Important Considerations for Lesbian Couples on the Path to Parenthood

By Michelle Hester, LCSW-C
Licensed Clinical Social Worker

An increasing number of lesbian couples are using reproductive lesbian coupletechnology to become parents.  Not having suffered the heartache of infertility, many come to this process hopeful and thankful that there is a technology to help them achieve their dream of parenthood. For others, the reality of needing to use medical intervention to achieve this end is frustrating.

The social landscape for lesbian couples has, of course, changed dramatically in the last decade.  The recent Supreme Court decision legalizing same sex marriage helped to dramatically expand legal rights and protections. However, bureaucratic and logistical hurdles remain.

Deciding Who Will Carry the Pregnancy

lesbian couple - who will carry baby?For some couples, it is clear who will try to become pregnant. The decision is usually based on age, medical history, and the depth of the desire to become pregnant and give birth. Sometimes the plan is for each to have a child, often with the older partner going first. Some women may choose to carry their partner’s egg so that they both have involvement.

The “other mother” has a challenging role with no established road map. For example, the couple will need to figure out how to answer the intrusive question of “who is the ‘real’ mother?” For some this can be a painful question, which can tie into a sense of loss or of being marginalized. Like the heterosexual father, this other mother may indeed feel a bit sidelined in the first part of parenthood when there is a focus on pregnancy, childbirth, and nursing.  Couples will want to think about the many ways in which they can establish meaningful, mutually supportive roles. In addition they will want to think about how to handle the inevitable questions about their family make up. These are questions that children will also have to answer and they will look to their parents’ example.

Choosing a Sperm Donor

Some couples begin with the idea of using a known donor. If the friends with laptoprelationship that both prospective mothers have with the intended donor is based on trust and good communication, this arrangement can have benefits for all involved, including the child. Many people worry that one or more of the parties—and this would ultimately include the child—will in time want a new arrangement, which is not welcomed by the others.

For many, using an anonymous sperm donor seems simpler, and in this stage of the process it can be. From the vantage point of future offspring, the picture might look different. Couples often report that accessing the sperm bank for the first time is a surreal experience, leaving them with the initial impression that they can order a child to specification. This, of course, is not a possibility for any prospective parent. In choosing a donor, couples find it useful to identify what is most important to them, whether that be physical attributes, values, health history, or interests.  Interestingly, people often find the donor’s voice clip useful.

One of the many decisions that couples will need to make is whether they want to choose a donor who says that he is open to contact after a child reaches age 18. This is not a guarantee, but a statement of intention. In the end, the most important variable in choosing a donor is that the parents have a positive regard for the donor because this gets communicated to children in many ways. Couples sometimes feel that if they are a loving, supportive family a child will not be interested in the donor. In fact, many people are interested in their genetic origins notwithstanding a nurturing family. Being a loving, supportive parent may include helping a child pursue his or her interest in their origin.

Seeking Support during Treatment

lesbian couple with babyGetting information from the clinic and from insurance companies about costs and coverage is usually time-consuming and often frustrating. Because the cost is considerable, couples sometimes need to alter their original plan. Coming to a consensus about what the plan should be can be difficult.

Consulting with a mental health practitioner experienced in the field of reproductive technology is another aspect of getting prepared. Same sex couples may initially wonder whether they are being singled out or feel that because they have thought about their plan at length, counseling should not be a requirement. However, counseling is the standard of care for all patients using gamete (egg or sperm) donations. The counselor will have certain topics to discuss, but the most worthwhile meetings for clients are when they bring up their particular concerns as well.

Developing realistic expectations for how long the process will take is also important. Even under the best circumstances, it can take a long time to get pregnant. It’s important to think about what will help you in getting through a stressful time. For some women that will mean simplifying their life and for others it will mean planning distractions.

Support systems are important in every family’s life. Inevitably these systems shift with the arrival of a child. For those who have had problematic relationships with their families of origin, the prospect of a child can be an opportunity to rework that relationship. Indeed, all new parents need to rework their relationships with their families.

Couples will want to think about how they will manage information about donors, treatment, pregnancy, and delivery to achieve the goals of protecting themselves and a prospective child while taking into account the particular ways that their families operate. For example, there is a broad range of ways that couples can handle the information about the donor with family and friends. On the one hand, people may share all information about the donor because they think that family and friends will be interested and that this is a good way to include them in the process. On the other hand, some may limit what they say to a simple statement that they are happy with the information about the donor. They do this because they want to be sure that they are the first people to give their child that information.

