Ask the experts: What options exist for LGBT family-building?Publication: Philadelphia Gay News
According to the Williams Institute, about 27 percent of Pennsylvania’s LGBT residents are raising children.
From fostering to fertility treatments, LGBT people have a plethora of avenues available to welcome children into their families; as laws and technology evolve, those options are continuing to become more robust. PGN checked in with agencies that specialize in helping local couples and individuals start families to find out how prospective parents can get started and what they should expect as they set off down the path to parenthood.
Assisted-reproductive fertility treatments
Cisgender women and men using a gestational carrier may seek the assistance of a fertility center.
Among the assisted-reproductive options available to LGBT parents-to-be is intrauterine insemination — a process by which sperm is implanted into a woman’s uterus — using donor sperm, or that of the prospective father for men using a surrogate. In-vitro fertilization involves the extraction of a woman’s eggs, fertilization by the sperm outside the body and subsequent implantation of the embryo into the uterus; this path may be taken by women unable to achieve pregnancy by IUI or as reciprocal IVF — in which one woman’s eggs are extracted, fertilized and placed into her female partner.
Dr. Jacqueline Gutmann of RMA of Philadelphia said approximately 15 percent of the fertility practice’s patients are LGBT-identified.
Gutmann said RMA has recently seen influxes in the number of men seeking services and women choosing reciprocal IVF.
RMA has also worked with an increasing number of trans clients on sperm and egg cryopreservation, to plan for family-building prior to an individual’s physical transition.
Each patient has individualized needs, and fertility plans have to be tailored to those needs, Gutmann said. The path to a successful pregnancy may be a quick one for some patients, or may involve more time and involvement of advanced technology for others.
Gutmann said chief among the challenges facing LGBT couples seeking fertility care is cost.
“Using a gestational surrogate and egg donor can certainly get quite expensive for men,” Gutmann said. “There are also some insurance companies that won’t pay for fertility treatments in single women or a same-sex female couple where they use donor sperm because the company argues infertility benefits can’t kick in until they can document fertility attempts.”
RMA clients meet with the practice’s financial coordinators before treatment begins to explore insurance coverage, treatment packages and discount programs.
“Though there are expenses involved, it might not be as expensive as you may think,” Gutmann said. “The unfortunate thing is the patients I see and care for are only a segment of the population; I fear that those with the greatest misconceptions are people I’ve never had the opportunity to meet. So I’d certainly say education is power. Ultimately, people have to learn what the options are so they can make a decision for themselves.”
Before moving ahead with assisted-reproductive options, the first stop for many women is at the cryobank.
There are a number of national sperm banks, including Fairfax, which has a branch in Philadelphia. Fairfax tests, stores and catalogues sperm samples from donors around the country, from which women, as well as men experiencing fertility issues, can select donors for insemination.
Michelle Ottey, Fairfax lab director, said more than a third of the agency’s clients identify as lesbian, a figure that has evolved in the company’s three decades in business.
“In the mid-1980s, the majority, if not all, of the clients were heterosexual couples dealing with male infertility,” Ottey explained. “In the ’90s, we started to see a shift from serving heterosexuals to what appeared to be single women, though many may have had female partners and not been out. And then into the 2000s, just forget it; [LGBT clientele] skyrocketed. People are building families whether they’re single women or lesbians, and those are the majority of our clientele.”
Fairfax employs a very-rigorous application process for potential sperm donors — only about 1 percent of applicants are accepted into the program. If an applicant makes it past an initial questionnaire with FDA-exclusionary questions, he is then required to submit several generations of medical history on his family, which is screened against two eligibility guidelines.
If he passes that stage, the applicant will be brought into the clinic to submit several samples that will be tested for quality; samples should have above-average sperm counts and motility, as the specimens need to survive the freeze/thaw process. Successful applicants then undergo a physical exam and extensive infectious-disease and genetic testing; if all comes back clear, the applicant is admitted into the program. He must commit to weekly donations for a minimum of six months. Ottey said most donors stay in the program for 13-15 months.
Fairfax usually has a database of about 400 donors at any given time, whose basic profiles are available free of charge on the company’s website. Those looking to buy sperm can sort the donors by a number of filters, such as race, age range, eye and hair color and level of education. A childhood photo is included for almost all donors, along with an audio clip, medical history, written interview and other basic details; some donors also have adult photos available for purchase, along with a fuller audio interview.
Ottey said the process tends to have a different feel, depending on the clients.
“It’s very different for two women who are excited to start their family than if it’s a heterosexual couple where the husband is dealing with mourning his fertility,” she noted. “It tends to be more exciting and positive for same-sex couples, and for single women, too; we’ve gotten feedback from women who said they had all their friends over and sat around with wine and went through the donor list. It’s almost like a dating site.”
Ottey said Fairfax aims to recruit as diverse a donor pool as possible, to give buyers options that suit their needs.
“Having 400-plus people to choose from can be overwhelming, but once you start to narrow down your choice based on your preference it gets a little easier,” she said. “Some people say, ‘I have a Ph.D. and my wife has a master’s and we’re both interested in science so we chose a donor with a similar educational background,’ or ‘I’m Italian and my wife’s Irish so we’re looking for an Irish-Italian donor.’ That helps you whittle down the list.”
About half of the donors are categorized as ID-optional, meaning they are comfortable with a child conceived from their sperm contacting them once they become an adult. Ottey said Fairfax has seen more donors signing up for the ID program in recent years.
“There are more people speaking openly about being donor-conceived and that’s making it a more positive experience overall, where they’re able to better see the benefit of what they’re doing,” Ottey said. “And as we talk more openly about these things in society, it gets a little bit easier because people don’t have to feel like they have to be secretive anymore.”
