Fertility Options: Same Sex Female Couples

Hi everybody. Today’s Freedom Day in South Africa, so it’s a public holiday. I’m filming this video from home so please bear with me if you hear any background noises. I thought seeing as it is Freedom Day to day and CAPE Fertility does not discriminate against any couple who comes to see us for treatment. Let’s have a chat about same sex couples.

Let’s start off with the same sex female couple. We’ll make a video about same sex, male couples, and options for surrogacy later on. So as a same sex female couple, you are obviously going to need to access donor sperm. We do have our own Sperm bank at CAPE Fertility it’s called the Cape Cryobank. I will leave all the links below, so you’ll be able to access them on our Instagram, Facebook and on our YouTube channel okay.

What we will ask you to do is have a look through all of the profiles and choose three profiles in order of preference. You may see next to some of the profiles that they are listed for either inseminations or ICSI or IVF. The reason being that when we get down to only two straws of samples left for any donor, they will only be available for IVF. So, if you’re wanting to do an insemination treatment, you will not be able to use that specific donor. When looking through the profiles, they are listed first of all, in order of race and then described according to their physical characteristics. Once you’ve had a look through these, you can ask the lab to send you more detailed profiles. You will, however, not know the name of the donor, you will not see adult pictures of the donor. And once your child is born, even when they turn 18, they will not be able to access this information about the donor.

So, I’m going to start off talking about inseminations because this is the most common treatment that the same sex female couple would come and see us for. So, the woman who is wanting to carry the pregnancy will need to have a medical evaluation. This includes a history of physical examination and ultrasound and some blood tests. All of this is described under our video about the first consultation and what to expect. So, at this stage, we should have done the complete medical evaluation and have your sperm donor choices all lined up. What’s next? Well next we wait for your treatment period. So, this will be the start of a period, and we will add the do what is called a natural cycle, or we might medically assist the cycle, going to run through those two options for you now.

The point of any cycle, whether it’s natural or medically assisted is to make sure that you grow an egg and that at the right point, when that egg is mature, we make you ovulate that egg so that we can place sperm inside of the uterus, which is the womb at the appropriate time when you are obviating. We don’t want to put sperm in at any time in the cycle because there’s a narrow window at which point you will be likely to conceive. So, how does the natural cycle work? Well, you let us know day one of your period, and we will let you know when you should come in for an ultrasound that’s usually around about day 11 or day 12 of your cycle. And we will do an ultrasound measure, the size of the follicle we see in the ovary and follicles that little egg factory full of fluid and an egg, which we can’t see on ultrasound is within that follicle. So, we measure the size of the follicle and if it measures a correct size, we know that the egg inside should probably be mature, and we can plan for the insemination.

A natural cycle is our first choice in a woman who we know ovulates reliably on her own. So, she grows her own egg without needing any medical assistance. Sometimes some of our patients might also have polycystic ovaries or they might have another reason for not ovulating or growing an egg on their own, which case we would add in medication. This would be a medicated cycle. Most of the time, this is in the form of tablets, so we’ve got a variety of tablets that we might choose to use. Otherwise you might want to add in injections or simply start off with injections. Regardless of the type of cycle, we will usually plan your first scan to be roundabout day 11 or day 12 of that cycle. Now there’s no need to panic if on day 11 or day 12, that follicle isn’t there, or perhaps it isn’t big enough. We can give it a bit more time. We might adjust our strategy, but we do always have a few tricks up our sleeves. This is the reason why when you start a cycle, I can’t tell you, this is the exact day we will be doing the insemination. Because we have to listen to what the ovaries are telling us on this ultrasound.

We can’t make you ovulate the follicle that isn’t ready, we will be jeopardizing your chances of success. So, based on this, we have to wait for that ultrasound to guide us as to when we can do the insemination. So now we’re at the point where we’ve done an ultrasound and we found a follicle that’s ready to trigger. So that might be day 11, day 12 might be a little bit later. What do we do next? What we will do is usually that evening give you a specific time we would like you to take an injection that we call the trigger injection. What this does is it starts the ovulation process. Now it’s not a case of injecting you ovulate usually takes about 36 hours roughly in order for that egg to be released and ovulated. So, we will give you a very specific time according to when we plan on doing the insemination.

We might ask you to do some blood tests, what these blood tests tell us is where you are in the natural process of ovulating. As sometimes we might scan you and there’s a very big follicle and we’re worried you might be in the process of ovulating. Then we will ask you to do some blood tests for us. Okay so now we’re at the big day, the day of the insemination, what can you expect? Well you’re coming to the office, we’ll run through all the sample details with you and explain these to you. We will verify the sample with you that it matches all of your details. We will then take you into the examination room, ask you to undress the lower half, cover you up and then prepare for the insemination. So, the insemination procedure starts with us inserting a speculum into the vagina. This is very much like a pap smear, so if you’ve had a pap smear, that’s what you can expect from this.

