LGBTQ Fertility in Los Angeles
The California Center for Reproductive Health and Dr. Mor pride themselves on helping to build non-traditional families by offering the lesbian, gay, bisexual, and transgender (LGBT) community the entire variety of fertility treatment options. With offices located across the greater Los Angeles area and West Hollywood, CCRH celebrates every person’s wish to become a parent irrespective of their sexual orientation or identity.
LGBTQ Fertility Options Q & A
The California Center for Reproductive Health (CCRH) is committed to helping all individuals who desire to become parents, regardless of their marital status or sexual orientation. We are a progressive and impartial innovative fertility Center with a long history of working with non-traditional families (same-sex couples, and single men and women) towards beginning or expanding their family. We know that fertility options and issues facing gay couples and single men and women may be quite different from those available to traditional families. In addition to a host of medical treatment options that require understanding, there are legal, financial and emotional obstacles that demand special attention and knowledge. Our Center is committed to supporting our gay and single patients through the entire process of creating or expanding their family, whether it is in selecting an egg or sperm donor, coordinating egg donation, or choosing a gestational carrier. Here at CCRH, we are proud to offer a variety of reproductive choices within a fully versatile, all-inclusive Center where you will receive comprehensive and personalized care in a private and sensitive medical environment.
Reproductive Options for Gay couple or Single Men
Reproductive care for gay couples and single men requires the services of both an egg donor and a gestational surrogate. One available treatment option is traditional surrogacy, in which the surrogate also serves as the egg donor. In traditional surrogacy, pregnancy may be achieved via insemination of sperm (intrauterine insemination=artificial insemination), using one individual or a combination of both men’s sperm. Traditional surrogacy is a simple and relatively inexpensive treatment option, which can achieve pregnancy with little coordination and through basic fertility treatments. If more conservative treatments such as mid-cycle intrauterine insemination (IUI) fail, a traditional surrogate may be treated with more advanced techniques such as ovulation induction (using oral or injectable medications) with IUI or assisted reproductive technology (ART).Another treatment option involves gestational surrogacy in combination with egg donation, wherein the surrogate and egg donor are different individuals. Because this process involves coordination between the intended parents, the egg donor, and the gestational surrogate, this treatment option tends to be more involved than traditional surrogacy. The ART process involves stimulating the egg donor’s ovaries to produce multiple eggs, harvesting of the eggs, fertilization of the eggs with sperm, and embryo transfer into the designated surrogate’s uterus. Eggs may be fertilized using one man’s sperm or equally from two men, creating a diversity in embryo selection. Egg donors may be anonymous or non-anonymous. In non-anonymous egg donation, if the egg donor is related to one of the men in a gay relationship, sperm from the other male partner is used to fertilize the eggs, creating a genetic link in the offspring to both intended fathers. Success rates of gestational surrogacy combined with egg donation are high however the process is more costly than traditional surrogacy.
At CCRH, our extensive experience in third-party reproduction (egg donation, surrogacy) also means we work with reputable egg donation and surrogacy agencies, providing our gay couples and single men with the best in reproductive choices. In addition to screening which egg donors and surrogates undergo at the various agencies, our team of professionals will administer further extensive screening of prospective egg donors and surrogates on behalf of our patients, before determining eligibility. In compliance with FDA requirements and ASRM (American Society for Reproductive Medicine) guidelines, various tests will be administered at our Center for all involved individuals (intended fathers or father, egg donor, gestational surrogate) to ensure a safe and healthy outcome.
Reproductive Options for Lesbian couple or Single Women
Artificial Insemination with Donor Sperm (AID)
Reproductive options for lesbian couples or single women involve, in the vast majority of cases, sperm donation only. After a basic evaluation of the intended recipient’s (one of the women in a lesbian relationship or a single woman) reproductive function (ovulatory function, normalcy of the uterus and fallopian tubes), one basic treatment course is artificial insemination with donor sperm (AID). Donor insemination is a simple procedure, which requires the pre-selection and purchase of frozen sperm from a licensed sperm bank. Qualified banks boast an extensive list of screened anonymous sperm donors to include information such as ethnic background, body build, eye color, hair color and skin tone as well as education, profession and hobbies, among other details and attributes. They also test their donors for all FDA mandated infectious and basic genetic diseases. The main goal of sperm banks is to offer a diverse selection of high quality sperm, which will withstand freezing and is likely to lead to pregnancy.
