Hello, and welcome to Fertility Cafe. I’m your host, Eloise Drane. As I am sure you are aware, every person’s fertility journey is unique, every family different, each set of circumstances and motivations for building a family is special. It’s a fact, however, society favors quote/unquote “traditional” family makeups. Man, woman, 2.2 children – the nuclear family. Literature and education about fertility is almost always written with this type of family in mind. Though it’s more common now, it’s still pretty rare to see same-sex couples or single parents represented in the media we consume. And when they are, these families are often presented in terms of the hardships they face rather than in a way that normalizes different kinds of families.
We’ve come a long way, but there’s still an uphill battle to be fought in how non-traditional families are viewed and in the access they have to necessary resources. In today’s episode, I’d like to talk about fertility issues for unique populations of intended parents. What options exist for them? How can they navigate the complicated world of fertility and third-party reproduction? And what can they expect in terms of acceptance, access, and support?
I’m talking in particular about four unique populations of intended parents: men and women who choose single parenthood; LGBTQIA+ individuals; intended parents over the age of 50, and intended parents who are HIV+. In each of these populations, there is a biological or medical barrier to having a baby. And in each case, third-party reproduction can offer a solution. While the knee jerk reaction to these situations might be “why don’t you just adopt” or “some people never have kids and are perfectly happy,” I reject that line of thinking. Every single person has the right to choose parenthood – and adoption is just one potential pathway. It’s a pathway that is not for everyone, for a variety of reasons, nor is it always accessible. Private agencies are allowed to discriminate in many cases. Wait lists are enormous. Many parents in unique populations will be automatically disqualified, due to advanced age, for example.
The truth is, there is a path to parenthood for everyone, and no two journeys will look the same.
There is one thing that does remain constant, however. No matter the circumstances, the biology of making a baby stays the same: egg and sperm must be combined to form an embryo, and that embryo needs to develop inside a uterus. Egg, sperm, uterus. Those are the biologically necessary components for everyone. So really, the question for each fertility journey can be boiled down to “Where will each part come from?” A donor, the intended parent, a surrogate, or a combination of some or all of these? How you answer that question is where each path becomes its own unique journey.
Alright, let’s dive in to talk about third-party options for those who choose single parenthood.
It is becoming more and more common for individuals to pursue parenthood without a partner. There are a number of different scenarios of when and why one might choose this path, but let’s first talk about single women becoming pregnant without a partner. In past years there has been a stigma around being single and having a baby. In fact, a survey conducted by Pew Research Center in 2015 showed that two thirds of adults felt that the increase in single women raising children on their own was bad for society. For many years, society was led to believe that ‘you can’t raise a child without a father’. More and more women are proving that may not necessarily be the case.
There are several reasons one may choose this path of single motherhood. A woman may find herself emotionally and financially ready to build a family, but she hasn’t met the right partner yet. Or, she has little to no desire for a romantic relationship. There could also be a fear of running out of time as their age might begin to affect their fertility.
When a woman reaches her upper 30’s or early 40’s, knows she wants to have a baby, is aware her biological clock is ticking, but hasn’t found the right partner yet…she has some tough choices to make. Does she get serious about updating her Tinder profile, or does she go it alone? For those women who have no interest in rushing romance, they may turn to assisted reproductive technology for help.
One option is pursuing pregnancy through IUI or IVF with donor sperm. For those unfamiliar, IUI is intrauterine insemination in which sperm is placed directly into a woman’s uterus through a small tube known as a catheter. IVF, or in vitro fertilization, is when the sperm and egg are combined in a lab, and the embryo is then later implanted into the woman’s uterus.
Most women choose to pursue IUI as their first step as it is less invasive and much less expensive than IVF. However, if IUI is not successful or if there is some underlying medical condition such as endometriosis, IVF may be necessary. Though costs will vary greatly on each specific scenario, the average cost of IUI is around $2,000/cycle while IVF runs closer to $20,000/cycle.
As mentioned earlier, the woman would need to find donor sperm whether that be from a known donor or through a sperm bank. When choosing to work with a sperm bank, the process will vary a bit from bank to bank. Generally speaking, the sperm banks do a varied level of screening for various health conditions and then enter it into their donor database.
