Episode Transcript
Courtney Collen (host):
Hi there. Welcome to ourHealth and Wellnesspodcast 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 Hansenat theSanford Fertility and Reproductive Medicine Clinicin 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:
基本上，他们和其他有类似问题的人有相同的障碍，但他们也有一些独特的障碍，在试图帮助一对想要孩子的夫妇方面，不管他们的性别认同是谁或什么，我们试图帮助他们的因素有很多。你知道，首先，我们总是评估一对夫妇，试图确定，你知道，确保没有潜在的疾病可能使怀孕或使婴儿问题复杂化，并试图在他们怀孕前解决这些问题。所以我们一直在做的一件事是我们想要确保夫妇，也就是将要怀孕的人，服用含有叶酸的维生素，因为这样可以将神经管缺陷的风险降低70%到90%。我们还想确保他们的甲状腺功能正常。然后我们检查可能对怀孕有影响的实验室，这是非常重要的，可以降低怀孕的风险，希望帮助她们怀孕，自然怀孕。我们也想做一个深入的研究，你知道，历史，查看他们过去的病史，手术史，查看他们的家族史来确定他们是否有遗传给婴儿的任何遗传疾病的风险?
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:
对于没有男性的同性伴侣，女性伴侣，他们必须使用捐献的精子，或者可能的捐献胚胎，但通常这是捐献精子的一个因素你必须去一个冷冻库，全国有很多冷冻库。在过去，我们有成堆成堆的书人们需要阅读这些书是针对那些患有严重男性不育的夫妇的。我们要做的是，他们会翻阅这些书，找到一个符合他们要求的捐赠者，选择捐赠者，然后把精子运到这里。现在都在网上了。所以他们实际上可以上网，查找他们想要选择的捐赠者，选择，然后选择那个捐赠者，将冷冻保存的精子送到这里，我们可以将其冷冻保存，然后当准备使用时，我们可以进行宫内受精，希望这是他们能够怀孕的方式。
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.
当夫妇上网时，他们可以找到这个人的信息，然后决定，你知道，如果他们能找到的唯一的捐赠者是一个携带囊性纤维化的男性，那么我们可以回去，确保我们对提供卵子的人，也就是妻子进行筛选，或者我们可以对她进行筛选，以确定她是否携带相同的基因突变?如果她这样做了，那么我们就必须坐下来谈谈他们的选择，包括体外受精，对胚胎进行活组织检查，确保它是正常的，然后再把它放回去。
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 thepregnancy. 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):
如果一个病人或一对夫妇没有住在桑福德健康生育诊所附近就像这个有生殖内分泌专家的诊所，你建议他们从哪里开始?2022世界杯巴西阵容如果他们想要扩大家庭呢?
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):
大笑>不止这些。
Dr. Keith Hansen:
是的。实际上，我想说有18年了，但信不信由你，它甚至超过了18年。我们来这里是为了帮助夫妻们怀孕和实现他们的梦想。我们有一个非常敬业的员工，从前台一直到我们的护理人员，医生，每个人都致力于帮助夫妇实现他们的梦想，有一个成功的，健康的宝宝和一个健康的妈妈。
Courtney Collen (host):
或爸爸。
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):
是的。感谢你在这一过程中所做的一切，从一开始就成为夫妻旅程的一部分，引导他们度过这一过程，并最终帮助他们迎接新宝宝。那对你来说是什么感觉?
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,
Courtney Collen (host):
No returns. For sure.
Dr. Keith Hansen:
是的。一个也没有。
Courtney Collen (host):
汉森医生，非常感谢你的专业意见。当我们谈到夫妇们正在接受生育治疗并希望有一个孩子时感谢你们所有的时间，感谢你们所做的一切。
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):
这是Sanford health健康播客的另一集。2022世界杯巴西阵容我考特尼Collen。谢谢你的到来。我们很快就会再见。
Learn more:
…
Posted InGynecology,Inclusion at Sanford,Pregnancy,Sioux Falls,Women's