The chosen donor sperm is purchased in vials, and can be stored and thawed at the ideal time as determined together with your fertility specialist. Insemination can be performed during a natural menstrual cycle or a cycle in which ovulation is enhanced by oral medication such as Clomid or injectable ovulation induction agents that can significantly increase pregnancy success and often shorten the duration of treatment. The procedure requires no cuts or anesthesia, and carries little risk.
Directed Donor Insemination (IUI)
When a lesbian couple or single woman chose a known sperm donor (relative or friend) as their donor, the process is considered directed sperm donation. A directed sperm donor will normally require a full panel of infectious disease screening followed by a six-month quarantine of frozen sperm and then retesting of the donor for infectious diseases, before sperm can be deemed eligible for insemination. In lesbian couples or single women who do not desire a six-month delay in treatment, an alternative for directed donor testing involves a full physical examination and infectious disease screening of the sperm donor within one week of each insemination. Directed sperm donation is relatively inexpensive, may provide genetic familiarity (if a related sperm donor is chosen), and may reduce the anxiety associated with the outcome of the pregnancy. However, it may create unforeseen future social strains, which have to be taken into consideration while deciding on the right treatment for you.
As in anonymous artificial insemination with donor sperm, women undergoing directed donor insemination from a known donor may also be treated with ovulation induction agents (oral or injectable) to improve their success.
Combining Sperm Donation with Assisted Reproductive Technology (ART)
In women of advanced reproductive age or those experiencing tubal factor or other types of infertility, in vitro fertilization (IVF) may be performed using donor sperm to achieve high pregnancy rates. Briefly, in IVF, a woman’s ovaries are stimulated with hormone injections to induce the growth of multiple eggs at once. This is followed by an egg harvesting procedure done under light sedation. Eggs are then fertilized with donor sperm (anonymous or directed) to create embryos, which are transferred into the recipient’s uterus. In a truly “shared” ART experience, lesbian couples may designate one woman as the gestational surrogate while the other serves as the egg donor, assuring that all parties are equally involved in the process. For some lesbian couples, under certain clinical circumstances (uterine anomalies, diminished ovarian reserve, medical contraindications to pregnancy…), it may become necessary to have one of the women serve as the egg donor, while the other becomes the gestational surrogate.
Egg Freezing
As women age, reproductive capacity diminishes. For lesbian couples and single women not quite ready for a child, one option for fertility preservation is egg freezing (egg cryopreservation). The egg freezing process is similar to IVF (stimulation of the ovaries with hormone injections, egg harvesting procedure…), except that eggs are frozen without being fertilized. At a future date, eggs can be thawed and fertilized using donor (anonymous or directed) sperm, or a partner’s sperm (in the case of single women). Lesbian couples may choose to have both partners’ egg frozen for future use, increasing their reproductive options.
Embryo Freezing
Just as egg freezing is used for fertility preservation, embryo freezing for future use is a wonderful choice for lesbian couples and single women who have already chosen a sperm donor but are not prepared for having children at the present time. As patients go to great lengths and place great care in choosing a sperm donor appropriate for them, if the future availability of a chosen donor (anonymous or directed) is in question, undergoing IVF/embryo freezing while the sperm donor is still available, is an excellent option for some. Furthermore, as some women reach advanced reproductive age (>35 years old), options for fertility preservation via egg freezing may become limited, as “older” eggs may have a reduced capacity at surviving the freezing/thawing process. Since embryos in general are more resilient than eggs and tend to survive the freezing/thawing process well, IVF/embryo freezing is a reasonable treatment course for women of advanced reproductive age who wish to postpone childbearing.
At CCRH, our team of dedicated professionals is highly experienced in working with lesbian couples and single women who desire to conceive. With an extensive array of available reproductive choices, our team will direct you in the right direction, according to your specific reproductive needs.
