Trying to conceive as an LGBTQ+ family or single parent does not come without challenges, and it can be confusing to know where to start. Despite the hurdles, remember that finding allies in the health professions who affirm your identity and sexual orientation, unique experience, and goals is important while you put together your team of support for family building. Fortunately, there are options available to help grow your family at home and with the help of your doctor or fertility clinic. See below for some possibilities.
Everything but the sperm: lesbians, trans men, and non-binary people who want to carry a pregnancy
Starting at home:
For prospective parents, if you or your partner can carry a pregnancy, but you need sperm for conception, it is possible to choose donor sperm and try to get pregnant at home. Home insemination might feel like the safest place to begin if you have had any negative experiences with the medical community. Starting with home donor insemination gives you more freedom around the process of conceiving, especially with a known sperm donor.
Donor sperm can be from a known donor (a friend or family member) or an anonymous donor through a sperm bank. Once you have chosen donor sperm, you can try intra-vaginal insemination (IVI, placing sperm into the vagina) or intra-cervix insemination (ICI, placing sperm directly inside the cervix using a needle-less syringe), often called the “turkey baster” method. If you have access to midwives in your area, in some states, you can hire one to come to your home for intrauterine insemination (IUI, placing sperm directly into the uterus).
Seeking out support:
If trying at home is unsuccessful or not an option, a consultation with your doctor, gynecologist, reproductive endocrinologist, and/or local fertility clinic will be your next step. Find a specialist or clinic that will listen to your concerns and provide a thorough investigation into your fertility through lab work and additional testing, if necessary. They will come up with a plan that is right for your individual needs and will often suggest one of the following next steps.
Intrauterine insemination (IUI)
An IUI can be performed in-office and is an option that many people opt for right away. There are a variety of interventions available for an IUI.
The IUI process may include:
- Natural cycle by tracking your hormones at home with an ovulation predictor kit
- Medication to promote ovarian follicle growth
- Ovulation trigger shot to optimize and ensure ovulation and timing
- Ultrasound monitoring and hormone testing
In-vitro fertilization (IVF)
An IVF cycle is a series of reproductive procedures that consists of the stimulation of follicles with medications followed by an egg retrieval and then fertilization of the egg(s) to create embryos with a sperm sample outside of the body. An embryo transfer is then administered to either the person who underwent the egg retrieval or to another person who will be the gestational carrier.
Reciprocal IVF is possible for couples where both partners can carry a pregnancy and/or produce follicles (i.e. lesbian couples and queer or non-binary people in couples). One partner goes through an egg retrieval, and donor sperm is used to create embryos in the same way as a standard IVF cycle. Then an embryo is transferred to the second partner to carry their child as a gestational carrier. This way both partners can share in the creation of their child.
Seeking an egg and a nest: options for gay men, trans women, and non-binary people with sperm
If you can produce sperm and are interested in growing your family, you will need a surrogate or an egg donor and a gestational carrier. If you are just deciding whether or not to try to conceive, it can be beneficial to have a semen analysis done a few months before you are interested in getting started with family planning.
A semen analysis is often done through a fertility specialist. Nowadays, you also have the option to send a sample from the comfort of your own home with mail-in services. Your fertility clinic will often want to perform a semen analysis, so if you know you are ready to get started with the process, you can wait and have one done through your clinic of choice. If your analysis is not optimal, discuss with your doctor whether there are ways to improve the health of your sperm and test again a few months later.
Freezing your sperm
If you are not ready to start trying but want to preserve your fertility for any reason, it is possible to have a sperm sample frozen and held for you in a sperm bank to use in the future. Age, health, and lifestyle are considerations for healthy sperm just as they are for healthy eggs, so if you have the budget to be proactive in this way, you can.
Choosing a surrogate or gestational carrier
A surrogate is someone who carries a pregnancy to term for another person or couple—either by being inseminated with sperm or having an embryo implanted. A gestational surrogate (also called a gestational carrier) is a person who does not supply the egg used in conception but carries and gives birth to a child for another. Choosing between surrogacy and using a gestational carrier is a personal decision as well as a financial one.
