Melanie Cole, MS (Host): Welcome to Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. Today, we're learning about LGBTQ+ family building. Joining me is Dr. Ashley Ulker. She's a board-certified obstetrician gynecologist with fellowship training in reproductive endocrinology and infertility.



The Reproductive Science Center of New Jersey combines a commitment to sensitive care with a state-of-the-art program. We proudly present Fertility Talk with RSCNJ. Here's Melanie Cole.

Melanie Cole, MS (Host): Dr. Ulker, it's a pleasure to have you join us. I'm so glad you could be with us. And this is such a great topic. It's really important. So for someone just beginning to explore fertility, if they're in the LGBTQ+ community, what's the first step? What does their initial planning look like?

Ashley Ulker, MD, FACOG: Yeah. So, the first step is really just having a conversation. We'll have our initial consult, talk about your goals, your intended family structure, your timeline, you know, go through your medical history. And we'll determine what is needed from there. Sometimes a fertility evaluation is needed. We'll help you understand kind of the legal implications, emotional, financial aspects. And then, just based on your goals, we'll go from there and we'll get you in touch with the right people and all the right information.

Melanie Cole, MS: For any couple going through this, it's a journey and there are steps to take. So, this fertility journey, and you and I have talked about it, it can look very different for whatever kind of couple that you are. But for LGBTQ+ couples or individuals that are exploring this, what are some of the most common pathways? Because not everybody knows all the different tools in your armamentarium and what that looks like, because there are many now.

Ashley Ulker, MD, FACOG: Yes. This is one of my favorite parts of counseling because there are so many options depending on your situation and what your goals are. But for example, for same-sex female couples, you can do inseminations using donor sperm. That could be a known donor or anonymous donor sperm. You could do IVF using donor sperm. you could also do what's called shared IVF, which we can go into in a little bit. For same-sex male couples, this usually involves the use of an egg donor or some kind of an egg source, whether that's someone who's known to them or anonymous, and the use of a gestational carrier. So, there's a lot of different options for these individuals.

For transgender or non-binary individuals, there's also different pathways that can incorporate fertility preservation if that is desired prior to undergoing gender-affirming care. So, these are all varied options that are available to patients today.

Melanie Cole, MS: And we're gogoing toet into our transgender community in a minute, but we've heard the term reciprocal IVF. What is that, Doctor?

Ashley Ulker, MD, FACOG: Yeah. So this is a great option for couples who both have ovaries and a uterus. And so, essentially, one partner undergoes IVF or in vitro fertilization to obtain the eggs and create embryos. And then, the other partner undergoes embryo transfer and carries the pregnancy and delivers ideally to term. So, this is a great way for both partners to have a physical involvement in the family-building process. And really, a lot of couples like it because they each feel like they do their part, you know, in that sense.

Melanie Cole, MS: Well, I hear what you're saying there, and I think one of the things when you were talking about talking and counseling, how do you help couples decide who would be the carrier and how that all works? Because that's got to be a bit of an emotional discussion sometimes.

Ashley Ulker, MD, FACOG: Yeah. I mean, honestly, a lot of times patients come in and they already know which partner wants to be the carrier or, more commonly, which partner does not want to be the carrier. I would say that's more common. But sometimes they're each open to it. You know, they both want to undergo an evaluation. And they want me to let them know, you know, who would be the better candidate. Usually, if someone's younger, you know, I would say the younger eggs would be the better egg source, because eggs are the single most important determinant of pregnancy. So, there's different factors in that way. But most of the time, couples have somewhat of an idea of what they're willing to do or what they desire.

Melanie Cole, MS: Yes, thank you for that. So for our trans patients and listeners, touch a little bit for us on fertility preservation, because that's really an important part of this journey before transition or before beginning hormone therapy.

Ashley Ulker, MD, FACOG: This is important because fertility preservation does create the possibility of more choices in the future if that's what they want. So for those who produce eggs, we can always freeze eggs or freeze embryos for future use. And for those who produce sperm, we can always do sperm banking. And that's an easy and very available option. and that can be done again before starting estrogen or gender-affirming treatment. And for those who have eggs, we can freeze eggs or freeze embryos before starting testosterone or undergoing surgeries that affect fertility. Alternatively, if treatment has already been started, this doesn't always preclude you from fertility preservation or from undergoing care, but each case is individual. So, it kind of depends on the person, and we can always do a fertility evaluation and see if that's a possibility. But it's definitely not impossible.

Melanie Cole, MS: I love to hear that because there's just so much hope around what you do. What are some of the biggest misconceptions among this community and fertility that you have heard that you want to clear up right now?

Ashley Ulker, MD, FACOG: One of the most important misconceptions is just that LGBTQ+ individuals are not infertile. You just need a little bit of assistance to expose sperm to egg and create embryos and, you know, build your families in that way. But also, there's not one-size-fits-all in fertility land. There's a lot of different ways to make a family. There are many different types of families and many different realities, that are possible to create the options that you desire. Research has been done and consistently shown that children raised by LGBTQ+ parents thrive just as well as any other child that's raised in a loving, supportive home. So, I think that's a very important misconception to understand.

Melanie Cole, MS: I agree with you. Very well said. Now, for this specific community, the LGBTQ+ community, how has it evolved to the point where we're having this discussion today where it's more inclusive, it's more affirming? Tell us a little bit about what's so exciting and how you've seen that change.

Ashley Ulker, MD, FACOG: Yeah. I mean, we've definitely seen tremendous progress in recent years. Many clinics are now moving away from making assumptions about gender and family structure, and the shift has focused more on the individual and each individual's goals. Simple things like intake forms are becoming way more inclusive. There's more staff education and training on affirmative language. And treatment plans are also more designed around patients rather than a traditional definition of family. And so, while there's still work to be done, the field is increasingly recognizing that everyone deserves equitable access to family building.

Melanie Cole, MS: I agree with you. That was well said. So for listeners or people that love someone in the LGBTQ+ community who may feel overwhelmed, discouraged, or unsure if parenthood is really possible, and you just gave a lot of hope in this talk today, Doctor, what would you like them to know? What would you like to them to take away from our discussion that gives them so much hope for the future and for creating this family however it looks?

Ashley Ulker, MD, FACOG: Yeah. I mean, it's very common to feel overwhelmed and discouraged. You know, there's a lot of information out there, lots of misinformation out there. But I just want them to know that family is possible. There's a lot of different ways to get there, but family is absolutely possible. And we'll work with you to achieve your goals and create your family the way you see it.

You know, the journey might look a little different than how you may have imagined it. And there might be some extra steps, whether those are legal steps or medical steps. But there's definitely more opportunities now than ever before. And just know that there's a community behind you and people that are dedicated to helping you. So, I hope that you leave your consultation or phone call with us feeling more encouraged and excited and not overwhelmed and discouraged because there's always a way.

Melanie Cole, MS: Thank you so much, Doctor, for joining us today and really giving that hope to so many to create families when that's really what they desire and to tell us about all the tools that are available for that journey. Thank you so much for joining us. And for more information, you can visit fertilitynj.com to schedule an appointment or to speak to one of our fertility specialists.

That concludes this episode of Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. I'm Melanie Cole.