Long gone are the days of June Cleaver, her dress and pearls, and her white picket fence. Nowadays, the face of families has had a major facelift. Two mothers, two fathers, working mom with a stay-at-home dad…it has all changed. Kudos to choice and change! But while you can mold your family to take whatever shape you want without an egg and sperm source, you will need some outside help manipulating the “clay.” Cue your friend, the fertility doctor.
While all pregnancies require an egg, a sperm, and a uterus, how these three sources meet and where they come from can be quite variable. It is our job (a.k.a. that of the fertility specialist) to help make these necessary introductions and ensure that, from this meeting, comes a baby!
The first order of business when we meet with a same-sex female couple is to figure out preferences and timing. Simply stated, do both partners want to give an egg, do both partners want to give a uterus (a.k.a. carry), and if so, when? And taking it one step further, do both partners want to carry their own genetic child or their partner’s genetic child? (Don’t worry if this sounds confusing; we will explain!) We then use this information to formulate your fertility plan. Here’s how.
Timing is not only everything in relationships but also in family planning. Which partner should go first (#getPREGNANT) is not only based on personal preference but also on medical factors (egg quality, egg quantity, and uterine receptivity). Therefore, before any final decisions are made, it’s a good idea for both partners to visit a fertility specialist and get checked out.
What your MD finds might have a major impact on what fertility options are available and in what order. For example, if you are 35 and your partner is 38 but your ovarian reserve is approaching that cliff (a.k.a. about to take a sharp decline), we may recommend that you go first in the pregnancy process. On the flip side, if your partner is 40 and you are 30 and you were hoping to have your little one before 31, we will probably recommend that you put your baby button on pause and let your partner go first. Nuances like this are not apparent unless you get down to the nitty gritty (blood work, ultrasounds, and a full exam) with a fertility doctor.
After you have been checked out, there are a few options for you to check out. Unbeknownst to most, there are a couple of ways (other than the obvious) to get egg and sperm to meet. These include inseminations (IUI) or IVF.
And the variety doesn’t stop there. When it comes to IUI, you can do it as bare bones as possible (a.k.a. time the inseminations to when you are ovulating) or add medications to boost your fertility (e.g., Clomid, letrozole, gonadotropins). Which route you choose to take is often made after recommendations from your doctor. If IUI isn’t working out, we might recommend that you amp it up a bit (#IVF). If other medical issues exist (low egg reserve, advanced maternal age), we may suggest skipping IUI altogether and going right to IVF.
In many ways, same-sex female couples have the most options on how to make and carry children. Let’s face it: although you may be at a loss for sperm, you have double the eggs and double the uterus. This doubling will come in very handy when mapping out how you want to enter motherhood. The reason is that, if you want, you can switch things up. You can carry the embryo created with your partner’s egg and donor sperm, and she can carry the embryo created with your egg and donor sperm. It’s a unique way to build a family, though it requires IVF, creativity, and cash. (We too believe the lattermost is unfair. We have added our voices to the fight against insurance inequities!).
Think about a cake. While the core ingredients are always the same (think flour, sugar, and butter), there is more than one way to mix it up (add cinnamon, nutmeg, or chocolate chips). The same goes for building a family—although you need those core ingredients (an egg, a sperm, and a uterus), how you combine these three can vary. Today’s family should have the flavor and flair of you and your partner—rigid guidelines are “rotten.” Anyone who tells you otherwise has way passed his or her expiration date.