Positionally statement: This post is written by Audrey Gatewood. I am a senior in the UMBC School of Social Work, completing my field placement at the Women’s Center. I’m writing this blog as a result of learning about reproductive technologies in my personal life, with the belief that other people may be interested too. I do not have any background in medical education, and do not have first- hand experience with reproductive technologies. This blog is written from research I’ve done for myself, prompted by my own interest in using reproductive technologies, and does not cover everyone’s experience or all possible circumstances in which reproductive technologies may be used.
(A simplified illustration of the difference between artificial insemination, in which sperm is injected directly into the uterus, and in vitro fertilization, in which an egg is fertilized in a petri dish before being inserted into the uterus. Photo via https://www.invitra.com/ )
When I mention my partner and I may consider having kids, generally a beat of intrigued confusion follows. My partner and I are both women, and cannot get pregnant on our own. Even surrounded by other LGBTQ people, follow up ensues: Adoption? Intrauterine insemination? Sperm donor?
Fertility is typically viewed as a given for people of a certain age, and parenthood as inherent in long-term heterosexual partnerships. For women in particular, fertility and motherhood are seen as defining states of being. But what about people who are infertile, who can’t get pregnant for health reasons, who want children but don’t want to be pregnant, who are older, lesbian and gay couples, and so on? Disrupting the typical image of childbearing comes with many questions of intention, method, and outcome. Particularly interesting are the medical technologies and methods that people may use to get pregnant, called artificial reproductive technology, or ART.
Artificial reproductive technologies are innovations in healthcare that help people conceive. According to the American Center for Disease Control definition, ART includes
“any fertility-related treatments in which eggs or embryos are manipulated. Procedures where only sperm are manipulated, such as intrauterine inseminations, are not considered under this definition (Jain and Singh, 2023).”
The most well known and common ART procedure is in vitro fertilization, or IVF, in which a sperm and an egg are combined outside of the body in a laboratory dish. Eggs are retrieved in a process called ovarian stimulation, in which a person is given hormonal fertility medications to stimulate multiple egg growth in the ovaries, instead of just one per month (Jain and Singh, 2023). This way there are more chances for the egg to be effectively fertilized and result in a pregnancy, as not every egg will fertilize, and not every fertilized egg will result in a full term pregnancy. The fertilized egg, or multiple eggs, are then transplanted into the uterus, where they may or may not attach to the uterine lining and develop into a pregnancy.
(Illustration of the in vitro fertilization process. Photo via dreamstime.com)
In this same process, one could choose to have eggs and/or embryos frozen for future use in a process called cryopreservation (Jain and Singh, 2023). This saves the person from having to go through the process of ovarian stimulation again, as it’s a relatively involved, 1-2 week long process that requires many doctors visits and potential side effects from hormone fluctuation. Some people choose to use cryopreservation to preserve eggs before undergoing major health undertakings, like chemotherapy, to prevent eggs from being damaged, or if age is a concern, one may choose to freeze their eggs at a younger age and use them at a later time, when they are ready to be pregnant.
IVF is the most common ART in use, but there is also intrauterine insemination, or IUI. IUI is the process of inserting sperm directly into the uterus around the time of ovulation to increase the chance of fertilization (Planned Parenthood). Sperm is collected either from a partner or from a donor, “washed” in a process that collects healthy sperm and removes chemicals in the semen, and inserted via a catheter. The process is much more low- tech than IVF, less invasive, and generally takes about 5-10 minutes. But how do you get pregnant when sperm isn’t readily available? Most likely through a sperm bank, using donor sperm.
(Illustration of the intrauterine insemination process, in which washed sperm is injected into the uterus via a catheter. Photo via Jonathan Dimes for BabyCenter)
People may choose to use donor sperm for a variety of reasons: if their/their partner’s sperm is infertile, to avoid passing down hereditary diseases, if a single woman is ready to have a kid, or if neither partner can produce sperm, like many lesbian couples, for example. People can use sperm from a friend or relative, but often sperm is coming from donors with varying levels of anonymity. Whether and to what degree a donor remains anonymous depends on the sperm bank and policies local to the state and country. Generally, though, total anonymity cannot be guaranteed to a sperm donor, particularly with the rise of consumer-level DNA testing for websites like 23AndMe or Ancestery.com. Generally, a medical history and varying levels of descriptors are provided to a person or couple looking to use donated sperm, descriptors that may include hair color, self-reported personality traits, ethnicity, personal interests/hobbies/ career, and sometimes, though not always, a photo. Sperm donors are heavily screened for infectious and hereditary disease, undergoing extensive medical questionnaires, full physical exams, and sperm analysis. Donors will also go through mental health screening and a criminal background check (UCSF Health 2020).
ART and other related procedures like IUI come with a price. A single IVF cycle can range from $15,000 to $30,000 on average (Forbes Magazine, 2023). IUI can cost between $300 to $1,000 per session, depending on if donor sperm is used (Planned Parenthood). Neither procedure guarantees a full term pregnancy. In fact, national data from the Society for Assisted Reproductive Technology reports that “the rate of live births following first-use IVF for women under the age of 35 using their own oocytes is only 37% (Center for Reproductive Rights, 2020)”. Private insurance companies may cover some or much of the procedure, and there are grants, discount programs and clinical studies that can reduce the cost (Forbes Magazine, 2023).
Even so, fertility treatments come with a barrier of accessibility, and may only be available to those who can afford them. IVF in particular can be burdensome for those who utilize it, not only coming at a huge financial cost, but demanding an investment of time and emotional and physical strain, causing many people to discontinue using it after an unsuccessful first attempt.
IUI faces a much lower barrier of accessibility, but is not an option for everyone in need of fertility assistance. In addition to being financially inaccessible for many, infertility or using ART can come with a stigma, one which typically affects women. Deviance from the typical fertility narrative challenges the societal expectation of women as inherently mothers, and of the normative family dynamic of a married man and woman having children ‘naturally.’ Women using ART due to fertility issues may experience social stigma, personal shame, and anxiety or depression (Center for Reproductive Rights, 2020). Despite the fact that male-factor infertility accounts for 50% of clinical cases, women tend to receive the brunt of this stigma. For lesbian couples using IUI, stigma can follow the couple through their whole lives as a family, as the rules of a normative family structure are broken when a man is removed from the equation, and when pregnancy is achieved in a non-normative way.
There isn’t much representation of lesbian moms. Even surrounded by my sizable LGBTQ community, in a “progressive” city, I haven’t had many examples of what parenting as a lesbain couple could look like. Sometimes I find myself wondering, if I had a kid, what their experience would be like having two moms? Will it be a huge difference from how I grew up? How would our family be treated by others? Will they be asked invasive questions about their birth? How much would they look like the sperm donor? What if they got in touch with the sperm donor when they were older, and what would that mean?
Regardless of these questions, I’m grateful that reproductive technologies exist, and hope to see barriers to access removed. The future potential for growth, not only in the technological aspect, but in the regulation and accessibility of consumer use of fertility treatments, and of societal understanding, points to ongoing questions about medical technology, genetics, parenthood and more.