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Q Health

How to become pregnant — for lesbian couples

Written by Rixt Luikenaar

I recently spoke with a lesbian couple trying to have a second baby. They are using the frozen specimen from a sperm bank out of California. After several insemination attempts, they haven’t yet become pregnant. They said they spent $1200 for washed semen per vial instead of $1000 for unwashed.

They also said many lesbian couples in Utah have no idea where to start if they desire to get pregnant.

Others have conceived by an arrangement made with a consenting male donor, or through semen banks, intrauterine insemination, and other fertility center procedures. For example, transgender or gender-nonconforming patients who want to start testosterone, there’s a recommendation of 15+ eggs, or preservation/freezing of embryos, in vitro fertilization, and surrogacy. Sometimes partners wish to donate eggs to their partner to carry a baby (co-maternity or reciprocal IVF) through egg preservation and IVF. Fortunately, Salt Lake City has several LGBTQ-friendly fertility specialists who help with semen preservation, insemination, and egg preservation.

Before attempting pregnancy, it’s important to be healthy. Quit smoking, don’t drink alcohol, decrease sugar intake, exercise regularly, and have a preventive visit with a doctor (including pap smear, STD screening if indicated, discuss medical and family history, and take 400 mcg of folic acid daily — get a TdAP if your vaccinations are not current).

According to the 2010 Census, it was estimated that more than 111,000 same-sex couples are raising nearly 170,000 biological, adopted, or stepchildren. Among female couples, nearly 24 percent are raising a biological, adopted, or stepchild, compared to 10 percent of male couples.

For same-sex, or transgender or gender-nonconforming, couples with a uterus and no semen, find out specifics of donor insemination. The most common means of collecting sperm for insemination is by masturbation and ejaculation into a container. The number of sperm, the motility, the amount of semen and their shape all are important to determine viability. The number of sperm in semen is essential. Motility, speed, and quality of movement scores between 1–4. The average amount of ejaculate is 2.5 to 5cc. It’s not the amount of semen but rather the concentration of sperm that increases fertilization.

Fresh sperm is the most viable chance for conception. It has better mobility and concentration and lives 48–72 hours. Advantages are the sperm lives longer, is less expensive, and likely covers peak days of fertility. Disadvantages include the sample is not tested for STDs and genetic diseases, as well as legal and emotional consequences. Use legal documentation of sperm sale, donor, and parenting agreements. (A Legal Guide for Lesbian & Gay Couples from Nolo, 2016). The average sperm count in a fresh ejaculate is 50 million.

Frozen sperm is from a cryo-bank, collected in a sterile container, and mixed with glycerol drops or egg yolk to aid in survival during the freeze/thaw process. Once frozen it’s kept at negative 196 degrees centigrade for a six-month quarantine. Shipped in liquid nitrogen tanks keep it frozen for days. The sample can be thawed in warm water, leaving it at room temperature or against the skin. Though thawed semen survives 24 hours, insemination must occur within 20 minutes. It’s tested for STDs and many genetic disorders.

Frozen sperm can be obtained “washed,” where debris and abnormal sperm are removed to increase concentration and is ready for intrauterine insemination. Frozen semen is lower in volume and motility.

A menstrual period happens when fertilization did not occur during the previous cycle but does not guarantee that you are ovulating. Ovulation is the process where the egg leaves the ovary to travel through the tube to wait for the sperm. Tracking your cycles and confirming ovulation is vital to time insemination correctly.

You can find out if you’re ovulating by monitoring your basal body temperature — when you wake up, you see a drop in temperature the days before ovulation and an increase after ovulation because of progesterone secretion. Another way is by monitoring your cervical mucus — as your estrogen levels rise at ovulation, the mucus becomes clear and stretchy (you can feel it at the opening of the vagina). Easier is an ovulation predictor test that measures LH (luteinizing hormone) from urine and detects the surge that happens before ovulation. Inseminate within 12 to 24 hours after the test darkens or shows positive.

It is best to use the methods together and figuring out how it works months before insemination, so you know when to expect ovulation at the time of insemination.

If you’re within 10 percent of people with a uterus who don’t ovulate, fertility prescriptions like clomiphene citrate or Letrozole often work, followed by hormone injections from a fertility clinic. After closely monitored, ovulation can initiate with an HCG injection.

There are three types of insemination

Intravaginal insemination — The process places the sperm into the vagina with a syringe, often called the turkey-baster method. You can do it at home by yourself or with a partner. It is easier to use a menstrual cup. With fresh semen, have the donor ejaculate in the cup and insert it into the vagina. Practice this before you inseminate, so you know where it goes and doesn’t spill. In the case of frozen sperm, thaw it and put in the cup. After insertion, try to have an orgasm. It dips the cervix into the sperm, helping move it upward. Leave the cup for at least 2 to 3 hours, but less than 12 hours.

Intracervical insemination — Use a speculum where a partner deposits the sperm, thawed or fresh, around the opening of the cervix, so the sperm doesn’t have to “swim” far. Slowly remove the speculum and lie down for 20 minutes to increase effectiveness. It is an at-home or physician process.

Intrauterine insemination — A process of washed sperm administered by a physician or health practitioner. The sperm, through a unique washing process, imitates what the cervical mucus does — slowly, directly injects into the uterus.

The average rate of pregnancy is 8 to 16 percent per month, depending on the usage of frozen versus fresh sperm, intra-vaginal, intra-cervical, or intrauterine insemination. The quickest to conceive is IVF. The least expensive is by the natural cycle of fresh semen or intrauterine insemination.

Reciprocal IVF is where one partner provides the eggs, and the other carries the pregnancy. It allows physical involvement in the pregnancy. The partner who has the embryo implanted will take medications to prepare the uterus for implantation. Menstrual cycles synchronization includes the retrieval of the eggs, fertilized with donor sperm, and placed in the uterus.

Other insemination procedures

Uterine transplants for transgender women — This procedure hasn’t yet received approval for transgender women; however, a few hospitals in the U.S. show interest in doing it soon.

Same-sex reproduction for men  You need sperm, eggs, and a uterus. Some couples use a friend or family member to donate eggs, which raises legal issues (addressed ahead of time). A legal contract is essential.

A gestational carrier is a person who will carry the pregnancy. It can be arranged through various agencies or with the help of a reproductive attorney. Sometimes friends or family members offer to be GCs. They need to be someone you trust. A GC who is the egg donor is a “true surrogacy,” which is illegal in many states. It’s important to consult a reproductive endocrinologist and a reproductive attorney since laws differ state to state. Also, it’s important to know whose names are on the birth certificate, and the rights each person will have as a parent.

Rixt Luikenaar MD FACOG
Rebirth OB/GYN

For more reading:
An article by Luikenaar for Pornhub Sexual Wellness Center about Lesbian Health
The Rainbow Babies
A Donor Insemination Guide” written by and for lesbian women by Marie Mohler, MA and Lacy Frazer, PsyD.

About the author

Rixt Luikenaar

Rixt Luikenaar, M.D. FACOG, is a board-certified obstetrician and gynecologist with over 15 years of experience. She received her Medical Degree Cum Laude from the University of Groningen Medical Sciences in Groningen, The Netherlands and did her residency training at West Virginia University Hospital in Morgantown, WV. She joined the University of Utah Faculty in 2003. She has privileges to perform surgery and deliver babies at the University of Utah Hospital and St. Mark’s Hospital.

Dr. Rixt Luikenaar has special interest in transgender hormone therapy and GLBTQ healthcare, including pregnancy and preventive care. She is a professional member of the GLMA and WPATH. She is also a member of the International Society for the Study of Women’s Sexual Health.

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