Single and lesbian intending moms ultimately need to decide where they will be treated, and thereafter may face a handful of questions: whose eggs will be used? Who will carry the child? When does it make sense to move from IUI to IVF?
Clinic or Home-Based Insemination
Many women at the beginning of the process will consider whether to try home insemination or whether to be inseminated at a clinic. According to most sperm banks, the rate of home inseminations is quickly growing. That said, home inseminations represent the distinct minority of total artificial inseminations, amounting to less than 5%.
Individual couples who undergo home insemination bypass a number of the medical costs and processes associated with working through a clinic, and many believe it amounts to a more intimate experience than having the procedure done within the confines of a center.
That said, home insemination is still very much a process, and if donor sperm from a sperm bank is used, it will involve properly thawing the sperm that has been shipped. For this reason, most banks require a note from a medical professional attesting to the fact you’re capable of doing the procedure, and it is appropriate. That said, most banks do not require that medical professional to be a doctor, let alone one versed in women’s health or reproduction.
Many reproductive endocrinologists believe undergoing at-home insemination is risky, especially when it comes to the chances of disease transmission or the passing along of genetic mutations that could impact offspring. Many who work at the sperm banks see this as less of a risk. Sperm banks theoretically take steps to ensure samples are disease-free and screen for any genetic abnormalities.
Maybe a more compelling reason to avoid home insemination is for legal reasons. Many states require that donor sperm be used in a medical setting to establish that the donor has no parental rights to the child. Similarly, a note from the clinician can be helpful when trying to add a second parent onto the birth certificate, or in entering into a second parent adoption. This may help to solidify in a judge’s mind that there is no male partner whose rights need to be accounted for.
If a couple fully knows that they will have trouble conceiving, or wants to try reciprocal IVF (one intended mother provides her eggs, while her partner carries), then home insemination is an impossibility, and going to a clinic is the best route.
Selecting A Clinic
If intending single and lesbian mothers want to select a clinic, there are often 15 – 50 in any major metropolitan area. The experience you'll have at each clinic varies to a tremendous extent based upon how aggressive the clinic is with treatment, the size of the practice, the quality of the lab, price, and more.
One factor to consider is whether the clinic is prepared to help a single woman, or lesbian couple, have a child in the first place. Last time anyone surveyed clinics, nearly a decade ago, a fifth were “very or extremely likely” to turn down lesbian or single female parents. Many clinics do not appreciate how this process is different than for their heterosexual couple patients, and that can make the experience all the more trying. You can read accounts from all intended parents, including those specifically marked as LGBT, at FertilityIQ.
Who’s Eggs and Who Carries:
Lesbian couples need to decide which partner will play what role in the process. While it’s very much a personal matter, most clinics will suggest using the older partner’s eggs, unless it is clear that she will have trouble conceiving. The ideas is that provided her testing looks good, she should be able to conceive without issue, and if both partners want to be biological mothers, the younger partner will have better success than the older partner down the road.
In some circumstances, couples will consider “reciprocal IVF”, whereby the eggs from one partner are retrieved, inseminated, and then transferred into the other partner’s uterus. This requires one partner has a healthy supply of eggs, and the other partner a healthy uterus, and the ability to carry to term. When intended mothers decide to go this route, which medically and legally looks like an IVF cycle using a gestational carrier, the couple needs to put in place legal safeguards that ensure the mother who provides the eggs is legally entitled to the right of parentage.
Moving From IUI to IVF
Many single and lesbian women who are trying to conceive do not have a diagnosed fertility issue, so if they are at a clinic, they will start off with IUI. While the success of IUI often hinges on the woman’s age, one study looking at lesbian women in their early 30’s saw that after four- to- five IUI cycles, nearly half of the women conceived. And after seven- to- eight cycles, nearly 70% conceived. For single women in their late 30s, IUI was less effective, presumably because they were less fertile on account of their age. After four- to- five cycles, roughly 30% conceived, and by 10 cycles, nearly half conceived.
This means that for a number of women, there is the question of at what point do they decide to stop using IUI, and advance to IVF. The reproductive endocrinologist will certainly weigh in, and in a number of situations (e.g. a tubal issue is detected) there won’t be much debate: the patient will go straight to IVF. But for many women, there will be more ambiguity and the extent to which a patient is steered from, or towards, IVF, will influence the timeframe and expense of the process.
IVF is a more intensive process than IUI, often involving aggressive stimulation of the ovaries, harvesting of the eggs, laboratory work to create embryos, and then placing one, or more, embryos back in the uterus. Below we try and compare IUI vs. IVF success rates by age, but since there is no IVF data on lesbian and single women specifically, we use numbers from the general population, which may be less fertile than a typical single or lesbian intended mom. As you can see, on a per cycle basis, IVF tends to be three- to- five times more likely to succeed.
At the same time, IVF (including the cost of medication, ICSI, and PGS) is 8 – 20x the cost of an IUI cycle, which itself can vary dramatically in cost depending on whether the patient is placed on hormones, and in what city she is treated.