Abstract
For same-sex female (SSF) couples, assisted reproductive technology (ART) is prevalent as a means to family building. These couples may face significant burdens in finding insurance coverage for ART, choosing a sperm donor, and taking on the second parent adoption process in many states. Previous reports have compared pregnancy success rates using intrauterine insemination (IUI) between the general infertility population and members of same-sex female couples and have shown up to 67% cumulative pregnancy rates over 12 cycles.1 Of all evolving assisted reproductive technology, in vitro fertilization (IVF) provides the best overall chance of pregnancy. Additionally, IVF lends the unique opportunity for both members of a SSF couple to have involvement in treatment as either oocyte source or recipient. In order to best treat same-sex female couples, a population-specific criteria for prognosis should be established for IVF. The success of SSF in IVF treatment compared to the general infertility population is not yet established. We sought to determine if there exists a difference in IVF pregnancy rates between members of SSF couples and the general heterosexual infertility population. Retrospective chart review at a private infertility center. All IVF treatment cycles performed on patients in SSF relationships from 2016 to 2018 were analyzed. Both fresh and frozen transfers were identified, and we divided the data set into 2 groups, for female patients in same-sex and heterosexual couples. A binomial test was used to analyze the data using SPSS 21.0 (SPSS Inc., Chicago, IL, USA). A total of 205 treatment cycles were identified: 51 transfer cycles (42 frozen and 9 fresh) for SSF and 154 treatment cycles for heterosexual population (115 frozen and 39 fresh). Baseline characteristics between the SSF group and control group were the same, with a mean age in the SSF couples of 35.9 years old compared to 37.5 in the heterosexual group (p > 0.05). We found that the clinical pregnancy rate in the SSF population was significantly lower than the heterosexual patient population (39.2% vs. 55.8%, p = .025). Our analysis shows that patients in same-sex female relationships do not show a higher pregnancy rate with ART than the general infertility population. Given that this population showed a higher pregnancy rate with IUI than the general infertility population, we had expected a higher pregnancy rate with IVF as well. This data can be utilized to establish clinical guidelines in managing patient expectations about the outcomes of their treatment. Treating physicians need to look at SSF couples trying for pregnancy with ART with a very open mind when it comes to exploring all possibilities for care and exercise caution to not assume better pregnancy outcomes with IVF among this population. ART has the power to redefine modern family-building; a realistic view of all reproductive options can empower same-sex female couples to make the best treatment choices possible.
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