Some of these databases are quite detailed with information regarding height, weight, hair color, and personality traits while others are a bit more limited. The cost of donor sperm varies, but is significantly cheaper than donor eggs. Donor sperm ranges from $300-$4,000 while donor eggs cost between $15,000-30,000. Much of this comes down to the level of difficulty and risk involved for the donor. Women have to take fertility medications, submit to multiple physical exams, and undergo an invasive procedure in order to donate their eggs. Men, on the other hand, well… They have a much simpler and relatively risk-free way to donate their sperm.
The big question for a single intended parent is cost. How does a person with one income afford to undergo costly assisted reproduction such as IVF? The costs can be prohibitive for someone with a moderate to lower income. Fortunately, there are a number of options available to help fund the procedure and ultimately become a parent. Some of those avenues include grants, loans, or crowdfunding, and in some instances a person’s health insurance or fertility benefits will kick in.
In terms of insurance, most of the time insurers require there to be a medical reason for seeking infertility treatments, so in the case of a single person pursuing IVF, this likely wouldn’t be an option. However, this may be improving, slowly but surely.
Right now, in the United States, fertility coverage is not offered across the board, but we do see this changing in a positive direction. Many large employers are starting to offer optional fertility care coverage as an additional benefit to their employees. Big names like Apple, Bank of America, Johnson & Johnson, and Starbucks all offer varying degrees of fertility benefits.
Facebook is another big name offering big benefits, giving up to $100,000 in IVF coverage to employees and $20,000 toward surrogacy. They will also pay for egg freezing, which is an option often pursued by women who want to delay parenthood until later in life. The frozen eggs can then be used when the intended mother feels ready to have a child.
More and more companies are adding or expanding fertility benefits each year as a way to attract and retain top talent, and also as a way to build a diverse, equitable, and inclusive workplace.
According to Carrot Fertility, one of the top fertility benefit providers in the nation, 71% of companies have begun looking into offering fertility benefits to support their diversity & equity initiatives. They are realizing that the narrow definition by which most traditional health insurance plans define infertility – as in, a cis-gender woman who has been unable to get pregnant despite trying (implying that she is having sex with a male partner, of course) – that this definition is discriminatory. It excludes same-sex couples, transgender people, and single parents by choice. 58% of benefit managers surveyed say that failing to offer fertility benefits by 2025 will be a discriminatory practice.
For single intended parents, it may very well be worth looking into the growing list of employers offering this kind of coverage. A job change to gain benefits might seem kind of extreme, but it’s actually pretty common, especially in today’s job market where the job candidates actually have the upper hand. Changing jobs for better benefits happens more than you might think – Almost 60% of women say they would choose a new company that offered fertility benefits. And 68% of all employees say they would definitely switch companies in order to gain coverage. Bonus: many of these same companies also offer generous paid parental leave and other perks for new parents.
All of that to say, for a single person who is facing an expensive fertility journey, it is worth it to understand all your options. Third-party reproduction doesn’t always have to be paid out of pocket, and access to fertility benefits might be more prevalent than you thought.
Specific fertility benefits aside, your regular health insurance plan might help you out to some degree as well. It’s certainly worth taking the time to do a little investigative work to see what might be covered. Definitely reach out to your provider to ask for clarification. You might be pleasantly surprised to learn of certain medications or tests that are actually covered, even if your plan doesn’t cover the cost of full IVF treatment.
Having insurance coverage available to you for fertility care can be a total game-changer for many intended parents. Be sure to look into your specific plan to find out what might be covered for you. Thankfully, coverage for fertility treatment is becoming more common, but we still have a long way to go.
I started out this topic of single parents by choice using a single intended mother as the example. Single men can and do choose single parenthood too, of course. The single intended father is going to face the same barriers as a single woman, however, it becomes much less likely that his health insurance will pay for anything. With the exception possibly of the more inclusive fertility-specific benefits, a single intended dad is going to have to look at other ways to afford everything.
In the case of single fathers or single women who cannot carry for whatever reason, their only options to have a baby are adoption or surrogacy. If they feel strongly that they would like a biological tie to the child, or if they would face barriers to adopting or simply prefer not to adopt, then surrogacy becomes the only option.
And of course, by adding another piece to this puzzle, you’re going to see the price tag shoot up.
Surrogacy is quite expensive and can range from $100,000 to $200,000, depending on various factors, and it adds a whole slew of additional decisions to make.
