Episode Transcript
Courtney Collen (host):
Hi there. Welcome to our “Health and Wellness” podcast by Sanford Health. I’m your host, Courtney Collen with Sanford Health News. Well, this series starts new conversations and continues the important ones, all designed to keep you well, physically and mentally, featuring our Sanford Health experts. We’re so glad you’re here. In this episode, we’re talking about the fertility journey for same-sex couples. And to do that, we have board certified reproductive endocrinologist, Dr. Keith Hansen at the Sanford Fertility and Reproductive Medicine Clinic in Sioux falls, South Dakota. Dr. Hansen, welcome. Thank you for being here.
Dr. Keith Hansen:
Well, thank you, Courtney. Appreciate it.
Courtney Collen (host):
Sanford Health provides some pretty high quality, compassionate fertility reproductive medicine care that is appropriate for all patients who come in right with various needs and concerns, no matter their gender identity or sexual orientation.
Dr. Keith Hansen:
That’s very right. We take care of, you know, any couples that are having difficulties conceiving or carrying a pregnancy. We’re happy to evaluate them and help them on our journey to hopefully to have a baby.
Courtney Collen (host):
Are you seeing same-sex couples in this clinic who are looking to grow their family?
Dr. Keith Hansen:
Yes. We see really any couples that want to have a baby or are trying to increase the number of babies they have, you know, whether they’re same sex, opposite sexes, you know, we will see those and help them to hopefully conceive and have a baby.
Courtney Collen (host):
For two men or two women that journey to parenthood looks a little different because they’re missing at least one essential piece to that puzzle. So Dr. Hansen, let’s talk through some of the hurdles that they might face.
Dr. Keith Hansen:
Basically they have the same hurdles as anyone else with a similar type of issues, but they do have some unique hurdles also, in terms of trying to help a couple who are trying to have a baby, no matter who or what their gender identity or sexual identity is, there are a number of factors that we try to help them with. You know, first of all, we always evaluate a couple to try to determine, you know, to make sure that there’s no underlying disease that could complicate a pregnancy or complicate an issue for a little baby and try to fix that before they get pregnant. So one of the issues we always do is we like to make sure that the couple, that the person who’s gonna be carrying the pregnancy, is taking a vitamin with folic acid, because that’s been trying to reduce the risk of neural tube defects by 70 to 90%. We also like to make sure that their thyroid is functioning normal. And then we check labs that may have an impact upon pregnancy, which could be very important and lowering the risk of the pregnancy and hopefully helping them to conceive and carry a natural pregnancy to term. We also like to do an in depth, you know, history, looking at their past medical history, surgical history, looking at their family history to determine are they risk of any sort of genetic illnesses that might be passed on to the infant?
Courtney Collen (host):
How can Sanford Health help same-sex couples conceive? I know the patient journey obviously looks different from males to females. So let’s start with females.
Dr. Keith Hansen:
In same-sex, female couples where there’s no male, well, they have to use a donor sperm, you know, or the possibility of donor embryos, but usually it’s a factor of donor sperm where what happens is you have to go to an to a cryo bank, which there’s multiple cryo banks throughout the country they look on. And in the old days we used to have piles and piles of books that people had to go through and this was for any couple with severe male factor infertility. And what we would do is they would go through the books, find a donor that met the criteria that they wanted, select the donor, and they’d ship the sperm here. Now it’s all online. So they can actually go online, look up the donor that they would like to pick, select, and then pick that donor and have the cryo preserved sperm sent here where we can keep it cryo preserved and then when ready to be used, we can do intrauterine insemination, hopefully that’s how they could conceive.
It’s important, I think, to realize that males who give, you know, that cryo preserved sperm is very carefully evaluated before releasing it for use. First of all, the males that donate it, undergo a thorough history and physical examination, including family history. And a lot of them have screening to make sure that they don’t have any underlying genetic illness such as that they’re not carriers of a disease like cystic fibrosis or spinal muscular atrophy, or one of these other devastating genetic illnesses.
When the couple goes online, they can actually find that information out about that individual and then decide to, you know, like if the only donor they can find is a male who carries cystic fibrosis, then we can go back and make sure that we screen the person who’s given the eggs, the wife, or we can screen her to determine are her, you know, does she carry that same genetic mutation or not? And if she does, then they, we have to sit down and talk about that and their options that are available, including at that point in vitro fertilization, with biopsying the embryo and making sure it’s normal before we put it back.