Being part of a supportive community is also very helpful for new families. Many communities have LGBT organizations that particularly address the needs of families. They may have support groups for prospective parents and sponsor functions for families. Later on, being part of these organizations may provide opportunities for children to be with families built like theirs.

Becoming Parents

Families built so intentionally have many strengths; this is supported by research that shows that on the whole children do well. Parenting is always challenging and rewarding with each kind of family having its own set of particular issues. Families with same sex parents are squarely in the broad and expanding spectrum of the modern American family.

Michelle Hester has 30 years of experience working with couples, individuals, and groups in a variety of settings. She has specialized in adoption services, both before and after placement, with interest in infertility, adoption, and early adjustment issues for new parents. She is a Licensed Clinical Social Worker in Maryland and the District of Columbia. She sees patients in Shady Grove Fertility’s D.C. and Maryland offices.

If you would like to learn more about Shady Grove Fertility’s support services for lesbian couples or to schedule an appointment, please speak with one of our New Patient Liaisons at 877-971-7755.

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Egg Freezing and the Pursuit of (my Future) Family

Dr. Shruti Malik - My Egg Freezing Story

Shruti Malik, M.D.

Written by Shruti Malik, M.D., of Shady Grove Fertility’s Fair Oaks, VA, office

“Having a family is hugely important to me and I didn’t want to lose that opportunity. Because of egg freezing, I can now focus on my life in the present without having to worry about the future.”

A Career with a Sense of Purpose

I went into the field of reproductive medicine because it gave me a sense of purpose.  I sympathize with the women and men dealing with infertility. They position themselves to become such amazing parents, and to be able to help them achieve this goal is a privilege greater than anything else I could do.

As we continue to make technological advancements in the field, I’ve found that my role has expanded beyond treating infertility. I’m now in a position to empower women through egg freezing. Egg freezing technology has been around for many years, but in 2009, we achieved a major scientific breakthrough with a freezing technique called vitrification. Success rates with vitrification are now on par with fresh (i.e. non-frozen) in vitro fertilization (IVF) cycles. In part due to this advancement, egg freezing is no longer deemed experimental and is making its way into the mainstream.

The Best Position to Have a Family

An advancement like egg freezing allows women to position themselves to be in the very best place to have a family—when they’re ready. While having a child naturally may be the optimal form of conception, should that plan not work egg freezing is a reliable option for women. It allows women to focus on their life without the pressure of finding the right partner and starting a family right now. They don’t have to worry about losing out on the opportunity to have children at a later date, which is very reassuring to women.

This empowerment is something I’ve not only seen from the physician standpoint but in my experience as a patient. Like so many women, I hadn’t found the right person to start my family with yet, and I wanted to take the weight off of my shoulders without letting go of that hope. Egg freezing has afforded me the opportunity to do just that. Now I know that I will be able to pursue my family when I’m ready and continue to live my life in the present day. Having gone through the process of egg freezing provides me with a unique perspective to understand what my patients are going through. We have insurance policies for everything else in our lives, so why not one for our future family?

The Reality of Ovarian Reserve Testing

I’ve also seen how important it is for women to be aware of their fertility options and consider ovarian reserve testing to determine her current fertility potential. When I decided to move forward with egg freezing, one of my friends also had her ovarian reserve tested. Even though she was in her early 30s, she discovered that she had low ovarian reserve. Having this knowledge gave her the power to do something about it in the present, even though she was not ready for children yet. She successfully froze her eggs and gave herself an opportunity to have a family; an option she may not have had if she had waited a few more years.

Egg freezing may not be the right choice for every woman, but knowing that the option is there is incredibly empowering. We I generally recommend that women consider freezing their eggs in their early to mid 30s, as women in this age group will still likely have great results with the overall process, and excellent pregnancy rates in the future if they move forward with using their frozen eggs. Even if a woman is in her late 20s or late 30s, it is still reasonable to consider ovarian reserve testing and discuss the results with a physician.

The entire egg freezing process only takes a few weeks but the result can afford years of relief. If you’re even remotely thinking about egg freezing, speak to a physician. It doesn’t commit you, but the information is powerful and can help you decide what’s best for you. I’m very glad I made the decision to move forward with egg freezing. If you’ve ever considered egg freezing or are just thinking about it now, I urge you to at least talk to your physician and take the first steps towards insuring your future.