For example, you’ll need to decide if you’ll engage in a compensated or compassionate surrogacy; a traditional or gestational surrogacy; or an agency-led or independent journey.
Your choice hinges on several factors including local laws and regulations, your personal circumstances, and the values that are most important to you. It’s crucial to work with and consult surrogacy professionals who have expertise in this arena so you can make the best informed decision for you and your family building goals. While it’s not necessary to work with a surrogacy agency, the expertise can be well worth the additional cost, especially for first-time intended parents.
Surrogacy laws vary from state to state and country to country. There are also specific laws regarding surrogacy as a single parent. Depending on where you live, it may not be allowed to list a single parent on a birth certificate or to even have a child via surrogacy.
For example, California, Colorado, Nevada, Oregon, Georgia, Montana, and South Dakota do allow one parent to be listed on a birth certificate. States such as Arizona and Illinois also allow a single parent to be listed, but only if that parent is genetically related to the child.
With so many different laws regarding surrogacy for both couples and single parents, it’s really important to seek guidance from an experienced professional.
Let’s jump back to the cost of surrogacy. As I mentioned earlier, surrogacy typically costs around $100,000-200,000. I think it’s fair to say that most people do not have that kind of money just laying around. Fortunately, there are a number of ways to potentially lower your cost of surrogacy.
A compassionate, or altruistic, surrogate is a woman who agrees to receive little to no compensation for the surrogacy process. Often, your best bet for finding a compassionate surrogate is to ask someone you’re close with. Compassionate surrogates are usually family members or friends, but you can occasionally connect with compassionate surrogates via other means. Compassionate surrogates are still reimbursed for medical expenses, attorney fees, and other related expenses, but they either don’t receive compensation, or they may receive a very minimal amount of compensation.
Compensated surrogates, on the other hand, receive monetary compensation on top of having all related expenses covered by the intended parent. Amounts vary, but typically compensated surrogates will receive a base pay of $40-60,000. This is reflective of the time, energy, risk, and physical labor involved.
You might be thinking once again, How does anyone afford this? Especially a single person?? Well, it’s not easy, but there are some creative ways to finance a fertility journey, even if you aren’t among the lucky employees who enjoy fertility benefits.
There are several fertility grants, loans, and scholarship programs. We will add a link to resources for these programs in the show notes. There’s also the crowd-funding route: many intended parents turn to their network of family and friends to help them raise money for the journey. Some will even share their story and need more widely, through social media or local news outlets. I’ve seen people surprise themselves with how much they are able to raise with the help of others.
Of course, crowdfunding campaigns tend to do best when they really tug on heartstrings – a young married couple who has struggled with infertility, the LGBTQ couple longing to have a child of their own… those types of stories can take off, earning loads of compassion and goodwill.
For single parents, I’m sad to say, those types of appeals don’t always land in the same way. I say this not to be discouraging, but to help you understand that, unfortunately, individuals who choose to go it alone will likely face judgment. They often get the side-eye from people who think (and sometimes say out loud) that single parenthood by choice is a bad idea. That raising a child without two parents will harm the child. That they just need to be patient and wait to find a partner, or accept the fact that a family isn’t in the cards for them.
All of that is nonsense, of course. Any person who chooses to tackle the difficult, expensive, and emotionally draining pursuit of fertility by themselves should feel empowered to do so. There is a large community of single mothers and fathers by choice out there – I highly recommend you seek out a solid support system, both in person and online. Support is key to helping you along the path to parenthood.
For anyone who is considering single parenthood by choice, I highly recommend checking out the organization Single Mothers by Choice or the Solo Parent society. Both can be found linked in the show notes.
LGBTQIA+
The next unique population I’d like to talk about are intended parents who are LGBTQIA+
Third party reproduction makes it possible for more and more intended parents of any sex or gender to have children of their own. And increasingly inclusive legislation and cultural awareness is protecting their right to do so. Just a short time ago, the consensus seemed to be that life outside of the normative cis-gender heterosexual couple meant you’d be facing a child-free life. That’s simply not the case anymore, which is welcome news for the more than 6 in 10 LGBTQIA+
people who say they want to have children.