So in same-sex, female couples, once they picked out the donor, they ship it up here. The easiest way for them to get pregnant is to do in insemination. And so what we do is if the woman has regular periods, what she’ll do is ovulation predictor kits. When it turns positive, she’ll give us a call. And like, if it was positive today, which is Friday, we’d have her come in tomorrow on Saturday, thaw out one vial of sperm and inject it up inside the uterus. And then we’d have her come back on Sunday and do the exact same thing. In San Francisco, they did this large study where they compared single insemination versus dual inseminations and they had a higher pregnancy rate with dual insemination when you’re using frozen sperm. So we really like to do that.
If that doesn’t work, you know, like if let’s say they’re not pregnant after three to four cycles, then at that point, we usually start to look at things like, are her fallopian tubes open? We’ll do a hysterosalpingogram to make sure the tubes are open. How do her ovaries look? Is there any evidence of like premature menopause or anything like that? So usually for couples who have severe male factor or same-sex female couples, usually we try to help them to conceive with, intrauterine insemination to give them the best chance of having a successful pregnancy.
If that doesn’t work, then we can do further testing and we can move on to other therapies. One of the things we do offer, you know, like, we’ll talk with them about if there’s a factor, like let’s say if one of the gals that’s planning to carry the pregnancy, if she’s had a history of like a ruptured appendix, then we’ll do an HSG before they do the IUI to make sure that the tubes are open before we pursue that. Or if we have a couple that say, look before we invest any money in donors sperm, we wanna make sure those tubes are open and the ovaries are working good. Then we’ll test those before they proceed. But a lot of people like to try before they do any further testing and that’s fine.
Courtney Collen (host):
Now what about male couples?
Dr. Keith Hansen:
Their journey is a little bit more difficult mainly because we have to get an egg. And then we also have to have someone carry the pregnancy. So there’s really two factors involved there.
In the past, the only way we could get eggs would be to have a woman, you know, undergo the same like ovulation test to see if she was ovulating and then do intrauterine insemination with one of, with a person’s sperm that was gonna father the pregnancy. And that was what’s called traditional surrogacy where you would just take, and then she would get pregnant and carry the baby to term.
Nowadays, with in vitro fertilization, most people have turned to donor eggs and a gestational carrier, and they don’t have to be the same person. For donor eggs, in the past, the way we would do it is we would have, the couple would find a donor who’s willing to go through the stimulation. We’d stimulate ovaries, take the eggs out, fertilize it with the sperm, and then put the embryo up inside her uterus or a different, or a gestational carrier’s uterus. It doesn’t have to be the same person.
Nowadays though, they actually have donor banks for eggs, just like they do for sperm. And actually a couple can go online, look up the donor, you know, find a donor that’s consistent with what they want, they pay for it. And of course they ship the eggs up to us. We thaw out the eggs and then we can fertilize them. Or the other option is we can take the sperm and ship it down to them and then they can fertilize it and ship the embryos up here. And there’s different reasons for doing it both ways.
And then once we have the embryo, we can place it into a gestational carrier which is, you know, is a little more complicated mainly because the person has to go through so much when they, you know, we have to see the gestational carrier, do a history, physical examination, testing based on what’s going on. And then we have to, you know, prepare her uterus and put the embryo back up inside her uterus.
There is, you know, testing that’s required also, you know, for both people who use donor sperm and people who use donor eggs. And it’s the same. I mean, they have to go through, you know, a battery of tests to make sure that there’s no potential infectious diseases that could be spread. We usually require the American Society of Reproductive Medicine has come out with guidelines, like for gestational cures, they have to go through extensive screening with psychological consultation. You always want to check with your insurance company and make sure they cover pregnancies that conceive from that method.
Courtney Collen (host):
Are there any additional support services that the clinic offers alongside the fertility treatment? Be it, you know, emotional support, financial support to … kind of talk through some of that.
Dr. Keith Hansen:
That’s a great question. We do. We offer pretty much the same services to all of our couples. I mean, we do suggest, you know, a counselor. They can be very beneficial and help with some of the stressful situations because a lot of time it’s kind of like being on a roller coaster, you know. First of all, the hormones go up you know, and then they come crashing down and that can be kind of like a roller coaster of emotions. On top of those of the hormones, acupuncture has been trying to improve blood flow of the uterus. And I don’t know why, but a lot of gals tell me it’s very, very relaxing, even though, you know, they’re sticking needles in you. So I don’t know how that’d be relaxing, but they swear to God it is. And then it also, one of the kind of sad things is a lot of times insurance does not cover infertility. And so, you know, it is a lot of it is up front, which is, you know, I wish we could get more support for it and stuff, because we’re just trying to help them have a baby.
