What Fertility Options are Out There for LGBTQ Families?

LGBTQ fertility options

When you identify as LGBTQ, you know from the get-go that babymaking is probably going to be just a little bit more complicated for you than it was for your cousin Mackenzie and her boyfriend.

So what do you do?

First a little good news: An increasing number of fertility clinics in the United States are throwing open their doors to make sure members of the LGBTQ community can live their dreams of becoming parents. No matter your sexual orientation or gender identity, there are options open for you in the fertility world.

I identify as a…

Lesbian

Pregnancy comes down to two things: An egg and sperm. Once these come together, ideally, they make an embryo, which grows into a baby, and you know where this is going.

Sperm donation

You can ask a friend or family member, or you can opt for donor sperm purchased from a sperm bank.

Intrauterine insemination (IUI)

Once you’ve got your sperm lined up, an OB/GYN or reproductive endocrinologist can insert it directly into the uterus in a process known as IUI. Hopefully (fingers crossed!) the sperm will do its job and fertilize the egg on its own.

In vitro fertilization (IVF)

This process takes some of the “hopefully” out of the fertilization equation. A reproductive endocrinologist will collect your eggs and send them to the lab. Once they get there, a specialist called an embryologist will take your donor sperm and use it to fertilize the egg(s), creating embryos. One or more of those embryos will then be transferred into the uterus, where the hope is they’ll implant and you’ll become pregnant.

Gestational surrogacy/reciprocal IVF

Typically, when a woman carries a baby created with an egg that isn’t biologically hers, it’s called gestational surrogacy. If you’re opting to carry a baby created with your partner’s egg, that’s called reciprocal IVF. This option is growing in popularity, Diaz says, as it offers each mom an added connection to their baby.

Sometimes, couples even opt to undergo IVF together, each carrying the embryo created with the other’s egg—so they can both enjoy the process of pregnancy and bringing their partner’s biological child into the world.

Gay man

You already know you’ve got the sperm part of the baby-making equation. Now you just need two things: An egg…and someone to carry the baby through nine months of pregnancy to make your dreams come true.

Egg donation

Just like sperm donation, eggs can be procured from a “known” donor such as a friend or family member. They can also be purchased from an egg bank or via a donor agency.

Surrogacy via IUI

Friend? Family member? Stranger? Any one of these folks could potentially carry a baby created with their own egg and your sperm inserted into the uterus via IUI. Known as traditional surrogacy, this process is only legal in some states, which limits its usefulness for many couples. It also means your surrogate will have a biological connection to baby—which can get complicated and that relationship should be worked out ahead of time.

As for which male partner will have a biological connection, even though both partners can provide sperm samples for insertion during IUI, there are no guarantees, Dr. Diaz says. “The strongest sperm usually prevails,” he notes.

Gestational surrogacy via IVF

As with lesbian couples, this option means no biology tying the pregnant woman to the baby. It requires a donor egg from yet another female, but it’s legal in more states than traditional surrogacy (although still not all).

As for which partner has the biological link to baby, only one sperm can technically fertilize the donor egg. That said, IVF does allow for two embryos to be transferred—one fertilized by one partner’s sperm and the other fertilized by the second partner’s sperm. If both transferred embryos implant, each partner will have a biological link to one of their twins.

Transgender man or woman

If you’re transgender and thinking about having a baby, the path for you is a matter of personal preference and how far along you are in your transition, Dr. Diaz explains.

“If hormonal therapy has already been started, the hormones can be temporarily discontinued,” he says, “inducing the genitals to resume production of sperm or eggs respectively within 2 or 3 months.”

That could mean a biological tie to baby for either a transgender man or a transgender woman. As for carrying the baby, if the uterus has not been removed, that can be an option for someone assigned female at birth, although it requires remaining off of hormones for the entirety of the pregnancy.

If you’re early on in your transgender transition but plan on having kids down the line, Dr. Diaz recommends freezing your sperm or eggs before proceeding with transition to ensure you have a supply when you’re ready for a baby. The frozen gametes can be used later on via IUI or IVF.

Bottom line

Families look different, and they’re made differently too. So call that fertility clinic. They can help you find the right way to make your family grow.

Jeanne Sager

Jeanne Sager is a writer and photographer from upstate New York. She's strung words together for The New York Times, The Atlantic, The Washington Post, and more.

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