Gay, lesbian, or transgender individuals experience the same fears as any individual in the world. One of these is trepidation that they might not be able to have children. In the United States of America, same-sex marriage has been legal nationwide since June 26, 2015, when the United States Supreme Court ruled that state-level bans on same-sex marriage are unconstitutional. Same sex couples now have equal right as do straight couples and do not have to fear discrimination based on their gender. Reproductive medicine is for everybody’s benefit, and should not be restricted to heterosexuals. I have been treating infertile couples for more than three decades, having been involved in the genesis of in vitro fertilization in the US virtually from its inception. During this time, I have helped hundreds of same sex couples go from infertility to family. With very few exceptions, the medical challenges faced by such couples and the family relationships that emerged and evolved following the births of children, have hardly differed from that which affects heterosexual couples undergoing the same treatment. Many of these babies are now adults providing a real life opportunity to observe some of them as they confronted life’s challenges. Based on this experience, it is my opinion that the fact that they were born to same sex couples did not disadvantaged any of them. Furthermore, the commitment made by these same sex parents to one another and to the raising of their offspring seems to me to have been no different than in the case of sexually differing parents. I have concluded that in spite of the enormous pressures imposed on same sex couples by an often bigoted society these couples, recognize their responsibility to maintain a cohesive relationship for the well being of their offspring. Let’s face while there are indeed many enlightened people who are willing to embrace same sex families, the majority of our society is so caught up in confusion caused by entrenched religious and moral ideologies that they are not ready for this. Granted, the preservation of stable, monogamous relationships in same sex couples is subject to more pressure and scrutiny. Yet, once cemented by a profound decision to have a child together, the chance of them falling apart appears to be no greater than for heterosexual partnerships. There are many options available to same sex couples seeking parenthood. For female couples: In the case of female couples, the simplest approach is to undergo artificial insemination (IUI) with donor sperm. However in some cases the matter is complicated by the existence of infertility that cannot be adequately addressed through IUI with donor sperm, thus necessitating in vitro fertilization. Regardless of the approach to treatment, stringent FDA guidelines require that all sperm donors whether anonymous or known or recruited from a licensed sperm bank or independently r be tested for potentially lethal transmittable viral infections (e.g. HIV) at the time of producing the specimen and that the sperm specimen then be freeze/stored for several months at which time the sperm provider be retested before the sperm is dispatched for IUI or IVF. Once embryos are generated with donated sperm either female partner will choose to bear the child. Often times, both female partners may wish to share in the biological contribution of a pregnancy where one partner will produce the eggs necessary to be fertilized with donor sperm and the embryos will be transferred to the prepared uterus of the other partner. In some cases the couple will elect to use a gestational carrier (surrogate mother) For male couples: Ever since the Baby M case more than 2 decades ago where a gestational carrier, who conceived after being inseminated with the sperm of the intended male partner (classical surrogacy), sued for custody and won, we have strongly advocated against the use of IUI and in favor of IVF using donated eggs and thereupon a surrogate in whose uterus the embryo(s) are implanted. In fact, in my practice I confine gestational surrogacy to situations where the carrier has no genetic link to the offspring (gestational surrogacy). Simply stated, I only conduct surrogacy when the egg provider and the carrier are different individuals. This mandates the use of in vitro fertilization rather than artificial/intrauterine insemination (IUI). Surrogacy is surrounded by legal issues, and thus a formal legal arrangement should be sought in order to prevent any future complications and can provide peace of mind. For male same sex couples, the sperm provider needs to be tested among other things for certain viral infections (including HIV, Hepatitis B and C) and the specimen must be held in quarantine for several months before being used. In Summary: Aside from the effects of social and political pressures, same sex couples experience the same concerns as those in any other relationship. They wonder what the future holds and whether they will be able to fulfill their desire to have children and accomplish the dream of building a family. While at times this may all seem quite overwhelming, in today’s age it is easier than ever for them to experience the joy of parenthood. There is no evidence that there is any harm to anybody from same sex couples having a child. Children need to be brought up in a loving, caring environment and it is the loving care that is most important, not the sexuality of the parent.
Fertility Topics Explained from the Experts at SFS