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Gay Pride Month: Family Building for Same-Sex Couples

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June is Gay Pride Month, also known as Lesbian, Gay, Bisexual, and Transgender Month. With many festivals and celebrations throughout the country, there is awareness being raised of many LGBT issues, including same-sex family building and options for having a biological child.

The American Fertility Association (The AFA) hosted Family Building Tents at Gay Pride Festivals in Boston, Brooklyn and Philadephia this past weekend, and will be in San Francisco on June 25-26. The organization also debuted its new LGBT Handbook, which provides answers and insights to those wishing to start families.

"The new Handbook published by The American Fertility Association for the LGBT community is a comprehensive primer on all aspects of how to start your family when you are ready to have children," says Corey Whelan, program director for The American Fertility Association. "This Handbook was much needed, and has already been disseminated to hundreds of people both online and in print at Pride events, less than one month after its completion. As the author, I hope that the takeaway message individuals will seize upon — particularly during an era when marriage equality is not a given — is the need to create healthy, safe families that are protected by law. I also wanted to transmit a realistic optimism to gay people about their choices for parenthood, because the future truly is bright for these families of choice.

Biological Family Building Options for Same Sex Couples

For gay men, the road to biological parenthood will lead them to a surrogate. A surrogate or gestational carrier carries and gives birth to a baby for another individual or couple. In traditional surrogacy, the carrier’s eggs are used; in gestational surrogacy donor eggs are used.

If the gay couple is going to have more than one child, they may decide that one partner is the biological parent in the first pregnancy, and the other partner is in the next pregnancy. Or the couple may choose to fertilize donor eggs with sperm from both partners, and embryos from both partners are implanted. Another option is for the couple to use donor eggs from the relative of one partner and sperm from the other partner, so each has a biological connection to the child.

For lesbians with no infertility issues, biological parenthood can be achieved with artificial insemination. Donor sperm can be obtained from sperm bank or from a “known donor” such as a friend. There are a few different insemination options: vaginal insemination, which can be done at home, or intracervical or intrauterine insemination (IUI), which are typically done in a doctor’s office.

Lesbians may also choose a process known as reciprocal IVF (in vitro fertilization) in order to share the experience of the child’s conception. In this process, the couple chooses to retrieve the eggs from one partner and inseminate the eggs with donor sperm. The embryo(s) is then transferred into the other partner who then becomes pregnant.

"LGBT families, like all families, go through a period of questioning prior to starting their family building journey," Whelan says. "The first question is typically: "Am I ready to do this, am I ready to be a mom or a dad?" And then, if the answer is "yes," gay men and women will consider how they wish to proceed with their plans. Most important in the beginning will be the choice between conceiving with the help of third party reproduction, if there is a strong desire for at least one partner to have a genetic or a biological link to the child(ren), or to consider adoption."

Success Rates for Same-Sex Couples

When a same-sex couple researchers fertility clinics, they should note that the clinic’s success rates are representative of women/couples who have infertility issues — they are not representative for a couple who does not have any issues. For example, the success rates for a lesbian couples undergoing IUI or reciprocal IVF could be much higher, because this is not necessarily a group with infertility.

"What is true for lesbians is that infertility — at least initially — is not the reason for seeking reproductive assistance," says Samuel C. Pang, M.D., medical director at the Reproductive Science Center of New England. "It is also true that many lesbians may not know if they have infertility. At RSC New England, lesbians who do not have a history suggestive of infertility are offered basic diagnostic testing, but have the option to proceed with treatment without it. If they initially decline testing, but then are not successful in conceiving after several cycles of donor sperm insemination, we would then recommend that they undergo basic diagnostic testing."

Same-sex couples should pay attention to success rates, according to Whelan. "Success rates at clinics do in fact apply to this population as the technologies utilized for conception are the same as those used for straight couples and individuals. IUI, IVF, surrogacy/egg donation, even ICSI. Just as straight people should look at statistics as well as other determining factors when choosing an reproductive endocrinologist, so should LGBT individuals."

Dr. Pang, agrees. "Whenever seeking ART treatment one should include pregnancy and live birth data among the criteria for choosing a provider."

It is important for a same-sex couple to find fertility doctors, fertility clinics, attorneys, and egg donor or sperm donor agencies who are experienced in working with same-sex couples. Look for professionals who are knowledgeable and sensitive to a same-sex couple’s specific situation or needs.