LGBTQIA+ Fertility Services and Family-Building Options
Many individuals and couples in the LGBTQIA+ community pursue parenthood through fertility treatments such as in vitro fertilization (IVF), egg/sperm donation or gestational carriers. Many factors go into selecting the option that’s right for your family. University Hospitals fertility specialists offer expert guidance and compassionate, affirming fertility care to help you achieve your family-building goals.
Make an Appointment with a Fertility Specialist
A fertility consultation can help determine which family-building options may be appropriate based on your goals and medical history. Call 216-765-3352 today to schedule a consultation.
Quick Facts
- Fertility treatment options for LGBTQIA+ individuals and couples will depend on several factors, including family-building goals, reproductive anatomy, fertility testing results and medical history.
- Options for same-sex female couples include using donor sperm for intrauterine insemination (IUI), in vitro fertilization (IVF) or reciprocal IVF.
- Options for same-sex male couples include using an egg donor and gestational carrier to achieve pregnancy through IVF.
- Transgender patients may consider undergoing fertility preservation, such as egg or sperm freezing, before gender-affirming treatment.
- Consulting with a reproductive endocrinologist, or fertility specialist, allows LGBTQIA+ couples to understand their options and choose the best path for their unique family-building journey.
Understanding Fertility Care for LGBTQIA+ Individuals and Couples
Individuals and couples in the LGBTQIA+ community may pursue parenthood through several reproductive pathways depending on family goals and medical considerations. A fertility specialist can evaluate an individual or couple’s reproductive health and help determine which assisted reproductive technologies (ART) may best support pregnancy or family building.
Fertility treatment selection depends on:
- Reproductive anatomy: The presence or absence or reproductive organs such as uterus, ovaries or testes for an individual or couple will help determine which fertility treatment options are available.
- Fertility testing: Individuals and couples may undergo testing such as hormone and ovarian reserve tests, semen analysis, pelvic ultrasound and hysterosalpingogram (HSG) to evaluate their fertility.
- Medical history: This may include factors such as history of reproductive conditions or surgery, general health, genetic or family medical history and gender-affirming hormone treatment or surgery.
- Family goals: Preferences to consider include having children that are biologically related, using an identified (formerly “known”) versus a non-identified (formerly “anonymous”) donor and gestational carrier selection.
Family-Building Pathways for Same-Sex Couples
Assisted reproductive technology (ART) makes it possible for same-sex, transgender and non-binary people and couples to have children through a variety of different pathways. Whatever your unique situation, our fertility specialists can find a solution to help you achieve your family-building goals.
- Family-Building Options for Same-Sex Female Couples
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There are a variety of fertility pathways available for same-sex female couples. Treatment selection depends on fertility testing, reproductive anatomy and family goals. Treatments include:
- Intrauterine insemination (IUI) using an identified or non-identified sperm donor for insemination.
- In vitro fertilization (IVF): Embryos are developed in a lab and transferred into one partner’s uterus.
- Reciprocal IVF: One partner supplies the eggs and the other partner carries the pregnancy.
- Family-Building Options for Same-Sex Male Couples
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Same-sex male couples who desire biological children typically pursue parenthood through a combination of:
- Egg donation: Using an identified or non-identified egg donor.
- IVF embryo creation: Using either partner’s sperm and donor eggs to develop embryos in a lab.
- Gestational carrier: The person selected to carry the pregnancy and deliver the baby for the intended parents.
Fertility Treatments for Same-Sex Couples
Several assisted reproductive technologies (ART) may support pregnancy or family building for LGBTQIA+ couples. The right treatment will depend on factors such as fertility evaluation, individual circumstances and the couple’s preferences.
Intrauterine Insemination for Same-Sex Female Couples
With intrauterine insemination, or IUI, washed sperm is placed directly into the uterus around the time of ovulation. IUI can be performed during a natural cycle or in conjunction with fertility medications to stimulate egg production. IUI may be recommended as an initial treatment depending on your fertility evaluation.
IUI Steps:
- Sperm selection: Couples or individuals can either use an identified or non-identified through a sperm bank. Donors must undergo a semen analysis, screening for infectious diseases, genetic testing, personal/family medical history and other screenings to confirm their eligibility for donation.
