As we announced our pregnancy, we knew that a certain question would be on the minds of many. In fact, when we had the opportunity to announce to one person face-to-face, we could see a both the huge smile and the wheels furiously turning. The thought bubble above his head read: “Yay! But how did you do it? And am I even allowed to ask?”

I’ll start by saying that we had a wonderful conception process. So many of the medical professionals and administrators we worked with were incredibly understanding and supportive. (We are ready to make our fertility doctor an official member of our family.)

For those who hadn’t thought about how two women go about making a baby, we faced more of a lack of awareness versus any willful ignorance or opposition. Many people simply never thought about how same-sex-partnered women make families. We understand the curiosity and are happy to share parts of the story. Needless to say, a lot of intention went into the conception process (shocking, says Liz).

So, for those of you who have thought about it a lot and for those of you for whom this is completely new: Welcome to the wild and wonderful world of LGBTQ conception!

Putting yourself in our shoes, you can probably intuit our starting point:  lots of eggs, multiple wombs, and no sperm. What might come less intuitively, however, are the many options we found for going about this and the important choices along the way.

For heterosexual couples, the approach to conception can be fairly linear. Most couples first attempt to conceive naturally. If those attempts are unsuccessful, the immediate next step is typically intrauterine insemination (IUI), more typically known as artificial insemination. If this is unsuccessful, then in vitro fertilization (IVF) is in order. As with all things fertility-related, none of this is easy. It can be complex, emotional, iterative, and deeply frustrating; everyone has their own experience and their own story.  In most cases, however, the genetic material involved in each scenario is the same, and there’s an assumption that patients step through the process directionally, attempting one intervention before escalating to the next, more invasive option.

The approach for same-sex partnered women can be completely different. There is a not a linear escalation through increasingly invasive options. Instead, there are discrete choices which represent different processes and, in some cases, different combinations of genetic material. Think of it as four potential options:

• At-home insemination: Insemination without the advice or support of a doctor.  Includes birth mother’s egg and donor sperm.  This is probably the closest you can get to unaided heterosexual conception.
• Intrauterine insemination (IUI): A medical provider injects sperm directly into the uterus with a syringe. Includes birth mother’s egg and donor sperm.
• In Vitro Fertilization (IVF): Combining of sperm with birth mother’s egg in a Petri dish. The resulting embryos are either transferred into the uterus or cryopreserved for future use. Includes birth mother’s egg and donor sperm.
• Reciprocal IVF (sometimes called “Shared Maternity” or “Co-Maternity”): Retrieve the eggs from one partner, inseminate those eggs with donor sperm, and then place the resulting embryo into the birther mother. Includes one partner’s egg, donor sperm, and the birth mother’s womb.

[Note that there other fertility interventions beyond these – surrogacy, known donor, etc.; I describe this all as a patient and not as a medical professional, speaking from our personal experience rather than any professional knowledge.]

Unlike heterosexual conception, the order of these options is not in ascending level of intervention. Instead, each represents a different level of Liz’s and my involvement, and that’s the factor we cared about most in determining the right approach for us.

Liz and I chose to do reciprocal IVF, meaning that I am carrying Liz’s egg. We love that everyone is involved in a biological way and that the child will have a unique connection to both of us. While it’s certainly not right for everyone, it’s right for us.

That’s your brief introduction. Now you know ‘how we did that.’ To those who wondered what they could ask in person; as with any pregnancy, the answer is ‘not much.’ The decision and process is different for every couple and while Liz gave me the thumbs-up to write this blog, you aren’t going to see detailed information about the retrieval or transfer. So, when faced with the next LGBTQ pregnancy, I’d suggest doing what so many of our lovely friends and family did and waiting for the soon-to-be parents to share any details on their terms.

Moving forward from here, the next frontier of LGBTQ conception is expanding this dialogue with the broader set of stakeholders – particularly with those who determine what health benefits are supported and for whom (Liz and I aren’t infertile, but that is how the conversations had to start) and how parental leave is described (Daddy-to-Be isn’t exactly a good fit for Liz). But that’s a broader social justice issue for another day. In the interim, we’re just delighted to have this healthy little monkey (parts of both Liz and I) on the way!

With love,
Meredith, over halfway through pregnancy (!)