Planning a family takes a lot of coordination and careful preparation for LBGTQ couples. Since they cannot conceive a child on their own, that does not mean they cannot have a child through natural birth. Dr. Lauren Weissmann of South Jersey Fertility Center is here to answer and talk through any questions or concerns you may have about conceiving a child through your natural fertility.
SJ Fert Discusses LGBTQ Family Planning
Hi everyone, we’re live! It’s just now 8:00, thanks everybody for tuning in. This is Dr. Lauren Weissmann from South Jersey Fertility and tonight’s topic is going to about LGBT family building and all of the options that surround it. I really look forward to hearing from all of you and any questions you may have. This is your chance to be able to ask any questions that you want and I hope that it’s informative so you guys can learn something that you may not have seen or heard before. Once again, it’s 8:00 and this is the South Jersey Fertility LGBTQ family building workshop to talk about how we can help you and answer any questions about how to help build your family.
Approaching LGBTQ Family Planning
So some of the first questions that we usually get asked are: What information do you need to have? What ideas do you need to have to even set up a consultation with any one of us? The answer is you really need to know nothing and you don’t need to have had any prior exposure to information. It’s really an information session to understand all of the options and ask any questions that you have, which hopefully some of it I will address today for all of you. We have a whole range of folks who come to us to learn about the options to build families. Some know exactly what they want to do when they set up their consultation while others really don’t have any sense and are looking to hear all of the options. So we’ll begin talking about some of these options right now.
Basic Family Planning for Female / Female Couples
I’m going to start with some very basic things about how to help build a family for female/female couples. Some of the first things that we talk about are essentially just natural fertility. I think it’s important to have an understanding of natural fertility so that expectations going through the process are realistic. Just so that everyone knows, usually per month the chance of conceiving when sperm and egg are present at once is approximately up to about 20 percent. So again, just on a per month basis, people only conceive about 20 percent of the time and each cycle. This is certainly not a big number but one that we hope to get up to when we do thinks like insemination – so, 20% per month and then that usually over a span of one year trying. It’s a normal amount of time for there to be a female who oxalates and then have sperm be present. Through intercourse, for example, the 12 cycles of attempting to conceive is considered normal in the sense of measuring one’s fertility. It’s really only if one hasn’t conceived after 12 months of attempts that it’s considered abnormal – and that goes for all women who are under 35. Above 35, it’s about 6 months of attempting to conceive. It’s important to have that basic sort of understanding and framework when we try to help same-sex couples conceive. We’re really striving to minimize the attempts at conception and maximize the success, but it’s really difficult to overcome what is the natural course of things.
Egg Insemination from a Sperm Donor
Any treatment that we offer is going to help get us up to that normal number of a chance for success. The most popular choice is using insemination – where essentially we allow couples to have previously selected a sperm donor. Most of the time this is from an anonymous source, so typically sperm banks – and we’ll talk about selecting that for banks in just a few minutes. Using sperm that is stored in a facility like ours, we then would thaw that day for the person that is ready for ovulation and starting the process of evaluation through insemination, which is used to inject that sperm into the uterus. We try with each attempt and hope to get everyone up to that 20 percent per cycle chance.
Analyzing Your Body for Fertility
There are some things you’ll need to take a step back and talk about prior to getting to that point. Just giving that framework is what I even talk to my patients when we try to say, what testing is appropriate? How do we select sperm? How do we know we’re getting sperm from a reputable source? What I first tell my patients is that you guys are investing a lot of time, energy and money. A lot of times you don’t necessarily need to go the route of investigating how your ovaries are functioning. We all think that they would be normal and in normal function compared to anyone else your age. We try to talk about that there’s a low chance of having any problems with your uterus or your tubes – like there may be for some of our infertile patient population – but because you’re investing so much time, energy and money, it’s not a bad idea to undergo a few tests just so that we can make sure that we’ve optimized every single thing that we possibly can. We’re not trying to help you conceive for 5 to 6 months using this precious sperm with your time, energy and resources only to find out that there may be some other issues that we could have known from the beginning. We’ll then offer different treatment or more effective treatments to help with whatever issue we may have uncovered.
