I have been treating infertile couples for more than 30 years and have had the great privilege of participating in the genesis of in vitro fertilization in the US, virtually from its inception. During that time, I and my associates have helped hundreds of committed same sex couples go from infertility to family. With very few exceptions, the medical challenges faced by such couples, and the family relationships that emerged and evolved following the births of children have hardly differed from those experienced by other couples undergoing the same treatment. Many of these babies are now fully grown, thus providing me with a real life opportunity to observe some of them as they have confronted life’s challenges. Based on this experience, it is my opinion that the fact that they were born to same sex couples did not disadvantage any of them.

Furthermore, the commitment made by these same sex parents to one another and to the raising of their offspring seems to me to have been no different than in the case of heterosexual parents. I have concluded that in spite of the enormous pressures imposed on same sex couples by an often bigoted society, they recognize their responsibility to maintain a cohesive relationship for the well being of their offspring.

Let’s face it, while there are indeed many enlightened people who are willing to embrace same sex families, there is a segment of our society that is so caught up in confusion caused by entrenched religious and moral ideologies that they are not ready for this. Granted, the preservation of stable, monogamous relationships in same sex couples is subject to more pressure and scrutiny. Yet, once cemented by a profound decision to have a child together, the chance of them falling apart appears to be no greater than for other partnerships.

Massachusetts was the first state to legalize same sex marriage. A few other states followed and it is probable that there will be more in the future. This having been said, it is highly unlikely that same sex marriage will be legalized throughout the United States in the foreseeable future. But then again, marriage does not always provide a blueprint for enduring love and commitment. Nor is it essential prerequisite for having a family. In fact, nowadays many couples are choosing to have children without first tying the legal knot. Some do so for financial reasons while others simply don’t see the need for a legal contract to confirm their commitments to one another. Regardless of marital status or sexual preference, willfully creating a family together represents a profound expression of mutual love and commitment.

There are many options available to same sex couples seeking parenthood.

For female couples: In the case of female couples, the simplest approach is to undergo artificial insemination (IUI) with donor sperm. However, in some cases the matter is complicated by the existence of infertility that cannot be adequately addressed through IUI with donor sperm…thus necessitating in vitro fertilization. Regardless of the approach to treatment, stringent FDA guidelines require that all sperm donors – whether anonymous, known, recruited from a licensed sperm bank or selected independently – be tested for potentially transmittable viral infections (e.g. HIV) at the time of producing the specimen, and that the sperm then be frozen/stored for several months, at which time the sperm provider be retested before using it for IUI or IVF.

In some cases, both female partners may wish to share in the biological contribution to a pregnancy. In such cases one partner will produce the eggs necessary to be fertilized with donor sperm and the embryos will be transferred to the prepared uterus of the other partner.

For male couples: Here, the available choices are IUI or IVF using an egg donor and a surrogate. As with the use of donor sperm, the sperm provider needs to be tested for a variety of factors such as certain viral infections (including HIV). In addition, the specimen must be held in quarantine for several months before being used. Ever since the Baby M case more than 2 decades ago (where a gestational carrier, who conceived after being inseminated with the sperm of the intended male partner, sued for custody and won), we have strongly advocated against this “traditional surrogacy” approach where the carrier is also the egg provider. In fact, at SIRM we confine the use of surrogacy to situations where the carrier has no genetic link to the offspring (gestational surrogacy). This mandates the use of in vitro fertilization rather than IUI.

In summary, aside from the effects of social and political pressures, same sex couples experience similar concerns to those that occur in any other relationship. They wonder what the future holds and whether they will be able to fulfill their desire to have children and accomplish the dream of building a family. While at times this may all seem quite overwhelming, in today’s age it is easier than ever for them to experience the joy of parenthood. There is no evidence that there is any harm to anybody from same sex couples having a child. Children need to be brought up in a loving, caring environment and it is the loving care that is most important, not the sexuality of the parent.