Focus on Providers: The San Francisco Team at Pacific Fertility

Pacific Fertility Center in San Francisco serves a market with a significantly queer presence, as same-sex couples, would-be single parents, and others come to the center's team for guidance and know-how around IVF, IUI, and surrogacy.

PFC is one of more than 90 clinics belonging to The Prelude Network, the largest and fastest-growing fertility network in North America. It's a point of pride for The Prelude Network that they actively embrace and uplift families of all sorts, including the rich and varied array of queer families that turn to them for help in making their dreams of parenthood come true.

IVF – in vitro fertilization – involves bringing sperm and eggs together under laboratory conditions to create embryos. Typically, one embryo is implanted in the womb of the gestational carrier, whether that might be someone looking to be a single parent, a member of a queer couple, or a surrogate carrying a child for somebody else. Additional embryos can be frozen and saved for future pregnancies.

IUI – intrauterine insemination – involves introducing sperm to an egg inside the womb of someone with two X chromosomes, whether that is the intended parent or a gestational carrier. This relatively simple procedure involves placing a prepared sperm sample inside the uterus via a thin catheter at the right time, increasing the chances of conception.

Whichever route a queer couple hoping to build their family might choose, a third party is likely to be involved. A "third party" in this context is anyone from outside the couple – or besides the prospective single parent – who contributes one of the three essential biological contributions to a pregnancy.

"What we do is really simple," Dr. Isabelle Ryan, one of PFC's doctors, explains. "We need eggs, sperm, and uterus. How these things get combined can either be sort of a traditional approach or can be very creative."

As simple or elaborate the creativity around a hopeful couple's journey to parenthood might be, the accompanying process of educating and guiding patients can be complex, and PFC's team of experts provide individualized, detail-oriented attention to each family's needs.

"We have about 100 staff members, and we have numerous facilities here on site because of the complexity of the work that we do," Dr. Ryan details. "We have the clinical team, meaning the physicians, the nurse practitioners, the medical assistants, the nurses. The clinical team makes clinical assessments, guides decision making, and executes clinical plans."

"We have the lab, obviously, because most of what we do is IVF, and so we have a very specialized trained staff in the lab," Dr. Ryan adds. "And because of the nature of what we do, we are open seven days a week" in order to be available to patients throughout every step of the process.

"For us in San Francisco, this is not new," third party coordinator Daragh Castaneda says of working with queer families. "We are set up to be able to receive patients of all family building types. That starts with forms: just making the forms not confusing. Our physicians are very comfortable with different family building options. We have our form setup so that it can facilitate that."

Adds Castaneda: "You don't need to explain what you want to do. We know what you want to do. So that having to explain yourself, and the reasoning why, doesn't exist with us."

Simple as the forms might be for queer families, matching those families with third parties remains a complex undertaking. Before a donor or a surrogate become part of the family-building equation they must first pass a rigorous screening. Meanwhile, the team ensures careful, empathetic communication with patients.

"We'll partner up with patients that are working on getting all of their clinical orders taken care of, their clinical tasks and care," Castaneda explains. "We'll talk about helping them figure out which aid donor to select, and then help them navigate that road."

To illustrate, Castaneda offers the example of one of the creative approaches referenced by Dr. Ryan: a couple who wish to do reciprocal IVF, a process in which one partner serves as the gestational carrier for an embryo created using the other partner's egg.

"The third-party coordinators help them navigate the road ahead," Castaneda says, "telling them what the steps are: 'Okay, now you need to bring in your sperm donor, whether it's a known donor or it's from a sperm bank.'"

But another team member comes into play at this point.

"For anybody that's using donor sperm or a surrogate, we have them meet with our marriage and family therapist," Castaneda explains. "They'll talk about everything that comes along with sperm donation, whether it be known or de-identified gametes" that are used.

For patients who provide their own sperm, "We have our own egg donation program in house," Castaneda notes. Once the patient has selected the egg donor, be it from PFC's in-house program or elsewhere, "then they're back to the clinical team to create those embryos. Then hopefully they will have embryos for transfer, and that's usually done by the clinical team and the physician – so, it comes full circle. It's a lot of people and a lot of steps."

The way the team meshes and coordinates with prospective parents to fulfill their dreams is a major part of the center's attractiveness to queer families, but there are other reasons patients entrust their family building journeys to PFC.

"Having our in-house egg bank is a huge draw for the LGBT community on the single male or male couple side," Dr. Ryan notes. "Our egg bank is very active, also, for patients who are single women, heterosexual couples, or lesbian couples." Dr. Ryan says that even patients with ovaries might need to use eggs from a third party, since IVF has made it possible for patients with a uterus to become parents later in life.

"The bottom line is, 25% of our patients need an egg donor," Dr. Ryan says. "And a lot of that, truthfully, is the demographics of this, of being in San Francisco, both in terms of women waiting until they are older to get pregnant, and, separately, the whole LGBT community."

Along those lines, Dr. Ryan discusses another option made possible by stimulating egg production and then freezing the resulting ova: Gathering eggs while a patient is younger and preserving them for future use, in which case a third party egg donor won't be necessary.

What about the other two factors needed for the creation of an embryo? While PFC doesn't have an in-house sperm donation facility, "there's so many sperm banks out there," Dr. Ryan notes, "and recruiting men and freezing sperm is very well templated."

"And as for gestational carries," Dr. Ryan clarifies, "there's definitely less regulation around gestational carrier agencies, so it's a little bit of a different landscape than, for example, sperm banks that are regulated by the FDA. But we have relationships with gestational carrier agencies out there, and that is how we then provide that service for single men or gay men or women who need a gestational carrier. That is how we then accommodate these other needs, even though we personally do not have an in-house agency."

"We feel very strongly that we want to do our part to get the patient as close to what they need," Dr. Ryan summarizes, "which is an embryo. That is, in a broad scope, who we are and what we do."