Your Questions About Getting Knocked Up
Why do only a few states require insurance companies to cover “infertility” treatments for same-gender couples?
Christina: Because they’re jerks? Actually, more likely is because the insurer’s cheap. Fertility treatments are expensive and employers and insurance companies think of the bottom line first. Only 15 states require insurers to provide fertility benefits to straight couples either and only eight of those cover IVF. I believe that Maryland, my Maryland, is the only one to provide insurance coverage to same-sex married couples without any benefits, as of July. The state mandates what infertility issues insurance is required to cover and they are usually health based. If you don’t have a fertility issue (PCOS, endometriosis, etc…) but have been unable to conceive, insurance will cover infertility treatments after a year of unsuccessful attempts. So, in my case in DC, after a year of working with a clinic, they’d have kicked in funds.
This is an issue where, in my opinion, law hasn’t caught up to technology. Infertility treatments, especially IVF are a new, incredibly lucrative process. Insurers see that it’s expensive and don’t volunteer to step up. it hasn’t become a broader health reform issue, probably because of price and because fertility issues are often clouded in secrecy and shame.
KaeLyn: If you are lucky, you will find a doctor, as we did, who will preauthorize you for fertility coverage, usually under “unexplained infertility.” My insurance technically requires you to try for one year. However, my partner and I have different insurance through our respective workplaces and my preauth wasn’t flagged. I was surprised. I thought we’d have to pay for everything out of pocket. My insurance has been great so far and I’m so grateful. The issue is definitely that you have to be medically infertile in order to get coverage in states where same-sex couples aren’t explicitly mandated to be covered by state law. Our laws need to catch up to the times!
Are there organizations who provide financial assistance for queer women trying to get pregnant (costs of sperm, medical expenses, etc)? How much did it cost you?
Christina: Not that I am aware of. There are a few foundations that help with infertility costs, but they require a diagnosis from a physician. I’ve joked that when I win the lottery, I’m starting up a foundation to help queer couples with fertility and adoption costs. Some clinics offer discounts for those who do not have insurance coverage – ours did and had an easy application process. Our donor sperm and infertility procedures for 7 cycles cost us about $8,000.
Tips to save money:
- The good news is that all of your treatments and materials are tax deductible, the bad news is that it has to be 7-10% of your income to be deducted from your taxes.
- Max out your FSA if your work offers one. It can be used for donor materials and fertility treatments.
- Find a sperm bank close to home, if you can. Delivery fees can cost $150 per order. Downside – pick up / drop off hours for the tank are often during work hours.
- Choose ICI over IUI sperm if you can. A clinic will do a wash anyway and it’s considerably less for ICI.
- Ask your clinic for a discount. The worst they can do is say no.
If you used a sperm donor, did you pick one where they can be contacted after 18 years?
Christina: We did not. Because it was out of our price range (double the cost, I believe). We are active on the donor sibling registry as a way for our daughter to meet siblings with the same donor. I have lingering guilt about this because I would have liked for my daughter to know the man who fathered her, but on the other hand, if we’d used other materials, I wouldn’t have my daughter, I’d have a different baby.
Lucy: We did! We felt it was really important for that choice to be for our children to make. If they want to contact him they can and if they don’t that’s totally cool too.
KaeLyn: Yup. It was a must for us. Our donor can be contacted and it’ll be future kid’s choice to make. I’ve even thought about springing for the $40 pics of him so our future kid has that, too. If I conceive with this donor, I’ll probably get the pics.
Asher: I haven’t used a sperm donor yet but part of my criteria is that the donor be willing to be contacted after the child was 18. I want my child to be able to have the option if it’s something they want.
What are the costs and benefits of at-home insemination?
Christina: While we chose not to go this route, it would save you costs of working with a clinic (which for us was $200 per IUI). Cost should be just the cost of donor sperm if you’re going that route and a lot of places will send it to you ready to insert. The downside is that it’s usually delivered within a 7 day window of viability, so if you are off with your guesses, you may have wasted that purchase (which is not cheap). Moving to a clinic for the next level may be more difficult. If you are working with a known donor, you just have to work around their schedule, so that’s free except for a kit (and there’s always the turkey baster!). I would strongly, strongly, strongly encourage you to get legal paperwork drawn up to deter future custody issues.
