Family Building Options for LGBTQIA couples and individuals.
Regardless of your sexual orientation, inclusive family building options are available to help you achieve your dream of becoming a parent. Dreaming of Baby speaks with Dr Brian Levine, Founding partner and Practice Director of CCRM New York, about the LGBTQIA journey to baby and how this is achieved.
Dreaming of Baby: Hello and welcome, thank you for joining us today Dr Levine. To help our readers get to know you more can you tell us a little about your focus and specifically your focus on working with the LGBTQIA community?
Dr. Brian Levine: Hi! Thank you so very much for inviting me to the interview today! I am a reproductive endocrinologist and fertility expert working in Manhattan. As part of our practice, we take care of patients who want to preserve their fertility (eggs & sperm), those who are trying to get pregnant, and those who cannot stay pregnant. The LGBTQIA community is an important part of our practice since these patients are not infertile, they just don’t have access to either eggs or sperm.
Unfortunately, many LGBTQIA patients don’t feel comfortable going to fertility clinics because they don’t feel that many clinics are sensitive to their needs. Other patients feel that clinics don’t focus on the needs of a same-sex couple. We have a different approach – we have a holistic approach that involves both partners and lets the couple make informed decisions. And, because we are part of the Colorado Center for Reproductive Medicine, we have great resources for patients who might need a gestational carrier (for example male/male couples).
Unfortunately, many LGBTQIA patients don’t feel comfortable going to fertility clinics because they don’t feel that many clinics are sensitive to their needs.
Dreaming of Baby: This is understandable, from your experience how does the journey differ for them? As an example: it is my understanding that a lesbian couple will generally require donor sperm, with IUI & ICI as an option, what may be the reasons and benefits for visiting a clinic as opposed to home insemination for example?
Dr. Brian Levine: In the clinic setting we can help control factors that can improve success rates. For example, timing of the ovulation, helping improve the parameters of the sperm, or simply starting progesterone support. Plus, an intrauterine insemination is hard to do at home and can put a patient at risk of an infection; in a clinic those risks are mitigated.
Pregnancy Options for Lesbian Couples
Dreaming of Baby: If you can walk us through the journey, I am assuming it all begins with a visit to the clinic; what are the main steps a lesbian couple would take from dreaming of baby to the delivery room? (With the aid of a fertility clinic)
Dr. Brian Levine: Great question! It would start with an appointment with a doctor where we would assess the fertility of the partner who would like to become pregnant. Provided everything is within normal limits, and dependent upon her age, we would recommend that we follow her natural cycle (which means that we note when she gets her period, monitor with blood work and ultrasound when she has a mature egg, and have her monitored for when she ovulates). We would then have her come back to the clinic 24-36 hours after ovulation to have the insemination procedure where the sperm is refined in the lab and concentrated to be placed at the top of the uterus. Fourteen days after the insemination, she would come in for a blood test (or at home test) to see if she’s pregnant.
Dreaming of Baby: You mentioned above that the sperm is refined and concentrated to be placed at the top of the uterus, is this a surgical procedure? Is any sedation required? Can you give us a little more information on this step?
Once the sperm is refined and processed in a laboratory, the patient has the IUI procedure, a simple oupatient office procedure.
Dr. Brian Levine: I’m so sorry. This is a very easy procedure. The sperm is refined and processed in a laboratory. The patient then has the IUI (intrauterine insemination) procedure which is a simple outpatient office procedure.
It starts off like a pap smear with a speculum being placed. The cervix is cleaned with a qtip to remove the mucus. And then a small flexible catheter (or tube) is placed through the cervical opening into the uterus and the sperm is deposited at the top of the uterus.
Dreaming of Baby: Don’t be sorry, I just know that sometimes these are concerns we have as we go through these kinds of processes. So, if I understand correctly, at the end of the procedure the mother to be is up and about with no discomfort?
Dr. Brian Levine: Yes! Most go back to work and back about their daily activities.
Surrogacy for Gay Couples
Dreaming of Baby: Excellent, you mentioned gestational carriers for male couples, I assume this would be a surrogate?
Dr. Brian Levine: Yes – that is what they are commonly called.
Dreaming of Baby: What is the normal journey for a male couple dreaming of baby? If you can give us the same walk through. (Is the term surrogate inaccurate?)
Dr. Brian Levine: For male patients, it is a little more challenging. For males, the first part of the journey starts with a selection of an oocyte donor or egg donor. Once the donor is selected, the couple can either use previously frozen eggs or they can use eggs that are part of a fresh in vitro fertilization cycle.
Some male couples choose to fertilize half off the eggs with one partner’s sperm and half of the eggs with the other partner’s sperm.
Dreaming of Baby: Can you walk us through the differences between Fresh & Vitrified Eggs?
Dr. Brian Levine: Once the eggs are retrieved, the next part is fertilizing them with sperm. Some male couples choose to fertilize half off the eggs with one partner’s sperm and half of the eggs with the other partner’s sperm.
Once fertilized, we then have embryos. These embryos are then cultured in the laboratory for 5-7 days where they can be genetically tested prior to cryopreservation or freezing of the embryos.
Once ready for transfer, the gestational carrier takes a series of medicines to help produce, and adequate the uterine lining for implantation to occur. After taking medication for 10 to 14 days, the patient starts progesterone to help mature her lining and then typically the embryo is transferred into the uterus.
For male/male couples, it is much more invasive since it requires securing eggs and someone willing to carry the pregnancy
To answer your question about frozen vs fresh eggs, both are viable options for egg donors, but typically frozen eggs are faster for a couple since they have already been harvested.
Dreaming of Baby: This I assume is especially important if the couple wants a child that is of their own genetic make up. What advice do you give male clients in choosing between vitrified/frozen eggs and fresh eggs? More importantly is there a considerable stock (so to speak) for them to choose from?
Dr. Brian Levine: Frozen eggs are typically cheaper than paying for a fresh cycle, but they get fewer eggs (typically 6 or less). This is designed to yield one baby.
Dreaming of Baby: Is there a difference in cost and success rates between fresh and frozen?
Dr. Brian Levine: If they want more than one child, I typically advise a fresh cycle. They are typically equivalent.
Dreaming of Baby: Thank you for your time today Dr Levine, it has been a pleasure speaking with you.
Dr Brian Levine: Really an honor!