Lesbian couples wanting a baby have different parenting options today thanks to infertility treatments, for which they have no alternative but to seek a sperm donor. Nevertheless, depending on the country, the legal framework for same-sex partners to get pregnant and become mothers may be more or less permissive.
The various sections of this article are assembled in the following table of contents.
Lesbian conception: options and statistics
There exist three main fertility options for women in a lesbian relationship to have a child, all of them obviously with donor sperm. The first is artificial insemination, in which case they have to decide which one is going to undergo the treatment. There is the possibility that both of them do so, too. On the other hand, traditional adoption is another option.
Should artificial insemination be unsuccessful, couples may be advised to move on to in vitro fertilization (IVF).
On the other hand, there exists a method called partner-to-partner egg donation, lesbian IVF, reciprocal IVF, co-IVF, or two-mom IVF, a technique that is increasingly becoming popular, as it allows for both partners to participate actively in the journey toward conception.
Out of the 605,472 same-sex couples that can be found currently in the United States, only 20% have achieved their dream of creating a family, and 50% have a strong desire to parent. Likewise, in the United Kingdom, statistics by the Human Fertilisation and Embryology Authority (HFEA) show that, of the 42,721 women accessing fertility treatment in 2013, 3% were in a same-sex relationship.
Self-insemination or at-home artificial insemination (commonly referred to as lesbian insemination at home), as well as natural sperm insemination, cannot be considered Assisted Reproductive Technologies, as there is no medical screening or assistance for the patient in either processes. Thus, even though it could be argued that they are fertility options for lesbian couples to create a family, we will not explain them hereinafter.
Artificial insemination starts with mild controlled ovarian stimulation (COS). One or two oocytes will develop and be released to the Fallopian tubes during ovulation ready to be fertilized.
Follicle growth and size are monitored by ultrasound scan to see whether they are developing as expected. Estradiol tests are also advisable in order for the increase in its levels to be observed.
Finally, when 1 or 2 follicles reach a size of 18 mm in diameter, insemination per se can be scheduled. The insemination process involves inserting the semen sample—after sperm capacitation—inside the patient’s uterus by cannula transfer.
After that, the sperm travel through the female reproductive system toward the Fallopian tubes, where egg insemination is expected to take place.
Same-sex female couples can decide who is going to be inseminated. The doctor may give them advice on who has the greatest chances for pregnancy according to the results of each woman’s fertility tests.
For IUI to be successful, the patient should have at least one tube “patent”, that is, unobstructed, as well as a good egg supply. Also, the presence of uterine abnormalities may hinder embryo implantation or have a negative impact on pregnancy.
Another feasible option is for both women to undergo artificial insemination, better known as reciprocal insemination. In such case, they can choose between using the sperm of two different, anonymous sperm donors, or a known sperm donor, whether it is a brother, family member, or friend of the couple.
What is reciprocal or lesbian IVF?
This method, as one can see in the picture below, follows the steps of in vitro fertilization, with the difference that it is one member of the couple who undergoes ovum pick-up for egg collection, while the other has the embryo transferred to her uterine lining, and is therefore the one carrying the pregnancy to term. This process is also called egg sharing or shared motherhood.
The process of partner-to-partner assisted reproduction comprises the following steps:
- One woman undergoes controlled ovarian stimulation (COS) for the maturation of multiple follicles in the same cycle
- Ovum pick-up to harvest the mature eggs from the ovary
- Egg insemination with donor sperm
- Embryo culture and selection of the one or ones with the best quality
- Transfer of 1 or 2 embryos to the woman not contributing the eggs
- Quantitative hCG blood pregnancy test: it is usually carried out at the fertility clinic as indicated by the gynecologist, within two weeks before the embryo transfer
The UK Law changed after the implementation of the Human Fertilisation and Embryology Act (HFE) 2008. The civil law was modified on 6 April 2009, and ever since civil partners or married lesbian couples who have children are both considered the legal parents.
Unmarried couples or those who are not civil partners are treated as legal parents as long as they conceive through a fertility clinic licensed by the HFEA.
The Spanish Law, however, grants access to infertility treatments only for married same-sex couples. Lesbian IVF is not covered by insurance in Spain, and therefore there is no alternative but to seek a private clinic.