Courtney Collen (host):
If a patient or a couple listening, doesn’t live near a Sanford Health fertility clinic like this one with our reproductive endocrinologists, where do you suggest they begin? If they’re looking to grow their family?
Dr. Keith Hansen:
Well, that does make it difficult, especially in you know, a rural area where people can be a long distance away from a clinic that actually offers these services. And so a lot of times, you know, nowadays with telemedicine, we can actually connect with people over a long distance. We can do a lot of the discussion and work out a lot of the details and then really have minimized the number of times they have to travel to like Sioux Falls or to Fargo. Yeah. Or one of the other facilities where they do this and then have them come in and do the actual procedures here because we really don’t have the option of doing it in other places, but we can reduce the number of times they have to travel nowadays and try to minimize it and maximize their chances of getting pregnant.
Courtney Collen (host):
That’s always a win.
Dr. Keith Hansen:
It is.
Courtney Collen (host):
If couples listening are shopping around for fertility clinics, what would you want them to know about the care experience that they can expect here at Sanford?
Dr. Keith Hansen:
One of the nice things about Sanford is we do offer our care to really, to any couple that wants to expand their family or have their first baby. And we try really hard to offer compassionate care to these couples to hopefully achieve their dream, which is to not sleep well for at least two years.
Courtney Collen (host):
<Laugh> More than that.
Dr. Keith Hansen:
Yeah. It’s actually, I’d say 18 years, but it even goes beyond that, believe it or not. Well, we are here to help couples to conceive and achieve their dream. And we have, you know, a really dedicated staff from the front office all the way, you know, through to our nursing staff, the doctors, everybody is dedicated to trying to help couples achieve their dreams of having a successful, healthy baby and a healthy mom.
Courtney Collen (host):
Or dad.
Dr. Keith Hansen:
Or dads. Yeah. Moms or dads at the conclusion of their visits and, help them achieve that. The other thing is, is both Dr. Von Wald and I are board certified in reproductive endocrinology and continue to maintain certification. We try to stay up on all the newest and latest technology to try to achieve the best outcomes for our patients.
It’s a long, complicated journey, but you know, it’s a very – for us, it’s a very rewarding experience. And for the couples, it helps, you know, to really, to achieve their dreams of having a lot, you know, having more children and increase or having their first child. And it’s very rewarding in terms of that. And we try very hard to be compassionate and try to help them to achieve that dream you know, as fast as we can, of course it takes a while, but we try, you know, we’re very open to all those couples and try to help them through this many times complex and highly technological process that in the past was not highly technological at all and you know, sometimes there can be little bumps in the road or sometimes big mountains in the road, but we can hopefully help them to get around those, those mountains and achieve their dream.
Courtney Collen (host):
Yeah. Well, appreciate all that you do to help in that process to be a part of couple’s journey from the beginning, guiding them through the process and then ultimately helping them hopefully welcome a new baby. What is that like for you?
Dr. Keith Hansen:
Oh, it’s, it’s really rewarding to be able to help couples to achieve their ultimate dream of having a baby. And just so they don’t bring ’em back. There’s, there’s no returns, you know, especially if you have more than one, <laugh> no return, especially when they get to be teenagers.
Courtney Collen (host):
No returns. For sure.
Dr. Keith Hansen:
Yeah. None. <laugh>
Courtney Collen (host):
Well, Dr. Hanson, thank you so much for your expertise. When we talk about couples going through fertility treatments and hopefully having a baby appreciate all of your time and thank you for all that you do.
Dr. Keith Hansen:
Oh, you’re welcome. Thank you so much, Courtney. It’s great to chat with you and hopefully we can help more couples out there to achieve their dream.
Courtney Collen (host):
This was another episode of the “Health and Wellness” podcast by Sanford Health. I’m Courtney Collen. Thanks for being here. We’ll see you soon.
Learn more about this topic
- LGBTQ+ patients can find high-quality care at Sanford Health
- When to refer to fertility, reproductive specialists
- What’s it like to go through fertility treatments?
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Posted In Gynecology, Here for all. Here for good., Inclusion at Sanford, Pregnancy, Sioux Falls, Women's
