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LGBTQIA+ Fertility Treatment Options
While the decision and process to have a baby for heterosexual couples may seem relatively straightforward, for same-sex couples the path to parenthood can be quite different. Dr. Alan Martinez discusses LGBTQ fertility options for same-sex couples.
Featured Speaker:
After graduating with distinction with a B.S in biology and B.A. in psychology from San Diego State University, Dr. Martinez received his medical degree from the David Geffen School of Medicine at the University of California, Los Angeles. He completed his obstetrics and gynecology residency training at Saint Barnabas Medical Center, an affiliate teaching institution with Rutgers New Jersey Medical School. He completed his fellowship training at the University of Cincinnati Medical Center.
Learn more about Dr. Alan Martinez
Alan Martinez, MD
Dr. Alan Martinez is a specialist in reproductive endocrinology and infertility. He was drawn to this specialty because it is an ever-evolving field of medicine that allows him to partner with patients and provide personalized treatment plans. He also appreciates that the field is filled with the latest laboratory technology, which continues to advance success rates.After graduating with distinction with a B.S in biology and B.A. in psychology from San Diego State University, Dr. Martinez received his medical degree from the David Geffen School of Medicine at the University of California, Los Angeles. He completed his obstetrics and gynecology residency training at Saint Barnabas Medical Center, an affiliate teaching institution with Rutgers New Jersey Medical School. He completed his fellowship training at the University of Cincinnati Medical Center.
Learn more about Dr. Alan Martinez
Transcription:
Melanie Cole, MS (Host): While the decision and process to have a baby for heterosexual couples may seem relatively straightforward, but for same-sex couples the path to parenthood can be quite different. Knowledge is power. Here to tell us about LGBTQ fertility options is Dr. Alan Martinez. He’s a specialist in reproductive endocrinology and infertility at the Reproductive Science Center of New Jersey. Dr. Martinez, pleasure to have you with us as always. Let’s start with some of the challenges that the LGBTQ community faces when they're deciding to have a child.
Dr. Alan Martinez (Guest): Basically when we have outside of the heterosexual couples we have same-sex female/female male/male then the challenges that exist are going outside of what we call the sexually intimate partners to procure either a donor sperm sample in the female/female relationship or a donor egg source for the male/male as well as a gestational carrier. So those are the overarching themes of this field, and that’s something that we navigate with patients all the time.
Host: So then let’s start with the initial consultation. Is it different for LGBTQ couples than for heterosexual couples? If so, how? What’s discussed that might be different?
Dr. Martinez: So all the couples going through any fertility evaluation. If it’s female couples then we’re talking about one of the partners actually carrying the pregnancy. So then it’s the same evaluation of the status of the uterus and potentially the fallopian tubes to check the function. It involves bloodwork to both examine the reserve of the ovaries for that female patient as well as the reproductive hormones and infectious disease. Then the new test involve some other kind of viral testing that is done specifically like a cytomegalovirus CMV which is a common flu-like virus that some people will carry. However when you're using donor sperm or donor egg, you want to assess the donor status in that case. That’s the female patients. Then we sometimes do something called reciprocal IVF where maybe one female partner will undergo the stimulation to procure eggs and then the other one will serve as the gestational carrier with use of donor sperm. So we involve both of those female patients.
For the male patients it involves semen analysis and infectious disease bloodwork. Then it involves discussing where we’re going to purchase the donor eggs as well as a gestational carrier and the details of that. So there are some overlapping tests that are done in both instances, but it’s either procuring donor sperm or donor egg and then some of the other subsequent laboratory testing that’s done.
Host: Dr. Martinez, do you help female same-sex couples decide who’s going to carry the baby? Is this based on medical history? You said you take some tests for ovarian reserve and that sort of thing. Do the couples generally come in knowing? How do you help them decide that?
