What fertility options exist for LGBTQIA+ parents-to-be?

At JunoDx™, we’re all about equal access to high-quality reproductive genetic testing and prenatal care. That’s why we’re using our clinical expertise and science-backed research to help all hopeful and expecting parents find answers to their most pressing pregnancy-related questions.

Here, we break down the different fertility treatment options for queer and same-sex parents. In decades past, adoption was the primary (and sometimes only) option for LGBTQIA+ couples that wanted to have children. Now, thanks to advances in assisted reproductive technology (ART), parents have more choices for growing their families.

Let’s take a look!

Fertility treatments involving carrying a pregnancy 

After you’ve decided to expand your family, one of the very first things to determine is who will carry a pregnancy. If only one partner has a uterus, while it may seem like the obvious answer for them to carry, it’s still important to talk about how they feel regarding carrying a pregnancy. Some trans, nonbinary, and other genderqueer individuals experience heightened gender dysphoria during pregnancy, and it can be wise to talk with a mental health professional in advance of seeking fertility treatment if you’ve experienced gender dysphoria in the past.

Another important consideration to discuss is the source of the sex cells - also referred to as gametes (eggs and sperm) - which will be used in creating the pregnancy.  If both partners have egg cells, but one partner is significantly older, the number and quality of their egg cells may influence the likelihood of achieving a successful pregnancy. Some same-sex parents might try to alternate so that one partner carries a pregnancy made from their partner’s egg cell, and vice versa. Talk to your OB/GYN provider about all of the medical factors that might be relevant for your family’s specific situation! 

When two people with egg cells want to conceive, there are two main options for fertility treatments. Both involve using sperm from a donor. Depending on the couple’s preferences, the donated sperm can come from a friend, family member (unrelated to the egg source), or an anonymous donor.

Intrauterine insemination (IUI): This is the simpler option, and it involves injecting concentrated donor sperm directly into the uterus of the person carrying the pregnancy. It’s done around the time of ovulation in hopes of making it as easy as possible for a sperm to swim into one of the fallopian tubes and fertilize the egg.

In vitro fertilization (IVF): With IVF, the person carrying the pregnancy can create embryos using their eggs together with a donor’s sperm, or the person carrying the pregnancy can undergo an embryo transfer using an embryo that was created using their partner’s egg with a donor’s sperm. The latter scenario is a more complicated (and expensive) process, but it can create a powerful connection between both partners and their child/children. With traditional IVF, the donor’s sperm sample is mixed with an egg cell in the embryologist’s laboratory. IVF with intra-cytoplasmic sperm injection (ICSI) requires an embryologist to select a healthy-appearing sperm from the donor’s sample and then inject the sperm into the egg cell. ICSI is commonly used to increase the odds of having fertilized eggs after an ovarian stimulation cycle, although there’s no guarantee that the selected sperm had the typical 23 chromosomes seen in sex cells. After an embryo made through IVF has grown to the “blastocyst” stage (usually day 5 after fertilization, although some IVF centers may use either day-3 embryos or day-6 embryos), the embryo is transferred into the uterus of the person who intends to carry the pregnancy.

While many people refer to this part of the process as “implanting” the embryo or blastocyst, it’s crucial to appreciate that not all embryos transferred into the uterus will successfully implant within the uterine lining and result in a pregnancy.  

 Thanks to advances in assisted reproductive technology (ART), parents have more choices for growing their families.

Fertility treatments involving a gestational carrier or surrogate

When neither partner has egg cells or a uterus, the most common fertility option is IVF. During this process, the couple might choose who will donate their sperm – or, in some cases, both will donate sperm so that the genetic parent of the child is a surprise. 

Next, parents-to-be choose an egg donor and a gestational carrier. A gestational carrier is a person who carries a pregnancy made from another person’s egg cell and another person’s sperm cell. In contrast, a surrogate is a person who both contributes their egg cell and carries a pregnancy for a parent who cannot otherwise conceive without this assistance.

The practice of surrogacy is uncommon, but does allow for the possibility of using IUI instead of IVF (since the surrogate could undergo insemination straight away, rather than requiring the pricier alternative of egg retrieval and in vitro fertilization). Couples may select someone they know as the egg donor or use a donor egg service. The same is true for gestational carriers, who may also be referred to as “GCs.” With a donor egg service, however, it’s not uncommon for the donated eggs to have been retrieved from the donor some time in the past and frozen for future use. Since a person only makes so many egg cells throughout their lifetime, the cost of egg donation services is much higher than that of sperm donation services.

Tips for LGBTQIA+ parents-to-be thinking of fertility treatments

When you’re ready to get started on this journey, it’s a good idea to talk with your physician, health insurance carrier, and maybe even a lawyer to help you understand your legal rights and financial responsibility. A genetic counselor can also be an invaluable resource if you have questions about your family history or about screening genetic parents for inherited diseases prior to pregnancy. No matter the conception method, you deserve the answers to all your questions every step of the way!

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Please Be Aware: JunoDx.com and the materials and information it contains are not intended to be and do not constitute medical advice, other health advice, or diagnosis.  Do not use JunoDx.com or the materials and information published at JunoDx.com as a substitute for medical care and treatment. You should always consult with a qualified physician or healthcare provider about your specific circumstances.

September 29, 2022 — Stephanie McClintock