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Caitlin Whyte: The first visit to a fertility clinic looks very different depending on the patient. Heterosexual couples are most likely visiting a fertility specialist because their attempts to conceive a child have been unsuccessful. A first visit would probably consist of questions, examinations or tests to determine their reproductive health. For females at Fertility Centers of Illinois, this includes blood tests and ultrasounds. For men it's a semen analysis. Same sex couples are in a very different position because they might not have a fertility complication. Same sex couples usually go to a fertility clinic in search of third party reproduction options like an egg donor, sperm donor or a surrogate, and since there is so much that goes into third party reproduction, they might also go to a fertility center for guidance and therapy. A first visit for a same sex couple will most likely include questions, examinations and tests as well, but it can also serve as a very informative session. From there. The couple can further explore options, the process and discuss family building goals on their own. With us to talk about these unique issues for same sex couples is Dr. Jennifer Hirshfeld-Cytron, a Physician with the Fertility Centers of Illinois with locations throughout the Chicago area. This is the Time to Talk Fertility Podcast. I'm your host, Caitlin Whyte. So to start us off, Dr. Hirshfeld-Cytron, tell us what assisted reproduction treatment is best for same sex female couples and what's best for same sex male couples?

Dr. Hirshfeld-Cytron: Well, the best fertility treatments for lesbian and gay couples depends in some degree on each couple's goals and objectives. So for instance, within lesbian couples, some of the desires are whether each woman would like to be a part of the process such as what is occurs with reciprocal IVF or for instance, one woman provides the X source while one woman provides the uterine source and therefore it's truly a shared experience. Alternatively, one member of the couple can attempt fertility in the context of insemination and then following the other member of the couple can attempt fertility in a similar manner. So it really depends on the goal of the couple. It depends on their desire of family size. It depends also on each individual's age and health. So for instance, in some lesbian couples that I help take care of, one member of the couple has more medical problems than the other. And that individual does not have the desire to actually carry or be a part of the pregnancy process, including providing the X source. And therefore the other member of the couple will receive a treatment such as insemination, therefore providing both the egg and uterine stores.

In other cases, both members of the couple would like to do it sequentially and alternatively both numbers of the couple would like to do it as a shared process so it truly depends on their desires. When it comes to gay couples, we know that we will be utilizing both an egg donor and a gestational carrier. In some cases the egg donor or gestational carrier could be someone that is already known or a family member or a friend. What that couple then decides is for instance, which member of the couple would like to provide the sperm source and is this something that both members of the couple would like to provide the sperm source in sequential cycles? So part of the process for gay couples really is some of the details that are involved in both identifying an egg donor, which can be someone known or someone anonymous and a gestational carrier, which could also be someone known or someone that is identified through an agency. I think in both cases we really look to couples to guide us and what their desires are and what feels the most comfortable.

Host: On that note, you know, deciding who will be a donor, can I just grab one of my good friends and have them be an egg or sperm donor?

Dr. Hirshfeld-Cytron: That is a great question. When we have a known donor, it's actually a pretty complicated process, so appropriately so the FDA gets involved to assure that medically that individual does not have infectious diseases that could pose a risk then to that person who is caring. It is important both legally, psychologically. What is the most important piece is if there's a relationship that exists between the couple and a potential donor, that that relationship is preserved following the birth of the child. Before any agreement occurs, a psychologist is utilized both for the potential donor and for the couple. So we assure that that is in place. We also then assure for the donor, depending on whether it's egg, sperm or gestational carrier, there's medical testing, there's psychological testing, there's family history, there's sometimes genetic testing and there's often legal agreements that are created even when it's someone that you know, and this is to protect the couple and really to optimize the health of that child once born.

Host: That's really fascinating. I didn't think of all the legality that comes from you actually knowing the donor. It sounds like it's almost more difficult.

Dr. Hirshfeld-Cytron: I think there are clearly pros and cons and so if it's someone that you know and it's a very dear friend or family member, then of course that can be a very positive experience, but I would argue even more so that is when the legal and the psychological components are even more important. There should be no vagueness about once that child is born, sort of responsibility, financial, medical, legal of that child. You also want to maintain that the relationship that you have with that person is maintained even after the child. And so really thinking through scenarios that could come up. And so I agree with you. I think sometimes it is much more involved than you would think.

Host: So what does the process look like for finding gestational carriers?

Dr. Hirshfeld-Cytron: So finding gestational carrier usually we work with different agencies. And so what has occurred, the level of an agency is women that have had a healthy pregnancy. So I think that is key. I gestational carrier is someone that has already had a child and has had a healthy outcome. That individuals also someone that does not have significant medical problems or is on significant medication, that person also becomes psychologically screened to ensure responsibility and carrying a pregnancy. Often that person lives in a similar geographic area as the clinic. And so I think what this brings too, is that each state has their own individual laws, own individual laws for what occurs once that child is born in terms of if the intended parents names can be listed on the birth certificate or not. So some States have more favorable laws such as Illinois versus other States where the intended parents in some cases actually have to go to a form of adoption after the gestational carrier had delivered the child. I think what is really important, not only in assessing and identifying gestational carrier, but to really do your due diligence to appreciate which State that person will be delivering and which State that person receiving medical care, so the couple is well-informed to what to anticipate.