According to the Spanish Law on Assisted Reproduction, only the woman herself or her spouse is allowed to use her gametes, so marriage is a prerequisite for this treatment to be done under legal conditions.
Normally, insurance providers do not cover reciprocal IVF services unless medical necessity is documented. So you can get an idea, the costs of partner assisted reproduction are similar to those of IVF with a known sperm donor:
- Fresh cycle of IVF: €11,000
- Fertility medications: €2,800-€9,400 for each partner
- Total cost: €20,000 approx.
It should be kept in mind that, in case of failure on the first attempt, a second cycle with frozen embryos would be necessary (i.e. frozen embryo transfer or FET), which would add €2,800-$4,700 to the overall cost. These prices may vary from clinic to clinic as well as by country.
Egg donation from your partner
Although less commonly, IVF can be done with one partner’s eggs and the semen of a sperm donor.
The steps to be followed are:
- Controlled ovarian stimulation
- Ovum pick-up to retrieve the mature eggs
- Egg insemination with donor sperm
- Embryo culture and selection of the embryo(s) with the highest quality
- Embryo transfer back to the uterus of the partner who has contributed the egg(s)
- Quantitative hCG blood pregnancy test: it is done by the staff at the clinic within 2 weeks after the transfer approximately
Donating to your partner is a fertility option that is becoming increasingly common among lesbians planning to have a baby. It is common for same-sex couples who choose this treatment to have another baby, thereby swapping roles for a second pregnancy. This option is not recommended for women under the age of 32-35.
FAQs from users
Can lesbian couples choose the profile of their sperm donor?
Yes, in this sense, it would work similarly to a known sperm donation process. Although patients are recommended to select a man whose profile is similar to their phenotypical characteristics, some lesbian-friendly sperm banks may allow you to choose the profile. There have been cases where a white same-sex couple have chosen a black sperm donor, a gay donor or even their brother (intrafamilial gamete donation).
How successful is reciprocal IVF?
The success rates of lesbian IVF are similar to those of conventional IVF procedures, as the process followed is essentially the same. Optimal rates can be achieved if the woman providing the eggs is younger than 35.
They depend basically on the quality of the eggs used for fertilization. For this reason, the partner providing the eggs is required to undergo preliminary screening procedures, including:
- Review of medical records
- Physical examination
- Blood testing
- Review of family history
- Psychological evaluation
On the other hand, the uterine lining of the partner carrying the pregnancy needs to be synchronized with the stage of embryo growth for a successful pregnancy to be possible. Also, the menstrual cycles of both partners are synchronized by means of Lupron and birth control pills. Should it not be possible, the embryos would be frozen for being transferred in a subsequent cycle.
Is donor insemination for lesbian couples available on the NHS?
According to the National Institute for Health and Care Excellence (NICE), IUI is offered on the NHS if you meet one of the following conditions: 1) you are unable to have vaginal sex; 2) you have a condition that makes it impossible or very difficult for you to conceive; 3) you are in a same-sex relationship.
NHS funding for fertility treatment is limited for everyone, and varies across the UK according to the criteria set by the Clinical Commissioning Group (CCG). Until February 2013, no official guidelines existed on what NHS funding should be offered to same-sex couples.
Now, gay couples are mentioned on the guidelines published by the NICE, which expects lesbians to have tried to conceive up to 6 times using IUI before being considered for NHS-funded treatment.
Do lesbian couples need a sperm donor contract?
Absolutely yes, especially in the case of same-sex couples and single women who decide to collaborate with a male friend or brother (i.e. known sperm donor). Sperm donor agreements are intended for those who do not use a sperm bank as intermediary.
The purpose of this type of contract is to make sure the donor is not the legal parent despite being the biological father of the child.
Is there any way for lesbian couples to use a sperm donor for free?
The only way this option could be possible would be by looking for a natural sperm donor, which basically involves one of the partners engaging into sexual intercourse with a man. However, this practice is totally unadvisable for various reasons.
On the one hand, his semen has not been screened for infectious, genetic and viral diseases likely to be transmitted to offspring. On the other hand, legal problems may rise regarding the parental responsibilities and rights of the donor.