A guide to LGBTQ+ family planning - Ruth Health

A guide to LGBTQ+ family planning

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Fast facts: 

  • LGBTQ+ couples and individuals have several family building options, including assisted reproductive technology, fertility preservation, and using a donor or surrogate.
  • There are legal complexities involved with using a known donor for sperm or eggs.  Consult with a lawyer familiar with your state’s laws before you move forward.
  • Hormone replacement therapy or gender confirmation surgery may temporarily or permanently affect your reproductive function. Discuss fertility options with your doctor prior to treatment.
  • Many fertility treatments are a significant financial investment. Determining how to pay for treatment is part of the planning process. There are resources to help with the expenses (see more below).

As options for family planning and fertility treatments expand, LGBTQ+ couples and individuals have many pathways to parenthood. This includes assisted reproductive technology, fertility preservation treatment, and using a donor or surrogate.

These options come with legal and financial implications, so careful research and planning is part of the family building process.

Here’s an overview of your fertility options and resources to support your journey.

Sperm donor

For individuals and couples with female anatomy, donor sperm may be used to have children biologically through intrauterine insemination (IUI) or in vitro fertilization (IVF). You can obtain donation sperm from a known or anonymous donor.

There are fewer legal complexities when using donors from sperm banks, as the donor will have already surrendered their rights as a parent. 

If you use sperm from someone you know, be sure to consult with a lawyer in your state about the relational complexities and parental rights.

This may be part of the family building journey for:

  • Female same-sex couples
  • LGBTQ+ cisgender women having a baby without a partner
  • Transgender men having a baby without a partner
  • Nonbinary individuals with female anatomy who are having a baby without a partner

Egg donor

Individuals and couples with male anatomy can have children biologically by using an egg donor. As with donation sperm, you can use an egg from a known or anonymous donor.

There are similar legal complexities, so consult with a lawyer before starting a family. IVF is the most common process for having biological children using an egg donor.

This may be part of the family building journey for:

  • Male same-sex couples
  • LGBTQ+ cisgender men having a baby without a partner
  • Transgender women having a baby without a partner
  • Nonbinary individuals with male anatomy who are having a baby without a partner

Gestational carrier

When male couples conceive through IVF, the embryo, or fertilized egg, is implanted into the uterus of a gestational carrier. This individual will carry the pregnancy to term but is likely not related to the child.

When pursuing this option, it’s important to have clear expectations about your relationship with your gestational carrier.

Some parents-to-be want a close relationship with their gestational carrier while others prefer more distance. Either approach is valid. It’s all about what feels most comfortable for you.

This may be part of the family building journey for:

  • Male same-sex couples
  • LGBTQ+ cisgender men having a baby without a partner
  • Transgender women having a baby without a partner
  • Nonbinary individuals with male anatomy who are having a baby without a partner

Intrauterine insemination (IUI)

Intrauterine insemination (IUI) is a process in which sperm is placed into the uterus. It is often used by female same-sex couples or male same-sex couples using a surrogate.

Like a gestational carrier, a surrogate carries a pregnancy. However, they will also donate their eggs, and will therefore be genetically related to the child.

This may be part of the family building journey for:

  • Female same-sex couples
  • Male same-sex couples
  • LGBTQ+ cisgender men and women having a baby without a partner
  • Transgender men and women having a baby without a partner
  • Nonbinary individuals having a baby without a partner

In vitro fertilization (IVF)

In IVF, an egg and sperm are fertilized in a lab and then implanted into a uterus. It may be performed with donor sperm or eggs.

Some LGBTQ+ couples pursue co-maternity, or reciprocal IVF. In this process, one partner provides the egg and the other carries the pregnancy.

This allows both partners to have a biological connection to their child even though only one will be genetically related.

This may be part of the family building journey for:

  • Female same-sex couples
  • Male same-sex couples
  • LGBTQ+ cisgender men and women having a baby without a partner
  • Transgender men and women having a baby without a partner
  • Nonbinary individuals having a baby without a partner

Fertility preservation

Procedures such as sperm or egg freezing allow individuals to extend their family building timeline or preserve family building options after gender confirmation treatment.

This may be part of the family building journey for:

  • Female same-sex couples
  • LGBTQ+ cisgender women having a baby without a partner
  • Transgender men and women having a baby without a partner
  • Nonbinary individuals having a baby without a partner

How do gender confirmation treatments affect fertility?

The physical process of transitioning — including hormone replacement therapy or gender confirmation surgery — may temporarily or permanently affect your reproductive function. 

Hysterectomies performed in a female-to-male transition or the removal of testicles in a male-to-female transition will impact your ability to have children biologically.

Researchers are still learning how testosterone and estrogen therapy impacts reproductive health. Ongoing use of testosterone and estrogen can stop sperm production and ovulation. 

However, some research indicates that these effects aren’t permanent, and that hormone therapy doesn’t preclude having biological children in the future.

If you are considering hormone therapy or gender confirmation surgery, discuss your child-bearing options with your doctor prior to treatment.

Questions to ask when planning your family

Since there are many considerations unique to LGBTQ+ family building, it’s important to understand your goals and account for the complexities in advance. All goals in this case are valid.

Here are some questions to consider during your planning:

  • If having a child as part of an LGBTQ+ couple, which partner will be genetically related to the child? (if applicable)
  • Do I want an anonymous or known egg or sperm donor? (if applicable)
  • If pursuing surrogacy or using a gestational carrier, what kind of relationship do I want with my surrogate or carrier? And which aspects of their pregnancy and postpartum care will I be financially responsible for?

Financial resources

Many fertility treatments are a significant financial investment. Determining how to pay for treatment is part of the planning process. There are ways to reduce the costs.

Many organizations offer financial resources for LGBTQ+ family-building. View Family Equality Council’s list of grants.

Your choice of fertility clinic affects the total expenses. As you explore your options, ask clinics about financial assistance and payment plans.

Researching your state’s laws about parental rights is essential when using a donor or surrogate. In some states, surrogates automatically receive parental rights as the biological mother, which need to be terminated through a legal process.

As a starting point, use Movement Advancement Project’s interactive map to learn about your state’s parental recognition laws. In addition, consult with a lawyer who has experience working with LGBTQ+ families and expertise in your state’s legal parentage procedures.

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At Ruth Health, we understand that nobody knows what you need better than you. We provide expert, evidence-based information and support so that you can make the best decisions for yourself throughout your family-building journey.

Learn more about our 1:1, personalized sessions designed to meet your needs. And don't forget to join our community by signing up below!

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