Essential things lesbians should know.
Same-sex couples are now getting married, planning for a family and living the American dream. What does living the American dream mean for the LGBT community when it comes to planning for a family? If you Google “Lesbians and Conception” the information that comes up on your home page is lacking the adequate details to really learn about the process. Being an OB/GYN in Los Angeles for over 22 years and caring for hundreds of lesbian couples I feel a commitment to responsibly and properly educate those of you wanting information about what it takes to conceive. Here are the things Lesbians should know when planning a family.
Emotional Readiness
Just because you can doesn’t mean you should. You and your partner need to do your homework and research what it takes to plan a family, the financial commitment to get pregnant and to bring a new member to your family. The process can lead to a lot of stress and depression for one or the both of you. Lengthy conversations regarding the process from start to finish is vital. Practical discussions regarding who will carry the pregnancy, whose egg will be used and where will you get the sperm are all questions that need to be honestly discussed. Will the sperm be from a known or direct donor or an anonymous donor?
The stress of starting a family is no joke. Straight couples are three times more likely to divorce or become separated after failed fertility treatments. This same study found that the most challenging time for couples is the transition to parenthood. If a couple wasn’t stable or had “marital” problems facing the challenges with the fertility process than they will likely continue to struggle with similar issues through the fertility process and beyond. I recommend that lesbian couples see a therapist prior to beginning the pregnancy journey just to ensure that they are making the right decision.
Selecting an OB/GYN
Living in Los Angeles, California my exposure to the gay community is open, accepting and widespread. I feel it is so important that you find an OB/GYN in your city that is comfortable in dealing with lesbians and fosters a positive and supportive environment from beginning to end. In the past doctors have often been obstacles for patients in wanting to learn about having a baby and what it takes to make this happen. I would suggest doing your research. If possible, seek out an OB/GYN in your community that has worked with lesbian couples. If your city has a LGBT community or health center I would find out whom they recommend locally. Talk to your friends who have been through the process. Get recommendations that will make your experience comfortable, welcoming, educational, and cost effective.
Choosing a Sperm Donor
Unknown Donor Sperm Choosing a reputable and accredited sperm bank is essential. You want to find a bank that has the proper credentials which include: American Association of Tissue Banks (AATB), Licensed by the State Department of Health, Certified by Clinical Laboratory Improvement Amendment of 1988 (CLIA) and is in full compliance with FDA regulations. The California Cryobank fits this description and is one of the best in the country.
Directed (Known) Donor Sperm You can chose a known donor or what is called a “directed donor.” If you decide to use a brother or a friend, their sperm would go through the same screening process as the unknown donor. The directed donor and his sperm are checked for medical problems and sexually transmitted infections. Tests that need to be done prior to using his sperm include:
- General Health blood draw (cholesterol, hemoglobin and chemistry panel)
- HIV, Hepatitis Panel, Sexual transmitted panel,
- Genetic testing: Cystic fibrosis, spinal muscular atrophy and hemoglobinopathy carrier screening. Additional genetic screening is performed on donors with Ashkenazi Jewish ancestry, Cajun or French Canadian ancestry.
The safest way to ensure your known donor is healthy is to quarantine his sperm for six months. The recommended guidelines from the American Society of Reproductive Medicine and the FDA are to quarantine the sperm for six months and have the donor tested for certain viral diseases, including HIV and Hepatitis. Putting the sperm in the freezer for 6 months doesn’t cause any damage to sperm of good quality.
The Insemination Process
Lesbian couples have to do artificial insemination using selected sperm. The two options include:
Intra-cervical insemination (ICI) Unwashed sperm in placed at the entrance of the cervix. ICI can be done in the privacy of your own home. I would discuss it with your health care provider to learn how it is done and possibly have your provider show you and your partner how to do it at home. Doing at home ICI is less costly and much more intimate. The good news is there are more advanced tools that you can use instead of using the old fashion “turkey baster.”
Tools needed for home ICI:
- Ovulation Predictor Kit
- One 3cc syringe
- Sterile cup
- Thin catheter-Tom Catheter that attaches to the syringe
Intra-uterine insemination (IUI) Washed sperm is placed directly into the uterus through a catheter that goes through the cervix. The sperm then swims into the fallopian tubes where fertilization takes place. This is typically done by a health care provider. A great way to include the partner is to allow her to push the sperm into the uterus once it’s proper placed.
Whether you are having an ICI or IUI, inseminations typically occur the day you ovulate or the day after. Your health care provider should give you all the necessary details on when to call her for further instructions. It is also good to know that inseminations can take place seven days a week.
Financial Impact
Lesbian couples have many unforeseen and unexpected expenses in order to create a baby, such as:
Donor and Directed (Known) Donor Sperm
- Intra-cervical Insemination (ICI) $595 per vial
- Intra-uterine Insemination (IUI) $695 per vial
- If the Donor is open to at least one contact with the children it can cost $100/vial additionally, and this includes 1 year of free storage.
Sperm Storage
- 3 month term $160
- 6 months term $275
- 12 months term $475
Insemination by a Health Care Provider $200-$300
Consultation with Infertility Physician Free-$350
Egg Freezing and Retrieval $5,000-$7,500 Egg freezing and retrieval is an excellent option if you definitely want to have children in the future but are not ready to get pregnant. If you have “aging” ovaries (35 years or older), it is something you should consider looking into.
In Vitro Fertilization (IVF) $10,000-$15,000 percycle Package options are typically available. IVF is a process where you are given fertility drugs to create many eggs in your ovaries. At a specified time during your menstrual cycle the eggs are extracted and placed into a Petri dish. Your selected sperm is added into the mix, an embryo is created and carefully injected into the uterus. This is sometimes done when eggs are removed from one woman so that her partner can carry the baby allowing both women to participate in the pregnancy experience. On average it takes four to six months to conceive a child through IUI. Approximation cost of six months of IUI with your healthcare provider is $5,970
Planning Ahead is Key
Plan to meet with your healthcare provider three to six months ahead of time to see if you are physically and mentally ready to have a healthy pregnancy. A review of your medical history is important to ensure that you don’t have any underlying medical conditions, such as diabetes or high blood pressure that might have an adverse effect on you or your unborn child. During this visit your healthcare provider can also go over medications you might be taking that could be teratogenic or harmful to the embryo during the early stages of conception. Also, making sure that you are on a prenatal or multivitamin that contains at least 400mcg to 1mg of folic acid at least three months prior to conception is vital.
Dr. Sheryl Ross is a board certified OB/GYN in private practice and founder of D3FY Vitamins, located in Santa Monica, Calif. (drsherylross.com)
*This article originally appeared in the June 2014 issue of Curve Magazine