Family Building for Lesbian Couples
Female couples have numerous options to conceive and build a family. Any woman who would like to become pregnant should assess her overall health with a primary care physician or gynecologist before working with a board-certified reproductive endocrinologist infertility (REI) for assisted reproductive treatments and procedures.
Preparing for pregnancy
Fertility evaluations include a physical exam (with a pelvic exam) as well blood tests that measure hormone levels required for pregnancy. Other common fertility tests and procedures for lesbian couples include:
- Hysterosalpingogram (HSG) – an x-ray procedure that examines fallopian tube function and evaluates normal uterine cavity shape and size.
- Transvaginal ultrasound exam – evaluates the uterus and ovary functions required for conception.
All women over the age of 35 hoping to conceive typically undergo a basic fertility workup, including blood work to test for levels of the hormone estradiol and follicle-stimulating hormone (FSH). Anti-Mullerian hormone (AMH) may also be tested, which reveals ovarian reserve, as well as the number and quality of eggs.
How to conceive
Once the fertility health of the couple is established, there are three primary methods for lesbian couples hoping to conceive. The method selected depends on a variety of factors and questions, such as:
- Which partner will be genetically related to the baby?
- Who will physically carry the baby to term?
- Where will the sperm come from; will the couple use anonymous sperm from a sperm bank or known sperm from a relative or friend?
Once a couple addresses the above considerations, they may choose the following methods for conception.
Artificial insemination (AI) is a procedure that inserts sperm into the cervix or uterus. A woman must experience regular menstrual cycles to succeed with AI. The procedure is performed while a woman is ovulating to provide the best chance of conception.
In some cases, if a woman’s chances of conceiving are lower due to decreased fertility factors, such as age, an REI may perform superovulation and insemination. This method uses medicine to allow more than one egg to be released and then timing the inseminating injection of the sperm into the uterus.
In-vitro fertilization with one partner’s egg and uterus
During in vitro fertilization (IVF), an REI stimulates the ovaries with injectable medications and hormones to release multiple eggs. The REI removes eggs from the designated partner during a surgical procedure. Sperm is then inseminated into the eggs in a laboratory in the hope that fertilization occurs. The resulting embryo(s) will be transferred into the uterus of the woman who supplied the eggs and will carry the child.
This form of IVF may be used in cases of lesbian couples who are having difficulty conceiving with AI.
Reciprocal IVF allows both partners to participate in the pregnancy. One partner donates her genes by supplying her eggs for IVF, while the other carries the resulting embryo in her womb. The procedure follows the same steps of in vitro fertilization with one partner’s egg and uterus, as described above.
Considerations of lesbian family building
The primary clinical consideration of planning for lesbians is deciding whether the baby will be genetically related to one or neither of the parents. But there are other factors, both legal and emotional, to contemplate when undergoing assisted reproductive procedures.
Each state differs in the level of legal protections and considerations for same-sex couples using assisted reproductive technology. These considerations include the listing of same sex-partners on the birth certificate, surrogacy rights, egg and sperm donor situations, and privacy rights.
Colorado assisted reproductive law provides favorable protection when using both a known and unknown sperm donor, but working with an experienced attorney will ensure that each couple and partner receives the highest protection and legal understanding. Working with an attorney will also help address an agreed upon course of action if the couple were to separate in the future.
Emotional considerations weigh heavily on the decision to start or grow a family. Regardless of the sexual orientation of the couple, having children is a monumental life step. Speaking with a fertility counselor prepares couples to open a healthy line of communication as they begin to grow their family.