Testing for Fertility
About 10% to 15% of couples, or people in general, will have some kind of issue with fertility that we can detect with these different tests. We always recommend that takes only about 2 weeks to get all the tests done. It’s timed to a certain part of your cycle and the tests usually just involve an ultrasound and blood work to look at how your ovaries are working. One particular test using an x-ray will help to make sure that the fallopian tubes that carry the sperm to meet the egg and the uterus that carries the pregnancy are both normal. Those couple of weeks within the first part of your of your cycle we would have those answers and we’ll be able to say, okay great, we’ve checked these things off, we know that everything is looking good or we’ve detected something that we can now offer more effective treatment to help you conceive. There’s usually a 2-week warning about recommending the kind of testing period in the first half of your cycle.
Selecting the Right Sperm
It’s also a good time in that month, after we answered all these questions, to really kind of think about selecting your sperm donor. So what are some of the characteristics that we look at with a sperm donor? We hope that it’s from a reputable source – meaning that it’s usually an FDA approved sperm bank or always an FDA approved sperm bank. So there are many of these banks across the country and even the world that have plenty of donors that are accessible. The reason why having an FDA screened donor is important that they’ve gone through a quarantine period where they’ve undergone a sexually transmitted disease testing and then frozen for six months. Then the donors have to get retested to make sure that they weren’t in the early stages of having any of these diseases that may not have been detective the first time. Because they’ve undergone the quarantine period and retested, that is the best that we possibly can do to make sure that there’s a little to no chance of having any kind of any donor with an STD. We highly recommend and really only use a sperm from FDA approved sources. The acquiring of the sperm process is pretty simple. You give the information and the address of the clinic that you want to have it sent to and you essentially get it shipped to the facility – hopefully in the month prior when you’re starting treatment so that we know that it’s there and available.
Testing for Cytomegalovirus or CMV
One other parameter that’s often discussed, not to spend too much time on it, but that is something called CMV or Cytomegalovirus. If any of you have looked at sources for sperm before, you may have seen it come up as a donor being CMV positive or negative. The reason why it’s something that is tested is that it’s a very common infectious disease. It’s not an STD, but it’s an infectious disease that most people would have no idea that they’ve ever been exposed to it. It has symptoms much like any kind of virus causing a cold. It’s really not of any significance for adults, but the concern is that if you were to have contracted CMW during pregnancy, it could have some pretty devastating effects on the growing and developing baby. So because of that, we try to avoid being in contact with anyone who may have active exposure or infection of CMV when someone is pregnant.
The Risk of CMV
How does this relate to the donors? There’s a theoretical risk – and I emphasize theoretical risk – that if a donor were to have been exposed to CMV at some point in their life and have antibodies to it, that it’s possible the recipient patient who’s never been exposed to CMV may contract the infection from a CMV positive donor. But again, it is theoretical. It is not anything that has been ever documented. My personal and professional opinion is that there are so many important factors to look at when selecting a sperm donor. As you can imagine, an ethnicity, an education, intellect, interests and all sorts of things that in my opinion are much more important to than actual CMV status. It’s something to know because you will need to know about the donor and it’s something that the fertility clinic would also test for you. You would know if you could be negative or positive, meaning that if you have been exposed to it before and then it’s something that you may need to consider. That’s a longer answer than I intended, but it’s a question that often comes up quite a bit because it’s something that people don’t know very much about on their own.
Shipping Sperm to a Fertility Center
Once again, once the sperm has been selected, it’s fairly easily shipped to a facility. Then what happens –and what we typically recommend – is to get us at least three samples in one shipment. That’s a good number to get, only about 15% to 20% chance using thawed, frozen or previously frozen sperm in a single insemination raises the change of pregnancy in that one cycle. It is not uncommon that you might need more than one cycle to conceive. Usually, three vials of sperm for insemination are recommended on a per shipment basis. That’s sort of a general rule of thumb.
Checking Fertility with Diagnostic Testing
I have one question asking back to you when we were talking about the test. So what are the tests? Sorry if I wasn’t specific enough about it. The tests are an ultrasound that looks at the ovaries and the uterus and blood tests specifically on day 2 or 3 of your cycle that look at different hormone levels. The hormone of FSH made by your brain always gets that test with an estrogen level and then another hormone that doesn’t have to be at any time in the cycle that also helps to look at the ovaries. Sometimes a hormone that we use is called AMH or Anti-Mullerian Hormone – and instead of being made by the brain, it’s made by the ovaries.
