(Originally published as my Mombian newspaper column.)
For same-sex couples wanting to have children, knowing where to begin can make a big difference. For couples starting their families through biological means, one new resource is the Family Building Options Web site, part of the Fertility Lifelines educational program created by pharmaceutical company EMD Serono.
Despite the corporate ties, there is no marketing of EMD Serono products on the site, and it provides some genuinely useful information for both lesbians and gay men, including a free, 24 page booklet with additional material. Endocrinologist Dr. Guy Ringler, a partner with California Fertility Partners in Los Angeles, is a spokesperson for EMD Serono’s campaign to raise awareness about fertility choices among same-sex couples. He shared with me some of his suggestions for those beginning the journey.
The first step, Ringler said, is to learn what options may be available to you. Aside from Family Building Options, he recommends the American Fertility Association’s site.
While not LGBT specific, the AFA site includes a directory of LGBT-friendly fertility professionals, and is clearly inclusive—one entry in the AFA blog is the video of Zach Wahls, a college student with two moms who spoke in support of marriage equality at an Iowa House hearing February 1.
It’s important to talk openly with your medical providers to make sure they are comfortable treating same-sex couples, Ringler noted. “You really want to seek fertility care in a setting in which you feel entirely comfortable and respected.”
Ringler then advised talking with your physician about what options fit your particular circumstances. To help determine this, he recommends a “baseline fertility evaluation.” For women, this would likely include an evaluation (usually a simple blood test) to determine where the ovaries are in their lifespan, a key factor in pregnancy success. An x-ray of pelvic anatomy can also confirm that the fallopian tubes are open. Men should undergo a semen analysis to confirm normal sperm production.
Ringler said some of these tests can be done by an OB/GYN, more of whom are now doing basic fertility work. Patients should ask, however, what services they offer in their offices and what they refer elsewhere.
For some patients, however, starting with a fertility specialist may be the better route. For example, office hours are critical, explained Ringler. Some OB/GYN offices are only open on weekdays, so “if you’re ovulating on a weekend, you miss out on a cycle.”
He also cautioned that when there are infertility problems, some OB/GYNs may hold onto patients for too long before referring them to a specialist. Because ovarian age is the primary factor in pregnancy rates, time is of the essence.
His own approach, if the baseline evaluation does not indicate any problems, would be to start with the simplest treatment option first—donor sperm inseminations—for three to six cycles, monitoring them closely to catch any potential problems.
He warned, however, that “even in the best of conditions, pregnancy rates are not as high as people think,” averaging only about 12 percent per cycle. The primary factor in pregnancy rate is the age of the woman ovulating, he said. Under age 40, it is about 12 percent per cycle. Over age 40, it can drop to between five and seven percent.
If things are not successful after a set number of cycles, he would then consider a more involved treatment, such as increasing the number of eggs per cycle or trying in vitro fertilization (IVF), where egg and sperm are combined outside the woman’s body and then placed in the uterus. IVF, whose success rates have grown over the last 10 years, can increase the pregnancy rate to perhaps 50 or 60 percent under age 40. Women over 40, with signs of decreased ovarian reserve, also have the option of using a donor egg.
Gay men interested in creating a family through biological means, he said, will most likely pursue egg donation and gestational surrogacy—where the surrogate does not use her own egg. Aside from a fertility evaluation, you would need to find agencies to provide the surrogate and egg donor, unless you are using ones known to you.
Regardless, you should consult a reproductive attorney, he advised. Laws regarding surrogacy vary from state to state, and things may get even more complicated if the intended parents and surrogate live in different states.
IVF is then used to impregnate the surrogate. “The good news,” he said, is that pregnancy rates are very high, “about 75 percent per cycle,” because agency egg donors are in their 20s and surrogates have proven fertility.
Ringler noted that surrogacy is not only an option for gay men, but also for women with uterine problems. In the last five to ten years, he believes, “surrogacy has become much more accepted by our culture,” thanks in large part to the media.
Overall, Ringler advised potential parents, “One has to be patient. . . . It’s really helpful to know about the process, to know what to expect, what testing has to be done, what the success rates are, and have a realistic time plan. That’s a conversation that has to come between you and your health care team.”
And beyond the factual information, “You want to feel cared for.”
The information above is not meant as a substitute for the advice of your own medical professional.