“The need right now is significant and great. It’s a crisis right now,” Megan Flanagan, a case manager at Turning Points for Children, said about the number of children in need of foster families in the Philadelphia area.
Turning Points for Children works with the city’s Department of Human Services to provide needed services to families in crisis, including placing children in crisis with foster families.
The opioid crisis ravaging the nation has had a marked effect on their work, Flanagan noted.
“The number-one cause [of children entering foster care] is drug abuse, and that often goes hand in hand with untreated mental-health illness,” Flanagan said. “We see a lot of cycles of trauma; a parent never dealt with their own trauma and then get into a cycle of addiction to deal with it, self-medicate and it comes out on their own kids.”
Flanagan said the “epicenter” of the city’s opioid crisis is in Northeast Philadelphia, but noted the agency sees kids being affected throughout the region.
“It’s everywhere, and that’s the number-one thing causing kids to be in care.”
Turning Points works to provide in-home services to families before a foster situation arises, with programs that help with buying food and basic necessities like diapers. When a threat arises and DHS removes children from a family, Turning Points works to have foster families lined up.
“The city will shoot us a referral and then we are serving the family moving forward,” Flanagan said about the process. “We’re hoping to address the parents’ goals of having the child come back home but sometimes that’s not an option and it becomes an adoption situation.”
Turning Points vets and certifies potential foster parents — including in kinship situations, in which a relative or family friend of the child steps up after DHS has removed the child from the parents’ custody. Potential foster parents must pass a series of background screenings, including FBI and child-abuse checks, as well as undergo safety trainings like CPR.
Beyond that, they should have a willingness to work with the children to address trauma they’ve faced in their young lives.
“We’re looking for people committed to a child who is not always an ‘easy’ situation, somebody who will work with the child, treat them like their own,” Flanagan said. “They will be the first person the child goes to in the middle of the night or if they’re having a tantrum relating to something they went through.”
The agency’s foster-care recruiters work with community organizations, churches and nonprofits to raise awareness about the need for foster parents.
Flanagan recalled a case of a lesbian couple in Fishtown who became kinship-certified to care for the children of their upstairs neighbors. The women had already become informal caregivers, as the parents grappled with domestic violence, and formally stepped in for several years until DHS allowed the kids to return home.
Another same-sex couple ultimately adopted three children they’d fostered — who were 4, 3 and six months when they entered their care; the baby had opiates in his system and his sisters had seen their mother using drugs.
“The couple was really committed to working with that trauma,” Flanagan said. “They got the girls into play therapy twice a week, had in-home services for the 4-year-old when she started getting aggressive. They had services around the clock and just completely opened their home to them.”
Most foster parents take in children more than once, Flanagan said.
“Sometimes people take time off in between because it is a loss for them when kids go home. But the whole system runs on these special people who are willing to open their homes to kids in need. Even if it’s just for a short time, you’re giving them a home, love and support. Regardless of the time, you can change a child’s life for the positive.”
The landscape for prospective LGBT adoptive parents has changed drastically in the last two decades, said Open Arms Adoption Network Director Meredith Rose.
“Things have thankfully changed a lot in that last 20 years. Even 10 years ago, I would have said to LGBT families who came to us inquiring about the likelihood they might be chosen by a birth mother to adopt that, in all honesty, only the most sophisticated birth parents may see them as a viable option,” Rose said. “I would absolutely not say that at all now. In the past five years especially, more and more women are asking, at our very first meeting, if we have LGBT families hoping to adopt in our program. That’s a particular interest for them.”
Open Arms Adoption Network is a program of JFCS of Greater Philadelphia, and has offices throughout the region.
The agency works with birth mothers and prospective adoptees to find a match. The organization focuses on “child-centered adoption” and supports open adoption, a process by which adoptive families maintain connections with biological mothers.
Open Arms has facilitated about 250 adoptions. Approximately 20 percent of its adoptive families are LGBT, Rose estimated, noting the organization operates an LGBT support group that meets throughout the year.
Rose noted the value of the children growing up in LGBT-headed adoptive families getting to meet other kids whose paths have been similar to theirs.
“I would say with our agency in particular, people choose us because they’re looking for an adoption community,” she said. “We encourage our incoming hopeful adoptive families who are LGBTQ to come to our educational, supportive and fun events prior to adopting. They can see that it’s rewarding for the families to be a part of a community and most importantly for the children to look around the park or other gathering place and see other families that look like theirs; it’s validating and enriching for the kids and parents to be a part of a community.”
Before a placement, prospective parents are encouraged to attend free informational meetings, at which they can learn about the agency’s practices and philosophies, and the adoption process. The next step is a series of background checks as well as a home study by a social worker, which involves in-home meetings in which the prospective parents share their own backgrounds and goals for the growing family.
The families then put together a booklet of information and photos about themselves, which is shown to birth mothers pursuing adoption. Then, the waiting begins.
“You may get chosen in a couple months, or it could be in a couple years,” Rose said. “It really depends on when that woman who is looking for a family just like yours comes to us.”
LGBT adoptive parents, in particular, may worry about finding the right match.
Rose advised those considering adoption to educate themselves, and to stay positive.
“The best way to get rid of that angst an LGBT family might feel is to take the steps to learn more, check out local adoption agencies; most have free informational meetings where you can learn about their practices and their experiences working with the LGBT community,” Rose said. “I think the biggest misconception is that LGBT families really worry that their dream to become parents may not happen, and that’s absolutely not true.”