LGBT people have gradually stepped out from shadows over the last 50 years, not only transforming our own lives, but those of our families and communities. A generation or two ago, the children we raised were born of previous heterosexual relationships. This began to change in the 1970s and ‘80s, aided by helpful court rulings that reflected cultural sea change in attitudes toward gay people in general. In 1997, New Jersey became the first state to allow same-sex couples to adopt jointly.
Adoption, artificial insemination, in vitro fertilization and surrogacy are now viable avenues available for LGBT individuals and couples. Ultimately, the choice of how to build your family (adoption vs. fertility treatment) is a personal decision based on many factors. Those who seek help from assisted reproductive technologies want to have children with whom they share a genetic connection. What is this path like?
The Fertility Clinic
There are over 500 fertility clinics across the country, assisting individuals and couples who want to become parents. Originally, fertility clinics helped heterosexual couples unable to conceive naturally. But today, when LGBT people come to a clinic, it’s usually not due to infertility, but to access assisted reproductive services involving an egg or sperm donor, and potentially a gestational surrogate as well.
Dr. Dan Kaser, a reproductive endocrinologist at Reproductive Medicine Associates of NJ, with locations throughout the state, has a unique perspective on this process. Even as he regularly takes his own patients through donor insemination or egg donation and gestational carrier cycles, he and his husband are beginning to plan for their own family. As a clinician, Dr. Kaser knows the questions prospective LGBT parents face, and understands some of the anxiety and uncertainties as well. He is able to explain the basic landscape of LGBT family building from a fertility clinic’s perspective.
Genetic options for gay men and gay male couples
Family building for gay men requires both an egg donor and gestational carrier. The IVF/donor egg/gestational carrier process is a series of steps in which eggs are removed from one woman (the egg donor), fertilized with sperm to create embryos (IVF), which are then implanted in the gestational carrier’s uterus.
The IVF process has improved over the last 10 years. There is more success with single embryo transfers, improving the health outcomes of children born via IVF by reducing the likelihood of carrying multiples. Genetic testing increases the ability to predict which embryos are healthiest and most likely to result in a pregnancy.
“I love working with all patients, but it’s particularly satisfying to work with other members of the gay community. Many folks don’t know what is involved in this process, and to be able to help them on their path to parenthood is truly a joy.” -Dr. Dan Kaser, RMANJ
The legal status of surrogacy has also evolved in the last ten years, making it feasible in a wider swath of states (though it’s still not possible to work with a paid surrogate who lives in NJ or NY). Surrogacy is not inexpensive, stemming from the combination of medical fees, agency fees, legal fees, supplemental insurance, and surrogate and egg donor costs.
Egg Donor Selection
Gay men have several options for choosing egg donors (or embryos). Many choose women they know (such as the sister of a partner, or a friend). Others choose anonymous egg donors, through an egg donation agency or fertility clinic. There are many reputable egg donation programs in New Jersey, including RMANJ’s Ovatures Egg Donation Program, providing access to a significant amount of information about a donor—age, ethnic background, photos—but usually never introduce the donor herself.
Some choose an egg donor bank. Donors there have already cycled and the eggs are immediately available and can be sent directly to the fertility clinic. Another choice is embryos from an embryo donation program, established by couples who have completed their own families and intend to donate their remaining embryos by matching them to hopeful parents.
When choosing and working with a gestational surrogate some gay men choose to work with a friend or relative to carry the pregnancy, but most prefer using a reputable agency and a matched gestational carrier. Whichever route you choose, what is critical is the ability to communicate well with your surrogate and her family, to manage each other’s expectations, and empathy toward each other’s lives in this important journey together.
Options for women
When choosing a sperm donor, women have three choices, a known donor (a friend or your partner’s family member), an anonymous donor whose identity is not disclosed, or an open-identity donor, giving your child the option to contact him after turning 18 years old.
Even if you are choosing to use a known sperm donor, similar to anonymous donors, he must be screened by a licensed sperm bank prior to donation, in accordance with federal law.
IUI vs IVF
To achieve conception, women can choose intrauterine insemination, also known as artificial insemination, or IVF, which may be appropriate for women who may experience problems conceiving through insemination.
IUI can work with a woman’s natural cycle to time insemination with ovulation. Oral or injectable fertility medications may also be added to help stimulate and promote ovulation.
“It’s a unique perspective, being a clinician as well as an intended parent just starting out—talk to me in five years!” – Dr. Dan Kaser of RMANJ
During an IVF cycle, eggs are collected from the ovary, inseminated with donor sperm to create an embryo, which is then transferred back to the woman’s uterus to carry the pregnancy. IVF involves additional steps and expense compared to an IUI cycle, but the success rates are usually much higher. It is also a good option for older patients, women with blocked fallopian tubes and for those who have not conceived after multiple tries using IUI. Lesbian women also have the option of doing co-IVF, in which one woman provides the eggs, and the other woman carries the pregnancy — this way, both women are directly involved in the process.
Since August 2017, New Jersey’s insurance mandate redefined female infertility, and now states that all women who are state or public school employees, straight or gay, can use infertility benefits after they meet the revised criteria for infertility. The law also reduces the waiting period for IVF coverage.
Fertility preservation and treatment options exist for trans individuals and couples, too, both pre-and post-transition. The freezing of eggs, sperm or embryos prior to hormone therapy or surgery retains the opportunity to be a genetic parent in the future.
Anonymity in assisted reproduction
Intending parents go to a fertility clinic to have a child with whom they share a genetic connection. However, if you choose a truly anonymous donor, your children will not know who their other genetic parent is or ever be able to meet him or her. As the oldest generation of children born through anonymous donation come of age, a significant number have clamored for the ability to know and contact their donor.
Because of this, there’s been a move to encourage identity-release, or open ID, for egg and sperm donation. Under open ID, the donor provides contact information, and signs an agreement that provides the child the information to contact the donor after age 18, or under certain circumstances by parents if there’s a health issue that requires the donor’s assistance.
For LGBT people considering parenting options, it’s vital to rely on the wisdom gained by people who have become parents before you, and partner with compassionate, knowledgeable and reliable care providers in your step-by-step process.
Another step in community building
Dr. Kaser believes that what’s important in building a clinic program that supports LGBT intended parents, like that at RMANJ is assuring that every person with whom a patient comes in contact, from the initial intake call all the way to the nurses and physicians, is comfortable working with LGBT clients, and to do so in a thoughtful, supportive and affirming manner.
As recently as a year or two ago, upward of 50 percent of fertility clinics nationally didn’t have any reference to LGBT fertility and reproductive options. Dr. Kaser is proud to count RMANJ among those that have built a program, and are reaching out and working with the LGBT community.
The number of growing LGBT households has both changed lives and created new ones. There’s an irony, too, that the long fight for our rights has led many of us to raise our children in the kind of suburbs and communities from which we originally sprang.