This is Part Two of the Great Big Gay Woman’s Guide to Making A Baby. If you’re still at the point of considering the legalities surrounding your decision to make a baby with your female partner, are deciding whose eggs to use and who will gestate the baby, and getting your head around sourcing donor sperm, you might like to read Part One first. If you and your partner are already in agreement about how you want to proceed then let’s crack on with the logistics of getting knocked up.
I’m sure that it goes without saying but I’m not a doctor or any type of medical professional or fertility specialist – just a mum who has been through the TTC process and researched all of her options.
ARTIFICIAL INSEMINATION AT HOME
Artificial insemination at home* is the least medically and financially intensive way to get pregnant as a two-woman couple or as a single-mum-by choice. Women choose artificial insemination for a variety of reasons: because they want to use a donor that they know, because they want a less physically invasive and more ‘natural’ conception, because obtaining donor sperm via a sperm bank and inseminating at a clinic is considerably more expensive.
In the UK, artificial insemination at home usually requires a ‘fresh’ donation. Sperm don’t tend to live outside of the body for very long at all and in order to increase the chances of conception it’s important to transfer the semen quickly from its mode of storage to the vagina. There is a misconception that this tends to involve a turkey baster but it’s actually better to use a syringe, which you can obtain from your local chemist. You should fill the syringe slowly, insert it into your vagina as far as it can go and very slowly deplete the syringe so as not to damage the sperm with the force of the expulsion. Try to lie down for at least half an hour after insemination to keep as much of the semen where it should be as possible. Some women choose to insert a soft cup before standing, to keep the entire emission close to the cervix.
*we’ll use ‘home’ to mean ‘not in a hospital or clinic, assisted by a medical professional’.
INTRAUTERINE INSEMINATION (IUI)
Intrauterine insemination, or IUI, is a middle-ground between artificial insemination at home and IVF. Women tend to use intrauterine insemination when they aren’t comfortable sourcing donor sperm informally and would like the legal protection of conceiving through a clinic. It is less medically invasive and cheaper than IVF, but there is still significant financial outlay – especially if you have to purchase donor sperm. IUI may be available to you on the NHS; to find our whether you are eligible for NHS-funded fertility treatment, you will need to speak with your GP. If you choose to fund IUI privately, whilst the cost varies per clinic, you should expect to pay around £1000 per cycle on top of the cost of donor sperm.
IUI is a procedure that introduces the sperm directly to the uterus by way of a small catheter that is inserted through the cervix. Some women will opt for additional ovarian stimulation, which increases the chances of success by producing more than one egg to be fertilised. This also increases the chance of twins or higher-order multiples, and the risk of overian hyperstimulation syndrome which is where your body overreacts to the medication. Other women do not take medication to stimulate their ovaries; the natural production of the egg is monitored by transvaginal ultrasounds and when the follicle is ripe, ovulation is stimulated by an injection of hCG and the following day the insemination takes place.
The success rate for IUI is about 20% per cycle depending on subjective variables such as the woman’s age. If you decide to conceive using intrauterine insemination, you may choose to purchase donor sperm that has already been ‘washed’ or prepared for IUI – your clinic will be able to advise you.
IN VITRO FERTILISATION (IVF)
In vitro fertilisation, or IVF, is the most medically invasive and the most expensive of all of your fertility options. However, it also has the highest chance of success – at about 30% per cycle for women under thirty-five. The risks are primarily ovarian hyperstimulation syndrome, an ectopic pregnancy (where the embryo implants somewhere other than the uterus) and multiple births.
The IVF procedure involves stimulating the woman’s ovaries to produce lots of follicles, surgically removing the resulting eggs and fertilising them outside of the body. The eggs are then allowed to develop into embryos over a period of two to five days before the best embryo or embryos are transferred back into the uterus to (hopefully) implant. At this juncture if you have left-over embryos that are of sufficient quality, they can be frozen for future cycles of IVF to add to your family at a later date.
Women in some parts of the country are eligible for IVF via the NHS; to explore your eligibility you would need to begin by visiting your GP. Other women, who are not eligible for IVF on the NHS, or who wish to circumnavigate the lengthy waiting lists, choose to fund IVF privately instead. Costs vary per clinic but you should expect to pay around £5000 per cycle on top of the cost of donor sperm. You may like to consider an egg-sharing programme, where your eggs are split with a woman who can’t produce her own eggs, in exchange for a free cycle of IVF. If you are interested in sharing your eggs you will be required to meet with a counsellor to explore whether the decision is right for you and to consider the potential consequences of doing so, as well as to provide information about yourself and your family and to write a letter to any potential children created from your eggs and their parents.
As mentioned in Part One of this guide, some two-women families choose to do something called reciprocal IVF. This is where one woman provides the eggs that are fertilised by donor sperm to become embryos, but then – plot twist – they are transferred into the uterus of the other woman. This is the most costly form of IVF as it requires medical treatment for both women, but some two-mum families consider it to be worth the expense as it allows both women to play a more involved role in the creation of their baby.
I hope that helped.
As I mentioned previously, I’m not a doctor, medical professional or fertility specialist, just a mum who researched her options extensively over the course of creating her own family.
If you’re interested to read more about how we created our own family, you might like to read my TTC, artificial insemination and – ultimately – IVF story of how my first set of twins were conceived. I also journalled my IVF story with my daughters (all three of them, as Vita was conceived in that round too). I also journalled the story of my frozen embryo transfer with Vita and a letter that I wrote her during that cycle, as well as a pregnancy announcement with a video showing the moment that second line appeared on the test.