Unfortunately, despite the increased access and acceptance, there remains a lot of inequality in the world of fertility for this population. Some people refer to the cost of third-party reproduction as the “gay fertility tax” – highlighting the disproportionate burden of expenses faced by an LGBTQIA+ couple. Simply due to sexual orientation, an otherwise healthy person and their partner face tens or even hundreds of thousands of dollars just to have a baby, which, in many cases, costs nothing for male-female couples. I will remind you of the discussion about fertility benefits and why they are viewed as an important component to building a diverse, equitable, and inclusive workplace.
Fertility equality is becoming understood more and more, and there are groups lobbying for change. In a New York Times article from last year, Ron Poole-Dayan, founder of the nonprofit Men Having Babies, said this:
“This is about society extending equality to its final and logical conclusion. True equality doesn’t stop at marriage. It recognizes the barriers LGBTs face in forming families and proposes solutions to overcome these obstacles.”
His organization is leading the drive for change by arguing that our very definition of infertility needs to be changed. Right now, even our most respected institutions continue to use language that excludes vast numbers of people from being deemed “infertile.” This is important, of course, because insurance providers use that narrow definition of infertility to deny care when someone is seeking assistance for other reasons.
This is what the American Society of Reproductive Medicine defines infertility as: “Infertility is the result of a disease (an interruption, cessation, or disorder of body functions, systems, or organs) of the male or female reproductive tract which prevents the conception of a child or the ability to carry a pregnancy to delivery.”
The CDC defines it as: In general, infertility is defined as not being able to get pregnant (conceive) after one year (or longer) of unprotected sex.
Now, I would argue that any same-sex couple having unprotected sex for a year or longer will not be able to get pregnant; therefore, they should be covered. Unfortunately, the insurance companies don’t agree with me.
Both of those definitions seem to focus only on the physical, and they are written from a hetero-centric perspective. Advocates for the community argue that there needs to be a secondary aspect to infertility: the social causes of infertility are equally as important as the physical.
The New York Times article goes on to illustrate the problem: the author tells the story of a US Navy veteran who is gay and, because of his combat injuries, is qualified to fertility services through the VA.
When he decided it was time to start a family, he inquired about using those benefits. He was told “they only offer these procedures to male soldiers who are married to women.”
The policy specifically stated that in order to access these benefits, the couple has to be married, and not only that, one partner must have “an intact uterus and one functioning ovary.” The other “must be able to produce sperm.”
I don’t know about you, but that sounds like it was written specifically to discriminate against LGBTQIA+ people and single parents by choice even. And in my book, that is absolutely not okay.
There are currently several lawsuits in the courts attempting to take on this issue. For now, as I mentioned earlier in the episode, the cause is being taken up by private organizations, many of them in the tech industry. Microsoft, Apple, Google, Facebook, and others are leading the way with offering equitable fertility care. This is welcome news, but we still have a long way to go, unfortunately.
Because without equitable fertility benefits, the fact is, LGBTQIA+ people are limited by what they can afford. Does an intended parent max out their credit to afford IVF, or do they resign themselves to remaining child-free? It doesn’t sound like a very fair choice to me.
So with all this in mind, let’s talk about what options do exist for LGBTQIA+ people who are ready to start a family.
Similar to other people facing fertility journeys, there are a lot of factors to consider. The type of third-party reproduction needed varies depending on a couple’s particular circumstances. Lesbian couples will need donor sperm to use in conjunction with an at-home insemination or an outpatient IUI procedure. Or, some female couples choose reciprocal IVF, meaning the egg of one partner is extracted and fertilized with donor sperm, and then the embryo is transferred into the uterus of the other partner. Some couples feel that this is a way they can both be intimately involved in the conception of their child. Still other lesbian couples may need to work with a gestational surrogate, if neither is able to safely carry a pregnancy.
Male same-sex couples will need to work with a surrogate – it’s most common to work with a gestational surrogate, meaning someone else’s donor egg is combined with one of the male partner’s sperm and then carried by the gestational surrogate – she has no biological ties to the child.
The other option here is traditional surrogacy, which is when the surrogate supplies both the egg and the womb, making her a biological mother to the child. This option is typically frowned upon in the third party industry because of the complicated legal and emotional situation it creates. However, I will say that in the LGBTQ+ community, it is seen as a viable option for men who cannot or don’t wish to afford the extra costs associated with gestational surrogacy. Working with a traditional surrogate means they can utilize the less expensive IUI procedure and avoid the additional compensation needed for the surrogate.
