Fertility treatment pathways for queer women over 40

In the LGBTQ+ community, many opt to wait until their relationships, finances and careers are stable to begin having children — often due to the higher cost of building their families. When that time comes, many queer women are in their late 30s or early 40s, leading to an increased need for more advanced fertility treatments (such as IVF) to successfully conceive. 

As a reproductive endocrinologist who has helped LGBTQ+ families grow for over two decades, my goal is to educate and empower each hopeful parent so they have the best possible chances of success.

Here’s what you should know about family building as a queer woman over 40.

Planning for Pregnancy Over 40

When you’re dreaming of having a baby and your “biological clock” is ticking, it’s tempting to want to dive right into fertility treatment as quickly as possible. However, there are a few steps you should take before attempting pregnancy to optimize your health. Doing so will not only improve your own wellbeing, but also increase your chances of success with fertility treatment and lead to a healthier pregnancy and baby. 

Here are six important areas to focus on before trying to conceive:

1. Lifestyle Changes: Limit alcohol, quit smoking, get the flu vaccine, limit exposure to environmental risks, be physically active with low-impact activities and consider your BMI. While everyone is different and there is no set “ideal weight” for conception, being underweight (BMI < 19, or overweight, BMI >30) can sometimes throw off hormones that impact menstrual cycles and ovulation.
2. Optimize Your Nutrition: Establish a healthy diet (whole grains, fruits, vegetables, lean proteins, heart-healthy fats), avoid processed foods, fish with high mercury levels and unpasteurized cheeses, limit caffeine to two 8oz cups of coffee per day and take a prenatal vitamin to help optimize your nutrition prior to conceiving.
3. Focus On Mental Health: Incorporate stress management and relaxation techniques like yoga or meditation, consider attending LGBTQ+ support groups or talking to a trained mental health professional to ensure you have proper support throughout your journey.
4. Financial Planning: Reach out to your insurance provider (and HR department) to check your coverage for fertility testing, procedures and various fertility treatment pathways. This can often be an especially challenging step for LGBTQ+ individuals, due to archaic definitions of “infertility” and restrictive insurance requirements – so start your research now.
5. Create a Support System: If you already have a solid group of local friends and family ready to support you on your family-building journey, great! If you feel a bit isolated or alone in this experience, don’t be afraid to reach out to loved ones for a listening ear, let them know of your plans (if you’re comfortable doing so), and ask for their support along the way.
6. Get Started: Schedule a preconception visit with your OB/GYN and be up to date on pap smear and mammogram, then contact an LGBTQ+ inclusive fertility clinic to undergo fertility testing and rule out any unexpected roadblocks to conception. 

Fertility Treatment Pathways for Queer Moms-to-Be

Depending on your age, personal medical history and the findings of your baseline fertility assessment, your reproductive endocrinologist may suggest one of the following treatment methods to optimize your chances of success. 

Here are the main fertility treatment pathways available to queer women:

Intrauterine Insemination (IUI)

This method involves a simple, minimally-invasive procedure where sperm is placed directly into the uterus with a thin, flexible catheter. For this process, frozen donor sperm is usually shipped to your physician, and is thawed the day of insemination. Fertility medications are often used prior to your IUI procedure to encourage the development of multiple mature follicles (eggs). 

IUI has an average success rate of 9.8% per insemination for women aged 40-42.

In Vitro Fertilization (IVF)

In vitro fertilization (IVF) is a process that involves stimulating the ovaries to develop multiple eggs, an egg retrieval procedure, and then fertilizing those eggs with donor sperm in the laboratory to create embryos. Those embryos are closely monitored in the lab as they develop, and then a few days later, are either transferred into the uterus to hopefully establish a pregnancy, or cryopreserved (frozen) for future use.

IVF success rates vary by fertility clinic and age, but at our practice, the average IVF success rates* are 51.9% for patients 38-40, 22.2% for patients 40-42, and 11.4% for patients over 42. As you can see, there is a sharp decline in your chances of success as you continue to age.

