For most couples, starting a family follows a simple equation: the male partner provides the sperm and the female partner provides an egg and then further solidifies her biological connection to the child by carrying the pregnancy. The biological relationship of each partner to the child is clear. Typically, the emotional bond between husband and wife is enhanced through their shared biologic link to their children.
For two married women, however, reproduction is not nearly so simple and requires thought, exploration of the various options to start a family, and careful planning. To date, the technology to unite eggs from two female partners to make an embryo is not available, so it is not possible for both women to be genetic parents of the child.
However, there are now many different ways that female same-sex partners can start their families. The simplest, least expensive and most common approach is for one woman to undergo insemination with donated sperm, usually through a donor sperm bank. She carries the pregnancy and delivers the child. Prior to the legalization of gay marriage, her partner could not be considered a legal parent without adopting the child.
The legalization of gay marriage has significantly benefitted same-sex couples considering reproduction. Both female partners in a marriage now must provide consent to attempt conception with donor sperm insemination. Most states will now record each married woman on a birth certificate as a parent--even the partner with no biological connection to the child. Legal consultation is usually still recommended to make sure that the rights of both women and their child will always be protected, and a “second parent adoption” provides extra protection that the partner who did not deliver the child has all the rights and responsibilities of parenthood.
Still, the partner who did not undergo donor inseminations is left with no biological link to the child--neither genetic by providing the egg nor gestational by carrying the pregnancy. If the married couple wants to have a second child, the second partner may attempt conception using the same sperm donor. If successful, the two children in the family are then linked to each other through the sperm donor and will be genetic half-siblings.
Advanced reproductive technologies using in vitro fertilization have been an important pathway for female couples to start a family and may provide the best opportunity for two married women to each have a biological relationship to their child. One partner may wish to provide her eggs to start a family, but cannot or may not wish to carry the pregnancy. Conversely, age or a diminished egg supply may prevent one partner using her own eggs to conceive, but she may still want to have the reproductive experience of carrying a pregnancy. Or perhaps the couple just wants to appreciate the shared emotional bond that stems from both partners having a biological connection to their child. In any of these situations, the two females can share the traditional maternal biological roles, one by providing the eggs and the other by carrying the pregnancy.
Prior to the legalization of gay marriage, this sharing of maternal roles was often offered by fertility clinics as part of their egg donor or surrogacy programs, for the purposes of things such as consenting, data entry, and billing. One partner would be designated as the “intended parent” and the other would be the “egg donor;” in this case the egg donor would relinquish all rights to her eggs, the resulting embryos and the children. Alternatively, the woman who provided the eggs would be the intended parent and her partner would be treated as the “gestational carrier.” Always, this seemed contrived to call this arrangement “donation” even though the women were sexually intimate and both planned to be parents of the child. Fertility clinics and their patients then depended on good reproductive lawyers to somehow make both partners become legal parents.
When gay marriage finally became legal in the state of Washington in 2012, Pacific NW Fertility in Seattle already had established a program for female couples to share the maternal roles, so that both partners could experience a biological connection to their child. Our goal then became to simplify the process and to respect the impact that gay marriage has had on reproductive options. We developed unique informational material and consents, and carefully considered a name for this program. Other programs have called this procedure “Reciprocal IVF,” “Co-IVF,” “Co-maternity” or “Shared Biological Parenthood.” After polling our patients and carefully considering the most appropriate name, we introduced this arrangement in Seattle as simply “Shared Maternity,” to respect the biological and rearing intent of the process rather than the procedure itself.
In this program of Shared Maternity, one partner may elect to be the “egg provider” and the other may elect to be the “gestational partner.” The egg provider undergoes ovarian stimulation to mature multiple eggs and then has a surgical procedure to retrieve them, similar to any in vitro fertilization procedure. The eggs are inseminated using donated sperm that has been selected previously by the couple, screened for infectious diseases, and frozen. After the embryos are developed to the blastocyst stage, they are either frozen for later use or transferred fresh into the woman who chooses to be the gestational partner. The gestational partner will have undergone hormonal stimulation in order to prepare her uterus to accept the embryo. Once pregnant, she will continue on hormonal support until 10 weeks of pregnancy.
Because the women are married, they both consent for the procedure, and both are considered parents of the child. If there are any unused frozen embryos, both women need to consent to thaw and transfer them, or to discard them. Even though one partner is initially designated as the “gestational partner,” these embryos may be transferred into either partner.
In support of our wonderful patients in the LGBTQ community celebrating Pride Week, we want to acknowledge some of the many creative family-building options. One couple described their experience at our clinic as they considered their options to create a family. “At some point in the process our physician said approaching fertility is like ‘a choose-your-own-adventure’ book. There are many tools available, but ultimately it’s up to us to decide what steps are right for our family. This idea reassured us about the fertility process, and it also reinforced the sense that all families and all paths in life are welcome here.” Now, with the option of Shared Maternity, both partners may become biological mothers, one through her genes and the other by carrying the child. It confirms their reproductive relationship, and provides a solid foundation to share in the upbringing of the child.
Contributed by Dr. Lorna Marshall from Pacific NW Fertility in Seattle, WA.