Admittedly, this is one of the only scenarios in which I am okay with traditional surrogacy – but only if everyone is super clear on expectations and boundaries up front, and all legal due diligence has been double and triple checked over. There are a handful of states where traditional surrogacy is explicitly allowed, but every state differs in their own handling of the matter.
Let me briefly describe some of the procedures I mentioned above. One of the options I mentioned is something we haven’t really talked about on this show before, but it’s worth a quick discussion. I’m referring to the at-home insemination option. This is called intracervical insemination, also known as ICI, or the “turkey baster” method. This involves collecting a sperm sample – either from a known male individual or a sperm bank – and then injecting the sperm near the cervix with a disposable, needleless syringe. Not an actual turkey baster. There are legitimate ICI sterile kits on the market that you can purchase to use at home, or you can ask your doctor to perform the procedure in office.
This might sound like a very old school way of doing things, but it’s actually an option, especially common in the LGBTQ+ community. It’s viewed as a way to avoid many of the costs associated with assisted reproduction. And for a healthy person with a uterus, it can be a simple, low-cost way to get pregnant. In queer communities, people often recommend donors to each other, making this DIY route more accessible.
It’s very important to take legal matters into consideration with ICI. With any third party option, really, but especially in this case. There may be some situations where at-home insemination with donor sperm does not cause the legal risks. For example, if a single woman or a lesbian couple obtain sperm from a reputable and licensed sperm bank. In these cases, there is little to no legal risk because the sperm donor has signed consent and release forms through the sperm bank.
Each state has different laws about whose name can and must go on the birth certificate, and using donor sperm from a known donor can complicate matters. Without proper legal documentation, the known donor could very well change their mind about seeking parental rights or an involvement in your child’s life sometime down the road.
No matter which route you end up taking, it’s important to note that despite the expanded rights and protections for the LGBTQ+ community, there are still a lot of hurdles out there. Unfortunately, there are still several states that make it difficult for same-sex parents to be granted legal parental rights. There are certain states that allow so-called “religious freedom” exemptions, allowing clinics and agencies to refuse to work with LGBTQIA+ people. Advocacy groups such as Family Equality are doing incredible work tracking and lobbying against discriminatory practices all over the country. I highly recommend checking them out.
All of this aside, once you know the particular path you’ll be on, ICI, IVF, IUI, donor eggs + gestational surrogate, reciprocal IVF, or something else altogether, you can start moving forward.
The great news is that there are many, many wonderful clinics, providers, attorneys, agencies, and others who are eager to help LGBTQIA+ people become parents. There are specific grants and financial assistance programs. Many gestational surrogates feel led to step up and work specifically with this community as a way to live out their allyship in a very tangible and important way.
When you are searching for professionals to help you in your journey to parenthood, you should feel empowered to ask them about their experience working with people whose circumstances are similar to yours. Ask for testimonials, for particular examples of the work they’ve done in the past. It’s one thing to put a rainbow flag on your website; it’s quite another to be comfortable with and skilled in the particular third-party assistance you need for your unique situation. There are still too many people who are held back from seeking fertility assistance for fear of stigma, misgendering, or discrimination.
Despite the unfortunate barriers that still remain, third-party reproduction is making it possible for so many to become parents. As a professional in the field, I believe it’s crucial to lead with empathy and openness, and I know there are many others like me out there. You can check out some great resources from groups like Men Having Babies, Family Equality, and Gays With Kids. We’ll link those in the show notes for you.
OVER 50
The next population of intended parents that I’d like to talk about is the over 50 population. It’s no secret that the average age for first-time parents is on the rise. There are lots of reasons for this – people delay parenthood due to career, financial constraints, or simply personal choice. Some people wait until they reach a certain stability in their life, only to discover down the road that their biological clock has run out.
Others may enter into a romantic relationship later in life, or get married for a second time, then decide that they would like to build a family together. With the type of reproductive technology we have today, becoming a parent after age 50 or so is definitely possible.
Let’s talk about what this looks like for people. The starting question is the same for anyone else looking for assistance with fertility: where will the egg and sperm come from, and who will carry the child?
Biologically, eggs tend to age faster than sperm, meaning that a woman’s egg supply diminishes in quality and quantity before a man’s sperm supply does. So, women over a certain age, typically after age 40, are more likely to be encouraged by their doctors to use an egg donor.