Dr. Martinez: So some couples do come to us and have a very specific plan. We will listen to that. Then what we do is we undergo testing. So we want to make sure whoever wants to carry the pregnancy, they have to make sure they undergo a uterus evaluation to look for any structural things such as fibroids, polyps. Then in the case of potentially serving as the egg source they have to undergo ovarian egg testing. So some couples that have an idea then we will undergo the testing in a very specific manner. If we find that there's some abnormal test either of the uterus of the ovaries are not working as well as we would think for that individual then we would do some additional testing. In some cases that could dictate my guidance on who should serve as the egg source, who should serve as the uterus. So some couples that are doing reciprocal, or co-IVF is what it’s called, that becomes more of a concern. Other couples they may just want to serve as both the egg source and carry the pregnancy and that is a little different process. We evaluate and guide the individuals based on the results of the test.
Host: So do couples generally as about using a family member as a sperm or egg donor? Do they generally prefer anonymous? How does all of that decision making work for both types of couples?
Dr. Martinez: So the patient’s on their consultation and their evaluation, we discuss the potential source of either a gestational carrier—of utilizing a person’s uterus to carry a pregnancy—and/or the source of the sperm. You have both the known donors, which is family/friends, and you have the anonymous donors. We discuss both of those aspects. If a patient or couple expresses an interest in using a known donor then there are tests that we do to first of all make sure that that person would be a good candidate. We also have both the intended parents as well as the individual where we’re getting the sperm, the eggs, or using the uterus—we have them undergo both legal consultation as well as psychosocial counselling to make sure that they understand all of the aspects of the process and there’s agreements on the involvement and the relationship with who is going to be ultimately the parent and is responsible for that particular baby should that result in the process.
Host: So I can see where some of these challenges come up. Tell us about the treatment options themselves for gay and lesbian couples. Tell us what are their options and what do you do with them and how have your outcomes been?
Dr. Martinez: Okay so overall the outcomes are oftentimes very good for the same-sex female patients as long as you're using an egg source that has very good quality, and that’s based on our testing. As long as structurally the uterus is ready to carry the pregnancy. Procuring donor sperm is a relatively easy process either through an anonymous or through a known donor and we walk them through that process. So the number one for female/female is the age of the egg as well as the status of the uterus. So if all tests are favorable then the pregnancy rates are very high depending upon the level of treatment whether it’s IUI—which is intrauterine insemination, just placing sperm in the uterus of one of the partners—or IVF where we look at embryo quality. So both of those can range anywhere from the IUI around 20% to IVF 50% and above up to 60 or 70% per essentially transfer. That depends upon the testing that’s selected.
For the male patients, they need to make sure they have good sperm quality. Then the egg source is often a young egg donor, so the egg quality is inherently good in most cases. Then they use a gestational carrier, some individual that has been proven pregnancy. So they have a good outcome. They have a live birth and they didn’t have pregnancy complications. In those cases often times we can be at 60% if not higher for a particular embryo transfer. So it really depends on the level of treatment, but it can be very favorable as long as the individuals meet a certain standard as far as using the egg, sperm, and/or uterus.
Host: So for male same-sex couples, if they find a gestational carrier what else needs to be done from a medical point of view? How about for the gestational carrier? How does all of that work?
Dr. Martinez: Well what happens is the gestational carrier will settle into a legal contract that will denote the monies that is paid to that individual because often times the gestational carrier is compensated, both to carry the pregnancy as well as medical costs. That gestational carrier will have to undergo what we call FDA screening and laboratory evaluation to make sure that they're not carries of any active infectious diseases, make sure that structurally their body is ready to take the pregnancy. They are often evaluation by us as the medical providers. So they come to us for an evaluation no matter where they’re from in country. Then we do a thorough psychological evaluation and get clearance. Then when both parties agree on the terms of the treatment then the process is initiated, and they are ultimately monitored. Their uterus is prepared to take an embryo and then they undergo an embryo transfer within the confines of one of our offices. Then they go back to their life and monitor their pregnancy. Then they give birth and have a gift for that same-sex male couple.
Host: What an exciting time and what a great service that you offer, Dr. Martinez. Before we wrap up, you mentioned social and psychosocial counselling, some emotional discussions that go on. Do you ever hear doubts from patients about having children while in a same-sex relationship? What do you tell these patients? What would you like to tell them now about coming to RSCNJ and exploring their options for fertility?