Lucy: My wife was in med school at the time I got pregnant so she did the IUI at home (and was complimented by our OB about it). It’s not easy and I would not recommend it. I had one foot on a laundry basket, one foot on the nightstand, and was trying to hold a flashlight so she could see what she was doing. I would let the doctor do it. Also, as I said above, frozen sperm don’t swim well so if you’re using frozen sperm and just shooting them into your vagina you might as well just light money on fire.
Michelle: Yes at-home insemination can be FREE. I’ve given some lesbian patients of mine who have a known donor some cups and syringes (without the needle) to use. One can time ovulation by just looking for ovulation cervical mucus or doing basal body temperature charting. It starts costing money when you start using ovulation predictor kits. In NY state, frozen sperm has to be delivered to a physician’s office so we were not able to do the insemination at home. I do know how to do an intrauterine insemination. With the right equipment, it’s easy so I guess I could have had it delivered to my office and dragged the liquid nitrogen tank home (those things are heavy!) but I didn’t know how long to thaw the vial to yield the most number of mobile sperm. And each vial is expensive. $600 and up. And they charge an additional $100-150 for shipping.
Using your partner’s brother’s (or other family member’s) sperm: Would you do this? Have you done this? How did you ask them? How did it go?
Christina: We chose not to because my wife is an only child and I wanted to carry. If we had pursued it for her, it probably would have involved fedexing materials, since my brothers live many miles away.
Lucy: I love my wife and she loves me for a thousand reasons. One of these reasons is that we are who we are and not any of our siblings (who are all lovely people but neither of us wanted to have a baby with the other’s brother). Also we both wanted to carry a baby and we wanted our girls to share genes so having a brother donor would have made that impossible.
KaeLyn: I know some folks who have done this. Unfortunately, there are not here in this roundtable. It seems like it was the right choice for them, as they wanted their kid to have both of their family’s genetic material. That said, I’d say there’s some stigma around it and people may judge you for it if you are open about it. Also, there is the issue of whether or not to tell your kid, which is something you should think about before you go for it. Overall, though, people I know who’ve had their brother donate have been happy with the decision. And their brothers were happy to help out.
What are the reasons to use washed sperm versus unwashed sperm?
Christina: My understanding is that the washing basically concentrates everything to ensure you get a more effective batch of stuff in there and higher sperm motility. If you’re working with a fertility center, they may just do this as a matter of course. If that’s the case, try to purchase ICI sperm over IUI sperm. IUI sperm is already washed and more expensive, so if your clinic is going to wash anyway and ICI is available, save yourself a couple hundred bucks and get the unwashed.
Michelle: Unwashed sperm should not be used for intrauterine insemination. The prostaglandins and other chemicals in the semen can cause severe cramping and possibly bleeding. It can be used for intravaginal insemination but thawed frozen sperm do not move well (as Lucy said “they don’t swim for shit”) so your best chances of getting pregnant are with intrauterine insemination (IUI) of washed sperm. Our clinic washes their own sperm to wash out the bad stuff and concentrate the good as well as get a sperm count. So we purchased unwashed sperm which did save us a significant amount of money as Christina advised.
What do you think about genetic testing?
Christina: I had Counsyl and a bevy of bloodwork before we started trying to conceive, which basically told me that I didn’t have any genetic issues to worry about passing down to a kid. At 13 weeks, you get an ultrasound and they do some genetic tests for various syndromes. Not too long after that, they do a test about something or another with your alpha-fetal protein. Both of these provided us great peace of mind – after the 13 week test, our chances for Downs went from 1 in 200 to 1 in 6,000. We’re both naturally anxious people, so having something to point to that the baby was fine was helpful.
Lucy: I know it has advanced a lot since we had our babies (in 2008 and 2011) but the lucency test was standard for us at the time. That let us know our risks for Down’s was very low. Other than that we just did the tests they told us to do without much questioning.