While an older woman may have plenty of eggs remaining, those eggs have the potential to have chromosomal abnormalities. Those abnormalities can lead to a greatly increased risk for miscarriage, disease, or developmental issues. The fertility clinic’s main goal is to create viable embryos that result in a healthy pregnancy. In light of this, most doctors will want you to use donor eggs to minimize risk. Other options include seeking donor embryos. If you previously had your own eggs frozen, this is certainly another avenue you can pursue, although again, you may face clinics who are unwilling to risk the procedure on someone age 50 or older.
As for sperm, most doctors agree that the advanced reproductive age for men is over 45 years old. At this point, a man’s sperm motility and mobility declines, making it more difficult to fertilize an egg. You will work with your clinic to determine if you can use your sperm or if you will need to find a donor.
A woman who is 50 or older will probably need to work with a gestational surrogate rather than carry the pregnancy herself. Advanced age increases the risk for complications such as: obstetric hemorrhage, preeclampsia, pregnancy induced hypertension, gestational diabetes, higher rate of Cesarean delivery, preterm delivery, and low birth weight, even when the embryo is created using donor eggs. The doctor will need to do a full physical evaluation to determine if it’s possible for the intended mother to carry. However, there are not a lot of clinics willing to take that risk, so chances are, you’ll be looking into surrogacy.
The ASRM – the American Society for Reproductive Medicine – is not particularly supportive of women over 55 carrying, even with donor eggs. Their official statement says “In view of the limited data regarding maternal and fetal safety, as well as concerns related to longevity and the need for adequate psychosocial supports for raising a child to adulthood, providing donor oocytes or embryos to women over 55 years of age, even when they have no underlying medical problems, should be discouraged.”
They also say “It is ethically permissible for programs to decline to provide treatment to women of ARA based on concerns over the health and wellbeing of the patient and offspring” – in other words, there’s no ethical problem with a medical professional refusing to help an older woman get pregnant.
A lot of this is based on health risks, which is understandable. As well as the concerns for the psychosocial supports and longevity, meaning lifespan of the parent. There are a lot of criticisms lobbed at intended parents over 50 that may or may not be based in reality. What if you don’t live long enough to care for the child? What if you experience health problems related to aging? What if you can’t keep up with an active toddler? It’s not fair to the child!
People who choose parenthood later in life unfortunately face a lot of judgment like this. And yet, studies have shown that there are benefits to raising a child later in life…
One study found that older mothers are more patient with their children. They are less likely to discipline them or get angry, less likely to abuse or neglect a child. So in turn, their children are less likely to experience the behavioral or developmental challenges that can result from things like this.
Other studies have shown that children of older parents tend to have higher IQs and faster development when compared to peers with younger parents. Still, the bias exists. In reality, there are many reasons why later in life is the best time to have a child. Most older adults have reached a very stable and secure season of life – financially, materially, mentally, and socially
Of course, much of the discussion just now, at least regarding the ASRM recommendations, has to do with a woman over 50 carrying the pregnancy herself. That’s just one option, and honestly it’s the less common one for this population. More commonly, older adults choose to work with a surrogate. This person, a woman between the ages of 21-40 most generally and far less likely to experience complications, will carry for an older person. If the intended mother has had her eggs previously frozen, those can be evaluated and used to form embryos. If not, donor eggs are of course an option.
As an older person, you may find it challenging to find an agency or surrogate who is willing to work with you. In fact, many intended parents over 50 turn to third party reproduction after being turned away by adoption agencies that have an upper age limit. Unlike in the adoption field, though, there are many clinics that do not discriminate based on age.
Be prepared to experience some raised eyebrows and negative attention. Focus on the advantages that come with age: your ability to provide for your child is so much greater now than in your twenties, your support system is more stable and established, and you are much more confident in yourself and your abilities.
HIV+ Parents
The last unique population I’d like to address includes parents who are living with an HIV positive diagnosis.
We have thankfully reached a time when it is possible to live a healthy, full life while being HIV+. Not only that, but it is now possible to have a baby without the fear of passing HIV to the child. There is still a lot of stigma and misunderstanding about what it means to become a parent while living with HIV. Much of that is centered on the fear of passing on the virus to the child.
