TTC for Lesbian Couples: Treatment Options
If you haven’t read the first part of this blog, go back and read it. It’s all about the first steps you need to take before starting your family.
What are your options?
IUI
During Intrauterine insemination, the sperm goes into a catheter, a speculum goes into the vagina, and the sperm goes into the uterus. IUI can happen in a natural cycle. You use an ovulation predictor kit to track your cycle. When you get a positive, an IUI is done the next day. IUI can also be one with ovulation induction using oral medications such as Clomid or Letrozole or with gonadotropins like FSH. We can also use a combination of both. Most of my couples use ovulation induction to give them the best chance of getting pregnant. It is important to know that with ovulation induction, there is a higher risk of multiples. While using oral medications, the risk of twins is 6-8 percent and 1 in 300 for triplets. With FSH injections, the risk of twins is 20-30 percent. The risk of triplets is 1-3 percent. This risk is something to keep in mind for those with medical comorbidities who cannot have multiples. If you do not ovulate and have PCOS or irregular cycles, natural cycles does not make sense. In general, doing IUIs for lesbian couples is only going to get you your age related chance of getting pregnant.
Let’s review this.
Your chance of getting pregnant per month if you have never had a baby.
Less than 30 - 20-25%
30-33 17%-19%
34-35 11%-12%
36-37 8%-10%
38-39 5%
40-44 3%
Using IUI does not give you a higher percentage.
If you are 39 and you come to me with your partner ready to get pregnant and think you just need sperm, your chance of an IUI working is 5%. We have to keep that number in mind. If you combine IUI with ovulation induction, your highest chance of getting pregnant is 10-15 percent. Sometimes we presume that sperm is the only missing piece. However, there are a few other factors that come into play.
IVF
In vitro fertilization is another option for lesbian couples. Traditional IVF, reciprocal IVF, or something new called Invocell are the three different options. For traditional IVF, we take the eggs outside of the vault and get them to grow with injectable FSH. Then we take the eggs out during a procedure called an egg retrieval, which is done under anesthesia. The entire process takes about two weeks. Then we fertilize the eggs in the lab. It takes about 5-6 days for the embryos to get to implantation stage also known as a blastocyst. Embryos can be frozen, biopsied for genetic testing, or implanted at that time. What we decide depends on your goal. In traditional IVF the partner whose eggs we retrieve is the same partner who has the embryo implanted. In reciprocal IVF, the eggs get retrieved, fertilized, and implanted into the other partner. So, essentially they are carrying for their partner. Depending on your age and goals, we may want to do pre-implantation genetic testing also known as PGT. PGT allows us to determine which embryos are genetically normal and which are not. The older you are, the more genetically abnormal embryos you may have. At age 35, about 50 percent of your eggs are going to be abnormal, and at 40 about 80 percent are going to be abnormal. The next option is INVOcell, which is a minimal stimulation, lower cost IVF option. I think it is wonderful for lesbian patients. You go through a stimulation process similar to IVF, but instead of stimulating the whole group of eggs, we aim for eight to twelve eggs. You go through egg retrieval, and we put them into a plastic device called the INVOcell along with sperm. Then the device goes inside your vagina, and you incubate your own embryos because it’s the right PH and temperature. Next, the device comes out, and the embryos can be taken and put inside your uterus. Extra embryos can be frozen. Not everyone is a great candidate for INVOcell, but for most lesbian couples it is. One positive for INVOcell is you need less sperm than you do for IUI.
COST
IUI is typically about $2000-$3000
Invocell is a 10,000 cap point with everything included.
IVF depending on what you choose will range from $15,000-$30,000. Doing PGT will be at the higher range as well as reciprocal IVF.
My take home message is that I love you and am so excited to help you on your journey. Also, this is very personalized, and it should be. Your doctor should be asking you about your goals and what you want your journey to look like. I am so happy that we have all of this technology so our non traditional couples can make a family in the most traditional way.