Dr. Martinez: I would advise anyone considering or listening to this podcast that all of the initial appointments are informational appointments and there’s no pressure for them go through any treatment. Rather it should be served as an educational session. In that, oftentimes their fears and their worries are allayed primarily because they just don’t have an understanding of the process. Once they understand that it’s very regulated, that we walk them through each step, then it’s answering any individual concerns or misconceptions. Then we come to an agreement as a provider and as a patient to move forward with the treatment oftentimes with a high level of success.
Host: That’s excellent. Thank you so much Dr. Martinez. You are a great guest as always. Thank you for joining us. That concludes this episode of fertility talk with RSCNJ, the Reproductive Science Center of New Jersey. Please visit our website for more information at fertilitynj.com and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all of the other Reproductive Science Center of New Jersey podcasts. I'm Melanie Cole.
Melanie Cole, MS (Host): While the decision and process to have a baby for heterosexual couples may seem relatively straightforward, but for same-sex couples the path to parenthood can be quite different. Knowledge is power. Here to tell us about LGBTQ fertility options is Dr. Alan Martinez. He’s a specialist in reproductive endocrinology and infertility at the Reproductive Science Center of New Jersey. Dr. Martinez, pleasure to have you with us as always. Let’s start with some of the challenges that the LGBTQ community faces when they're deciding to have a child.
Dr. Alan Martinez (Guest): Basically when we have outside of the heterosexual couples we have same-sex female/female male/male then the challenges that exist are going outside of what we call the sexually intimate partners to procure either a donor sperm sample in the female/female relationship or a donor egg source for the male/male as well as a gestational carrier. So those are the overarching themes of this field, and that’s something that we navigate with patients all the time.
Host: So then let’s start with the initial consultation. Is it different for LGBTQ couples than for heterosexual couples? If so, how? What’s discussed that might be different?
Dr. Martinez: So all the couples going through any fertility evaluation. If it’s female couples then we’re talking about one of the partners actually carrying the pregnancy. So then it’s the same evaluation of the status of the uterus and potentially the fallopian tubes to check the function. It involves bloodwork to both examine the reserve of the ovaries for that female patient as well as the reproductive hormones and infectious disease. Then the new test involve some other kind of viral testing that is done specifically like a cytomegalovirus CMV which is a common flu-like virus that some people will carry. However when you're using donor sperm or donor egg, you want to assess the donor status in that case. That’s the female patients. Then we sometimes do something called reciprocal IVF where maybe one female partner will undergo the stimulation to procure eggs and then the other one will serve as the gestational carrier with use of donor sperm. So we involve both of those female patients.
For the male patients it involves semen analysis and infectious disease bloodwork. Then it involves discussing where we’re going to purchase the donor eggs as well as a gestational carrier and the details of that. So there are some overlapping tests that are done in both instances, but it’s either procuring donor sperm or donor egg and then some of the other subsequent laboratory testing that’s done.
Host: Dr. Martinez, do you help female same-sex couples decide who’s going to carry the baby? Is this based on medical history? You said you take some tests for ovarian reserve and that sort of thing. Do the couples generally come in knowing? How do you help them decide that?
Dr. Martinez: So some couples do come to us and have a very specific plan. We will listen to that. Then what we do is we undergo testing. So we want to make sure whoever wants to carry the pregnancy, they have to make sure they undergo a uterus evaluation to look for any structural things such as fibroids, polyps. Then in the case of potentially serving as the egg source they have to undergo ovarian egg testing. So some couples that have an idea then we will undergo the testing in a very specific manner. If we find that there's some abnormal test either of the uterus of the ovaries are not working as well as we would think for that individual then we would do some additional testing. In some cases that could dictate my guidance on who should serve as the egg source, who should serve as the uterus. So some couples that are doing reciprocal, or co-IVF is what it’s called, that becomes more of a concern. Other couples they may just want to serve as both the egg source and carry the pregnancy and that is a little different process. We evaluate and guide the individuals based on the results of the test.
Host: So do couples generally as about using a family member as a sperm or egg donor? Do they generally prefer anonymous? How does all of that decision making work for both types of couples?
