LGBTQ+ Family Building

General Gynecologic care includes annual screening and comprehensive gynecologic care in an inclusive environment.

Fertility and Family Building Services begin with a consultation and fertility evaluation of the partner(s) providing the eggs and carrying the baby.

The fertility evaluation involves a review of menstrual history and evaluation of the reproductive system with further testing. Ovarian function and reserve are assessed with a transvaginal ultrasound and simple blood panel. We may also advise a saline sonohysterogram, a transvaginal ultrasound that evaluates the cavity of the uterus, and/or a hysterosalpingogram (HSG), an x-ray study to check the uterus and fallopian tubes for any abnormality that may prevent the egg and/or embryo from reaching the uterus. Since donor sperm will be needed for fertility treatment, a discussion reviewing the different donor sperm options is performed during the initial consultation.

Fertility and Family Building Treatment options for Lesbian couples typically includes Intrauterine Insemination and/or In Vitro Fertilization.

Intrauterine insemination (also known as Artificial Insemination) – is a procedure where donor sperm is placed into the uterus when one of the female partners is ovulating. Ovulation can be achieved in a natural or medicated cycle. Donor sperm options include:

1. Directed (known) donor – Utilizing a directed sperm donor for artificial insemination (IUI) is possible provided that the sperm donor has the proper FDA testing, which includes a psychological evaluation, sperm donor questionnaire, and infectious disease testing. We can help acquire the proper FDA evaluation and testing of potential sperm donors.
   
2. Anonymous donor- Anonymous donor sperm can be ordered and shipped from any FDA-approved sperm bank. A few of which we have listed below:

1. 1. 1. California Cryobank
      2. Cryogenic Laboratories
      3. Fairfax Cryobank
      4. NW Cryobank
      5. Pacific Reproductive Services
      6. Seattle Sperm Bank
      7. Xytex Cryo International Sperm Bank

In Vitro Fertilization (IVF) options

1.  Traditional IVF – where one partner is utilizing her eggs and uterus undergoes the IVF injectable medication stimulation, egg retrieval, and embryo transfer process. HMSA insurance typically offers coverage for this if the partner meets criteria for coverage. Other insurances typically do not cover IVF for same-sex couples.
2. Reciprocal IVF (Co-IVF) – the process in which both partners of a same-sex female relationship take part in the IVF process; one partner provides the eggs, and the other partner carries the resulting pregnancy.Reciprocal IVF allows both partners of a same-sex female relationship to experience the physical and emotional journey of building a family through IVF. A legal contract between partners is necessary for the protection of both partners and their resulting offspring from any unforeseen complications. Your physician at the Fertility Institute of Hawaii can give you more guidance regarding this and can refer you to attorneys who are familiar with these types of contracts.
3. INVOcell – Can be used in a Traditional or Reciprocal IVF cycle. During an INVOcell IVF cycle, the fertilized eggs are placed into the INVOcell which is a device that allows the embryos to ‘incubate’ in the vagina for up to 5 days (the same amount of time they would typically incubate in the IVF laboratory).
4. Fertility preservation – Utilizing IVF to freeze eggs or embryos to preserve future family building options.
5. While most lesbian couples will utilize one of the IVF options listed above, some couples may want or need to use Donor Eggs or Donor Embryos  with a Gestational Carrier.

Although some portions of fertility testing and IVF may be covered by your insurance, with the exception of HMSA possibly covering traditional IVF many insurance companies do not cover the majority of the process. Our billing team at the Fertility Institute of Hawaii can help you obtain more information regarding your particular coverage, and can refer you to various financing options to help make the process more affordable to you.

If you and your partner are interested in undergoing fertility treatment with any of the options available for lesbian couples at the Fertility Institute of Hawaii, or if you would like to learn more about it, the first step is to schedule a consultation. 

Fertility management – The path to parenthood for gay men begins with a consultation to discuss sperm, donor eggs, and surrogate options. A semen analysis will need to be completed on the partner(s) providing sperm.

Family Building Treatment options include:

1.  IVF utilizing Donor Eggs and a Gestational carrier:

1. 1. 1. Donor eggs (oocytes) – Donor eggs can be obtained from a person known to the intended parents (directed donor), an egg bank, or an agency. The donor will undergo the IVF injectable medication stimulation process to obtain eggs that will be fertilized with sperm from one or both partners. The resulting embryos can be utilized with a Gestational Carrier (Surrogate).
      2. Gestational Carrier (Surrogate) -is the female who will carry the baby for the intended parents. After embryos are created utilizing a Donor Egg IVF cycle, an embryo transfer can be performed on the Gestational Carrier who will carry and ultimately deliver the baby. Gestational carriers can be already known to intended parents, or they can be sought through an agency.

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2. While most gay couples will utilize IVF with Donor Eggs and a Gestational Carrier, some couples may want or need to use Donor Embryos with a Gestational Carrier.

If you and your partner are interested in undergoing fertility treatment with any of the options available for gay couples at the Fertility Institute of Hawaii, or if you would like to learn more about it, the first step is to schedule a consultation. 

Menstrual management- gender dysphoria can be further exacerbated for transmale patients with irregular vaginal bleeding or regular menstrual bleeding. This can occur prior to affirming hormone therapy or after the initiation of therapy. There are management options for menstrual suppression that can be discussed and prescribed.

1. 1. 1. Menstrual suppression
         • Hormonal suppression with GnRH agonists
      2. LARC placement (long acting reversible contraceptive)
         • Nexplanon placement
         • Intrauterine system (IUS or IUD)
      3. Other hormonal management
         • Oral progestin
           1. Norethindrone
         • Injectable progestin
           1. Medroxyprogesterone acetate
2. Testing for sexually transmitted infection (STI)
   1. 1. Menstrual suppression
         • In the office
         • This can be done as part of a routine health evaluation.
      2. Out of the office
         • This can be offered as laboratory testing for established patients and does not require an office visit unless the patient is symptomatic and needs physical evaluation.
3. Pubertal suppression
   1. 1. This is offered for transgender youth as part of a multidisciplinary team which includes a pediatric endocrinology specialist (hormone specialist), an adolescent specialist and a pediatric gynecologist. The team is dedicated to providing the medical expertise and support for the patient and their family.
4. Fertility preservation prior to gender affirming therapy or surgery – freezing of eggs or sperm. For patients on gender affirming therapy, a return to fertility may require 3-6 months off of hormonal therapy
   1. 1. Consultation is also available for patients already on gender affirming therapy before any surgical management of the reproductive organs has been completed.
5. Hormonal management
   1. 1. Support for established hormonal management is offered or community referral to providers or clinics that focus primarily on transgender services is available.
6. Fertility management and treatment
   1. 1. There are many different options for building a family. At the Fertility Institute of Hawaii we are proud to work with ALL patients regardless of gender, gender identity, gender expression, or sexual orientation. We offer all currently available fertility protocols and procedures to facilitate your family building goals.  Contact us for a consultation today!