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LGBTQ Family Building

Quick look at LGBTQ family building

Many lesbian, gay, bisexual, transgender and questioning or queer (LGBTQ) individuals need treatment from fertility specialists to become parents. However, they often worry that they will be judged or discriminated against because of their orientation.

At Positive Steps Fertility, we care for people of all races, ethnicities, religious beliefs and orientations, as all people deserve dignity and respect. Moreover, the modern family has meaningfully evolved, and we believe people should have the freedom to make their own parenting decisions without interference from others.

Beyond equal care, another issue LGBTQ individuals and couples face is that they often don’t have infertility, and simply face circumstances or have partners where conception is impossible. Evaluation before treatment is still important because one doesn’t want to be overly assertive if fertility is normal (a thorough fertility work-up helps eliminate certain situations like the increased risk of conceiving twins, which can occur more frequently with in vitro fertilization and cause a higher risk pregnancy). However, we’ve also seen many couples who’ve tried to achieve pregnancy on their own, such as with home inseminations, without infertility testing and wasted money, time and energy due to conditions that could have been fixed easily if identified through evaluation in advance.

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LGBTQ fertility treatment options overview

We typically start with a consultation to get to know you and your personal goals. This is where we identify key health considerations that may affect the ability to become or remain pregnant, address who may be best suited for a particular role with pregnancy, and create a roadmap for testing (male and female) as well as treatment. Some of the most common combinations of treatments and situations we see LGBTQ people exploring include the following.

Donor insemination: For lesbians wanting to conceive.

IVF: For lesbian couples where one donates eggs and the other carries the pregnancy so each is contributing to conception in her own way. Also used by gay males (see below).

Donor egg and gestational carrier: For gay male couples wanting to conceive using the sperm of one, or both, partners in IVF. Of note, while many refer to a gestational carrying a pregnancy as surrogacy, there are some notable technical and genetic differences with important legal implications.

Sperm, egg or embryo banking: For transgender patients undergoing gender reassignment surgery wishing to preserve fertility options with their own DNA.

Options for lesbians

Lesbian individuals and couples have several treatment options available to help them to grow their families. When initially meeting to discuss goals, several issues are often addressed. These include the following.

  • Deciding who wants to carry the pregnancy.
  • Deciding who may have the best chances of becoming pregnant.
  • Deciding who is most likely to have the healthiest pregnancy.
  • Discussing sources of sperm.
    • Best value sperm banks.
    • What type of sperm to order.
    • Why intrauterine insemination (IUI) is typically more cost-effective than vaginal insemination.
    • What to look for in a donor.
    • Advantages and disadvantages in using a known donor.
  • Discussing when one partner should donate eggs and the other carry a pregnancy.
  • Balancing safety and success in conceiving.
  • Potential legal considerations. Of note, we are not lawyers, so we do not claim to be experts on the law, but we can draw attention to issues that may warrant further exploration.

Options for gay men

Same sex male couples, like same sex lesbian couples, often require third-party assistance in the form of an egg donor and gestational carrier surrogate.

The egg donor can be anonymous, a friend or a family member. In cases where both partners wish to be genetically related to the child, one man can ask one of his female family members to act as the egg donor while the other partner would provide sperm. The resulting child would have the genes of the man supplying the sperm and of the male whose female relative donated the eggs.

Gay couples must often decide which man will contribute sperm. After that has been determined, we will conduct a semen analysis to make sure there are no issues with sperm quality. Some gay couples want to mix both of their sperm together so they don’t know whose DNA fertilized the egg. Though this is possible, this can result in custody issues, so many couples initially wanting to go down this road later change their minds.

Classically, gay couples would use a surrogate, who undergoes artificial insemination, resulting in both her eggs being fertilized and her carrying the pregnancy. This pregnancy results in a child that is genetically related to the surrogate and to the male who contributed the sperm. Today this approach is frequently discouraged because of associated legal issues, where the intended parents may not end up with the rights or custody that they thought they would.

If a gay male couple is using both an egg donor and a separate gestational carrier, the selected donor’s eggs will be extracted and fertilized with the sperm of the partner decided upon for use. One, possibly two, of the resulting embryos would be placed in the uterus of the gestational carrier selected to carry the pregnancy, and any remaining embryos can be cryopreserved for later use, donated to another couple in need or donated for research.

Though reproductive rights can be complex, classically the combination of an egg donor with a gestational carrier has better custody implications for intended gay parents. We can connect patients with an attorney specialized in these issues.

Read more about surrogacy

Fertility treatments for bisexual and transgender couples & individuals

If a bisexual couple consists of two men or two women, their treatment options mirror those available to gay male or lesbian couples. Bisexual couples likely will not require assisted reproductive treatments unless one or both partners are experiencing infertility.

Options for transgender couples & individuals

Transgender couples and individuals may need to use an egg, sperm or embryo donor, a traditional surrogate or a gestational carrier in order to expand their families. The course of treatment is dependent on the anatomical makeup, whether sex reassignment surgery has been completed, and the desires of the individuals.

For example, in couples that consist of two transgender women, or a transgender woman and male, third-party reproductive assistance in the form of an egg donor and/or surrogate will be necessary.

Similarly, couples that consist of two transgender men, or a transgender man and a female, will need the assistance of a sperm donor. If the transgender male so desires and is physically able, he could carry the pregnancy.

Reassignment treatments and surgery can pose significant challenges to couples and individuals looking to have biologically related children. Reassignment is the process of altering one’s physical appearance so that it matches the identified gender. These procedures can involve the removal or alteration of reproductive organs and accompanying hormone therapies can diminish fertility.

Fertility preservation can assist couples and individuals to have biologically related children later in life with the help of assisted reproductive technology. For example, if a male surgically transitioning to a female were to freeze his sperm prior to the procedure, with the help of advanced reproductive technologies he would be able to have biologically related children after transitioning.

Additional considerations for LGBTQ couples & individuals

Infertility isn’t easy, and though LGBTQ people often have additional challenges, helping you become a parent is what we do, regardless of the hurdles faced. Medical, emotional, social, financial and legal challenges are normal for infertility (and all of medicine). So even if a concept or issue seems foreign to you, it can be very normal to us.

That’s the most important message with all of this: don’t suffer through things alone, as we can help, and there are more solutions and hope than you may realize!