Host: Can you explain to us partner assisted reproduction and reciprocal IVF?

Dr. Hirshfeld-Cytron: So partner assisted reproduction, be very honest. I'm not sure what is supposed to be implied by that. Assistant reproduction is any type of treatment, whether it's IUI or insemination or IVF. Partner potentially could include individual’s partner or someone that is already known to them. Reciprocal IVF means that in a lesbian couple that one woman has desired to be what I'd view with the egg source. So they undergo an IVF cycle and her eggs are combined with sperm and an embryo is created from those eggs and the other member of the couple is the individual that carries that pregnancy. The advantages are clear. It becomes a really special shared process for this couple. It sometimes provides a venue for a woman who had medical problems who cannot carry a pregnancy, to still be genetically connected to the child. Some of the cons that can occur versus reciprocal IVF can depend on the insurance. So if insurance is not contributing, it can provide a much more costly treatment than for instance IUI or insemination provides. But it is a mechanism where one member of the couple can provide the egg source and be genetically connected to the child. While the other member of the couple provides the capacity to carry the child and share it in the experience of the pregnancy.

Host: So wrapping it up here, what is a fertility awareness checkup and is that something I should be getting?

Dr. Hirshfeld-Cytron: I think what is great about fertility awareness checkup is whether it is a lesbian couple or a gay couple. These are not infertile couples. These are not individuals who had, quote unquote, demonstrated exposure of egg and sperm for six to 12 months. These are really untested individuals and now we're going to embark on a whole bunch of, quote unquote, fertility based treatments to allow to have a family. And so what a fertility awareness checkup does is it helps provide some gauge or some sense for a woman how her ovaries act compared to other individuals her age. So things such as how her egg reserve is. We do that with ultrasound and blood work. It also helps a male to identify if there's any issues than his semen analysis. And so I think this is a really important first step for that individual who may want to provide the egg source. That individual who may want to provide a sperm source to assure there aren't any, quote unquote, issues. It is a $90 test for same sex female couples. That includes both blood testing and ultrasound to assess health an age of the ovary, for both members of the couple for same sex male couples. That provides an opportunity for both members of the couple to have their same analysis assessed and it's almost like a quick and dirty way of saying, yep, there'll be no issues with me or look, here's something we've now identified for me to be aware of.

Host: Is there anything else you want to add about same sex couples and fertility treatment?

Dr. Hirshfeld-Cytron: I think in the idea of LGBTQ family planning. One thing that I hear from patients that I appreciate can be frustrating is once you enter the medical community, it almost feels very medicalized so to speak, like it feels very involved. There's a litany of to do's and I think ultimately yes, that first month, there is some testing that we've done. There is some checks in terms of theoretically things like legal contracts, how we best assess donors, but in the end these are the tools that have been put into place to assess not only the health of that couple but the health of their future family, the health of that child, to ensure that it is as positive experience as possible. I think it's also helpful to know, particularly for lesbian couples that this involvement of treatment can be quite minimal to quite involved, and that they are the ones who are running the show. They are the ones that are going to dictate what makes the most sense for them and their family.

Lastly, in regards to LGBTQ, what we had not talked about at all, were in the context of members within the transgender community, individuals that are currently potentially transitioning by the use of hormone treatments born as female who identified as male. That in that context, if there is a desire to preserve future fertility such as the desire in the future to have a genetically connected child that before introducing a hormone replacement therapy that will then be that first step of transition which is so incredibly important to know that there are options to freeze eggs if that's a priority. Conversely, there are options to freeze sperm. That's a priority. And the reason to think of that even now is it can be incredibly disruptive to stop among therapies, to assist in creating the process of transitioning in order to then go back and obtain either egg or sperm to utilize the have a genetically connected child. And so if that is a priority to the individual to even be mindful and aware of that now.

Host: So it sounds like for these couples there are quite a few options like you said, depending on how kind of involved you want to get.

Dr. Hirshfeld-Cytron: Absolutely. I think for our lesbian couples there are quite a few options. For same sex male couples, it is going to be more involved because there'll be a requirement of identify not only an egg donor but gestational carrier. And so I think in that appreciation it is going to be more involved and it can be more costly and like anything else in life, the more we know to anticipate the beginning, I think the more seamless the process can be.

Host: Well, thank you so much for your time and conversation today, Dr. Hirshfeld-Cytron. That was Dr. Jennifer Hirshfeld-Cytron with the Fertility Centers of Illinois with locations throughout the Chicago area. Find out more about what we discussed today and other fertility options on our website at fcionline.com. If you enjoyed this podcast, find more like it in our podcast library and be sure to give us a like and a follow, if you do. This has been the Time to Talk Fertility Podcast. I'm your host, Caitlin Whyte. We'll catch you next time.