LGBTQ Parenthood Can Be a Journey of Self-Discovery

Helping LGBTQ partners build a family is a passion for our providers. While heterosexual and LGBT couples start fertility and family planning in similar fashion, there are specific questions and concerns for those using third-party donor eggs, sperm and embryos. Jacalyn (Jackie) S. Finnerty, MS, APRN, WHNP-BC, explains.

Our women's health nurse practitioner supports LGBTQ families every step of the way

I’ve been working at Women & Infants Hospital for more than 22 years – about half my life! I have worked in many areas of women’s health at the hospital, from nursing in labor and delivery, reproductive endocrinology, the operating room and education. In furthering my education, my goal was to rejoin the reproductive endocrinology team as nurse practitioner (NP). The fertility center brings all those specialties, and my experience within them, together. My biggest joy is sending patients off with their new families. It’s an amazing experience!

I have had the good fortune to work with single women, heterosexual couples and LGBTQ couples on their fertility and family planning journeys. While much of what LGBTQ parents-to-be experience in fertility treatment is identical to heterosexual parents, there is also an element of self-reflection and additional testing that is very unique to this population.

LGBTQ and heterosexual family planning start from the same place

The first few steps in building a fertility treatment plan are pretty much the same for everybody. For the LGBTQ population without infertility issues, the treatments serve more as reproductive services.

• General health check, including a discussion about medical history, a pelvic exam, and blood tests to assess thyroid function, anemia, blood type, immunities for chicken pox and German measles and the like.
• Infectious disease testing is recommended by the American Society for Reproductive Medicine (ASRM) prior to anyone’s fertility treatment. This blood test screens for sexually transmitted diseases, hepatitis and other viruses that could harm an embryo, our lab staff, or one or both parents.
• Ovarian reserve testing would include blood work and a pelvic ultrasound that provide information about a woman’s underlying supply of eggs.
• Uterine studies examine fallopian tubes and/or the uterine cavity to make sure there are no structural abnormalities that might hinder conception.
• Genetic testing is recommended. This blood test determines whether someone carries recessive genes for any congenital disorders. If both parents are carriers of genes for the same disease, there is a 25% chance that their child will have the disease.

What’s unique to LGBTQ reproductive services

For LGBTQ couples or anyone who may use donor or third-party services, a little more attention is paid to screen and counsel for some specific concerns.

Cytomeglovirus testing

Cytomegalovirus (CMV) is a virus that’s part of the herpes family. When an adult contracts CMV, the symptoms mirror those of the common cold, so many people don’t even know when or if they have had it. The Centers for Disease Control and Prevention (CDC) reports that more than 50% of adults contract CMV by age 40. The virus remains alive but dormant in the body after symptoms subside. The danger with this virus is mostly to the unborn baby exposed in-utero.

Both donor and recipient parents must be tested for this virus because it causes birth defects and long-term health problems for in-utero babies. Approximately 1 in every 200 babies are born with congenital CMV infection, according to the CDC.

If a sperm donor was exposed to CMV in the past, the virus could theoretically still live in the sperm. That means for a carrying parent who has never contracted CMV the ideal donor would be someone who’s tested negative for the virus. If the mother has been exposed to CMV in her life and tests positive for antibodies, then the sperm can come from a donor who’s tested either positive or negative. Of note, egg donors are not tested for CMV since the egg is not considered a hospitable environment for this virus.

Counseling

Some of the most meaningful moments of determining LGTBQ pregnancy options are the times I get to spend talking with patients about who’s going to carry the pregnancy. What prompted a partner to decide to carry versus not? Is one partner in better physical health? Sometimes it’s a strong desire.

With everyone’s unique health circumstances and desires in mind, there are many options available for these couples. In many cases, one partner chooses to carry the first pregnancy, then when the couple returns for a subsequent pregnancy, the other partner may choose to carry.

Once in a while, reciprocal in vitro fertilization (IVF) is chosen, where the eggs from one partner are paired with sperm to form embryos. These embryos are then implanted in the partner who desires to carry the pregnancy.

For LGBTQ couples and anyone seeking donor assistance in our clinic, we require at least one meeting with our social worker. Whether the donor material is eggs, sperm or both, there are many legal and emotional considerations that need to be addressed in advance.

The LGBTQ parents-to-be may have unique circumstances to discuss, such as when and how to explain to the children where they came from. There are also complex societal issues, such as the potential for discrimination and stereotyping. Family acceptance is another big one.

In the counseling session, the social worker will review Rhode Island’s Equal Parenting Act. The counselor will also address how to talk to a child in the future about how they were conceived and the couple’s strong desire for them.

