Melanie Cole, MS (Host):   Same sex female partners who want to have a baby have a number of different treatment options to help them conceive. Joining me today is Dr. William Ziegler. He’s a specialist in reproductive endocrinology and infertility, and he’s the medical director of the Reproductive Science Center of New Jersey. Dr. Ziegler, it’s a pleasure to have you join us again today. Tell us a little bit about same sex female couples that want to have children and what are their options.

Dr. William Ziegler (Guest):   When we’re addressing the same sex couples, we have different treatment options for them. It really depends on which way they want to proceed. In many cases we are focusing on only one of the partners in getting pregnant, but it’s becoming increasingly popular for these couples both want to play a role in conceiving a child. Some women feel it strengthens their bond with both the child as well as with each other. That is where reciprocal and just IVF comes into play where one partner supplies the eggs to be used for IVF and the other partner is basically going to act as the gestational carrier of the pregnancy.

Host:   Well, thank you for that explanation. So tell us a little bit more about reciprocal IVF and how the process works. Kind of walk us through it.

Dr. Ziegler:   During our first meeting we really need to identify which partner is going to be contributing an egg or eggs and which one is going to be the carrier. We like the patients to not have really any infertility issues. In that situation, it gives them the highest success rate. The partner that’s going to be donating the eggs will need to go through an ovarian stimulation to produce multiple eggs similar to a normal IVF cycle. Her eggs would then be extracted just from her ovaries and they’d be fertilized with donor sperm. That’s something else that we have to identify is whether they're going to be using a known donor or whether they're going to be using an anonymous sperm donor. The partner that’s going to be carrying the pregnancy, her uterus is prepared for the embryo transfer. So we really need to kind of synchronize both of their cycles. As the one partner is getting stimulated, we have to monitor the other partner who’s going to be the carrier to make sure that her lining matches the embryos once they are created. If everything goes well, the embryo will be transferred into the carrier’s uterus to grow and progress through the pregnancy. The extra embryos that are created can be frozen so they can be used either in the other partner who donated the eggs or it could be transferred back into just the initial carrier. So it does give them some options to have multiple children and possibly have each one of them carry a pregnancy. We’d rather it not be at the same time just because of the issues in which could arise from that. That if I have two patients that are pregnant at the same time which are partners, we have to be concerned that they may be delivering at the same time or have pregnancy complications which could also effect their relationship as well as the pregnancy.

Host:   Dr. Ziegler, how do you help your patients decide which partner should provide eggs and who should carry the pregnancy? Tell us what goes on with that.

Dr. Ziegler:   Well we have to screen each partner. If they're not sure who is going to be giving us the eggs, we will check for their ovarian reserve. How well are their ovaries acting? We’d rather retrieve eggs from the partner who’s ovaries are matching their chronological age. We don’t want to retrieve eggs from somebody who has significant ovarian dysfunction. So that’s how we would determine which partner should give us the eggs. In many cases, they come into our office and they already know who is going to be contributing the egg part and who is going to be the gestational carrier. For the gestational carrier individual, we would, again, check their hormones and we’d also check their uterine cavity and make sure there's nothing deviant in the cavity like a uterine septum or a polyp or a fibroid just so we can maximize their chances. Both partners would need to be screened for infectious diseases. They would both need to undergo a psychological evaluation just to make sure they're both on the same playing field when it comes to raising the child, what happens in telling the child just how the child was created basically. So we want to make sure that conflicting information is kind of settled and they're both on the same page in proceeding with this treatment option.

Host:   Well that’s a very comprehensive screening situation. Tell us a little bit about some of the legal and emotional considerations. You mentioned in your screening some of that, but expand a little about when women are deciding these things and what's the legal considerations going on?

Dr. Ziegler:   Yeah, well I think the legal issue with reciprocal invitro fertilization is quite complex. It can vary from state to state. The best thing to do—and what we always offer our patients—is they need to consult with a reproductive lawyer because you really need to figure out what are their parental rights. Does the person that doesn’t deliver the child, do they have legal rights for that child? Do they need to legally adopt that child? I really do think that the parenting laws nationwide have not really quite caught up with fertility technology. Having an experienced attorney to help you through this process really helps. That some states recognize both partners as being parents. Then if they're legally married in some states it allows what's called second parent adoption where one parent is deemed the biological parent and the other one is able to adopt the child. So I think that’s something to really consider getting a reproductive lawyer to help a couple go through all the maze of the legal aspects.

Host:   Well, thank you for that answer. As far as sperm donors, how is that process started? Do they usually come in knowing who they want to donate sperm or is this more of an anonymous thing?

Dr. Ziegler:   In many cases when same sex couples just come in to us, in most they have contemplated using an anonymous sperm donor. That’s where sperm banks come into play. If they're going to be using a known sperm donor—maybe it’s a friend or maybe it’s a relative of the person that’s going to be carrying the pregnancy basically—then they would need to be screened and their sperm would need to be banked and really abide by the FDA guidelines. In many cases, what we would do is we’d give them a list of sperm banks in which we work with. We do recommend them making a list of the characteristics in which they want in that sperm donor. In some cases, the woman that we’re retrieving the eggs from, we may fertilize half of those eggs with one donor sperm and then freeze the other half of the eggs to be used at a future time, possibly with a separate sperm donor depending on the characteristics that each person wants to use. Sperm banks are pricey, but the sperm are screened for illnesses as well as genetic issues. These donors have waived any parental rights to the child. So going down the road of selecting sperm, we always recommend someone who has proven fertility. Sperm donors are locked out of specific geographical areas if they've been used quite a bit or if they’ve reached the maximum amount of children in which could be created in that one sperm donor. So it kind of gives some regulation so that half-brothers and half-sisters do not meet.

Host:   Dr. Ziegler, is reciprocal IVF covered by insurance?

Dr. Ziegler:   Well insurance coverage for invitro fertilization is not mandated in most states. In states that do require at least some coverage, insurance carriers usually do not cover the cost of reciprocal invitro fertilization unless there is a medical necessity. So it really varies by state. The cost of the diagnostic test and doctor visits for the woman who’s carrying the pregnancy may be covered. In most cases, insurance covers the diagnostic part of this process and after the woman is pregnant will cover for the pregnancy. Again, coverage can vary greatly from state to state. In general, the cost of reciprocal invitro fertilization are very similar to those of IVF using a known egg donor. The woman who undergoes treatment to create the embryos while the other is being prepared for a transfer. On the average, a fresh cycle’s probably can range anywhere between $6,000 to $9,000 plus the cost of fertility medication. In some cases, if someone is paying out of pocket for this there can be some discounts coming from the pharmacies. Again, it can be quite expensive especially if you're using donor sperm also. Through our practice we do have packages that make this more affordable, and we have some other programs to help with the medications. So it can offset that burden or that cost which can be psychologically traumatic.

With all of that said and with everything we’ve covered, reciprocal IVF can be a good choice for same sex couples who want to have a baby together. I think the big thing is patients need to come in here and have discussed the whole process between each other and really come back with them both being accepting of the whole process. This does involve the doctors as well as lawyers kind of getting involved. Both patients have to be comfortable with proceeding with this and know what their roles are in the pregnancy as well as in the upbringing of the child. Because they're both going to be the parents of this child despite who delivers and who provides the eggs.

Host:   What a great topic and such important information. Dr. Ziegler, it’s a pleasure as always to have you join us to share your expertise. Thank you again. That concludes this episode of Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. To schedule an appointment, please visit our website at fertilitynj.com for more information 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.