Maggie McKay (Host): Welcome to Fertile Edge, a podcast from the Reproductive Science Center of the San Francisco Bay Area. I'm your host, Maggie McKay. When it comes to family building in an LGBTQIA couple, there are options. And as we'll learn from reproductive endocrinologist and infertility specialist, Dr. Michael Homer, there are a lot of them. So, thanks for being here today, Dr. Homer.

Michael Homer, MD: Yeah. Thank you. This is fun.

Host: Let's just start with what fertility options are available for same-sex female couples trying to start a family?

Michael Homer, MD: Yeah, that's a great place to start. It's some of my most favorite visits that I have with patients, because there's options, which egg are we using or who's carrying that pregnancy. So when a couple comes in to make their appointment with us, we review all of those choices. And it's fun over the years to hear while people make those decisions between themselves.

We know where we want to go. We want to get to that pregnancy and growing that family, but the paths that we get there are very varied. So, we review all of the different paths to do that kind of a trail map, if you will. And it's really one of my most fun parts of my job to discuss that with a couple in this type of situation so I can really fully understand all the choices and kind of what it means for them as a couple.

Host: So, what are some of the most common options?

Michael Homer, MD: Well, the first part is that in these cases we are almost always going to have to find a sperm donor, right? And so, there's choices to that. Most times, we do use a frozen sperm bank from an anonymous donor, like say Fairfax or California Cryobank, but any U.S.-based sperm bank can work. Sometimes patients would prefer to use a known donor. So, this is typically a friend or maybe even a relative of the person who's not using their eggs to get pregnant. There's a process for that here at RSC as well to make sure that's as smooth as possible.

Once we have the sperm, we decide the best way to move forward to help you grow your family. And so, that could be either something as in our world, simple, which is like a natural ovulation timed and monitored. And we have that sperm and we thaw it on the day of ovulation and do an intrauterine insemination, which is a quick five minute procedure in the office. There's, of course, a whole bunch of setup and making sure you're optimized and healthy for pregnancy before we do that.

Another option is to do what we call autologous IVF or in vitro fertilization, and that's where we use that sperm, but the person who's carrying the pregnancy were also using their egg and they go through a standard IVF cycle. And the day the eggs come out, they meet with the thawed frozen sperm.

 And then, there's one more level of this where we can do what we call co-IVF. And sometimes you'll hear it referred to as reciprocal IVF. And that's where the choices and fun options are there. So, that's where we can use one partner's egg, and then the other partner would carry the pregnancy. And there's many, many reasons why couples will decide to do that particular and then, of course, who's the one that carries it, or who's biological egg that we're using.

Host: Wow. Okay. So now, let's go on to same-sex male couples. What fertility options are available for them?

Michael Homer, MD: It's an honor to take care of these couples. I mean, given historically how hard and disadvantageous it has been to create families in that space, in that community, it's fantastic that we have these choices and options now for this. When it comes to same-sex gay male couple, we have sperm, but we need the egg and we need someone to carry the pregnancy.

So typically, at a new patient visit, it is about an hour long, and it's to review both the aspects of procuring and purchasing and using those eggs as well as the gestational carrier or the use of a surrogate to carry the pregnancy. And so as a quick summary, when we have eggs, the eggs can either be a known egg donor or they can be an anonymous egg donor. If it's a known egg donor, we take you through the whole process of making that known donor, say, it's a relative or a friend. That would be almost an egg donor level with the FDA. So, it's a whole process that we help you all the way through working with the agents, with your friend as well, the person who's donating those eggs.

Host: Wait, the FDA?

Michael Homer, MD: Yeah, the FDA regulates this. Because ultimately, what happens is that the sperm and the egg are going to go into someone else's surrogate. So, you have to treat the egg and sperm as if it's like you're donating a kidney.

 From the patient's point of view, it's seamless. We take care of all the blood tests and the exams and things that are needed. So, it's not to worry for a patient. But yeah, the FDA actually regulates all of this. It's actually kind of interesting. And I'm glad they're regulating. This is great.

When it comes to other sources of eggs, it can be an anonymous egg donor, and then you can either use frozen eggs already in an egg bank, and we work with a couple of those as well, or this is going to be through an egg agency where it's just fresh eggs. So, eggs, they're in someone and there's a whole matching process for both of those that we would review in full detail.

Ultimately, what happens is that we get those eggs, and those eggs are going to meet with sperm. And this is going to be through IVF. And so, at that time, we also decide about which of the partners or potentially both wish to be biological parents. So, a lot of same-sex gay male couples will use, each partner will create their own embryos with their sperm, and then decide how to transfer in what order in the future.