To schedule an appointment with Dr. Malik to discuss your options and egg freezing potential, please fill out this brief form, or call 1-877-411-9292. To learn more about egg freezing, join us for one of our upcoming Wine & Freeze egg freezing seminars.

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Becoming Pregnant with Endometriosis

Rachana V. Garde, M.D.

Rachana V. Garde, M.D.

Written by Rachana V. Garde, M.D., of Shady Grove Fertility’s Woodbridge, VA, and Annandale, VA, offices

Endometriosis is a condition that occurs when tissue that lines the uterus—known as endometrial tissue—grows outside of that organ and attaches itself somewhere else, such as the ovaries or fallopian tubes. This tissue responds to your menstrual cycle hormones by swelling, thickening, and then shedding to mark the beginning of the next cycle. While the bloodshed from the uterus is discharged through the vagina during your period, the bloodshed from endometrial tissue that grows in the pelvis remains and can become scar tissue. This scar tissue can grow to block the fallopian tubes and interfere with ovulation. Additionally, endometrial tissue that spreads to and grows inside the ovaries may form a type of ovarian cyst called an endometrioma, which can potentially affect fertility.

If you have been diagnosed with or believe you may have endometriosis and are wondering whether you can get pregnant, the answer is yes for many women. While endometriosis may make it harder to conceive on your own, your chances of becoming pregnant can be high—depending on the severity of the condition, your age, overall health, and the treatment option you choose.

Diagnosing Endometriosis

“Endometriosis is not always easy to diagnose,” explains Rachana V. Garde, M.D. In some women there appears to be a genetic link, this is not the case for others. Some of the most frequently reported symptoms of endometriosis include:

  • Severe menstrual cramps
  • Chronic abdominal pain
  • Pain with intercourse
  • Excessive bleeding

While many of the symptoms listed above are common, it is important to know that about a third of women with endometriosis will not experience any symptoms. On the contrary, some women that experience similar symptoms will ultimately be found to not have this condition, says Dr. Garde.

laparoscopy for endometriosis

Laparoscopy is often used to diagnose endometriosis.

The only way to definitively diagnosis endometriosis is through an outpatient procedure called a laparoscopy. Historically, during this procedure the doctor would insert a thin scope near your navel to look for, and sometimes remove, endometrial tissue that is outside of your uterus. “As the medical literature continues to explore this type of surgery, it’s becoming less recommended for the purpose of diagnosis,” explains Dr. Garde. “Studies have found that surgery, especially on or around the ovaries, can damage the ovarian tissue, which can result in a decrease in ovarian reserve (egg supply). This decrease can ultimately make conception more difficult in the future.”

Dr. Garde suggests that women with the symptoms associated with endometriosis speak with a fertility specialist prior to initiating any exploratory surgery, in order to determine options and the appropriate next steps that will not compromise fertility potential.

Treatment Options for Women with Endometriosis

“For any woman that has or suspects endometriosis, the first step prior to treatment is to complete a full infertility work-up to identify any other potential challenges such as age or male fertility issues that the couple may experience when trying to conceive,” says Dr. Garde. A fertility specialist can help you rule out other health issues and determine which treatment options are best for you, depending on how far your endometriosis has progressed and if other factors may otherwise prevent conception. As you advance in age, your treatment options can become more limited—even if your condition is mild—so seeking help sooner rather than later is suggested.

Many women with endometriosis will start with a basic form of treatment called intrauterine insemination (IUI). During this treatment, the physician will prescribe medication to stimulate and grow one to two follicles containing an egg in the ovary. At the time of ovulation, the physician will perform the insemination, which involves placing a concentrated amount of sperm into the uterus. If these treatments don’t work over time, you have more severe endometriosis, or other factors that would impact the chances of success, your doctor may recommend moving to in vitro fertilization (IVF).

Waiting to Conceive

If you have endometriosis and do not have plans to conceive at this time or in the near future, preserving your fertility through egg freezing is recommended. While laparoscopic surgery can help to reduce the pain associated with endometriosis, it can also negatively affect your ovarian reserve. Therefore, freezing prior to surgery ensures you have options in the future.

If you have endometriosis and are trying to become pregnant—or think you may want to become pregnant in the future—don’t wait to speak with a fertility doctor. With proper counseling and care, endometriosis doesn’t have to stand between you and your dream of having a family.

If you would like to learn more about endometriosis or to schedule an appointment, please speak with one of our New Patient Liaisons at 877-971-7755.

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