Dr. Martinez: So the patient’s on their consultation and their evaluation, we discuss the potential source of either a gestational carrier—of utilizing a person’s uterus to carry a pregnancy—and/or the source of the sperm. You have both the known donors, which is family/friends, and you have the anonymous donors. We discuss both of those aspects. If a patient or couple expresses an interest in using a known donor then there are tests that we do to first of all make sure that that person would be a good candidate. We also have both the intended parents as well as the individual where we’re getting the sperm, the eggs, or using the uterus—we have them undergo both legal consultation as well as psychosocial counselling to make sure that they understand all of the aspects of the process and there’s agreements on the involvement and the relationship with who is going to be ultimately the parent and is responsible for that particular baby should that result in the process.
Host: So I can see where some of these challenges come up. Tell us about the treatment options themselves for gay and lesbian couples. Tell us what are their options and what do you do with them and how have your outcomes been?
Dr. Martinez: Okay so overall the outcomes are oftentimes very good for the same-sex female patients as long as you're using an egg source that has very good quality, and that’s based on our testing. As long as structurally the uterus is ready to carry the pregnancy. Procuring donor sperm is a relatively easy process either through an anonymous or through a known donor and we walk them through that process. So the number one for female/female is the age of the egg as well as the status of the uterus. So if all tests are favorable then the pregnancy rates are very high depending upon the level of treatment whether it’s IUI—which is intrauterine insemination, just placing sperm in the uterus of one of the partners—or IVF where we look at embryo quality. So both of those can range anywhere from the IUI around 20% to IVF 50% and above up to 60 or 70% per essentially transfer. That depends upon the testing that’s selected.
For the male patients, they need to make sure they have good sperm quality. Then the egg source is often a young egg donor, so the egg quality is inherently good in most cases. Then they use a gestational carrier, some individual that has been proven pregnancy. So they have a good outcome. They have a live birth and they didn’t have pregnancy complications. In those cases often times we can be at 60% if not higher for a particular embryo transfer. So it really depends on the level of treatment, but it can be very favorable as long as the individuals meet a certain standard as far as using the egg, sperm, and/or uterus.
Host: So for male same-sex couples, if they find a gestational carrier what else needs to be done from a medical point of view? How about for the gestational carrier? How does all of that work?
Dr. Martinez: Well what happens is the gestational carrier will settle into a legal contract that will denote the monies that is paid to that individual because often times the gestational carrier is compensated, both to carry the pregnancy as well as medical costs. That gestational carrier will have to undergo what we call FDA screening and laboratory evaluation to make sure that they're not carries of any active infectious diseases, make sure that structurally their body is ready to take the pregnancy. They are often evaluation by us as the medical providers. So they come to us for an evaluation no matter where they’re from in country. Then we do a thorough psychological evaluation and get clearance. Then when both parties agree on the terms of the treatment then the process is initiated, and they are ultimately monitored. Their uterus is prepared to take an embryo and then they undergo an embryo transfer within the confines of one of our offices. Then they go back to their life and monitor their pregnancy. Then they give birth and have a gift for that same-sex male couple.
Host: What an exciting time and what a great service that you offer, Dr. Martinez. Before we wrap up, you mentioned social and psychosocial counselling, some emotional discussions that go on. Do you ever hear doubts from patients about having children while in a same-sex relationship? What do you tell these patients? What would you like to tell them now about coming to RSCNJ and exploring their options for fertility?
Dr. Martinez: I would advise anyone considering or listening to this podcast that all of the initial appointments are informational appointments and there’s no pressure for them go through any treatment. Rather it should be served as an educational session. In that, oftentimes their fears and their worries are allayed primarily because they just don’t have an understanding of the process. Once they understand that it’s very regulated, that we walk them through each step, then it’s answering any individual concerns or misconceptions. Then we come to an agreement as a provider and as a patient to move forward with the treatment oftentimes with a high level of success.
Host: That’s excellent. Thank you so much Dr. Martinez. You are a great guest as always. Thank you for joining us. That concludes this episode of fertility talk with RSCNJ, the Reproductive Science Center of New Jersey. Please visit our website for more information at fertilitynj.com and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all of the other Reproductive Science Center of New Jersey podcasts. I'm Melanie Cole.