Helping Same Sex Couples Conceive

Having a baby can be relatively straightforward for most couples, but the path to parenthood is quite different for same sex couples. Columbia’s Fertility Program for Female Same Sex Couples, directed by Briana Rudick, MD, assistant professor of obstetrics & gynecology at CUMC, has been helping female couples realize their dream of having a baby since 2008.

“We treat people in the LGBT community the same as any other patient: We individualize care,” says Dr. Rudick. “Some want more intervention, some want less. Our job is to figure out when more medical intervention is needed and to help them figure out the initial stages of their family building process.”

A consultation is the first step for female couples who come to Columbia for treatment. “I review intravaginal, intracervical, and intrauterine insemination,” says Dr. Rudick. “In general, the higher up in the female reproductive tract you go with the catheter, the higher the chance of success. There is always IVF treatment if necessary and something called co-maternity, in which one female partner donates her eggs for the other female partner to carry.”

“We treat people in the LGBT community the same as any other patient: We individualize care.”

For couples who choose co-maternity—less than 5 percent of Dr. Rudick’s cases—she obtains a medical and gynecological history on both partners and inquires about the desire of one partner to carry. “Sometimes there will be medical problems in one partner that will make it either harder for her to carry, or more dangerous,” says Dr. Rudick.

Many of the couples choose natural-cycle intrauterine insemination, which doesn’t involve ovarian-stimulating drugs. “I think these couples worry that conception won’t be a special process because of the medical and financial aspects of treatment,” she says. “They want to be as ‘natural’ as possible, but there is still a lot of testing that goes into starting treatment.”

A decision all female couples must make is where to get donor sperm: anonymous donor or acquaintance? “Lots of people think that using someone you know is easier,” Dr. Rudick says, “but it’s actually much, much harder. It requires legal clearance, as well as a six-month quarantine of the sperm. And it is much riskier legally.”

For male couples who want a child, the process is more complex because they need a surrogate. “A surrogacy contract is not enforceable in the state of New York,” Dr. Rudick says, “so for legal reasons, we usually recommend that they seek treatment in New Jersey or Connecticut.”

To have a child, same sex couples must be proactive and analytic. “But it’s this same level of devotion to making things happen that will serve them in good stead when there’s a little one around,” says Dr. Rudick. “I admire same sex couples who embark on this journey because it’s clear that it costs them so much more in the beginning stages just to get pregnant, from both a medical and legal perspective. And with the medical treatments come a lot of ups and downs. They don’t have the luxury of just ‘letting things happen.’”

The Fertility Program for Female Same Sex Couples is part of Columbia’s Center for Women’s Reproductive Care, one of the largest and most successful fertility centers in the United States. For more information, call 646-757-8282 or visit columbiafertility.org/same-sex-couples-and-babies/. This article is adapted from “Introducing the Modern Family,” which appeared in the Winter 2014/15 issue of Connections, a joint pediatrics and ob/gyn newsletter.