We draw up the sample, which has been thawed out by the laboratory. It gets drawn up into a syringe and attached to a catheter. This little catheter is very small, and it’s inserted through the cervix, so the mouth of the womb into the womb itself, and we very slowly inject the sperm sample into the womb. Remember, this has all been very tightly timed to make sure that this is around the time of ovulation so that the sperm can get to where it needs to be in the tubes ready to meet the egg. Once we have done the insemination you do not need to lie down for 15 minutes, as you might have read. It makes no difference; we’re not putting the spermicide in the vagina where it can fall out. As with normal intercourse we are putting the sperm inside of the uterus, near the top of the uterus. So, you can get dressed, come back into the consulting room and we’ll run through the details of when you need to do your pregnancy test.

The pregnancy tests will usually happen roughly two weeks after the insemination. If you’ve not had a period, we will give you a blood form for you to go and do a blood test. The reason we want to do a blood test and not a urine test is we want to see the levels of the pregnancy hormone. So, whatever that level comes back at, if it’s positive, we will ask you to repeat that test in 48 hours. So, we can see the numbers are rising appropriately. And a good rise is roughly a double in the number. So, for example, if your initial test came back as 70, we would like the next test to be at roundabout 140.

So, discomfort wise, what can you expect? It shouldn’t be painful. The insertion of the speculum, like I said, it’s very much like a pap smear. And when we put the catheter containing the sperm inside of the uterus and might be a little bit crampy, but it’ll just settle down very quickly. Most patients don’t feel discomfort at all.

What should you do for the rest of the day? Carry on with your usual life. There’s no need to go home to take the day off work, to lie in bed all day with two legs up in the air, none of that is necessary. So, you can carry on with your normal daily life straight after the insemination. We’re often asked what are my chances of success. This is very individualized and the same as every other couple at home, trying to fall pregnant for the first time might not fall pregnant the very first month that they tried to conceive. The first insemination might not also work, even though we are timing everything very well, it’s still up to the quality of that egg and that sperm, the embryo that’s created, and then the embryos still has to travel all the way through the tubes and find its way to the uterus and implant. So, we might not be lucky the first time.

A commonly quoted statistic is 25% success rate per cycle. But bear in mind that this is influenced very heavily by your age and the presence of any other factors that might influence fertility. For example, tubal problems, endometriosis, polycystic ovaries. All of those factors can also affect you as a woman in a same sex couple. So, we can’t always guarantee that your individualized success rate would be 25%. That’s something to have a chat to your doctor about. Also bear in mind that statistics can be very dangerous when we are talking fertility. As you won’t be 25% pregnant and a 25% success rate doesn’t mean four cycles will put you at a hundred percent. So, every single cycle is 25%, on its own best-case scenario.

So, when do we need to start reevaluating? Well usually we put that ballpark figure somewhere between four and six cycles. But like I said, this is very individualized as some women might have higher risk factors than others. And we might want to have a look at other options a little bit earlier in some couples, a little bit later in others. Now a very interesting situation is when one partner would like to use her eggs and the other partner would like to carry the pregnancy. This is a very nice way of involving both partners in the pregnancy itself. And for this, we will need to use IVF. So, the one partner will need to be put through stimulation in order to get their eggs. We do have a video on IVF on our website, as well as on our Facebook page, you can watch a bit more information about that. And I will do a little video on that a bit later.

So essentially the one partner will need to undergo IVF. We will retrieve her eggs and inject those eggs with sperm from the chosen sperm donor, culture those embryos, which is a fancy word for grow the embryos in the lab. And then we transfer the embryos into the other partner’s uterus after her lining has been adequately prepared for the pregnancy. As I briefly mentioned earlier, if donation is also a possibility. So, if you are a bit older and egg quality is a problem, or perhaps you’ve had a few failed IVF cycles you might consider egg donation, in which case we would then choose an egg donor. Stimulate that donor retrieve her eggs, inject with the sperm, and then transferred that embryo into the partner who would like to carry the pregnancy’s uterus.

Let’s finish off by chatting about some of the legal aspects of an insemination as a same sex female couple. Things are a bit easier when you are married, if you’re not married, it might be in both of your best interest to have a legal agreement drawn up. And we do have excellent fertility lawyers that we can recommend. Usually what will happen is once the baby is born, you will require a letter from us to say that the pregnancy was conceived using donor sperm, which we are always happy to provide. You will then be able to register the birth of the baby with no male name registered to the birth. And usually there shouldn’t be an issue with registering both of you as the parents of the child. If you have any concerns, you’re always welcome to contact one of our fertility lawyers. They’re excellent in this field and you can also draw up an agreement at the very start of treatment to say that both parents will need to be registered as the birth parents of the child.

Thanks for watching today’s video. I hope this has given you a bit of information about what your options are as a same sex female couple. We’ve run through inseminations, a little bit of information about IVF, egg donation, and how to choose the sperm donor. If you’ve got any questions, please drop them below this video. You can leave your questions via our Facebook page or Instagram accounts, or even on our YouTube channel where all these videos will be.

If you want to get ahold of one of our fertility lawyers, drop us an email as well. You can always reach us at info@capefertility.co.za. You’re always welcome to schedule an appointment to come and have a chat to us about your options. And we will always run through the whole procedure with you in the consultation. Again, stay tuned and soon we’ll be covering a few more of your most frequently asked questions. Thanks for all of the updates and what you would like the videos to be on. We will be getting through all of those shortly. Stay tuned.