So those three things – FSH, the ultrasound and AMH – help us see how the ovaries are working. Then that other test I was mentioning is the HSG or Hysterosalpingogram. The HSG, the x-ray test is the one that looks at the tubes as well as giving us some information about the uterus to make sure that all of that looks normal. Again, if anyone has any question, please feel free to make a comment and I will absolutely answer them. Often, like I’ve mentioned, the most typical scenario is that you’ll undergo the test that I just mentioned and then we get some additional FDA required blood work, which includes testing for HIV and Hepatitis of a particular blood test that looks at exposure to Syphilis in the CMV antibodies.
Providing Genetic Testing Information
The routine preconception things that if you were to go to any OB-GYN and say you’re interested in conceiving, we want to make sure you’re immune to things like Chicken Pox and Rubella. We’d also make sure you’ve had appropriate counseling regarding potentially getting any kind of carrier screening for common things like Cystic Fibrosis or anything that may run in your family. A lot of times we look for donors that will provide some of the genetic testing information. It can be variable to the extent of how many diseases were tested for. If we find a donor that a couple, or person, is interested in, we’ll make sure that they have a carrier status for a particular disease. Then we can test to make sure that you or your partner doesn’t have it. The most common route is to do the intra-uterine insemination so the actual IUI is done again at the time of ovulation.
How do we figure that out? The way with the least sort of intervention is for you at home to detect the natural surge, meaning the hormone level, LH or Luteinizing Hormone is what the ovulation urine kits that are sold in drug stores. What happens is the LH hormone is secreted in your bloodstream and then shows up in the urine. Within about 24 hours of that test being positive, a woman would ovulate. So typically the way of going about this is you monitor the database that would be appropriate for the length of your menstrual cycle with ovulation kits. When that kit turns positive, you could call the office and have an examination scheduled for that following day after the LH is positive. You’d then come in that morning for the insemination and when in the office, we thaw the specimen. Just about half a liter of volume of the sperm is concentrated. Next, with a speculum in the vagina you can see your cervix and take a tiny little catheter through the opening – most people don’t feel anything at all – to inject the sperm. Then you can carry out the rest of your day as you normally would. You’d either get a period within the two weeks or if not, we test for pregnancy and then go from there.
Then there’s a stepwise progression. We can either decide to do that with LH monitoring or you can potentially have more monitoring with ultrasounds and blood work. We would do this at the beginning of the menstrual cycle and then around the time that you might be ready for ovulation usually around age 12 and then in a 28-day cycle – one being the first day of a period. That gives us a sense of when the best time might be to pinpoint. This can increase the chances of pregnancy in some sense because we know we’re optimizing the time timing of everything, as it needs to be so precise since we obviously only have usually one shot in that cycle.
Women commonly elect to use a fertility medication such as oral medication like Clomid or Letrozole along with a one-time injection to make one ovulate. When we see by ultrasound and blood work that the egg would be mature we’re able to time it that way. Since a lot of times we give instructions to take this one-time injection and then you’ll receive insemination either the following day or within 36 hours time. Depending on the patient’s preference, the patient’s age or how aggressive we want to be with the time that we have, all of these options are available. After 3 to four months of trying one particular method, we always suggest reviewing the treatment plan more formally. Then at that point, changing the plan a little bit to help increase chances.
Age and Fertility Rates
I see there are a couple more questions. So unfortunately in terms of chances of conceiving, age is the one thing that a 100% of the time as one ages, fertility goes down. Since women are born with all of the eggs they have, they only lose eggs every day throughout the course of their reproductive lives. Both the number of eggs is depleted as well as the quality of the eggs. At 46, I would say at that point, less than 5% chance overall, maybe even closer to 1% to 5% chance of conceiving. There are many other options including a donor egg at that point, which can be quite successful.
IVF Fertility Treatment
Another option that is open to couples that some do, but certainly fewer than those who choose inseminations, is something called IVF. This is the process by which we obtain eggs from one partner and then create embryos using donor sperm and then place an embryo back in the other partner’s uterus to then hopefully become pregnant and carry a pregnancy. The recipient parent, the one who’s embryo was placed in the uterus, is not genetically related to the child they’re carrying but is created from the eggs of their partner then as well as the donor sperm that they’ve selected together. It’s a very nice way, in my opinion, for both members of the couple to play a quite significant role obviously in creating that family.
