As advances in assisted reproductive technology (ART) and fertility preservation treatment open up new pathways to parenthood, more members of the LGBTQ+ community are choosing to have children than ever before, both as couples and individuals. A 2019 survey from Family Equality found that 63% of LGBTQ+ millennials were considering becoming first-time parents or adding to their growing families.
With many possibilities to consider — including different reproductive procedures and donor options — as well as additional legal complexities to account for, thoughtful research is part of the process. The guide below offers a starting point as you explore your options.
Many LGBTQ+ parents have children by using a donor egg or embryo and/or donor sperm.
Donor sperm allows same-sex female couples and individuals with female anatomy to have biological children through intrauterine insemination (IUI) or in vitro fertilization (IVF), reproductive procedures described in more detail below. The donor can be someone you know (known) or found through an agency (anonymous).
Donor eggs allow same-sex male couples and individuals with male anatomy to have biological children through IVF. Like sperm donors, an egg donor can be known or anonymous.
It is also an option to use a donor embryo, which is an egg that has already been fertilized by sperm, as some individuals choose to donate unused embryos from an egg freezing or IVF cycle.
Your family building journey may also include a surrogate or gestational carrier, who carries the pregnancy to term and gives birth. Though these terms are sometimes used interchangeably, there is an important distinction: a surrogate offers both eggs and uterus and often plays a role in IUI whereas a gestational carrier has the embryo implanted into her uterus but is not genetically related to the child.
If you are using a surrogate or gestational carrier, think about the type of relationship you’d like to have with them. Some couples become very close with their surrogates while others value more distance. The most important thing is to honor your needs.
Additionally, as part of your planning, determine which aspects of your surrogate or gestational carrier’s medical care you’ll be financially responsible for.
Reproductive Fertility Treatment
There are two main reproductive procedures to consider: intrauterine insemination (IUI) and in vitro fertilization (IVF).
Intrauterine insemination (IUI) is a simple medical procedure in which sperm is placed directly into the uterus by using a small tube that passes through the cervix. It may be part of the family building journey for both male and female same-sex couples, as well as individuals with female anatomy having a baby on their own. Male same-sex couples pursuing IUI must use a surrogate who will be genetically related to the child.
In the process of in vitro fertilization (IVF), eggs and sperm are fertilized in a laboratory and then placed into the uterus with the potential outcome of a pregnancy. It may include donor sperm, donor eggs, or donor embryos.
When pursuing IUI or IVF as an LGBTQ+ couple, you’ll have to decide which parent will be genetically related to the child. If you intend to have multiple children so that you and your partner can each have a biological connection to them, you’ll want to account for multiple courses of IUI or IVF during your financial planning.
Some LGBTQ+ couples explore reciprocal IVF, or co-maternity, an option for female same-sex couples as well as transgender men with female reproductive organs. In this process, one partner’s egg is implanted into the other partner’s uterus. While only one partner will be genetically related to their child, reciprocal IVF allows both individuals to actively participate in the pregnancy.
Gender affirmation treatment may affect a person’s ability to conceive in the future. Egg and sperm freezing allow transgender and nonbinary individuals to preserve their fertility options and have biological children after treatment or surgery, if they choose to.
Sperm freezing is a relatively simple process in which a sperm sample is collected or surgically retrieved by a doctor. It may be used before estrogen therapy or gender confirmation surgery.
In egg freezing, fertility medications are taken to stimulate egg production. Once the eggs are developed, your doctor will retrieve them from you in a minimally invasive procedure. Your eggs can then be frozen and stored for later use. Depending on how many eggs are yielded, you may have to undergo more than one cycle of egg freezing. This process may be used before testosterone therapy or gender confirmation surgery.
Note that while gender confirmation surgery can permanently affect reproductive function, researchers are still learning about the long-term impact of testosterone and estrogen therapy on fertility. Prolonged testosterone and estrogen use often stop sperm production and ovulation, respectively, but some evidence suggests that these effects may be reversible upon discontinuation of treatment. We encourage you to discuss your reproductive goals and options with your healthcare provider before pursuing gender confirmation treatment, so that you can have as much flexibility in your family building journey as possible.
ART and fertility preservation are often significant financial investments, and determining how to pay for treatment is an important part of planning.
Family Equality Council shares this list of family-building grants that can help make ART more affordable. Your clinic may also offer financial assistance programs and payment plans. At Alto, we have resources to help you understand your fertility benefits, compare the costs of cash pricing, learn about financing, or apply for assistance programs.
If you are exploring the use of a donor or surrogate, it’s critical to research your state’s laws about legal parentage procedures once your baby is born. In some states, a surrogate may automatically receive parental rights after your child’s birth since they are the biological mother, which will have to be legally terminated.
There are more legal complexities to navigate when using a known donor rather than an anonymous one, as an anonymous donor has already surrendered their parental rights.
Explore Movement Advancement Project’s interactive map on parental recognition laws as a starting point. You should also speak with an experienced LGBTQ+ family lawyer in your state before starting the process.
Choose the right fertility pharmacy partner
Alto is here to support your family building journey. We know that there are many paths to parenthood and that each individual or family’s needs are different. Our team of fertility-trained pharmacists has experience working with the LGBTQ+ community, and we’ll be here at every step of the way if you choose to pursue any of the above fertility treatments. We also offer discrete, private packaging and same-day delivery to keep stress at minimum during this special time in your life.