IVF and Queer Couples: A Practitioner's Perspective

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Emily & Jo

Emily and Jo met in their mid-twenties and right away knew that they wanted to have children together. For practical reasons, they knew they needed to wait until they could afford to do it, as queer couples face hurdles that heterosexual couples do not. Not only is there the cost of raising a child to consider, but also the added cost of getting pregnant that many straight couples don’t have to deal with. Lesbian couples must use assisted reproduction unless they are able to find a sperm donor on their own and are willing to take on the risk of using untested sperm. Emily and Jo were together for 6 1/2 years before they felt they were financially stable enough to visit the fertility doctor.

Emily, ever the researcher, threw herself into learning everything she could about assisted reproduction. Jo identifies as transmasculine and non-binary and was not interested in carrying a child. Emily had wanted to be pregnant and have a big family ever since she was a little girl, so she was the obvious candidate to carry their future baby. Emily appreciated Jo’s family’s healthy genetics as her own family’s genetics were not the best. Both of her parents had died young, as did some of her aunts and uncles. The couple didn’t consider intrauterine insemination (IUI) as an option, since Emily wanted to use Jo’s eggs, so IVF was the way to go.

She felt envious of heterosexual couples because their babies are usually genetically related to both parents. She adores Jo and wanted the baby to be a part of both of them. After much careful consideration, they chose to use Jo’s eggs and Emily would carry the baby. This way, the baby would have Jo’s genetics and Emily’s biology, since the baby receives all of its nourishment from Emily as she gestates it. Their situation is similar to carrying a donor embryo, in which the donated DNA of the embryo is like a page of outlines in a coloring book. The developing embryo gets all of its biology and nourishment (Qi and Blood) from its mother who carries it; she fills in the colors of the black and white outlines.

When choosing a fertility clinic, the things Emily and Jo looked for were the success rate of the clinic, and that it had to be LGBTQ friendly. They found a clinic in Colorado that fit their criteria, but even still, through the entire process, Jo was misgendered at every visit. Emily stressed that this made them both feel like aliens. They strongly feel that the world of healthcare, and in particular, reproductive medicine, still has a long way to go in providing welcoming spaces for the LGBTQ community.

Another consideration was which sperm donor to use. Genetic health was the number one consideration for the couple, specifically, no family history of diseases. The donor had to be negative for cytomegalovirus (CMV), since the couple also was. Fair-haired and blue-eyed Emily also wanted the donor to look a little more Italian like Jo so that people wouldn’t always wonder if Jo was their future child’s nanny. Queer couples with children are subjected to microaggressions that cis-gendered and heteronormative couples are not. If the baby looked like both parents, this could cut down on the constant invasive questions that straight couples don’t have to deal with while raising children.

Unlike some customers of sperm banks, they didn’t want a Nobel prize winner as their donor, but rather someone with a good heart; someone their child would be proud of if they chose to meet their donor after age 18. They deduced from reading his profile that he sounded honest and kind.

Jo was 36 at the time they went to the fertility doctor, so the pressure was on to get their eggs out, get them fertilized, genetically tested and then put on ice for transfer at a later date. The clinic retrieved 4 eggs from Jo, 2 fertilized, and after genetic testing there was *one* genetically normal embryo. I met Emily at the end of this process, when she was preparing to transfer their one perfect, precious embryo. After 2 months of twice-weekly acupuncture, the transfer was a success, and Emily is due in December of 2023.

Mel & Erin

Mel didn’t feel strongly about being a parent until she settled down and found the right person to do it with. Erin had always wanted kids, so the couple decided that Erin would carry the pregnancy. After they got married, and about 4 years after being together, they visited a fertility doctor. Something shifted in Mel, however, and she decided that in fact she did want to be pregnant. Since she is older than Erin, they decided that Mel would carry the first pregnancy, and Erin could carry a subsequent one.

Their closest friends, a lesbian couple already navigating the world of fertility, had lots of advice and experience to share with them. Even still, Mel says that knowing these details in her head and experiencing everything were two very different things. She had no idea how hard the emotional roller coaster of 4 failed IUIs would be.