There's also then the other parallel track, which is the gestational carrier. So just to clarify, sometimes and a lot of times, you'll see-- and I use the term surrogate. Surrogate technically is not what we do. A surrogate is someone who carries a pregnancy, but it's also their egg as well. That is no longer done. So, we use-- and everyone else uses-- the official term for gestational carrier or GC. That's where the carrier has no biological relation to the egg and sperm that they're carrying. A gestational carrier process takes a lot longer than getting those eggs. And so, we typically start those processes in parallel because this gestational carrier process can take six to nine months sometimes to find a gestational carrier. And depending upon which egg donor option that we use, between say, three to four months to do that.

So, we educate you on the road for both of those options and choices to kind of get them settled as soon as possible. And then, once everything is lined up and we have those embryos and we have the gestational carrier, then we would do an embryo transfer of that embryo back to the gestational carrier. And it's a wonderful moment. Everyone typically is invited into that transfer room. We get to see the embryo live up on the microscope through the monitor. It's a wonderful experience.

Host: Okay. Now, just go back a little bit, just out of curiosity. Why did you stop doing the option with the surrogate and her own egg?

Michael Homer, MD: Yeah. So, they had a big discussion a while ago regarding the ethics of it and the legalities of it. And when biologically it's your egg and you deliver, in the law, it's very tricky. And so, that's no longer a viable option. Because through this whole process, there are legal contracts, as you might imagine. And that's to help protect the intended parent, the gestational carrier, and that child to make sure that relationship is clear from the beginning.

Host: That makes sense. What fertility options now are available for transgender and gender diverse individuals or couples? And just for people who don't know, can you just briefly explain what gender diverse is?

Michael Homer, MD: Yeah, I think gender diverse is how the person wants to identify themselves, right? So from our point of view, we will fully respect and address that patient in the way that they feel the most comfortable. We're absolutely very happy to help and make sure everyone feels as comfortable as possible.

 We though do need to make embryos or help someone get pregnant, and we do need the sperm and we need the egg. So for those patients who are transgender, if they identify themselves as transgender, but there's been no hormone changes or alteration or medicines that they've taken, then we just go through the same processes we've already described in more traditional ways. If that individual has started taking hormonal medicines to help change to their preferred gender, or at least appearance of that as well, sometimes that can affect the egg or the sperm. So when they make that new patient visit, we would go through that thorough history and it starts with some blood tests and maybe a semen analysis if they felt comfortable with that. And a lot of times, even if you started the hormonal treatment and the transitioning, there are ways with which to still be able to procure eggs or sperm from that particular individual. So, you can reverse the hormones or pause it, and sometimes you don't even need to pause it at all. So, it actually can be a lot easier than you think.

That being said, if you are someone who is thinking about transitioning, it's generally a good idea to also consider fertility preservation because the hormones may affect your chances of those egg or sperm becoming a child in the future. So, freezing eggs or freezing sperm ahead of any hormonal changes is the safest thing to do, and we can also absolutely help an individual with that as well.

Host: That's a very good idea. I'm beginning to think, because I've talked to a lot of younger people who are freezing their eggs for so many different reasons, they're not necessarily gay or transgender, but I'm kind of thinking like do you see that as a trend for young people who don't know where their future's going, just to sort of have insurance that their eggs are out there?

Michael Homer, MD: Yeah, yeah. I always say, and actually I'm so glad you used that term. So, I always like to say in the very beginning, like, it's not insurance because it's not guaranteed, right? But what it is is a much better chance at your future and gives you options. And so yeah, absolutely, I think today as well as more and more people are embracing gender fluidity and more and more people are more open and the care is being provided for those young individuals, access to that is increasing. And so from our sort of science biological point of view, trying to help you in that future self version of you who, you know, maybe now doesn't necessarily think that you really want to have a children of your own, but a lot of people do change as they get older. It's always a really good idea to just consider the idea, meet with a specialist, just kind of understand the process.

It's not as scary as maybe you have it-- I mean, of course, I do this every day, so I think it's easy. But I know it's not the easiest thing for patients, of course. But absolutely, all together and with the coverage nowadays and with California Special Bill 729 coming in live in 2026, where insurance coverage is now going to be mandated in the state, it's very, very important to understand your options.

Host: That's another good point. Wow. Well, thank you so much for breaking this down for us, because it can be confusing. It's good there are a lot of options, but we need to have it just how you told us. So, it offers a lot of clarity and hope. Thank you, Dr. Homer.

Michael Homer, MD: Thank you so much. It was a pleasure.

Host: Is there anything else you'd like to add in closing?

Michael Homer, MD: If you have questions, come in. Don't read on the internet. That's not research. Come on. We're so helpful and we're so friendly and we can help.

Host: Again, that's Dr. Michael Homer. And if you'd like to find out more, ensuring focus on inclusion and personalized care plans, call 888-377-4483 to begin your family-building journey with Reproductive Science Center. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to The Fertile Edge from the Reproductive Science Center of the San Francisco Bay Area.