Choosing a sperm donor may be challenging, and our social worker can help you with this process. Recommendations about how to choose a sperm bank, as well as a sperm donor, are discussed.

This conversation includes what additional considerations may be important to the couple, such as considering an open donor (one whose identity can be released once the child is an adult), a donor who would be willing to disclose health information as it arises, and inquiring about a limit to the number of offspring one donor can have.

Perhaps one of the most important topics to discuss is the legal aspect of third parties. I always ask patients if they’ve thought about the legal implications and potential custody issues when working with third-party donors, in particular known donors. There must be a proper contract in place that outlines each party’s rights so everyone is protected.

Related Reading: How Our Women’s Health Nurse Practitioner Enriches Patient Care

Sperm donor considerations

I highly advise LGBTQ couples not to seek or purchase donor material without talking with their provider first. As practitioners, it’s our job to help patients find the best path toward pregnancy while taking into account all personal considerations of the intended parents.

There are many important questions to consider before purchasing sperm.

• Do you want an anonymous or known donor? In other words, do you want to use a sperm bank, where you can browse anonymous donors by ethnicity, education, height, eye color and lots of other criteria? Or will your donor be a friend or family member, someone known to you?
• If you choose a known donor, be aware that the fertility journey will take longer.
  • The Food and Drug Administration (FDA) requires that any third-party donor cell or tissue, including eggs, sperm and embryos, be tested for communicable diseases. Specimens must be tested for human immunodeficiency virus (HIV), types 1 and 2; hepatitis B, hepatitis C, syphilis, chlamydia and gonorrhea. Sperm donors in particular must also test for human T-lymphotropic virus (HTLV), types I and II, and cytomegalovirus (CMV).
  • ASRM recommends a six-month quarantine for known donor sperm. This is very surprising to some recipients, who assume the sperm will be immediately available. Actually, the specimen needs to be tested and then the donor needs to be tested again six months later to ensure there are no changes. This screening has already been done with sperm bank donors.
• Do you want your children to have the same biological parentage? If you think you’ll want more than one child and you want the children to be biologically related, then it’s important to purchase enough of the same donor’s sperm for future cycles.
• Does the donor carry any recessive disorders? If so, it may be beneficial to find out if the carrying partner carries the same disorder to best avoid having an effected child.
• What is the CMV (cytomegalovirus) status of the donor? As previously mentioned, if the carrying partner is negative, it is advised to purchase a negative CMV donor.
• What type of specimen do I purchase? Sperm specimens are prepared differently for intrauterine insemination (IUI) than for IVF. Talk with your provider about the best option for you.

Keep in mind that each assisted fertility cycle requires at least one vial of sperm, and the approximate cost of a vial is about $1,000. We recommend purchasing a minimum of two vials per cycle to be on the safe side. Shipping costs may also be a factor and should be considered while purchasing sperm.

Related reading: How Sandra & Meredith found success with donor sperm and IUI

It’s also important not to pick (or purchase) sperm from the first donor who matches the vision in your mind. It’s fun to look through the pictures at a sperm bank with thoughts like, I want him to look like a certain celebrity, or I want him to be tall with green eyes. But those may not be the ultimate criteria.

I recommend asking these kinds of questions:

• How many successful pregnancies has this donor had?
• Is there enough sperm in the bank if we need more for future cycles, or do we need to purchase everything that’s left?
• Is this the best sperm bank for us? Have they screened the donors properly? Do they offer pricing tiers that give you even more information about donors, such as baby pictures, career history or voice sampling, and is this important to you?
• Does the bank have a buyback program? These programs are designed to allow couples to “return” sperm that hasn’t left the bank in the event that the sperm is no longer needed.

Advice for LGBTQ couples considering reproductive treatment

First off, investigate your insurance coverage and financial means. Some insurance plans do not cover fertility services, and if they do, may have certain criteria. Not every cycle works the first time around. Donor tissue, lab tests and medications – the costs for those can add up very quickly. Providers will want to build a fertility plan that is both comfortable for you and works within your parameters.

Second, find a provider you are comfortable with. Talk openly with the person to review your goals and wishes in building a family. Discuss things like who wants to carry, what things mean more than others (e.g. known or anonymous sperm), and any time frame concerns.

Look at all the family planning and pregnancy options available within your comfort level and budget. If there is anything you’re nervous about, talk about it! It’s crucial to be open and honest with each other and the care team.

Lastly, don’t get frustrated. There’s a lot of planning involved, and treatments take time. The prep work alone, such as the work-up testing or waiting out the known donor quarantine, can be trying.

Be aware that the process is not always successful. Different approaches may feel like starting from scratch, however, they are more like building blocks to becoming a parent. You and your partner are not alone in this journey toward building your family. We will help in finding the right route for you!