2018 is just around the corner and if you want to add to your family in the New Year, you have options. While no one imagines having children with the help of a doctor, hormone shots or a surrogate, - in this season of gratitude, we give thanks that these options exist so that those who long to be parents can decide with the doctor what is the best course of action.
Here is a high-level overview of the many avenues you can explore with the help of a reproductive endocrinologist (RE):
Timed Intercourse: This is the process of having "well timed" intercourse around the time of ovulation. This is usually within one or two days of a positive ovulation prediction test or a spike in temperature if you are charting your basal body temperature (BBT). You can purchase an Ovulation Prediction Kit or a BBT thermometer at your local drugstore or online.
Medicated Timed Intercourse: Your cycle is monitored via ultrasound by your OB/GYN or at a fertility clinic and might involve the use of fertility drugs (either oral or hormone injections). Once you are close to ovulation, your doctor will advise you to have intercourse.
Intrauterine insemination (IUI): This is when your partner, husband or donor sperm (if needed) is cleaned and then inserted through a catheter into a woman's uterus around ovulation time. Similar to the above, IUI is done with the help of fertility medications so that the woman produces more eggs than usual.
In Vitro Fertilization (IVF): After taking hormone injections and being closely monitored by an RE, a woman's eggs are retrieved and mixed with her partner or donor's sperm. Any resulting, healthy embryos will either be transferred to the woman's uterus within three to five days or frozen for later use (either if the first cycle isn't successful or to have subsequent children).
Freeze All Cycles: This is similar to the IVF process, but all of the embryos are immediately frozen through a process called vitrification. Vitrification instantly freezes your embryos and reduces the risk to the embryo during the thawing process. Some doctors recommend this as it gives a woman's body a chance to return to its "normal state" after taking hormones to stimulate egg production. Freezing embryos can also be helpful should you want to genetically test them before transferring them into the woman's uterus.
Intracytoplasmic Sperm Injection (ICSI): This is when a single sperm is injected directly into your egg, rather than placing many sperm next to the egg, as in IVF. This is recommended when there has been previous poor fertilization with IVF, variable sperm counts, and/or unexplained infertility.
Reciprocal IVF: Reciprocal IVF is increasingly popular with lesbian couples. One partner supplies the eggs to be used for IVF, while the other partner is the gestational carrier of the pregnancy.
Donor Eggs: If a woman is unable to conceive using her own eggs or if you're a same sex male couple, you can have IVF treatment using donor eggs. The donor egg is combined with donor or your partner's sperm, and the resulting embryo is transferred to the intended mother or gestational surrogate's uterus. Egg donation agencies and egg banks are now found throughout the United States. At an egg bank, donor eggs are collected and frozen for purchase, similar to the way a sperm bank operates but you can also be matched with a donor for a fresh cycle. This typically costs more than if you went through an egg bank.
Donor Embryos: Donor embryos are always frozen. When a couple or individual undergoes IVF, they are able to cryopreserve any embryos not transferred during that cycle. If they do not use them for any reason (they don't want any more children, they've divorced, etc.), they donate them so other struggling couples or individuals can use them either to be transferred to the intended mother or a surrogate.
Traditional Surrogacy: Traditional surrogacy is when the surrogate not only carries the child, but also uses her eggs. This means she is the biological mother who carries the child with the intention of giving it to the intended parent(s) upon birth.
Gestational Surrogacy: Another woman who is not genetically related to the baby carries the embryo or donor embryo to term, and gives birth to your baby.
Adoption: You can adopt through either domestic, international or foster care. This is when you voluntarily take a child as your own.
If you have no known medical issues and have only been trying to conceive for a month or two, there's no reason for alarm. If you have been trying for 6 months to a year, depending on your age, you might want to seek the help of a doctor. If you have known fertility issues, it's up to you, your partner/spouse and doctor to discuss next steps for your family building goals. All of these are possibilities, but you need to take one step at a time.