- Cycle monitoring: The partner undergoing IUI will often be monitored via ultrasound and blood tests to determine the timing of ovulation.
- IUI procedure: During the procedure, the washed sperm sample is inserted into the uterus through the cervix via a thin, flexible catheter. This process is usually a quick and painless procedure that does not require anesthesia or pain medication.
IVF for Same-Sex Female Couples
Same-sex female couples may elect to undergo in vitro fertilization, or IVF, to achieve pregnancy using donor sperm. IVF may be recommended if IUI is unsuccessful or if additional reproductive support is needed. Couples can choose either traditional IVF, in which the same partner contributes eggs and carries the pregnancy, or reciprocal IVF, in which one partner contributes the eggs while the other partner carries the pregnancy.
IVF Steps:
- Ovarian stimulation: Hormone medications are used to stimulate the ovaries to grow follicles containing eggs during a single cycle.
- Egg retrieval: Egg retrieval is an outpatient procedure performed under sedation. A physician uses ultrasound guidance to collect eggs from the ovaries.
- Fertilization and embryo development: Retrieved eggs are combined with donor sperm in the laboratory.
- Embryo transfer: Generally, one embryo is transferred into the uterus using a thin, flexible catheter. The number of embryos transferred is determined based on age, embryo quality and medical guidance.
Gestational Carrier Services for Same-Sex Male Couples
Use of a gestational carrier is one of the most common paths to parenthood for same-sex male couples. With this pathway, donor eggs are combined in a laboratory with sperm from one or both partners to develop embryos. An embryo is then transferred into the uterus of a gestational carrier, who will carry the pregnancy for the intended parents.
A gestational carrier differs from traditional surrogacy, where a surrogate becomes pregnant using her own eggs with the intention of assigning parental rights at birth to the intended parent or parents. Traditional surrogacy is not an option offered at UH Fertility Center.
Gestational Carrier Steps:
- Gestational carrier selection and screening: Couples can select someone they know as a gestational carrier or go through an agency. Potential carriers must be screened and medically cleared by UH Fertility Center before proceeding with the embryo transfer.
- Egg and sperm donation: The couple selects an egg donor. Sperm can be provided by one or both partners.
- Embryo development: The donor eggs are combined with sperm in a lab for fertilization. If both partners choose to donate sperm, the eggs can be split into batches to create embryos using both partner’s sperm.
- Embryo transfer: The gestational carrier undergoes hormone treatments to prepare her uterus and a fertility specialist transfers the embryo.
Legal and medical considerations may be involved in surrogacy arrangements. Intended parents and gestational carriers are encouraged to engage independent legal counsel to facilitate legal agreements and contracts.
IVF with Egg Donation for Same-Sex Male Couples
For same-sex male couples, donor eggs are typically used to create embryos during IVF. Couples can either select a non-identified egg donor through an agency/bank, or choose an identified donor, such as a friend or family member. All potential egg donors will be screened and tested to ensure suitability for donation.
The donor eggs will be combined with sperm (from one or both partners) in an IVF laboratory for fertilization. A developing embryo will then be transferred to the gestational carrier’s uterus.
Reciprocal IVF for Same-Sex Female Couples
Reciprocal IVF is an excellent option for same-sex female couples that allows both partners to participate in the reproductive process.
With reciprocal IVF, one partner undergoes ovarian stimulation and egg retrieval. Her eggs are then fertilized in an IVF laboratory using donor sperm. An embryo will then be transferred to the other partner’s uterus, who will carry the pregnancy.
Choosing who will contribute eggs and who will carry the pregnancy will depend on factors such as partners’ ages and fertility evaluation results, medical history, and individual preferences.
Fertility Care for Transgender Patients
Transgender individuals have unique needs that should be taken into consideration when planning fertility care. Transgender women and men may consider fertility care at different stages of their transitions. Consulting with a fertility specialist can help individuals and couples evaluate options that support their family-building goals.
