TTC for Lesbian Couples: The First Steps
In this blog, we’re discussing same sex female couples and how they can get get pregnant. This will be a two part blog that starts with the first steps of starting your family.
What is your goal?
The first thing I always start by asking my lesbian couples is “what does your family look like to you?” and “what is your goal?” The vision of what couples are thinking can be very diverse. Maybe one partner is going to carry all the children and the other will be the support partner. Sometimes both partners want to carry a pregnancy with the same sperm donors. Other times couples are interested in reciprocal IVF which is my favorite. This is when one partner’s eggs go into the other partner and they carry the pregnancy.
What’s next?
Testing Ovarian Reserve
Once I hear your goals, I say let’s see what your body has and if that makes sense for where we are. The truth is, we don’t know how your bodies are. If you both want to carry, we need to run tests on both partners to see who should go first. We will get a history of both partners and do a basic evaluation. First, we test the ovarian reserve. That means an ultrasound for both partners so we can count the follicles. Now I am going to use my vault analogy to explain what this means. If you’ve heard it before, feel free to read over this part. Imagine in your ovary there is a vault where all your eggs are. Your eggs are kept in this vault, and we don’t know how many are there. At the start of every month, a group of eggs comes out of the vault. Each egg grows inside a follicle, so we use the words egg and follicle interchangeably. The brain will send out FSH (follicle simulating hormone), and it stimulates a follicle to grow. As the follicle grows, the egg matures and then ovulates. Then all the follicles outside the vault will die, and the next month you will have a new group. We have no way of knowing how many eggs are inside the vault, but we can evaluate the eggs outside the vault. This will give us an idea of how many are left behind. The more eggs inside, the more eggs come out each month and vice versa. It’s not perfect, but it gives the best idea of where we are regarding ovarian reserve. We test ovarian reserve with a vaginal ultrasound, and we count the follicles. We also do a blood test for AMH(anti mullerian hormone). AMH is made from the cells that surround the eggs. The more eggs you have, the higher the AMH. This is critical when we decide who is going first. These tests is giving us a current idea of where you are in the egg loss pathway. Something else to keep in mind is egg quality. Egg quality cannot be measured. However, we know that age is the biggest factor in egg quality.
HSG and other tests
I also recommend an HSG (Hysterosalpingography) test. It is an x-ray dye test to look at the fallopian tubes and the uterus. It is a very simple test. A speculum will go in the vagina, a small catheter goes into the cervix, and dye is injected into the uterus. This test gives us results right away letting us know if the tubes are open. If we are going to do insemination or an IUI, your tubes have to be open for that to be possible. In addition to these tests, we will test of other good health measures. This includes preconception labs, thyroid, vitamin D, blood type, and your CMV. Blood type and CMV are necessary because they help us pick the sperm.
Sperm Donor
You can either do anonymous sperm or known donor sperm. Most people choose anonymous because it is the easiest, cheapest, and fastest option. You never have to worry about whether or not that person has the rights to the child. When someone donates their sperm, they are signing those rights away. The sperm lab runs all the tests, does background tests, and evaluations. If it is your friend or family member in a known fashion, you will need to run the tests and evaluations yourself. The sperm donor will have to have FDA labs and typically the sperm will have to sit for six months in the lab and repeat infectious disease labs. It is often more expensive because you have to cover everything the FDA requires.
If you are going down the anonymous route, we will tell you how much sperm you need depending on the treatment we choose and what type of sperm to buy to make sure it is the most compatible and the lost risk of abnormality. Blood type and CMV are the most helpful tools when choosing sperm. For the blood type, it’s not about the letter. We care whether the RH factor is positive or negative. If you are positive, this means you have antibodies so you can choose positive or negative sperm. If you are negative, we will go with negative sperm to reduce the risk of complications. CMV is Cytomegalovirus which can cause birth defects if a someone gets CMV while pregnant. A lot of people have CMV. It’s like the flu or a bad cold and sometimes you don’t even know you have it. However, if you don’t have CMV and you get pregnant and have CMV for the first time, this can be a risk for birth defects or miscarriage.
I will admit, not every REI does this. They have the mentality that you are only missing sperm so they get the sperm and put it inside. If it doesn’t work, then they will do the tests. I completely disagree. Sperm is expensive and I do not want to waste your time or money if you have a blocked tube or if you are unable to get pregnant. I applaud the women who have an idea of what they want their family to look like, but let’s make sure your body and physiology align with those goals.
Be on the look out for part two where I discuss the options for lesbian couples to start a family.