*These 2019 statistics refer to live birth rates for new patients using their own eggs at Illume Fertility, according to SART.org

Reciprocal IVF

Reciprocal IVF is a process that allows both partners in a same-sex female relationship to participate biologically in the pregnancy. One partner takes fertility medications and goes through the egg retrieval process, then has their eggs combined with designated donor sperm in the IVF laboratory. Once embryos have developed, a fertility specialist completes an embryo transfer into the uterus of the other partner, who carries the pregnancy and delivers the baby.

INVOcell (IVC)

This innovative treatment method allows both partners (if assigned female at birth) to be intimately involved in the creation and carrying process. INVOcell uses an intravaginal culture (IVC) system consisting of a small rectangular clear plastic container with a soft silicone retention cap. The first step of INVOcell is similar to a traditional IVF cycle, with one partner taking medication to stimulate their ovaries to produce eggs, and then having an egg retrieval. 

After egg retrieval, Partner A’s eggs are placed into the INVOcell culture device with donor sperm. The device is then placed into the vagina, and protected by the soft retention cap. Eggs and sperm then grow in a nutrient-rich culture media inside the INVOcell device, incubated by body heat – an amazing way to be connected to the early stages of embryo development. 

Five days later, the partner carrying the INVOcell device has it removed, and any resulting embryos are assessed in the lab. One embryo is then selected and transferred into the uterus of the partner who wants to carry the pregnancy and deliver the baby. 

Known vs Anonymous Sperm Donors

With the rise of publically-accessible services like 23&Me, the concept of using an “anonymous” sperm donor is all but obsolete. The term “de-identified” sperm donor is now being used more frequently to describe a donor who chooses not to have their identity shared, but may still be able to locate in the future. 

It is important to speak with a counselor who is well-versed in LGBTQ+ family building and donor conception in order to fully understand the implications of your choice. 

Understanding Your Odds

With today’s advanced technology, we are able to help hopeful parents be more successful than ever. We have thorough fertility testing, expansive treatment options, and hyper-focused experts in place to make sure that we give every patient the highest chance of success. 

That being said, it is essential to understand the facts about fertility before embarking on a family-building journey as a queer woman over 40. While today’s fertility treatment methods are extremely effective, the age of the egg at conception is one of the most important predictors of success. Fertility treatment cannot overcome poor egg quality or diminished ovarian reserve (two common challenges for women over 35). 

However, if you find you are affected by either of these issues, there are ways around them, such as using donor eggs or donor embryos. Using donor eggs or embryos is not typically covered by insurance, so it’s a good idea to ask your fertility clinic team early on about any available financial plans or payment options, should you need to utilize these options. 

Alternatively, if you cryopreserved your own eggs when you were younger, those eggs will remain the “age” you were when you froze them (i.e. if you froze your eggs at age 30, your eggs will still be the quality they were at age 30 when you thaw them for use over 40). 

Why does age matter?

Women are born with a finite number of eggs, and that supply runs out at menopause. Well before menopause, age begins to impact fertility, statistically seen starting in your mid-30s. 

Being less than 35 years old puts a woman in the best prognosis category, and there is a slow decline in success rates from that point. This is due not only to a decline in the quantity of eggs, but also quality. As women age, the ratio of “good” to “bad” eggs decreases, meaning higher rates of negative outcomes, miscarriages, and aneuploidy (having too many or too few chromosomes). 

Explore Your Options & Stay Hopeful

The desire to grow a family and experience pregnancy is strong for many queer women, and the hope of that dream coming true does not automatically disappear after age 40. While your chances of success do decrease as you age, you still have options.

Find an LGBTQ+ inclusive fertility clinic with excellent success rates and experience working with patients over 40, reach out to set up an initial consultation, and ask them to lay out the best options for your personal situation. Help is available – with expert guidance and prompt treatment, becoming a mother in your 40s remains a very real possibility.