Editor’s Note: Here at Women AdvaNCe, we recognize and support that not everyone with a vulva is a woman and not every woman has a vulva. However, for simpler reading, we mean “people with vulvas” when we say “female” or “woman.”
For couples comprised of two women, it might be daunting to consider the different paths toward parenthood. There’s so much to evaluate; it’s a huge decision! But it’s important to know that there’s a variety of options. Depending on your needs, budget, health, preferences, and other values, one or more of the options will work for you!
FIRST: GETTING THE SPERM
The first part of reproduction that a female same-sex couple needs to address is how you will acquire the sperm necessary for fertilizing the egg. There are two main options: going with a sperm bank or using a known donor.
By going to a sperm bank, you’re able to select from a large variety of donors with different backgrounds. You can pick your donor based on attributes like their education level, appearance, what they looked like as a baby, their family’s medical history, and more. You can even purchase multiple units of the same donor’s sperm in case you wish to have more children with the same donor in the future. While this is the more expensive option — it can cost anywhere from $900 to $1000 — a lot of the process is streamlined because sperm banks are in the business of selling sperm.
The other option for acquiring sperm is using a known donor. This is when someone in a couple’s life — such as a family member or friend — is willing to donate their sperm to help the couple conceive. Some couples prefer that they expand their family with the DNA of someone they’re already close with, and it only costs what you and the donor work out as payment. However, this option can be a little more complicated as you’ll need a lawyer to make sure the donor’s parental rights to those children are waived from the beginning, or the donor will look like the rightful second parent in the eyes of the law.
IUI VS. IVF
Once you have the sperm secured, it’s time to consider how you’re going to combine it with the egg. If you plan on one partner’s eggs and uterus being used, intrauterine insemination (IUI) is a relatively cheap, minimally-invasive first option. It can cost anywhere from $500 to $4000.
According to Claire O’Neill, a former embryologist and founder of FertilitySpace, an online fertility clinic database, “IUI is less invasive and more affordable, but it does tend to have lower success rates per cycle compared to IVF. When women go in for testing, if they don’t have any diagnoses of infertility, a fertility doctor will often recommend moving forward with IUI to get pregnant.”
An IUI cycle takes “about 2 weeks to complete”, according to O’Neill. During those two weeks, the partner who will be carrying the baby is usually prescribed fertility medications to help grow follicles and control when they ovulate. The IUI is a basic procedure where a catheter is inserted through your cervix, aiming to release sperm in the uterus as close to ovulation as possible. About two weeks after the IUI procedure, you’ll find out if you’re pregnant. An IUI can often be done at your OBGYN’s office.
If you’ve undergone a few rounds of IUI with no success, it’s likely time to move on to in-vitro fertilization (IVF) at a fertility clinic. Per O’Neill, “IVF is a more invasive and expensive option, but this works better for same-sex females who do have a diagnosis of infertility, especially if they have failed several rounds of IUI.”
The IVF process includes one partner taking stimulants injected to their stomach to help produce many eggs, more than the usual one egg per cycle. During this time, a reproductive endocrinologist at a fertility clinic will monitor the eggs to make sure they’re growing and maturing properly.
When the clinic is satisfied with the eggs, around cycle day 12 to 14, they will retrieve them. This entails putting the patient under light sedation and using needle aspiration to go through the vagina and collect mature eggs. Then, they fertilize the eggs with sperm, and monitor the embryos for growth.
A few days later, one or two of these embryos will be transferred back into the partner’s uterus via a simple procedure done in the doctor’s office. The embryo(s) are loaded into a catheter and placed in your uterus, where they hopefully result in a pregnancy. Any remaining embryos will be frozen and can be used in future transfers.
While there are many factors that affect success rates, approximately 55% of first IVF cycles result in a pregnancy.
Another option is “reciprocal” IVF. O’Neill defines this option as when “one partner provides the eggs to create embryos and the other partner will carry the pregnancy, so both can be more directly involved in the family-building process.”
Reciprocal IVF is a newer protocol, but it’s gaining popularity as it allows both partners to be involved. In reciprocal IVF, one partner takes the injectable stimulants to produce the eggs. Once the eggs are fertilized, they are transferred into the uterus of the other partner. This allows both partners to contribute biologically to the process of expanding their family.
So, after you and your partner acquire sperm, it’s time to decide: Does IUI, IVF, or reciprocal IVF make the most sense for your family? While it’s a big decision, every couple will approach this with their own nuanced circumstances that will help guide them towards one route or another. There are many roads to parenthood, and all are valid.
This article was originally published on June 27, 2022.