Polly: Our adopted son’s mother is also adopted so we chose to do some genetic testing for him to tell us his ethnic origins (his birth mom had taken on the culture of her adoptive family and was unsure of her own ethnic makeup). However, $100 and a very combative cheek swab (in which our dog and cat might have participated) later we now know nothing more than that Little Dude is probably not white. Duh! Don’t bother with these kinds of genetic tests.
Michelle: I recommend screening for birth defects to all my pregnant patients. It’s actually mandatory for me to offer it but not mandatory for patient’s to do it. Most do. I recommend genetic testing when those tests come back abnormal. I also recommend genetic testing to my pregnant patients who will be 35 yrs of age or older at delivery (“Advanced Maternal Age”). Genetic testing is so easy now. You no longer need to perform an amniocentesis (needle through your belly) to obtain fetal cells. Now fetal DNA can be extracted from a vial of Mom’s blood. With 98-99% accuracy, they can tell you that your child does not have Down Syndrome or Trisomy 18. They can also tell you the sex. There are several companies that perform this test under their respective brand names. But the generic name for this is Cell-Free DNA testing.
How did you decide who was going to carry (if you and your partner both can)?
Christina: I was pretty anti-kids until my boss got pregnant when I was 28 and watching her belly grow made my hormones go BABY NOW, IN MY STOMACH. NOW. I WANT IT. So, I had pretty strong feelings about me being the one to carry. I also had an employment situation where the only way I would get any paid time off would be if I was the one delivering the child (they changed their policy to 6 weeks paid time off the instant I got knocked up WOOOO). My wife had gone through her baby crazy phase in her mid-20s, but had moved past it and also had a couple of genetic issues she was concerned about passing down. I think if it had gotten to the point where the fertility center wanted to move to IVF, we’d try getting her knocked up instead of me. She had thought maybe she’d have the next one (if there is a next one), but watching me go through pregnancy and labor has made her anti-carrying.
Lucy: We both carried and had pretty different pregnancies and deliveries (I delivered vaginally, she had a scheduled c-section). We both wanted to carry a baby and she was going to go first but the timing with school wasn’t working so we swapped and I went first. I am not sure I would have been so keen on it if I had watched her go through it first. But, I was an excellent non-birth parent because I knew all the stuff and could anticipate things she needed both during her pregnancy and after delivery.
Marybeth: We both planned to, but it did not work out for Michelle. So I carried both babies. I had fairly easy pregnancies and both were vaginal deliveries. I had a plan to try the birthing process without an epidural. Mason was tricky. Be open-minded with your “plans!” Anytime I tried to move, his heart rate would drop. Turns out the umbilical cord was wrapped pretty tight around his neck. So all of those nifty position changes I learned in birthing class weren’t possible when I could not move from my one position. In short order I asked for an epidural. It was heaven. Fast forward to Alisa, no time for an epidural. I hardly pushed for five minutes and she was here! I was happy to have experienced both!
I would be beyond thrilled to hear queer lady perspectives on egg freezing. Really anything at all about that.
Michelle: Ob/Gyn perspective: For years they could not generate a live baby from a frozen egg and therefore only recommended freezing embryos (eggs after they’ve been fertilized). In the past 5-10 yrs, advances in medical science and technology have made this a possibility. But please note, the take home baby rates are lower. Patients who take advantage of this are women who are about to undergo chemotherapy that may make them infertile. So they are referred to a reproductive endocrinologist for ovarian hyperstimulation and egg retrieval to harvest their eggs for freezing to use later after they are in remission from their cancer. Queer lady perspective: It would be really cool to have frozen some of my eggs and thaw them when they finally have the medical technology of fertilizing my egg with DNA extracted from Marybeth’s egg. Our hypothetical children would be both or ours genetically.
Did you find out the assigned sex of your child? Do you think it’s better to know or not?
Christina: We did! We mostly decided to find out boy or girl so we would know which sex of names to focus on, how to decorate and so we would get baby clothes that weren’t just yellow or green. We were very happy knowing, though I understand why the surprise would be fun as well. We did (and still do) work hard to make the distinction between sex and gender when discussing the baby.
