Over the years I’ve had many lesbians tell me they want children but don’t see themselves being pregnant. It’s not part of their “body image.”
At some level, I understand this feeling. Our gender identity and sexual identity are tied up in our body image and feelings of sexual desire. Being pregnant and carrying a baby inside is an incredibly unique, womanly experience. Men have no idea what this is like, despite how much some may try.
As an experienced obstetrician who’s cared for many pregnant women throughout their pregnancies and deliveries, and as a gynecologist who has cared for and has performed gynecologic surgeries for women for the past thirty years, I’ve seen first-hand the many phases of reproductive health (and experiences with ill health) that only women can experience.
I understand that some women may not identify with parts of that spectrum. For a lesbian couple it is sometimes easy to decide who will carry the pregnancy, while other couples struggle mightily with this uniquely lesbian decision. For single lesbian women, the choice can become more complex: to carry oneself and maybe go into new self-awareness territory, or to utilize the reproductive assistance of a gestational carrier.
Never Miss a Beat
Subscribe to our newsletter to stay ahead of the latest LGBTQ+ political news and insights.
We usually reserve gestational surrogates for women with a clearly defined medical need for surrogacy, yet lesbian women can often have very real issues that educate their life choices. Is body image a medical necessity for surrogacy? I believe that it can be if it’s tied into a woman’s sexual identity and sense of self.
We are very fortunate to live in a country where reproductive options are now available for all individuals regardless of gender, sexual identity, or marital status. This is not the case across Europe and other parts of the world. In my practice I see many patients from across the globe – from China, Europe and elsewhere – who travel for reproductive treatment options that are illegal where they live.
All women, and in particular lesbians, who might consider having children someday should talk with their doctor about reproductive options available, or ask for a referral to a fertility specialist to review the treatments that may best apply to their situation. It is imperative that lesbian women seek out a practice that is comfortable providing care to lesbians and same-sex couples.
Most lesbians have various options available to them.
The most unique option for lesbian couples in particular is reciprocal in vitro fertilization (IVF). This version of IVF refers to the creation of embryos using one of the women’s eggs and transferring those embryos into the uterus of her partner, ensuring that both women are part of the creation and birth of their child. The protocol is the same for any woman undergoing an IVF treatment cycle: hormonal stimulation of the ovaries to create multiple eggs, surgical recovery of the developed eggs, embryo creation, and then (uniquely to this experience) transfer of the embryos into the uterus of the partner. The partner’s uterus must be hormonally prepared to be “in synch” with her wife’s ovaries, so that the uterine lining is in its window of implantation when the embryos area ready for transfer. It’s a complicated, delicate process but one that can be managed to build a unique, wonderful family.
In the last decade egg freezing for fertility preservation has changed from an experimental protocol to a highly successful procedure for preserving one’s fertility for a later period in time. The fertility potential of a thawed human egg today has the same pregnancy potential as a fresh human egg. The chance for pregnancy is directly related to the age of the woman when the egg is removed. This means that eggs collected and frozen in the young and highly fertile years of a woman can be stored and defrosted years later to create embryos that can be transferred back into the woman providing her the pregnancy potential of the age at which the eggs were originally frozen.
It allows a young woman at the beginning of a career, or someone who is waiting to build a relationship, to delay childbearing until after she’s established her working life or partnership without giving up the chance to have biological child of her own.
For young lesbian women just starting the work force and exploring relationship options egg freezing can provide a sense of security by removing some of the time pressure that many women face toward having children. Their eggs can be stored indefinitely, then thawed and fertilized at a later point in time when they are ready to have children either on their own or with their life partner.
After an initial fertility evaluation performed by a gynecologist or a reproductive endocrinologist (fertility specialist), a common first step for a donor insemination procedure is an intrauterine insemination using washed donor sperm. The sperm can be purchased by a sperm bank that prescreens and quarantines all specimens, or the woman may elect to use a known donor such as a friend or colleague who has been medically cleared by her physician.
The insemination procedure involves placing the specially prepared and washed sperm specimen into the uterine cavity at the time of ovulation using a very thin plastic catheter. It is simple and painless.
The pregnancy rate per cycle varies with the age of the woman from 15% in women under age 35, to 10% in women between the age of 35 and 40, and 5% per cycle in women over the age of 40 years. Most pregnancies occur within the first three to six cycles.
For women who do not conceive with insemination procedures, or for women who desire to maximize their chance for pregnancy per treatment cycle, or for women with anatomical problems that make insemination not feasible, in vitro fertilization provides an excellent option for conception.
In this procedure a woman takes daily injections of follicle stimulating hormone (FSH) to develop all of the eggs that her ovaries have recruited for that month. Once the eggs have reached mature development – approximately ten to twelve days later – the eggs are surgically removed through a simple outpatient procedure performed under intravenous sedation. In this procedure, a needle is placed through the upper vaginal wall into the ovaries and the eggs are captured from individual follicles.
Several hours later the eggs are inseminated with sperm in the laboratory. Once fertilized, the embryos are cultured for six days to assess their pregnancy potential. An embryo that has the capacity to make a baby will divide and develop to become a “blastocyst” after five to six days in culture. A blastocyst is an embryo that has the potential to implant and initiate a pregnancy. Embryos at this stage may by biopsied to screen for chromosomal errors.
All women should talk with their gynecologist or personal physician about their reproductive health and their fertility preservation. Exploring the various treatment options and considering which one is best is a key step to start the process.
Reproductive medicine continues to develop and evolve. All women should ask for the latest updates and treatment options and not settle for anything less than the best. All women should have access to the reproductive fulfillment that is part of their life’s plan.
