LGBTQ Families: "What You Should Know About Fertility" by Ken Mosesian
Across virtually every demographic category, LGBTQ+ persons are embracing two of the most traditional institutions in the world, marriage and family, and demanding equality in both areas. The goal is not only equality on all fronts, but for the families that we form to be healthy. However, the information that supports the formation of healthy families may not be getting out to the LGBT community as completely as it should.
One example I’ve noticed is that gay men seem to be having multiples, twins or greater, as a result of surrogacy and in vitro fertilization (IVF).
I say, “noticed” because this is currently anecdotal information with no scientific data. It is still of concern. According to the Society for Assisted Reproductive Technology (SART), an organization dedicated to promoting and advancing standards for the practice of assisted reproductive technology (ART), the objective of infertility treatment should be the birth of a single, healthy child. And despite the fact that gay men are not by definition “infertile”, the technologies utilized to enable them to be dads, are infertility treatments which fall under this heading.
It is important for anyone utilizing surrogacy and IVF to strive to avoid multiple births, because pregnancy with multiples (twins or greater) may pose significant health risks to the surrogate and to the fetuses. Let me be clear: this is not meant to be a “shock” piece, but simply to call out what we do know about multiples. Understand that these risks are not inevitable, but they can include:
For the fetuses:
An increase in death rates in-utero or after birth
An increase in preterm deliveries and low birth weights.
For the surrogates:
Increased risk of heart failure during pregnancy.
Increased risk of gestational diabetes and high blood pressure during pregnancy.
For the intended parent(s):
The possibility of multi-fetal pregnancy reduction
Financial, logistical, and emotional complications after the children are born.
The most common reason given for transferring multiple embryos is the desire to increase the odds of pregnancy, thus making IVF more “affordable.” And of course, the additional costs of utilizing a surrogate are expensive. However, many people may not consider the true costs of having a multiple pregnancy, including those outlined above. In addition, if multiples are born prematurely the costs of the neo-natal ICU, if necessary, will be extremely expensive.
So, what’s the solution? Multiple studies demonstrate that elective Single Embryo Transfer (SET) produces very promising results in terms of pregnancy and “take home” baby rates when compared with the transferring of multiple embryos. eSET, which means transferring only one embryo at a time, should be discussed with your surrogate, physician and donor agency before pregnancy is attempted. eSET is not the only option, and the SART guidelines indicate best practices based on a number of factors, including the age of the surrogate.
Many multiple pregnancies proceed without any incident. But, if your goal is a healthy family, and if you are able to minimize the risks to both your future children and your surrogate, isn’t it worth the conversation?