Melanie Cole, MS (Host): Supporting LGBTQIA+ patients through fertility treatments right here on Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. I'm Melanie Cole and joining me today is Dr. Alan Martinez. He's a specialist in Reproductive Endocrinology and Infertility at the Reproductive Science Center of New Jersey.

Dr. Martinez, thank you so much for joining us today. I'd like you to start by giving us some of the unique challenges and considerations that the LGBTQIA+ community would face when considering fertility treatments and tell us a little bit about what your initial consultation is like.

Dr. Alan Martinez: Absolutely, Melanie. Thank you for having me today, joining the podcast. So, my couples from this community, undergo the same fertility treatment that any other couple would start evaluation for; which can include blood work to look at the reproductive hormones. It can include a uterus and or tubal, fallopian tube evaluation.

And, depending upon male female couple, it may include a sperm evaluation. So for our male patients. As far as the challenges that are presented to this community, I think initially there has historically been a stigma about access to care for individuals. And whether it's my female female couple, my male male patients, they all need to make a decision and feel comfortable with the practice that they're, they're seeking care with.

So, we try to really make it a welcoming environment, as with all of our patients, an informative environment, and a supportive environment.

Host: So are the treatments basically the same for same sex couples as they are for heterosexual couples? Yes?

Dr. Alan Martinez: Well, the treatments can be, in the case of female female patients, then it will involve use of a sperm donor, which in some male female couples, that is still used, but it's, that's a common entity. So, that involves preconception counseling to talk about the logistics of that, as well as the normal fertility testing, and then establishing care for the purposes of obtaining donor sperm for their treatments.

And so that donor sperm is either used with two entities. Either intrauterine insemination, or commonly known as IUI, or in vitro fertilization, which is IVF. In addition, there are some cases where the use of either what we call gestational carrier, or some people may say surrogacy, can be used, and that's when we use the uterus of another individual in order to carry a pregnancy. So that is involved with male male patients, And then sometimes even the use of donor egg, depending on the age and the ovarian reserve of the female patient can be used.

Host: Can you expand just a little, Dr. Martinez, on what we're talking about here? When we think of sperm donation and egg donation for same sex couples, how does that work? How do they find a sperm donor or an egg donor for male to male? How does that process work, and how are you involved in it?

Dr. Alan Martinez: So all the patients receive a thorough counseling session by me as an infertility specialist, right? And then this is followed by a fertility counselor, usually a licensed clinical social worker that talks about the psychosocial dynamics of the use of donor egg or donor sperm, whether you have a donor egg or donor sperm, where they are going to be contacted in the future to make a connection about the source of that patient and or sibling registries and things like that.

 So the counseling is done extensively by our office and specialized counselors. Then there are donor sperm banks and egg donor agencies where the patients have been thoroughly screened, both physical exam, genetic screening, and reproductive testing in order to cryopreserve either the donor sperm or the donor egg.

So then the patients initiate contact with these agencies. And they can look at demographics, they can look at the ethnic background, they can look at the educational background, and they make a selection which we guide, and then those reproductive tissues from the egg bank or the donor bank are sent to us for use for fertility treatment.

Host: Tell us about the role of genetic counseling. You've mentioned it a few times. And genetic screening, what role does this play in fertility treatments for this community?

Dr. Alan Martinez: So, both the female and the male patients that present for evaluation are encouraged to undergo expanded genetic carrier screening. The goal here is to make sure and assess, do they carry or test positive for any conditions that could be of concern for their reproductive health or the general health of their offspring?

 So then this information is compared to both the donor sperm individuals, as well as the egg donors who have undergone the same genetic testing. Then, this information can be used to assist them to help patients decide on which appropriate donor sperm or donor egg can be purchased and used so as to minimize any risk of transmission of any genetic conditions in their offspring.

Host: Dr. Martinez, how do you help couples decide? If it's a female to female, same sex couple, and can you help them decide which one of them will carry? How does all that process work?

Dr. Alan Martinez: So in the case of my female female patients, definitely the reproductive testing involves ovarian reserve testing. And what that does is that assess the quality of the eggs for that individual patient.

That guides us on recommendations of which patient to use to stimulate the ovaries to obtain eggs, and that's used for who is undergoing the IVF stimulation. Then a uterus and or tubal evaluation, but in the cases of in vitro fertilization, just the tubal assessment is performed for whatever patient wants to carry the pregnancy. This information is done to make sure that the uterus is going to be receptive. For instance, that there's no intrauterine lesions like a uterine polyp or uterine fibroid, which are very common in patients. So we assess both the reserve of patients, sometimes at the same time, as well as the uterus to assess, okay, would it

be recommended for one patient to undergo the stimulation and the other patient to carry, and that's called reciprocal IVF or vice versa, depending upon any identified issues or concerns for that couple.

Host: This is so interesting, Dr. Martinez, and you're such a great educator. What about the legal issues? What legal issues have you heard come up, and how does the community navigate these challenges?

Dr. Alan Martinez: That is discussed with the patients when we go review the process of using donor egg or donor sperm or a gestational carrier. This is called third party reproduction. And there are specialized lawyers in the case of individuals who may use an identified donor, right, somebody that they know, for instance, a extended family member, cousin, or somebody that they know from the community that they have a relationship with that may want to donate eggs or sperm.

In that case, they seek assistance from a reproductive lawyer to generate a legal contract so it provides and protects for the rights of what's called the intended parents so that there are no legal issues in the future. In the case of an established donor sperm bank or a donor egg bank, that process is already completed and the legal contracts are formulated and signed by these individuals.

So that when the patients purchase the donor sperm or the donor egg, they do not then have to undergo any additional advisement or counseling or documents, contracts with a reproductive lawyer.

Host: Dr. Martinez, what inspired you to become a specialist working with the LGBTQIA+ community? And if you were to pick one thing that really makes your clinic unique, welcoming, supportive for this community, what would you say that was?

Dr. Alan Martinez: Well, entering into the field in general and becoming a physician, I have a vow to take care of patients, no matter what ethnicity, background, gender identity, sexual orientation. I am very comfortable and enjoy working with all of my patients. I think at the Reproductive Science Center of New Jersey, there is something special here from my front desk individuals, to the nurses, to the laboratory staff.

We've really established a culture that is as family oriented as we can. And the goal is to make the patients feel comfortable. And these type of treatment cycles are unique. They are not that difficult at the end of the day to perform. And I think our expertise, it just allows us to really kind of take care of the patients in the most supportive, comfortable setting, free from any judgment, knowing that they're going to get the same care that any of my other patients would receive.

Host: That's lovely. Thank you so much, Dr. Martinez, for joining us. You're just a great guest as always. Thank you again. And for more information, please visit FertilityNJ.com to get connected with one of our providers. That concludes this episode of Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey.

I'm Melanie Cole. Thanks so much for joining us today.