I can remember the early days of the HIV/AIDS epidemic in the 80s and 90s, when people were worried HIV could be transmitted from traces of the virus on toilet seats. HIV+ kids were banned from schools, following massive public outcry. People worried they could get infected from mosquitos. None of that was founded in truth, of course. Much of this stemmed from a lack of knowledge, but it was also stoked and stirred up for political reasons as well, leading to massive amounts of discrimination directed at the gay community where it first spread.
Some of this fear and misunderstanding still lingers today, and it often comes up when we talk about HIV+ people who want to get pregnant or have a biological child of their own.
So let’s talk about what can be done to build a healthy family when one or both partners is HIV+. One thing to note up front: the Americans with Disabilities Act makes it illegal for someone to discriminate against a person with HIV, so agencies, clinics, and other professionals cannot simply refuse to work with you based on your diagnosis, unlike with LGBTQIA+ individuals who may face the challenge of so-called “religious exemptions” in several states. Good news for HIV+ intended parents.
The options that HIV+ parents have are going to depend on individual circumstances – and there are a couple of terms specific to this population to be aware of. The term serodiscordant means that one partner is HIV+ and the other is not. When both partners have the virus, that is referred to as seroconcordant. Of course, the other option is a single person who is HIV+ who wants to have a baby using third-party methods.
The most important thing for intended parents living with HIV is that they consult with their medical team in order to fully understand the risk and how to safely approach pregnancy. Above all, they will want to avoid passing the virus on to their partner or baby.
One option is to attempt intrauterine insemination – as I’ve described before, this is when semen is inserted into the vagina via a catheter, or if trying the DIY approach, an at-home insemination kit commonly referred to as a turkey baster. The semen is either supplied by the non-positive male partner or a donor. An HIV+ woman can safely carry a pregnancy and deliver a baby without passing the virus along. Antiretroviral medications that suppress that virus make this possible.
What many people don’t realize is that it is also possible for an HIV+ man to use his sperm during an IVF cycle. Before it is combined with the egg, sperm undergoes a process called “washing” – this is when the sperm is separated from the semen. Since the HIV virus lives in the semen, the sperm no longer carries any risk.
This process has been perfected and refined through the Special Program of Assisted Reproduction (SPAR), an international program designed to protect spouses, surrogates, and babies from becoming infected during fertility procedures. This makes it possible for men who wish to have children of their own, but are living with a sexually transmitted infection, such as HIV, to use their own sperm.
To proceed, the intended father must have an undetectable viral load for at least six months prior, and be following all treatment protocols. They will test and evaluate viral load throughout every step of the process.
There are many clinics throughout the country currently collaborating with the SPAR program that can collect a specimen. Once it’s collected, it will be sent to Bedford Research Foundation to be tested, washed, and cryopreserved. Once completed, specimens are shipped to the intended father’s clinic of choice. A special container will be used to keep the sperm at liquid nitrogen temperatures. Then, it can be used during IVF to create an embryo. That embryo can then be transferred to the intended mother or a gestational surrogate.
All of these steps are meticulously followed in order to ensure the safety of the surrogate and to prevent transmission. The first use of this method was in 1999, and there has never been a case of transmission. Still, they follow a strict protocol of testing following each pregnancy attempt and following the birth of the child, with tests occurring after 3 weeks, 3 months, and 6 months after the event.
SPAR technology is a major leap toward equality and empowerment for HIV+ people, making it extremely safe to have a baby in spite of a positive diagnosis.
CONCLUSION
Once you really start to dive into the world of fertility and assisted reproduction, you can really get a sense for how complicated it can all be, but also how incredible it is that we can achieve all of this.
Virtually any person who wishes to have a baby is able to do so, provided they have access to the right kind of fertility care. Which is of course where the problem lies. Fertility care and third-party reproduction are sadly not widely accessible for everyone who would benefit from them. I am hopeful that things are changing in the right direction – if you’d like to learn more about how to lobby for better access to fertility care, check out some of the wonderful organizations I’ve linked in the show notes.
I hope you’ve enjoyed today’s episode and that you gained a greater understanding about what it is like to walk in the shoes of intended parents who face unique barriers and challenges.
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Thank you so much for joining me today. Remember: “love has no limits – neither should parenthood.”
Listen to this episode here.
