Are you part of a cisgender lesbian couple wondering what it takes to have a baby? Are you a transgender, gender non-conforming, or nonbinary individual also looking for this info from an affirming expert on fertility? If so, we've got you. Dr. Darcy Broughton, a board-certified obstetrician and gynecologist, fellowship trained in reproductive endocrinology and infertility, practicing at Pacific NW Fertility, is answering your questions in our webinars on fertility for LGBTQ+ folks.
Read on for the answers to these questions:
- How can LGBTQ+ couples prepare for the process of getting pregnant?
- Does taking testosterone as part of a medical transition affect your chances of getting pregnant?
- What is reciprocal IVF? Is it more successful than traditional IVF?
- Is there a suggested age to freeze eggs by?
- How much does donor sperm cost?
- What is second person adoption?
How can LGBTQ+ couples prepare for the process of getting pregnant?
Scheduling a visit with your doctor
"Everything in this process takes longer than you think it's going to," says Dr. Broughton. Some couples choose to go to a fertility clinic as soon as they decide they want to conceive, and others, such as those who want to pursue home insemination (that's when a couple has decided to use a known donor for sperm and inseminate the partner who wants to carry at home, instead of in a clinic), may not visit a doctor unless they're having trouble getting pregnant. Dr. Broughton advises beginning the process, including any testing, between three and six months before you'd like to be pregnant.
How do you find a fertility specialist who’s familiar with LGBTQ+ family building? Many LGBTQ+ folks seeking to get pregnant have had negative experiences with the healthcare system, so finding someone who will support you on your fertility journey is key. "The fertility clinic you choose should have resources on hand," says Dr. Broughton, "as well as the American Society for Reproductive Medicine." (You can also check out this list at Modern Fertility.)
Staying on top of your menstrual cycle
Keeping up with your cycle is a vital part of understanding your fertility. "It's important for me that you be able to tell me a little bit about your cycle," says Dr. Broughton. She suggests getting an ovulation predictor kit (OPK) in order to see if and when you ovulate. They can help you get familiar with your body before you actually proceed with insemination procedures like intrauterine insemination (IUI) or in-vitro fertilization (IVF).
If you don't have a clear regular cycle, you definitely want to work with a healthcare provider to determine the reason. "We do have strategies for dealing with this," says Dr. Broughton, "But we need to get to the bottom of why." For example, too much or too little thyroid hormone can impair one's ability to get pregnant, and can lead to miscarriage, so doctors are aggressive about checking for thyroid issues and treating them.
“Optimizing” your body for fertility
"Start a prenatal vitamin as soon as you start thinking about pregnancy, because folic acid takes a while to build up in the body," suggests Dr. Broughton. Exercising, eating well, checking in with your body-fat percentage, and avoiding smoking are also important for preparing your body to conceive.
For trans men who would like to carry a baby, any dose of testosterone that stops periods is going to make getting pregnant (and chestfeeding) more difficult. "We do know that the effects of testosterone on the ovaries are reversible," says Dr. Broughton, "so you definitely want to talk with your healthcare provider to make a plan in terms of timing."
Does taking testosterone as part of a medical transition affect your chances of getting pregnant?
“Any testosterone that’s going to stop periods is going to make it challenging for people to get pregnant, if that’s the goal,” explains Dr. Broughton. But, “if the testosterone dose is low enough that periods are ongoing, then the potential for pregnancy is there.” She recommends talking with your doctor to find out how your testosterone dose might affect your chances of conception.
If you’re thinking about taking testosterone and pursuing fertility treatment options at a clinic, Dr. Broughton suggests talking through your options with a fertility doctor before starting hormone therapy. “However,” she adds, “If that’s not an option and you really want to start a medical transition, we do think that the effects on the ovary are reversible — so we can always go back to fertility treatment.”
What is reciprocal IVF? Is it more successful than traditional IVF?
In reciprocal IVF, one partner's eggs are harvested and fertilized by a sperm donor, and then the embryo is implanted in another partner. Traditional IVF involves the retrieval of eggs, which are fertilized by sperm in a lab, and then one embryo at a time is implanted into the uterus of the same person who provided the eggs. "While age is a consideration, the success rates with reciprocal IVF is incredibly high, since we're usually dealing with a healthy uterus or someone who has never had fertility problems." says Dr. Broughton. The cost of reciprocal and traditional IVF are the same per cycle: ~$20,000 per cycle, according to FertilityIQ.
In both kinds of IVF, it's possible to do either a fresh embryo transfer or a frozen one. If you want to pursue genetic testing on an embryo, it has to be frozen. While the data is inconclusive, says Dr. Broughton, "The likelihood of successfully transferring both fresh and frozen embryos is high." When it comes to the sperm, Dr. Broughton says the determining factor is how many are motile, or moving. "Five million is what we like to have to feel like we have a good chance at a pregnancy," says Broughton. That’s because some sperm will die after they’re frozen.
Is there a suggested age to freeze eggs by?
"Egg quality and quantity declines with age," says Dr. Broughton, "so the younger you freeze eggs, the better. But we also freeze all throughout the reproductive age spectrum." There is no testing that can be used to determine if the eggs retrieved for egg freezing are healthy, but, like we mentioned earlier, embryos can be assessed for genetic health. Whether or not a couple opts to use IUI (when the sperm is placed directly inside the uterus) or IVF, also depends on age. (IVF has higher success rates per cycle than IUI, so it can be a stronger option for those with fewer reproductive years remaining.)
But, Dr. Broughton clarifies, when a couple comes to her in which one person is older than the other, the assumption is never that the younger person's eggs will be used. "In fact, we might use the eggs of the person whose supply is lowest. It depends on the priorities of the individual and the couple,” she explains.
How much does donor sperm cost?
The process of buying sperm is more complicated than just getting a vial. Some sperm banks charge you to browse through their donor profiles, with an additional charge to look at photos. Depending on the bank, there may be a charge for storage of sperm — although, if the sperm is shipped directly from the sperm bank to the clinic, there's no storage fee. Dr. Broughton recommends starting by purchasing three vials of sperm when starting out. (FertilityIQ quotes the cost of each vial at around $500-$1,000.) "If we're not seeing a successful pregnancy, we may decide to switch donors."
If you know you want to have more than one child with the same donor, take that into account when deciding on the number of sperm vials. There’s no guarantee that the same donor will still be available later on, although some banks will contact the donor to find out if they are willing to donate again.
What is second parent adoption?
Second parent adoption is when the partner who did not carry the child officially adopts them. This might be done for the purpose of obtaining insurance or to secure parental rights, but the laws vary depending on the state. In the case of reciprocal IVF, says Dr. Broughton, second parent adoption isn't always needed, but "laws are behind technology, so the person who didn't give birth might want to adopt."
Watch both convos with Dr. Broughton below and read more about planning for kids as a lesbian couple or transgender, nonbinary, or gender-nonconforming individual. Plus, stay tuned to Modern Fertility for the latest on reproductive health, right from the experts.