Mel’s advice for other lesbian couples is to educate yourself about choosing a sperm donor wisely. This was an expensive lesson for them, as they bought 6 vials of sperm at $1000 per vial from what on paper looked like a great donor, only to learn that he had done no genetic testing. It was not possible to return the sperm to the bank since it had already been shipped to the fertility clinic. Even if they hadn’t shipped it and it had remained in the bank, they would have only gotten 50% of their money back if they hadn’t used it. There went $6000 down the drain.

Finding a donor with no genetic diseases and a clean medical history became a top priority. The second donor was CMV negative, and his genetics were good. However, after 3 failed IUIs with this donor, they learned the importance of finding one who has a history of confirmed pregnancies. Perhaps there was some incompatibility between his sperm and Mel’s eggs. They used 3 vials at $1000 each, and still have 3 left that they haven’t and most likely won’t use.

Their final donor had been on their favorites list for some time, and after months of testing, his sample became available again. His medical and genetic histories were clean, and he had confirmed pregnancies. After another failed IUI (their 4th), they moved on to IVF. The clinic retrieved 19 eggs from Mel which were fertilized and developed into 4 healthy embryos, all girls. Their first IVF transfer was a success, and Mel is due in October 2023.

My Approach

I have worked with reproductive endocrinologists (“RE”s- otherwise known as fertility doctors) for over 20 years. They trust me with their patients, because over the years they have seen how acupuncture improves their outcomes. It doesn’t hurt that many Western studies have confirmed the efficacy of acupuncture on fertility outcomes. The REs I work with are very open to acupuncture and often recommend it to their patients, especially if they have had failed IUIs or IVF cycles.

During IUI cycles, I recommend many of Mayway’s herbal formulas to help balance hormones, move Liver Qi, and/or boost Yin or Yang, tailoring them to the patient’s Traditional Chinese Medicine diagnosis. The REs I work with have seen great results with herbal formulas and are open to this. They are, however, not in favor of using herbs during the stimulation portion of IVF, saying they don’t know how the herbs interact with the medicines. Out of respect for our working relationships, I don’t recommend herbs during this time.

If a patient sees me before the stimulation portion of an IVF cycle, I will put them on Mayway’s patent formulas as needed to correct any constitutional imbalances according to Traditional Chinese Medicine. Some favorite formulas to boost Yin are Liu Wei Di Huang Wan or Zhi Bai Di Huang Wan, depending on how much internal heat the patient has. To boost Yang, I recommend Jin Gui Shen Qi Wan, and to boost both Blood and Yang, Shi Chuan Da Bu Wan. Many women love the relief they get from Jia Wei Xiao Yao Wan when they are overheated and grumpy from Clomid or other fertility drugs.

When preparing a patient for egg retrieval, some favorite acupuncture points are the Baliao points in the sacrum, with or without electroacupuncture. These points on the Bladder channel (UB 31-34) regulate the Qi and Blood of the Baogong or uterus. Patients can often feel a sensation in their uterus when these points are used, as they bring fresh Qi and Blood to the uterus and ovaries.

Other favorites, depending of course, on the patient’s constitution, are Spleen 6 to boost Yin and Blood, Liver 3 to move Qi during this very stressful time, and also Heart 7 and Pericardium 7 to calm Shen. According to the Mayo Clinic, research has shown that women with infertility have the same anxiety and depression levels as women with cancer, heart disease and HIV, so I always throw in points to calm the Shen during this time.

When preparing a patient for embryo transfer, especially if she has elevated Doppler readings of the blood flow in her uterine arteries, I use the Stener-Victorin protocol to reduce the impedance. As per the study, the points used are Urinary Bladder 23 connected to Urinary Bladder 28 and Spleen 6 connected to Urinary Bladder 57 with electroacupuncture. This treatment improves blood flow to the uterus making better implantation outcomes (Stener-Victorin and others 1996).

Although the IVF journey and treatment for queer and heterosexual couples converge at successful implantation, the societal challenges they face are different. As a practitioner, the best thing you can do for a queer couple (after correctly diagnosing them, treating their condition, and getting them in the best shape possible for egg retrieval and transfer, of course) is to listen with a compassionate ear, and accept and treat them as you would any other patient, straight or queer.

References

• Stener-Victorin, Elisabet, et al, Human Reproduction, vol.11, no.6, pp.1314-1317, 1996