LGBTQ Fertility Services
For same-sex couples, the journey to parenthood looks quite different than the journey opposite-sex couples undertake. Biological parenthood for same-sex couples involves significant medical and legal challenges that opposite-sex couples are less likely to have to navigate. At Columbia University Fertility Center, we support all paths to parenthood and will work with you to achieve a happy and healthy family.
Female Same-Sex Couples
Usually female same-sex couples have already begun the conversation of who will carry the baby before their initial appointment. One partner will decide to be the "patient," however, your physician will obtain a full medical and gynecologic history on both partners. Sometimes, there will be medical complications in one partner that will make it either more difficult for her to carry or more dangerous.
Female same-sex couples have a number of different options to achieve a successful pregnancy. Your physician will help you decide which option makes the most sense for you:
- Intrauterine insemination (IUI): Also called natural cycle with intrauterine insemination, IUI is the simplest and least expensive method of conceiving for female same-sex couples and can be done without medication. However, there is still a lot of testing that goes into starting treatment. This method has around a 20 percent pregnancy rate per month.
- In vitro fertilization (IVF): Typically IVF is the fastest option, because it carries with it the highest chance of success per month, but it is not usually the most cost-effective option.
- Co-maternity: With this option, one woman in the couple donates her eggs for the other to carry.
Couples can opt to use anonymous or known-donor sperm. There are benefits and challenges to both approaches. Using known-donor sperm requires legal and psychiatric clearance, and a six-month quarantine of the sperm is recommended to retest for infectious diseases.
Male Same-Sex Couples
Male same-sex couples who are seeking to start a family have two options when deciding who will carry the baby:
- Gestational carrier: This option involves choosing a woman who serves as the source of both the egg and the uterus. Legal aspects of this option present numerous complications, however, so it has become a less popular choice.
- Surrogate carrier: With this option one woman serves as the egg donor — either someone who is known to them or an anonymous donor — and a second, different woman carries the baby. This option presents fewer legal complications.
We will look at the carrier's previous obstetric history and she will undergo a routine evaluation of her uterus. An ideal gestational carrier should have no previous cesarean deliveries, because it places all subsequent pregnancies at a higher risk of complications. Prior full-term vaginal deliveries should be a prerequisite, and she should have no toxic habits such as smoking. A healthy lifestyle is a must.
Once the carrier is chosen, the couple decides whose sperm is going to be used. Some couples opt to fertilize half the eggs with one partner’s sperm and fertilize the other half with the other partner’s sperm.
The sperm provider's sperm will undergo a rigorous screening for infectious diseases. There are also many types of genetic screening (for autosomal recessive diseases) that can be offered. A routine semen analysis will also be performed to determine what type of fertilization will be most effective.
Because surrogacy is not contract enforceable in the state of New York, we usually recommend that male same-sex couples hoping to achieve biological parenthood make embryos at Columbia University Fertility Center and then have the frozen embryo transfer performed in New Jersey or Connecticut, or in a state in which surrogacy contracts are enforceable.