The IVF Process
In terms of what’s involved, which means IVF to obtain the eggs, or In Vitro Fertilization. One partner would undergo a process of a series of injections for an average of about 10 days. Then egg retrieval will occur under IV sedation, where through the vagina we use a needle to get all of the eggs from the ovaries. We combine the eggs with the donor sperm to create embryos and then we select the best looking embryo to be placed back into the uterus of the other partner. During this time, that other partner has been taking estrogen orally as well as with a patch. A few days before the embryo transfer starts with injections of progesterone. This is all to help prepare the lining of the uterus to get ready to accept the embryo and hope for pregnancy. It’s the best way for both members to have a role in the child creating and sharing process. Sometimes this would be an option for couples who may have already chosen and been successful with insemination first or potentially choose to do that at a different point depending on who wants to carry a pregnancy.
Asking Questions about Your Fertility
I’m very happy to answer any questions for you guys. Hopefully, if anyone has any particular questions of things we haven’t touched on, please feel free to contact me or anyone else in our office. You can do that by several ways. There’s an ask a doctor questionnaire on the home page of our website. There’s also a phone call consultation and of course, you can make an appointment for a sit-down conversation where you can review all of the options and everything we talked about here.
The Success Rates of Insemination
How successful can insemination or chance of pregnancy be with one working Fallopian tube? Usually, we say that if there is a working fallopian tube there’s not so much of a quotable difference in the chance of success. The 20% per month is pretty much with everything intact and working. If we had to pick a number, I would probably say a little bit lower than that – maybe 10% to 15%. That’s a per month basis average across the board for all reproductive age women, but as I mentioned, I understand that can be confusing because the overall chance of pregnancy does decline with age as does as a does the per month chances of pregnancy. These are all averages that I was mentioning before, but usually, when you have one working Fallopian tube, that might be an opportunity for us to help in the sense of trying to get more than one follicle with an egg inside of it to develop. We do this in hopes that we can optimize that one working fallopian tube and that we have an egg available on that side as well.
How Much Does Insemination Cost?
The cost of inseminations is on average $300 to $400 for the actual insemination. The success rates are 20% when fresh sperm is available with a natural cycle of an ovulatory woman. Usually, we quote a little bit lower using previously frozen-thawed sperm – so somewhere between 15% and 20%. Anything that we do with Clomid or other medications is an attempt to get up to that 15 to 20% chance of a pregnancy per month with insemination.
What’s the Best Age for IVF Procedures?
What age is IVF pregnancy possible? Usually, the recipient, the person who is going to carry the pregnancy, is about the age of 50 – occasionally a little bit older. The person who we’re attempting to retrieve the eggs from, success declines pretty rapidly after the age of 40. The upper limit of most clinics including ours would consider doing retrieval and hoping to get viable eggs.
Family Planning for Male / Male Couples
There’s another very good question that I didn’t mention yet about male couples. There’s a lot of planning that’s involved as you can imagine, so we usually have sperm available. We would do a semen analysis just to make sure that we can expect that it would be normal. Then there’s a selection process with either known or anonymous egg donors. We have a whole egg donor team and coordinator that help facilitate that process. We go through the process of IVF for the egg donor and use sperm from one or even both of the male partners to inseminate the eggs we retrieve from the donor to create embryos. Then at that point, we have what’s called a gestational carrier, which is a person who’s intended to carry the pregnancy. That person will have taken medication, estrogen and progesterone to prepare the lining of the uterus. When the embryos and carriers are ready, we place the embryo back using an embryo transfer. It’s a very involved process with a lot of coordination, but very successful and rewarding process to help a couple.
Answering Your LGBTQ Family Planning Questions
We do have an LGBTQ Family Building page on our website that helps to get a little bit more information about everything that we’ve talked about. We look forward to helping anyone who’s interested to embark on a very exciting journey of building a family and hope to see you all soon. Take care!
LGBTQ Family Planning in New Jersey
If you’d like to schedule an appointment with South Jersey Fertility and speak with one of our experienced fertility practitioners in New Jersey, feel free to contact us today for a consultation. We’re proud to be serving the LGBTQ community and make their dreams of having a family come true. To learn more about the fertility services and for additional fertility information, we hope to see you at our next live video on our Facebook page.