Dr. Samuel Pang is the medical director of the Third Party Reproduction Team at Reproductive Science Center of New England, one of the first clinics in New England to offer IVF to lesbian and gay male couples. Dr. Pang is responsible for the medical management of all IVF cycles involving Egg Donation and Gestational Surrogacy, as well as Reciprocal IVF cycles for lesbian couples.

Note: This is Part 2 of our interview with Dr. Pang. Part 1 of our interview deals with commonly asked questions about the IVF process for gay male couples. Part 2 will deal with insemination and IVF – what Dr. Pang coined as Reciprical IVF – for lesbian couples.

When did lesbian couples first begin doing elective IVF (When one partner provides eggs to be inseminated through IVF and the pregnancy is carried by the other partner)?

In 2007, we were approached by a lesbian couple who had never tried insemination before, but they wanted to get pregnant with IVF with one of them providing the eggs and the other one carrying the pregnancy. We agreed to do that for them and following that first case, we have had several other cases as word got out that this is an option. Since lesbian couples have been coming to us for this procedure, and as far as I could tell nobody had described it before, I came up with the term Reciprocal IVF.

Given that nobody had a name for it and – I think – we were the first people to do it – it may have been done elsewhere I don’t know – we said, “We need to give it a name.” So I coined the term Reciprocal IVF.

How many Reciprocal IVF cycles are common to achieve pregnancy for lesbian couples?

Reciprical IVF success rates depend on the age of the woman providing the eggs. Generally, if she is under 35, that is an optimal age for fertility.

Would you then recommend the younger woman in the couple be the egg provider and the older be the surrogate?

Yes. That’s what we would recommend. However, that isn’t always the case. And the reason is because the couple may decide that only one of them wants to be pregnant, the other doesn’t want to be pregnant. And the one that doesn’t want to may be older than her partner, so they will ultimately need to decide who will provide the eggs and who will carry the pregnancy. However we will counsel them that the likelihood of becoming pregnant is better when the younger partner provides the eggs. That being said, we have also seen lesbian IVFcases where the intention is for each to carry a pregnancy. So they will say, “Well you go first – I’ll provide the eggs for you be pregnant, then once we have our first baby, you’ll provide the eggs and I’ll carry a pregnancy.” So that’s another strategy. Although there are some cases of Reciprocal IVF where one partner will say, “I don’t really want to be pregnant at all, I’m going to provide my eggs and she’ll get pregnant.” It’s different for every couple.

Have you had cases where a lesbian couple has done Reciprocal IVF out of necessity – after not having gotten pregnant through IUI or ICI insemination?

Yes. And that would not be elective reciprocal IVF. We’ve actually been doing that for many years before we were approached to do it as an elective procedure.

It really depends – there are some people who may get pregnant with insemination within the first 3 cycles, and if they do, it’s great, but we’ve also had cases where it’s taken much longer and eventually IVF is needed. Without a crystal ball, I can’t really tell them what their experience is going to be.

Do you recommend fertility testing before doing Lesbian IVF or IUI?

It depends on the woman’s history, age, and typically I will meet with them, take a detailed history, and based on their information I will recommend whether I think we should do fertility testing before they proceed and I will offer them the opportunity to do that if they wish. For example, I would say you can do 3-6 cycles of insemination first, and we can then do the x-ray test and see if your tubes are open. Or, a woman may want to make sure her tubes are open before she and her partner spend any money doing the insemination.

Is that procedure covered by insurance?

In general, testing is covered by insurance, but treatment is not. In general, insurance covers treatment for couples who have infertility. Since many lesbian couples don’t have infertility issues, they typically find it very challenging to get treatment covered by insurance.

To your knowledge, is there any national insurance company that offers policies that are LGBT friendly for family creation of this type?

I’m not aware of any specific insurance company that is more LGBT friendly in THIS respect. I will say that a lot of insurance companies may not discriminate against LGBT couples, but as far as treatment for infertility is concerned, they treat straight couples the same as gay couples. I deal with this on a daily basis with straight couples as well.

Also, non-infertile lesbian couples – or single women for that matter – straight or gay – who want insurance coverage have to go through 12 cycles of donor insemination before they qualify as having “infertility”.

If a lesbian couple is doing at-home insemination can they document their attempts to qualify for insurance?

No, unfortunately the insurance companies caught wind that there were people who had fraudulently reported that they had done it at home for 12 months, and because of that, they decided that it had to be documented by a physician – or some clinician had to document the insemination. Now, insemination for lesbian couples needs to be clinician-supervised to qualify.

What is the typical cost of Reciprocal Lesbian IVF?

Reciprocal IVF would be the cost of the IVF process, plus the medications and testing and that would be, conservatively, $20,000. That does not include the cost of sperm – which is typically about $500 a vial, with a new vial for each cycle.

What is the typical cost of IUI for lesbian couples?

It depends on what kind of monitoring is done. The least expensive would be close to $500 per cycle if you do self-monitoring [of your ovulation cycle]. However, if a woman isn’t ovulating properly and requires medications or if she requires monitoring because she doesn’t ovulate properly it could be a little more expensive than that.

Dr. Pang is subspecialty board-certified in Reproductive Endocrinology and Infertility by the American Board of Obstetrics and Gynecology. He received his medical degree from the University of British Columbia, completed his residency in Obstetrics and Gynecology at the University of Toronto, and his fellowship training in Reproductive Endocrinology and Infertility at the UCLA School of Medicine.

Dr. Pang’s non-professional interests include music and swimming. He sang with the Boston Gay Men’s Chorus for 6 years, until 2002. He swam with Boston LANES, a GLBT master’s swim team, and participated in swimming events at the Gay Games in Amsterdam in 1998 and again in Sydney, Australia, in 2002. He and his husband have two sons through IVF with donor eggs and gestational surrogacy.

The Reproductive Science Center of New England was founded in 1988 and provides comprehensive diagnostic testing, evaluation, consultation and treatment for infertility. RSC New England also specializes in providing assisted reproduction options for the GLT community.

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