Pride: Helping LGBTQ+ Couples Become Proud Parents
Jun 17, 2021 Jasmine Aimaq
As we celebrate Pride Month, we recognize the strides we've all made in reproductive justice.
Cedars-Sinai's Fertility and Reproductive Medicine Center helps people have children outside the traditional mother-father model. Lots of new families are built every day using third-party reproduction. This way of making babies brings a few extra considerations, so we asked reproductive expert Dr. Erica Wang to talk about this joyful—and sometimes challenging—part of medicine.
Hoping to become fathers: what to expect
"We have many same-sex and transgender couples come to us, and the processes are similar as well as different," says Dr. Wang, who has been with Cedars-Sinai since 2012 and loves to help anyone who's longing for a little one. For same-sex male couples, the process typically involves four people—two hopeful parents, the gestational carrier and the egg donor.
"A traditional surrogate uses their own eggs and conceives with sperm from the intended parent," explains Dr. Wang. "This is much less common than a gestational carrier, who conceives using sperm from the intended parent and eggs from a donor, which is the process we work with at Cedars-Sinai," says Dr. Wang, adding that she discusses all options with patients and also connects them with agencies that help them find a donor or carrier. Some couples already have someone in mind, such as a trusted friend, but patients often use agencies.
Dr. Wang's team will help make embryos using sperm from the intended parents and an egg donor. Embryos can be made using one partner's sperm or both partners' sperm. The embryo is then implanted in the gestational carrier.
"The intended parents, the egg donor and the gestational carrier all become my patients for the process," she says.
"The intended parents, the egg donor and the gestational carrier all become my patients for the process."
Hoping to become mothers: what to expect
Women and transgender individuals in same-sex unions have different options than men. They need a third party's help for sperm donation. In most cases they'll turn to a donor sperm bank, although they sometimes choose someone they know. Donors are thoroughly screened by the sperm bank, but Dr. Wang's team provides crucial information.
"If the patients have a particular donor in mind, we'll advise them to buy lots of vials!" says Dr. Wang.
As for the medical process? "It involves the same things we'd do for anyone who wants to get pregnant and needs a bit of extra help," she explains. "We do a comprehensive workup looking for factors that could affect fertility, such as irregular menstrual cycles, and we figure out the ideal to time for donor sperm insemination. In the clinic, we can inject sperm directly into the uterus, a process called intrauterine insemination (IUI). The average is 3-6 IUI cycles. If that doesn't work, we can move on to IVF."
Same-sex female or transgender couples can also choose reciprocal IVF, where one partner gives the egg and the other gestates. If the couple would like more than one child, they can take turns at providing the egg and carrying the baby.
Patients take early pregnancy ultrasounds, and then they graduate to their OB-GYN at about 10 weeks.
"We transfer the care, but we definitely stay available," says Dr. Wang, who also helps single individuals or families with more than two parents, and who works with transgender men who wish to preserve their fertility.
"My patients are so committed to becoming parents. It's a privilege to share this time of their life with them."
For everyone: what to expect
Third-party reproduction takes time, consideration and planning. Legal counsel is important—for example, to make sure that the third-party gestational carrier knows they don't have any rights over the child. The selection of an egg donor, sperm donor and gestational carrier can take longer than patients think. IVF can also require several rounds, and success depends on many factors, so be prepared for ups and downs. There is also lots of support, including the reproductive team at Cedars-Sinai, which offers counseling, if desired.
Insurance can be challenging as coverage for fertility care can be limited, and there is still discrimination.
"Insurance may cover infertility care, but the issue here is not infertility," explains Dr. Wang.
Patients should make sure they understand their plan's coverage and be ready for out-of-pocket costs.
"If couples are able to move forward, this can be an amazing journey," says Dr. Wang. "My patients are so committed to becoming parents. It's a privilege to share this time of their life with them."