KaeLyn: As of now, we’re planning not to. In a nutshell, we don’t want to put gender norms on our kid before they even get here and we feel like that not knowing their designated sex is best. For us and for our family and friends. It’s hard not to engage in a little implicit bias when you know. This will keep us all honest. We also aren’t tied strongly to gender-neutral colors or anything, though. Like, we feel blue or pink can work for any gender, as can yellow or plaid or dinosaur. Leaning towards dinosaur.
Lucy: We absolutely did. It helped us choose names and, frankly, we weren’t going to have the doctors and nurses and ultrasound techs knowing something we didn’t know.
Asher: I plan on finding out the sex but I don’t plan on announcing their sex when I find out or even at birth. I’ll announce the name at birth and people can draw whatever conjecture they want. If asked I’d probably say that they were assigned female/male but who knows what their gender is, but I won’t be going out of my way to announce it. For me it’s better to know so I can prepare myself for any unexpected feels I might have on discovering the assigned sex. For a long time I had a very strong preference for baby that was assigned female but then I started to learn about gender and sex and how they’re different and I’m pretty much over caring about the assigned sex of my baby. But it had been such a strong preference for such a long time that, in case there’s an unexpected reaction, I want to know ahead of time. I would feel terrible if I didn’t find out, gave birth, and had an unexpectedly bad reaction. The only thing I want to feel upon meeting my child is joy so I’m finding out in order to facilitate that.
Marybeth: We chose to be surprised with Mason, although I was pretty sure he was a boy through most of the pregnancy. We wanted to find out with Alisa, mostly for practical reasons of clothing items, etc.
One Last Thing…
Where do babies come from? Is the thing about the stork true?
Christina: At midnight on the day you ovulate, go outside to a cabbage field and stand naked under the full moon. Sing a chant to the moon and dance while smudging yourself with sage. Call to an animal (for us, a unicorn) and leave offerings for it in your yard or on your windowsill every night until you take a pregnancy test. Promise it the gift of your sweet, sweet baby’s flesh if your pregnancy is successful. The moonlight will enter your stomach and your child will grab it and find themselves tied to your womb. Be warned, you must fulfill your promise to the animal after your child’s birth or else as a teenager, your child will find themselves tasked to go on a quest to save the stork from the moon’s evil mistress. We offered the unicorn a lock of the baby’s hair and the umbilical stump and thus far, the unicorn has been appeased.
If you do not ovulate near a full moon and attempt this ritual, your baby will come from the darkest timeline.
Asher: Actually hummingbirds deposit tiny little baby seeds near the flowers they sip from and whichever humans stops to smell the flowers with the seeds under them fertilize the baby seeds with their presence. After about a month of growth the seeds grow into fruit which their human eats in order to get the baby inside them.
Lucy: On the first of September you go to platform nine and three-quarters at King’s Cross station and your baby arrives by owl.
Polly: You get a phone call from a social worker who says that they have a baby at _____ hospital that needs a foster placement immediately. They know nothing about the baby including gender, ethnicity or given name. And then you scramble to be the first family to call the matcher back. Then two hours later you have a baby with no name (who you give a cute nickname and then discover, five days later, that he has two or three possible names…none of which end up being his given name). But you have a baby!
Jess: In the 80’s, my sisters and I memorized (and proceeded for many years to perform) a sing-a-long story about the original Cabbage Patch Kids. There was a particularly catchy tune about Bunny Bees and cabbage fields. I am pretty sure it is correct.
KaeLyn: I came on a transatlantic flight. I made up many stories about the 17 months before I touched down in JFK airport, but I’m sure none of them are true. From what I understand from some lesbian pregnancy book I skimmed and some movies I’ve watched, you poop on the table and curse at your loved ones and then there’s a baby or something. Should be fine, probably.
Phew! Did you make it this far? Did you get your question answered? Have even more questions? Leave your thoughts, feelings, gifs, and questions in the comments. Thanks for submitting such great questions, ya’ll! We had a blast answering them!