The journey to becoming a parent is full of excitement, but most first-time parents have a lot of questions.

As a lesbian couple, your journey will be a bit different, but the enthusiasm and excitement will remain the same.

Artificial Insemination

Artificial Insemination (AI) is a process in which sperm is inserted into a woman’s reproductive tract. This technique involves concentrating sperm into a small volume and then placing it into the uterus (IUI) or the cervix (ICI)

To begin with artificial insemination, you need to see your primary care physician and find a fertility agency that specializes in gay family building and same-sex surrogacy. You need to be up-to-date on all health care maintenance which may include a pap smear and mammogram if recommended. It is vital to track your cycle as you must have a regular menstrual cycle for artificial insemination to be successful.  The timing of insemination is based on cycle tracks. Some fertility agencies may also require a basic fertility evaluation that includes a hysterosalpingogram and documentation of ovulation.

A Hysterosalpingogram (HSG) is a type of X-ray that is used to evaluate the status of a woman’s fallopian tubes. It is also used to make sure that a woman’s uterine cavity has a normal shape and size or to identify uterine malformations, adhesions, polyps and fibroids. Such malformations may be the cause of painful menstrual periods or repeated miscarriages.

Documentation of ovulation is done through blood tests, by measuring high levels of progesterone, which is a hormone that is required for pregnancy.

For women over 35, completion of a basic fertility workup is required to evaluate their reproductive age. This may include the following tests:

• On day 3 of her menstruation cycle, blood tests are done to check the levels of three important substances for fertility: Follicle Stimulating Hormone (FSH), Estradiol (E2) and Anti-Mullerian Hormone (AMH).
• Follicle Stimulating Hormone (FSH) is secreted by the pituitary gland throughout the menstrual cycle. Low levels of FSH on day 3 indicates good fertility.
• Estradiol (E2) is a complimentary hormone of FSH, which is secreted by the ovaries.
• Anti-Mullerian Hormone (AMH) can measure ovarian reserve and the quality and quantity of the eggs. The results help doctors determine your potential of becoming pregnant now and in the future. This test can be performed on any day of the menstrual cycle.

It is also required to meet with a board-certified reproductive endocrinologist to successfully complete the basic fertility workup. During this meeting, you will discuss donor insemination. Donors can be a family member or a friend.  Careful consideration and consultation with an attorney is advised to protect paternal rights and to make sure that all adults are invested in the emotional development of the child to be.

A sperm bank can also help you find an anonymous donor. This means that the intended parents don’t know who the donor is, including his name and medical history. However, the selection is done based on characteristics such as family history, race, academic achievements, looks and other similar factors. This is the safest way to choose a donor as anonymous donors have been screened for genetic risk factors, infectious diseases and have been counselled on their release of parental rights.

Known donors are also an option. The donor is willing to be known by the intended parents and the child and has also been screened by the sperm bank. Once a donor is chosen, sperm is shipped to your physician and is thawed on the day of insemination.

After selecting a donor, you can proceed with natural cycle insemination. If recommended by a physician, you can undergo a special treatment known as superovulation. The focus of this treatment is to properly time and deliver sperm into the female reproductive tract. This dramatically increases the chances of pregnancy.

IVF with One Person’s Egg and Uterus

The first step in the IVF process is to stimulate the ovaries to develop multiple eggs. The desired result is achieved by injecting hormonal medications. The goal here is to produce many follicles and then retrieve the eggs from inside the follicles through a small surgical procedure. These eggs are then inseminated with donor sperm in a laboratory to develop embryos that can be transferred to the uterus of the recipient.

The screenings listed above are required to start this process as well. In addition, a uterine assessment with a saline sonogram is also mandatory. This is done before implantation, to investigate the health of the implantation site.

Reciprocal IVF

Most lesbian couples prefer this process as both females can participate in the joy of bringing a child into their home. One partner will donate their eggs and goes through superovulation with fertility medicines to produce multiple eggs. These eggs are retrieved as soon as they have matured. The retrieved eggs are then combined with designated donor sperm in the laboratory.

While this happens, the other partner who will carry the pregnancy takes progesterone to prepare her uterus for the embryo transfer. Optimally 1 or 2 embryos are transferred to the recipient’s uterus. The same screening is required for the person who is going to carry the pregnancy.