LGBTQ couples face particular hurdles, both social and physical while building a family[1]. A gay couple planning to have a child should meet with their physician to discuss fertility technologies they will use and choose an egg donor and gestational carrier[2].
Egg or embryo donation
Egg donation is when one woman donates her eggs to an LGBTQ couple to give them a chance to be parents. Another couple can also perform embryo donation by a gift of IVF embryo to an LGBTQ couple. Here are some questions recommended to discuss with your partner about egg donation:
- Is it essential to use a family member or close friend as an egg donor?
One of the partners’ female relatives (e.g., a sister) could serve as the egg donor; the sperm of the other partner would then fertilize her eggs. In this way, the child would be biologically related to both men.
- Do you prefer to use an anonymous donor instead?
Special agencies can provide an anonymous donor.
Both egg donors and one of the partners, whose sperm will be used during the fertilization process, must undergo special medical screening and tests[3].
Egg quality
The age of the egg donor is one of the most critical factors affecting the outcome of IVF. Because of fertility decline with age, the donor should ideally be between 19 and 33 years. Once selected, the woman will undergo an intensive screening that includes medical, psychological, genetic tests and exclude infection in the donor.
Sperm collecting
The partner wishing to use his sperm is required to quarantine sperm. The person undergoing quarantine must have medical, psychological, and genetic testing before collecting and freezing sperm. Some of these screenings must be completed again after the quarantine period to reduce the risk of infectious disease transmission. Only the most high-quality sperm will be collected for the fertilization process[4].
Some clinics can combine the sperm of each partner with separate batches of the donor’s eggs. This method could cause twins development, each with the same biological mother but different dads. If only one child is born, a DNA test will help determine the father.
In vitro fertilization
Fertility options for gay couples:
- IVF, using donor eggs and sperm from one or both partners when the embryo is implanted into a gestational carrier.
- IVF, using donor eggs and donor sperm when the embryo is implanted into a gestational carrier.
- Traditional Surrogacy—the egg from a surrogate is fertilized by a partnerʼs or donor sperm through artificial insemination or possibly IVF[5].
Gestational surrogacy
A woman who carries a pregnancy for another couple and has no biological link to that child is called a gestational carrier. An IVF embryo created with one of the partners’ sperm and donor egg (or both donated sperm and egg) is implanted into the surrogate mother’s uterus during gestational carrier surrogacy.
A woman who both carries the pregnancy and whose egg is used is a surrogate. The child from traditional surrogacy will have surrogateʼs genes and the genes of the intended father (or sperm donor).
Gay couples could find help in searching for a gestational carrier or surrogate by agencies and attorneys specializing in gestational surrogacy.
As soon as the gay couple has decided on an egg donor, the sperm source, and a gestational carrier, the IVF cycle can start. The egg donor has to begin the initial phase of the process by taking the pre-cycle and cycle injectable medications. When the donor is ready for egg retrieval, the procedure will be performed, and eggs will be fertilized in the laboratory with the chosen sperm. The formed embryos will continue their development in the lab and be transferred into the gestational carrier several days later.
The reproductive specialists who provide ART have their requirements on surrogate candidates. The factors that can harm both a child and surrogate or disqualify a woman as a surrogate are:
- No history of pregnancy
- Outside of age range (21 – 38 years old)
- BMI > 33
- Taking antidepressants
- PCOS
- Endometriosis
- History of preeclampsia
- HIV
- Hepatitis C
- Lupus
- More than two C-sections
- Cancer
References
- Washington, DC. Lesbian and gay parenting: A resource for psychologists. American Psychological Association. 1995.
- Grover SA, Shmorgun Z, Moskovtsev SI, Baratz A, Librach CL. Assisted reproduction in a cohort of same-sex male couples and single men. Reprod Biomed Online. 2013 Aug;27(2):217-21. doi: 10.1016/j.rbmo.2013.05.003.
- Practice Committee of the American Society for Reproductive Medicine and the Practice Committee of the Society for Assisted Reproductive Technology. Recommendations for gamete and embryo donation: a committee opinion. Fertil Steril. 2013 Jan;99(1):47-62.e1. doi: 10.1016/j.fertnstert.2012.09.037.
- Ahammad MU, Jarrell ZR, Benson AP. Sperm Collection of Differential Quality Using Density Gradient Centrifugation. J Vis Exp. 2018 Nov 29;(141). doi: 10.3791/58833.
- Sydsjö G, Skoog Svanberg A, Lampic C. Cross-border surrogacy: Experiences of heterosexual and gay parents in Sweden. Acta Obstet Gynecol Scand. 2019 Jan;98(1):68-76. doi: 10.1111/aogs.13456.