos are transferred into the second partner's uterus. This is a wonderful option in situations where both partners want to participate in the pregnancy!
Success rates with reciprocal IVF vary with age and fertility markers for both partners.
What is INVOcell?
Here at Gay Parents to Be and RMA of Connecticut, we're excited to announce a new technology that can help same-sex couples both participate intimately in a child's conception story - INVOcell. This new treatment pathway uses an intravaginal culture system, consisting of a small rectangular clear plastic container (often referred to as a culture device) with a soft silicone retention cap to keep the culture device safe and secure inside your body.
The first part of the IVF process with INVOcell is similar to a traditional IVF cycle - one partner will begin taking medication to stimulate their ovaries to produce eggs, and then have an egg retrieval.
After the egg retrieval, Partner A’s eggs are placed into the inner cylinder of the INVOcell culture device with donor sperm. The INVOcell device is then placed into the upper third of that partner’s vagina, and protected by the soft retention cap.
Eggs and sperm then grow in a nutrient-rich culture media inside the INVOcell device, incubated by body heat - an amazing way to be connected to the early stages of embryo development.
Five days later, the partner carrying the INVOcell device returns to the office, and the INVOcell device is removed. Embryologists can then locate and assess the health and quality of your embryos. Any growing embryos (or blastocysts) are carefully removed in the lab. One is selected and transferred into the uterus of the partner who wants to carry the pregnancy and deliver the baby. Just like a traditional embryo transfer, Partner A and B are able to watch on ultrasound as the embryo is placed into the uterus using a special catheter!
As with a traditional IVF or reciprocal IVF journey, any excess embryos that are grown in the INVOcell device may be frozen for a future embryo transfer.
What’s the difference between INVOcell and Reciprocal IVF?
With INVOcell, the partner who completes the egg retrieval is able to participate in the first five days of embryo growth and incubate the INVOcell device in her body. After five days, embryos are removed from the INVOcell device and an embryo is transferred into the carrying partner.
Both partners are intimately involved in “carrying” their future baby - what an amazing way to be involved in your child’s conception story!
Watch Dr. Richlin explain how INVOcell works and the success rates for this new technology!
What's the right fertility treatment for same-sex female couples?
The answer to that question is: there's no one right answer. Fertility success rates vary based on individual treatments and circumstances, and your journey will be tailored to your medical history and personal fertility.
If you decide that biological family building is right for you, there are multiple routes to pregnancy for same-sex female couples: IUI, IVF using one partner’s eggs & uterus, reciprocal IVF, or using INVOcell technology. And for single moms-to-be, your fertility specialist will help determine whether an IUI or IVF pathway is right for you.
It is also essential to remember that picking a sperm donor is a very important part of this process, since this person will be linked to your child’s creation story that you share with them as they grow! We recommend that you meet with an experienced reproductive mental health professional to help you with this decision, and to help you figure out how to craft the conception story that you will share with your child and the world.
Good luck in your family building journey, take the time to get educated, and stay hopeful!
Real families. Real stories. Hear how moms Stef and Denise chose a fertility practice, sperm donor, and found support during treatment.