Fertility Planning for LGBTQ+ Families

IUI is one of the most common fertility treatments for same-sex female couples and individuals using donor sperm. During IUI, specially prepared sperm is placed directly into the uterus around ovulation to increase the chances of fertilization.

IUI may be recommended for:

• Lesbian couples using donor sperm
• Single parents by choice
• Transgender patients preserving fertility options
• Patients without significant fertility concerns

IUI is typically less invasive and more affordable than IVF, making it a common first step for many patients.

IVF, or in vitro fertilization, involves retrieving eggs from the ovaries, fertilizing them with sperm in a laboratory, and transferring an embryo into the uterus or a gestational carrier.

IVF offers greater control over the fertility process and may improve success rates in certain situations. It is commonly used for:

• Same-sex male couples using donor eggs and surrogacy
• Lesbian couples experiencing fertility challenges
• Reciprocal IVF
• Fertility preservation before gender-affirming treatment
• Patients interested in genetic testing of embryos

IVF can also allow intended parents to create and preserve embryos for future family planning.

Egg donation may be recommended when intended parents need donor eggs to create embryos. Egg donors may be anonymous, known, or selected through an egg donor agency.

Egg donation is commonly used for:

• Same-sex male couples
• Patients with diminished ovarian reserve
• Patients preserving fertility after medical treatment
• Some transgender patients

Gestational surrogacy is commonly used by same-sex male couples, transgender individuals, and patients who cannot safely carry a pregnancy.

With gestational surrogacy:

• Embryos are created through IVF
• A gestational carrier carries the pregnancy
• The carrier has no genetic relationship to the child

Surrogacy often involves coordination between fertility specialists, legal professionals, donor agencies, and surrogacy agencies. Our team helps guide intended parents through every step of the process.

Egg donation may be recommended when intended parents need donor eggs to create embryos. Egg donors may be anonymous, known, or selected through an egg donor agency.

Egg donation is commonly used for:

• Same-sex male couples
• Patients with diminished ovarian reserve
• Patients preserving fertility after medical treatment
• Some transgender patients

Fertility preservation allows individuals to freeze eggs, sperm, or embryos for future use. This can be especially important for transgender individuals before beginning hormone therapy or gender-affirming procedures that may affect fertility.

Fertility preservation options include:

• Egg freezing
• Sperm freezing
• Embryo freezing

Preserving fertility before treatment can create more reproductive options later in life.

Fertility care for transgender and nonbinary individuals depends on each patient’s goals, anatomy, and transition timeline. Many patients pursue fertility preservation before beginning hormone therapy or gender-affirming surgery.

Potential options may include:

• Pregnancy: If an individual chooses to retain the uterus, a transgender man post-transition may choose to carry the baby.
• Sperm Freezing: This is an option where transgender women can freeze and store sperm if they are transitioning from male to female, and this is done prior to the transition process.
• Egg Freezing: Transgender men post-transition can either freeze or store unfertilized eggs before later use. Single transgender men have this option as a preferred option.
• Embryo Creation: There is the option for transgender men to preserve their fertility prior to starting testosterone therapy. For example, a cisgender (someone whose gender identity corresponds to their sex assigned at birth) partner may carry the pregnancy after the embryos are created using donated sperm.

Lesbian couples will require donor sperm to conceive either from somebody they know or via a sperm bank. The process can be flexible with one woman donating the egg with the other potentially carrying the pregnancy, but it’s essential to guarantee that both partners are cleared for pregnancy via fertility testing.

There are three types of options for same-sex female couples:

• Intrauterine Insemination (IUI): Using donor sperm, a doctor will use a catheter to insert the donor sperm into the uterus of one member of the partnership. If there are no previous fertility issues, this is usually the best course of action.
• In Vitro Fertilization (IVF): If one or both partners have female fertility issues, this is an excellent option using donor sperm. There are a number of different steps in the treatment. This includes medication, retrieving the egg, fertilizing within the laboratory, and finally transferring the embryo.
• Reciprocal IVF: This is an approach where both partners share in the pregnancy. One partner provides the egg while the other carries the pregnancy and delivers the baby.

Gay male couples typically build families through IVF using donor eggs and a gestational carrier. In some cases, both partners may fertilize separate groups of eggs to create embryos from each partner.

Important considerations may include:

• Sperm quality and fertility testing
• Choosing an egg donor
• Selecting a gestational carrier
• Embryo genetic testing
• Legal guidance for parentage rights