There are not many resources to guide same sex male couples when it comes to family building options. Most general physicians are not familiar with how to counsel these patients. The best resource for these couples would be to meet with a board-certified reproductive endocrinologist and infertility specialist.
Upon meeting with the doctor, a medical intake will be taken of either one of the two partners or both, depending on if the couple will be using sperm from only one man or from both. Blood work to assess the health of the patient and a semen analysis will then be performed.
The use of an egg donor is required. Egg donors are younger women in their 20’s and early 30’s, who have gone through a full medical, psychological and fertility evaluation to make sure they are good candidates for egg donation. Usually, the couple will meet with their clinic’s egg donor team to help them pick an appropriate donor. The couple is provided information on the personal and medical background of the donor. In many cases the couple is also allowed to see a photo of the donor. Most cases of egg donation are anonymous where the donor does not know the identity of the “recipient couple” and vice versa. In some scenarios, a known donor, someone who knows the recipient couple can be used but, in this case, legal contracts are required so that both parties are clear that the donor has no legal responsibility to any offspring and that the recipient couple are the legal parents of any offspring.
To produce eggs, an egg donor will go through an in vitro fertilization cycle (IVF). This entails the use of ovulation induction (OI) medications to get multiple eggs to grow in one cycle. Blood work and ultrasound are then performed to make sure the donor is responding to the medications appropriately. Once the blood work and ultrasound meet specific criteria then the donor is deemed ready for a vaginal oocyte retrieval (VOR), where the eggs are harvested under anesthesia. At this point the male couple is asked to produce a sperm sample which will be used to fertilize the eggs. Some couples will opt to only use one partner’s sperm while other couples may choose to split the eggs and fertilize one half of the eggs with Partner A’s sperm and one half with Partner B’s sperm. Personal preference, age of the partner, and quality of the sperm may play roles in making this decision.
Once the eggs are fertilized, it takes 3-7 days to see if there will be embryos to freeze for future use. The number of embryos a couple will have is partially dependent on the number of eggs that were retrieved. The attrition from the number of eggs retrieved to the number of eggs that fertilize to the number of embryos available is normal. For instance, a donor may produce 12 eggs, but the couple may only end up with 4 embryos to freeze. The whole IVF cycle from stimulation to creation of embryos takes approximately 3-4 weeks.
The couple also can do preimplantation genetic testing (PGT) on the embryos to see if they are healthy. This testing can be used to look for aneuploidy, where the embryo has an unhealthy number of chromosomes. The use of PGT-aneuploidy allows for the embryologist to pick out the healthiest embryo when it is time for transfer, which translates into a better pregnancy rate.
Donor eggs can also be obtained from a donor egg bank. In this scenario, the donor again undergoes medical screening and if deemed eligible an IVF cycle. The main difference is that after undergoing a VOR the eggs are frozen for future use. A database of the donors is created by the egg bank and as a recipient, the patient is granted access to this information. Once a donor is picked, a set number of eggs is released and shipped out to the fertility center where the frozen eggs will be stored until a time is set up by the embryology lab to thaw the eggs and fertilize them. After 3 to 7 days embryos are created and frozen for future use.
A gestational carrier is required for the embryo transfer and to carry the pregnancy. This can be an expensive and arduous undertaking. It is imperative that the intended parents use a clinic that is well versed in the use of gestational carriers. Gestational carriers are only permitted in certain states, such as New Jersey & New York. The use of a lawyer with legal expertise in reproductive medicine is recommended. Legal contracts need to be drawn up between the intended parent and the gestational carrier clearly stating the role of the gestational carrier.
Gestational carriers go through a vetting process where their medical history including previous obstetrical history is reviewed. A physical exam is performed including an analysis of their uterus to make sure it is healthy for the embryo transfer. It is recommended that the gestational carrier has carried a full-term pregnancy in the past with no complications. Once it is deemed that she is healthy and the contracts between the carrier and intended parent are completed a date is set for them to start.
The gestational carrier is usually placed on medication, called Lupron, to suppress her natural cycle from occurring. A form of estrogen is then given to allow proliferation of the lining of her uterus. Once the endometrial lining is adequate, progesterone is started to provide a nutrient rich environment for the embryo. An embryo transfer is performed, and a pregnancy test a few days later. If the gestational carrier is pregnant, she is slowly weaned off of her medications and then eventually discharged to her obstetrician. Usually only a single embryo transfer is recommended to reduce the risk of multiples, which is considered a higher risk pregnancy.
In conclusion, while there are many steps that need to be taken for same sex male couples to build a family, it is wonderful that the technology now exists to allow these patients to have this option outside of adoption.
We are here to inform and empower. If you have any further questions or would like to book a consult to discuss building your family, please reach out to us by filling out our contact form, or by calling us at 718.697.0255 or by reaching us through our social handles.
Melissa C. Yih, MD, is Board Certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility and has been practicing in the NJ area since 2002. Dr. Yih received her undergraduate degree from Wellesley College and her medical degree from The Robert Larner, M.D. College of Medicine at The University of Vermont. She completed her Obstetrics and Gynecology residency and her clinical fellowship in Reproductive Endocrinology and Infertility at New York-Presbyterian Weill Medical College of Cornell University. Her areas of interest include counseling patients regarding fertility preservation options.