'National Infertility Awareness Week' and Starting a Family with IVF

We are currently in National Infertility Awareness Week (April 21 – 27), making this the perfect time to learn more about the reproductive strategies available to same-sex couples who wish to become parents.

In a bemusing irony, while same-sex couples are no more likely than mixed-gender couples to be infertile, Dr. Heather Hoff says, they may find themselves medically labeled as such.

"It is a wonderful experience to go through the journey with same sex couples," says Dr. Hoff, who works with Aspire HFI, part of The Prelude Network, which is the largest and fastest-growing network of fertility providers in North America. But, she adds, the medical label of infertility can be "very frustrating" to couples who are not, in fact, infertile.

Simply put, before they will honor a claim, some insurance carriers mandate a diagnosis of infertility when two prospective dads or two prospective moms seek to grow their family by having children using In Vitro Fertilization, or IVF.

IVF is a medical intervention used by same-sex and mixed-gender families alike. The procedure brings together the gametes needed for conception under laboratory conditions that allow for a higher chance of successful fertilization. In the case of two dads, sperm cells are introduced to an egg provided by a donor and then the embryo is transferred to a female gestational carrier. When two moms use IVF, one or both of them might opt to have donated sperm used to fertilize their own ova – or, as some couples do, one member of the couple might be the surrogate who carries an embryo conceived using donated sperm and the egg of her wife or partner.

But IVF can be pricey, and insurance carriers might "require a certain number of IUI cycles," Dr. Hoff adds, "in order to technically diagnose them as infertile before they can get coverage [for IVF] with their policy."

IUI, or Intrauterine Insemination – another commonly used avenue to parenthood used by same-sex couples – involves depositing a partner or donor's sperm directly into the womb of a prospective mother, where a fetus grows and develops until birth.

"Thankfully, more of them are moving away from that," Dr. Hoff says of insurance companies needing a diagnosis of infertility, noting that "the majority of the time when a couple presents to me, they don't have underlying infertility."

That doesn't necessarily mean there are no challenges or concerns when a couple considers IVF.

Dr. Hoff notes that for each candidate for IVF, it's necessary to "evaluate their medical and surgical history," and, when working with a prospective parent with ovaries, it can be necessary to "evaluate their ovarian reserve – their egg count," as well as other aspects of their reproductive systems. As Dr. Hoff points out, "Women are born with all the eggs they are ever going to have, so the eggs that they have are just going to continue to age" over the course of their lives.

Human fertility declines with age, and that's an issue that any couple – whether same-sex or mixed-gender – will have to face at some point. "We are seeing an increasing number of advanced maternal-age couples coming to us," Dr. Hoff notes. "It may be that they found their person later in life; it may be that they weren't ready to start a family until now."

Whatever the reason, "Fertility rates do decline," Dr. Hoff adds, "especially after age 35 for women, and so it makes IVF an even more attractive option because of its higher success rate."

IVF is also an option geared toward making parenting dreams come true by maximizing the odds in a couple's favor.

"We really focus on efficiency and success," Dr. Hoff details, "and there's a number of supplements that I'll give them and variations in protocols that maximize response and number of eggs retrieved." Another key element: "It's important that we discuss their family planning." There might be factors that affect the ideal timing of a couple's parenting journey.

Dr. Hoff provided an example. "[I'll tell them], 'Let's talk about how many children you want, and who's going to carry the pregnancy and whose eggs we will be using.' I encourage them to keep an open mind, because sometimes once we do [the initial health assessment], we may realize that we need to change the plan. The ovarian reserve testing and age may dictate that we switch the order if they both desire to use their eggs to have a genetically related child. While we focus on obtaining eggs or achieving pregnancy for one of the women, the other partner may consider freezing their eggs or holding off on insemination. The plan is continually evolving to meet the family planning goals of the couple."

The process is somewhat different for male couples, though the level of individualized care is the same. "Basically, age is a little bit less important for men," Dr. Hoff notes. "Men make new sperm everyday throughout their lives, so when men come in, if they're a same sex male couple we'll say, 'Let's do semen analysis for both of you. Then we can decide if we want to fertilize just using sperm from one of you, or if we want to do half and half.' Basically, we discuss which makes the most sense medically – and then, of course, we take into consideration what their emotional preferences are."

Adds Dr. Hoff: "Every decision that we make is very, very individualized. We just have to determine, based on the testing, how do I make their family goals a reality? And make sure that we considered all possibilities before proceeding with the plan."

That individualized care is enhanced when a provider is a member of the LGBTQ+ community themselves.

"I love when I'm in a consult," Dr. Hoff recounts, "and there will be occasion where I'll [mention my wife], and the whole atmosphere of the room changes. I see their face – it's like they have this sigh of relief, and it's like, 'Oh, you get it.' There's just a level of understanding that you otherwise just can't achieve, and I think that that is something that is so valuable in a provider."

Dr. Hoff sums up by pointing out that it all comes back to family.

"One of the beautiful things that I think is true with our LGBTQ+ population is that the decision to have a family is so intentional, and it's so desired," she notes. "Every aspect of this has to be coordinated and planned, and so much thought goes into it that it really can be a very bonding experience for the couple. Of course, it can be full of trials, also – but, in general, it's a very rewarding and bonding experience that can bring the couple closer together and make them stronger. And, in most cases, it does."