Some couples choose to have both of their sperm used at the same time for insemination or IVF so that they can fertilize the eggs and create embryos without knowing which partner is the biological parent. This way, they are both given the possibility and opportunity, and it is left to some chance as to which sperm fertilizes the egg.
Fertility support for the trans community
Many transsexual and transgender people choose to undergo egg freezing or sperm freezing to increase the success rates of being able to conceive in the future.
If you have been taking testosterone, you’ll want to check your hormone levels and come up with a plan with a reproductive endocrinologist to pause gender-affirming therapies before getting pregnant. Testosterone suppresses ovulation and will need to be paused for a few months before trying to retrieve the eggs and throughout your pregnancy if you plan to carry the baby. If you have paused or have not yet started hormone therapy, it is also possible to complete the egg or embryo freezing process to plan for the future.
If you are a trans woman or assigned male at birth and are considering gender-affirming hormone therapy, freezing your sperm beforehand will give you the best chance of growing a family in the future. You may want to pause or delay medical transition to preserve your sperm. If you have already begun hormone therapy and are interested in conceiving with your sperm, you will want to seek out a fertility specialist or reproductive endocrinologist as soon as possible. They will help you understand your options and make sure that healthy sperm production is still possible for you.
Gender dysphoria can be triggered more intensely when pausing gender-affirming therapies and deciding to carry a pregnancy. Managing fertility treatments and decisions can be challenging. Make sure you communicate how you’re doing with your partner or support person so they can best support and advocate for you.
Building blocks for success
Additional costs for treatments and procedures vary. It’s important to understand what your health insurance will cover, if anything, so that you can find what works for you and your budget.
When a child’s birth comes into the picture, you will want and need to consult with an attorney to make sure that your parental rights are protected from any legal hurdles or state laws before entering into an agreement or paying any legal fees. Your fertility clinic will have resources and guidelines for you throughout this process, but if you are trying at home, you will want to seek out an attorney who specializes in fertility, parentage, and family law, specifically for reproductive matters such as surrogacy, egg donation, and sperm donation.
Trying to conceive can feel overwhelming. The extra barriers that the LGBTQ+ community and families face can take a toll on your mental and emotional well-being. This is true for all who struggle to conceive, but because of lack of access to an easier conception plan, your struggles are unique, so you can benefit from emotional support and allyship. Make sure to check in with your community, a mental health professional, a fertility coach, your partner, and/or your support system while you make your way through this process.
Health and wellness support
Many people start trying to conceive without checking in about their health and hormones. A basic health check-up, annual physical and pelvic exam, as well as basic lab work are good places to start if you want to be proactive about any health concerns or imbalances that may be present. This way you can address any potential issues before or in the beginning stages of trying to conceive. For those interested in carrying a pregnancy or using their eggs, you can check your hormone levels by visiting a healthcare provider or you can choose one of the reputable services online that offer basic fertility hormone testing.
If you have known health or reproductive conditions, check in with your doctor before trying to conceive so that you can be proactive regarding any issues that may hinder your ability to conceive. If you have irregular menstrual cycles or other conditions such as endometriosis, PCOS, fibroids, or cysts, you’ll want to visit your doctor sooner rather than later. Make sure you have discussed your fertility options with a doctor to give you the best chance possible to conceive on your desired timeline.
Most people in the LGBTQ+ community will likely need to work with assisted reproductive technology to achieve their goals of growing their families. Even if you have no known health issues that may cause infertility, it is extremely beneficial to think about ways to optimize your health and fertility potential. A fertility-friendly diet and lifestyle, in addition to nutritional supplements, is a good place to start. Guidance on your individual needs can be found through a coach, acupuncturist, naturopathic doctor, or nutritionist. There is so much that is out of our control on the path to parenthood, but we can take some of that control back by planning ahead and learning how to prepare our bodies for the best possible outcome.