Fertility Preservation
Transgender men and women may wish to preserve their fertility prior to beginning gender-affirming treatment. This can include:
- Egg freezing: Transgender men can undergo follicle stimulation and egg retrieval before gender-affirming treatment. Eggs can be frozen and stored until an individual or couple is ready to attempt pregnancy via IVF.
- Sperm banking: Transgender women can provide sperm samples before gender-affirming treatment that will be frozen and stored for future use. When ready, frozen sperm can be used for IUI or IVF.
- Embryo freezing: An option for both transgender men and transgender women, embryo freezing is sometimes pursued by couples before one partner transitions. It involves combining eggs and sperm in a laboratory and freezing the embryos after they develop. The embryos can be stored until ready to achieve pregnancy using IVF.
It is generally recommended to pursue fertility preservation options before initiating gender-affirming treatment. However, there may still be options for individuals who have already begun the transition process. This usually involves discontinuing gender-affirming hormone treatment. A consultation with a reproductive endocrinologist can help you determine which options may be available.
Family Planning for LGBTQIA+ People
The Path to Parenthood: Support for Your Fertility Journey
What to Know About Fertility at Every Age
Frequently Asked Questions
- How do same-sex female couples conceive?
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Same-sex female couples can conceive using donor sperm and assisted reproductive technologies such as intrauterine insemination and in vitro fertilization (IVF). They can also opt to undergo reciprocal IVF, in which one partner contributes eggs, which are fertilized with donor sperm to make embryos, while the other partner carries the pregnancy.
- How do same-sex male couples have a baby?
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Same-sex male couples can choose to have children through a gestational carrier using donor eggs. Typically, identified (formerly “known”) or non-identified (formerly “anonymous”) donor eggs are combined with one or both partner’s sperm to develop embryos in a lab. An embryo is then transferred into the uterus of the gestational carrier, who will carry and deliver the baby for the intended parents. Same-sex male couples can also choose to adopt or foster children to grow their families.
- What fertility treatments are available for same-sex couples?
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Fertility treatments for same-sex couples include intrauterine insemination or in vitro fertilization/reciprocal IVF using donor sperm for same-sex female couples and IVF using donor eggs and a gestational carrier for same-sex male couples.
- Is IVF required for LGBTQIA+ couples?
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In vitro fertilization is not required for all LGBTQIA+ couples, but it may be necessary for some depending on reproductive anatomy, medical history and other considerations. Same-sex male couples will likely need to undergo IVF with donor eggs and a gestational carrier to have biological children. Same-sex female couples may be able to use donor sperm to conceive using intrauterine insemination (IUI), which is less invasive than IVF.
- Can two women have a biological child together?
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Yes, two women can have a biological child together but it will require the use of donor sperm. Same-sex female couples can, however, share in the biological and genetic process of having a baby through reciprocal IVF. This process allows one partner to contribute eggs, while the other partner carries the pregnancy. While the baby will only be genetically related to the partner who contributed the egg, the other partner has the biological experience of carrying and delivering the baby. This shared motherhood experience allows both partners to participate in the reproductive process.
- Can transgender individuals preserve fertility?
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Yes, transgender men and women can undergo fertility preservation prior to gender-affirming treatment so they can store reproductive material for future use. Options include egg freezing, sperm banking and embryo freezing.
- When should LGBTQIA+ couples see a fertility specialist?
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Same-sex couples should seek a fertility consultation when they begin their family-planning journey, ideally about six months to a year before they intend to begin trying for a baby. This gives them time for fertility testing, selecting sperm/egg donors and/or gestational carriers if needed, and other fertility treatment planning. Transgender couples should consider consulting with a fertility specialist before they begin gender-affirming care so that they can pursue fertility preservation options prior to treatment if desired.
Related Resources and Next Steps
Learn more about some of the services offered for LGBTQIA+ couples:
- In Vitro Fertilization (IVF)
- Intrauterine Insemination (IUI)
- Gestational Carrier Services
- Egg Donor Services
- Fertility Preservation
Schedule Your Fertility Consultation
A consultation can help determine which fertility treatment options may support your family-building goals. Call 216-765-3352 to schedule.