The process towards expanding a family among same-sex partners and singles can require complex reproductive procedures and the involvement of multiple third-party agents like surrogacy agencies, egg donor agencies, sperm banks, and reproductive attorneys. At CCRH, we bring all the pieces together in order to make your journey as easy and successful as possible.
FAQ
Reproductive endocrinology and Infertility is a sub-specialty of Obstetrics and Gynecology. In addition to managing medical and surgical treatment of disorders of the female reproductive tract, reproductive endocrinologist and infertility (REI) specialists undergo additional years of training to provide fertility treatments using assisted reproductive technology (ART) such as in vitro fertilization.
Reproductive endocrinologists receive board certification by the American Board of Obstetrics and Gynecology in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility.
In general, patients should consider consulting with an REI specialist after one year of trying unsuccessfully to achieve pregnancy. The chance of conceiving every month is around 20%, therefore after a full year of trying approximately 15% of couples will still not have achieved a pregnancy.
However, if a woman is over the age of 35 it would be reasonable to see a fertility specialist earlier, typically after 6 months of trying.
Other candidates to seek earlier treatment are women who have irregular menses, endometriosis, fibroids, polycystic ovary syndrome (PCOS), women who have had 2 or more miscarriages, or problems with the fallopian tubes (prior ectopic pregnancy).
Approximately 1/3 of the time cause for infertility is a female factor, 1/3 of the time a male factor, and the remaining 1/3 a couples’ factor.
At CCRH, we emphasize the importance of establishing a correct diagnosis. Both partners undergo a comprehensive evaluation including a medical history and physical exam.
Furthremore, the woman’s ovarian reserve is assessed with a pelvic ultrasound and a hormonal profile. A hysterosalpingogram (HSG) will confirm fallopian tube patency and the uterine cavity is free of intracavitary lesions. A semen analysis is also obtained to evaluate for concentration, motility, and morphology of the sperm.
Additional work up is then individualized to direct the best possible treatment option for each couple.
In vitro fertilization (IVF) is the process that involves fertilization of an egg outside of a woman’s body.
The process starts with fertility drugs prescribed to help stimulate egg development. In your natural cycle, your body is only able to grow one dominant egg, but with stimulation medication we can recruit multiple eggs to continue to grow. After about 8-10 days of stimulation, the eggs are surgically retrieved and then fertilized with sperm in a specialized laboratory. Fertilized eggs are then cultured under a strictly controlled environment within specialized incubators in the IVF laboratory for 3-5 days while they develop as embryos. Finally, embryos (or an embryo) are transferred into the uterine cavity for implantation.
Before deciding if IVF is the right choice, it’s important to sit down with an REI specialist to discuss available treatment options. For some people, other methods such as fertility drugs, intrauterine insemination (IUI) may be the best first choice treatment. At CCRH, we believe each individual couple is unique and not everyone needs IVF.
While not painful, the fertility medications may some side effects including headaches, hot flashes, mood swings, and bloating. The injection sites may also bruise.
Unfortunately, no. Many people think once they start IVF it’s a matter of time that they will be pregnant and have a baby. But according to national statistics per the Society of Assisted Reproduction (SART), on average 40% of assisted reproduction cycles achieve live births in women under age 35. The chances of success then continue to decrease with advancing age.
At CCRH, we employ only evidence-based interventions to ensure patient safety and optimal outcome. While we cannot guarantee a baby, we guarantee that you will receive the best, most advanced, personalized care to help you maximize your chance of a baby.
The average IVF success rate (success measured in live birth rate) using one’s own eggs begins to drop around age 35 and then rapidly after age 40. This is due to the decline in egg quantity and egg quality as a woman ages.
Our clinic’s success rate consistently beats the national average year after year.
Individual insurance plans often do not have any coverage for infertility treatments. If you have a group plan, you can call members services to see if they have coverage for infertility (including consultation/workup and IVF).
After your consultation with our REI specialist, one of our dedicated account managers with sit with you to go over the cost of treatment.
