The ABCs of IVF

Queer families wanting to embark on their parenting journeys increasingly turn to fertility specialists in order to fulfill their dream of welcoming children, and IVF is an ever more common means of achieving parenthood. But what does that mean? What are the challenges? And how do LGBTQ+-affirming clinics like those in The Prelude Network – North America's largest and fastest-grown network of fertility clinics – fit into the picture?

What, in other words, are the ABCs of IVF?

All the Ingredients

Pregnancy is initiated through conception, which is when the genetic contributions – the gametes – of two people combine to create new sequence of DNA. That genetic blueprint will guide the development of a human embryo, determining many of the physical attributes (and even some of the psychological characteristics) of a new individual.

The process of reproduction, says Dr. William Ziegler of the Reproductive Science Center of New Jersey (with clinics in Eatontown, Toms River, and Lawrenceville, comprising comprising three of The Prelude Network's 90+ locations across North America) requires three basic components: Sperm, which carry the gametes of one biological parent; an ovum, or egg, which contains the gametes of the other parent; and a womb where an embryo can gestate – that is, grow and develop, culminating in the birth of an infant.

IVF brings sperm and egg together under laboratory conditions, enhancing the probability of conception. After five days the embryo is ready to be either implanted in the womb of the gestational carrier (who might be the parent-to-be, or who might be a third party) or else cryopreserved – that is, frozen – for implantation years later. This also means that families can determine their own timetable for bringing an embryo out of cryopreservation to be implanted in the womb of a parent or gestational carrier.

It's Okay to Need a Little Help

Queer or straight, not all couples can conceive on their own. Even for those that do, there are surprising obstacles to pregnancy.

"Doing it the old-fashioned way is fine," Dr. Ziegler says. "However, keep in mind that there's a big attrition rate of sperm. If you have 20 million sperm dropped off at the mouth of womb, only 200,000 make their way up inside, and 200 make their way out to the end of the tube," where the egg awaits.

"If we do insemination" – as with IUI – "we're taking all that sperm and putting it up inside, so we increase the number of 'bullets' heading towards a 'target'," Dr. Ziegler adds, using an easy-to-understand analogy. According to studies, he adds, fertility intervention doubles the chances of pregnancy, partly because "these couples that are undergoing treatment with us are taking medication to increase their success rate."

Even before gametes are brought together, whether by IUI or IVF, fertility care involves some essential steps that families won't want to skip over. Dr. Daniel Shapiro of Reproductive Biology Associates, in Atlanta, Georgia, breaks the process down into five factors.

"Vet the eggs, vet the sperm, screen the carrier," Dr. Shapiro says, enumerating the first three and adding that "element number four is everybody – all donors and all surrogates – must pass a psychological evaluation.

"And then last is legal," Dr. Shapiro adds, touching on an aspect that many prospective parents might not realize is of crucial importance. "Our professional guidance says specifically, 'Do not enter a contract with a donor or a surrogate until the psych is done'," Dr. Shapiro adds, "and yet, people do that out of order all the time. The agencies take $10,000 or $15,000 retainer fees that are non-refundable from intended parents before the psych is done, and then if the surrogate or the donor fails to pass the psych exam, you've got to start again. It delays the process and increases expense."

Knowledge is Power

Dr. Ziegler is used to explaining the process to prospective families, both in the clinical setting and as the host of a podcast, and he knows how important it is to address both the wishes and the anxieties of those looking to IVF to help them meet their goals.

"Whenever I'm presenting something on my podcast or to my patients, I think they need to understand why we're doing something," Dr. Ziegler notes. "It's not like a family doctor's office. You're not just going in there and getting an antibiotic. We're diving deep into their personal lives: Have they been pregnant before? Did they have a surgical procedure because a fetus may have not been developing correctly, or it wasn't a desired pregnancy at that time?

"Having them know how those things are impacting their fertility is important, because a lot of times that's not something they want to disclose, and here we are getting into the nitty gritty of their personal and intimate life and telling them, 'Okay, this is what we need to do.'

"And there's a lot of stuff on social media" about IVF, Dr. Ziegler says. "However, a lot of it is misleading, and that's where we jump in. We need to inform them of what actually is going to happen, and also motivate them to stay in treatment." Dr. Ziegler points out that IVF is a comprehensive process that can feel "overwhelming" to couples, but attentive care can defuse many fears and anxieties, helping ease the emotional journey.

It's not just that fertility providers need to convey accurate, fact-cased information to their patients; the prospective parents, too, need to provide critical information to their providers.

"A lot of times, men don't want to give us the sperm analysis, because they're concerned that that's going to come back abnormal, and it may have some implications on their masculinity," Dr. Ziegler notes. "So, I think the big thing with patients is understanding why we're requesting these tests," after which "the apprehensiveness of going through this process drops to the wayside."

Good Foundations for Better Outcomes

IVF helps boost the chances of a healthy pregnancy in other ways, such as genetic screening. "Women who are older have a higher instance for having what are called trisomies, like Down syndrome or Edward syndrome," Dr. Ziegler explains. "We can detect that in an embryo prior to transferring. For those that are of advanced maternal age, pre-implantation genetic testing has increased their success rate and decreased their pregnancy loss rate.

"For those that are carrying a sex-linked disorder, we can find that out also," Dr. Ziegler adds, going on to say that testing can also reveal "translocations, where the genes are not in the right order," helping prospective parents avoid pregnancy losses that might result.

Uplifting and affirming queer couples as they build their families is an essential part of the service. A blend of medical expertise, personalized care, and awareness around the sensitivities of gender identity and sexual orientation means that network's providers treat everyone with respect and attention and helps make The Prelude Network a premiere destination for queer couples who are ready to fulfill their family-building dreams.

But IVF is also used by people who are not yet ready to welcome children. More and more, people with ova are choosing to freeze their eggs during their younger years in order to increase the odds of a healthy, successful pregnancy in their late 30s, in their 40s, and beyond – ages at which their eggs will no longer be of the same higher quality as in their youth.

For transgender people, freezing eggs or sperm is also a way of preserving their fertility for biological parenthood after gender transition.

In other words, IVF is not only an increasingly popular approach to family building, but an unexpectedly rich and comprehensive avenue that entails a plethora of options for prospective families from across the rainbow spectrum. But, Dr. Ziegler notes, however complex and widely applicable the field of IVF might be, there's one very basic thing to keep in mind about the families that seek his expertise and his guidance.

"They want a baby," Dr. Ziegler says. "They want a baby yesterday, and our job is to help them."