All About IVF

The decision to use In Vitro Fertilzation is typically different among gay men than it is among lesbian couples.  For gay men interested in being biologically connected to their child, IVF is usually a necessary step in a long and costly process. For lesbian couples (and women in general), they may arrive at IVF only after other methods of insemination have failed (Also a long and costly process, unfortunately), or once they have discovered a fertility issue that makes IVF the best option for being connected to a child biologically.

What Is IVF?

IVF is the process of manually combining an egg and sperm outside of the body, in a laboratory dish. Once the egg has been fertilized, it forms an embryo, which is then transferred to the uterus of the woman who will carry the child (Surrogate). IVF is the most common procedure that falls under a larger umbrella termed Assisted Reproductive Technology (ART).

The IVF process can be broken down into 5 steps:

1. Monitor and stimulate eggs in the ovaries . This includes monitoring hormone levels and ultrasounds to examine the ovaries.

2. Collect the eggs

3. Collect the sperm

4. Combine the eggs and sperm in a laboratory dish

5. Transfer embryo(s) to the uterus

Who might use IVF?

  • Women who have fertility issues such that they need either an egg donor, gestational carrier, or both to have a child.
  • Single men who wish to have a biological child.
  • Gay men who are using a single partner’s sperm to inseminate using a separate egg donor and surrogate.
  • Gay men who would like to both be biologically connected to a child by using both partners’ sperm to inseminate eggs harvested from a donor and implanted into a surrogate.
  • Lesbians who would like to both be biologically connected to a child by using one partner’s egg, placed in the other partner’s uterus to carry to term.
  • Lesbian couples who have not had success with other insemination methods
  • Women who have chosen to freeze their eggs for later use

Note: For any lesbian couples planning on using their own eggs in IVF, most clinics have a cut-off age of around 45 for using a biological mother’s eggs. Although some may accept a bio mom’s eggs for another few years (up to 47), it is rare. In addition, success rates tend to start dropping for a biological egg donor after her mid-30s. However, age is not as much of a factor for a gestational carrier, and “cut-off” age for a carrier is usually determined on a case by case basis.

Egg, Meet Uterus

Because many gay men will use an egg donor that is separate from the surrogate carrier they choose, IVF is often a necessary procedure to join all the important players for baby-making. Those players include the sperm (from you) the egg(s) (from your donor), and the uterus (from your surrogate).

Your sperm, after being washed to remove seminal fluid, is placed in a petri dish with an egg from your donor 12-24 hours after egg retrieval. With normal, healthy sperm, about 70% of the eggs retrieved will be fertilized, forming embryos. Anywhere from 2-5 embryos are then implanted in the surrogate three to five days after retrieval. The number of embryos transferred varies, and should be determined by your doctor based on a variety of factors. You should be able to freeze and store any “extra” embryos that were fertilized but not used. Eggs retrieved from a donor may be used in the current IVF cycle, or frozen and used in later IVF cycles.

Note: Another additional procedure some gay men choose is to have the donor eggs split to be fertilized by both partners and have one embryo from each partner implanted into their gestational carrier. This could result in twins or multiples genetically related to both partners, or can also serve as a way of not having to choose specifically which partner will be the father and (sort of) letting nature decide.

The experience for the sperm donor: Before undergoing the first cycle, the clinic will perform a semen analysis to make sure you are fertile. After eggs have been retrieved from your egg donor, your sperm will be collected and prepared for combining with the retrieved eggs.

The experience for the egg donor*: Your egg donor and surrogate will first take a round of birth control pills to synchronize their cycles (unless you are using frozen eggs, in which case the surrogate’s natural cycle can be used). Next, your egg donor will begin taking hormones and injections to increase follicle stimulation. Your donor’s eggs (also referred to as oocytes) will then be extracted during a 30 minute outpatient procedure during which a needle-like device is guided through ultrasound to extract up to 20 eggs (depending on how many eggs she has produced). Your donor may experience light cramping during or after the procedure. There is also a small risk (less than 5%) of ovarian hyperstimulation syndrome. The entire process for the egg donor lasts a little over 1 month.

*For women undergoing IVF because of infertility issues, the experience may be slightly different than that of a voluntary or anonymous egg donor. You may have already tried many fertility treatments and/or IUI cycles with no success. You may already be emotionally and physically spent from trying using other methods. For these reasons, it’s best to carefully consider the time, money, and physical sacrifice you will undertake with IVF, and make sure you have considered all of your treatment options.

The experience for the surrogate: Before IVF takes place, your surrogate will be taking daily hormone injections (progesterone) that will prepare her uterus for embryo implantation. She may be required to take these in the 2 weeks after the transfer as well. On the third or fifth day after egg retrieval (during which time the sperm will have fertilized the egg(s)), anywhere from 2-4 embryos will be implanted in your surrogate’s uterus. This procedure is done without general anesthesia and is very similar to IntraUterine Insemination. Your doctor will then order a pregnancy test about nine to 12 days after the transfer.

Mini-IVF

Also called Minimal-Stimulation IVF, this procedure replicates the steps of traditional IVF, but uses less hormone injections for the egg donor to simulate a more natural cycle of ovulation. This means that a Mini-IVF procedure will typically extract fewer oocytes (eggs) from the egg donor, who will produce eggs in a way that is closer to the number and quality she would produce in a natural cycle. Proponents of mini-IVF argue that the multiple hormone injections and high number of eggs produced in traditional IVF methods result in an ordeal that is more painful, emotional, and expensive than mini-IVF with results that have similar success rates to that of Mini-IVF.

Success Rates for Traditional IVF

In the United States, the live birth rate for each IVF cycle started is approximately:

  • 30 to 35% for women under age 35
  • 25% for women ages 35 to 37
  • 15 to 20% for women ages 38 to 40
  • 6 to 10% for women ages over 40

Sources: http://www.cdc.gov/art/
Resolve.org
Center for Human Reproduction

For more on IVF and other ART procedures, The American Fertility Association has provided a wealth of fact sheets in the Lesbian, Gay, Bisexual & Transgender Support section here.

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