For prospective parents in all situations, deciding to start a family is a major life event! For couples in a heterosexual relationship, trying to start a family often means ceasing the use of birth control or pursuing fertility treatment or adoption, but for LGBTQ+ couples, there are some more options that will need consideration. This can make the entire family planning process feel more stressful, but getting informed is the best way to prepare yourself for this major life decision. As a reproductive endocrinologist, I work with all types of couples and families, so I want you to know that I am here to help guide you along the path to adding a little one to the mix. Below are some things I think you should know about what goes into LGBTQ+ family planning.

Put Thought into Your Fertility Clinic Choice

As with any decision throughout your family planning process, you should put extra thought and consideration into your choice of a fertility clinic. This can include looking into what types of fertility treatments are offered, the facility’s success rates, and if it has been given praise by other LGBTQ+ couples. You will be spending a lot of time at this place, including the people who work there, so you want to make sure you choose a clinic that you are fully comfortable with. Some considerations many couples prioritize include if the staff is friendly and professional, if the couple feels comfortable with each person they will be working with, and if the facilities are clean and welcoming. These questions are considered by all couples who seek out fertility treatment, whether they are LGBTQ+ or not, but same-sex couples may want to take some extra steps to ensure that they are comfortable with their choice before starting the process.

There are Different Donation Options to Pursue

The path to family building that many LGBTQ+ couples pursue requires a donor egg or donor sperm. Eggs can be chosen from an anonymous donor or from a family member and can be used by one of the prospective parents or by a surrogate carrier chosen by the couple. The eggs are retrieved and fertilized through IVF using donor sperm, and then the resulting embryo is transferred to the womb of whoever will be carrying the pregnancy. In the United States a very important aspect of protecting your parental rights and protecting the donor and the carrier’s right NOT to have parental obligations is that the person giving the eggs and the person carrying the pregnancy must be 2 different people. Donor sperm is used by many female same-sex couples who choose IUI or IVF for their path to a family- the donor sperm is used for fertilization and, like an egg, can come from an de-identified sperm donor from a sperm bank or known donor (Known sperm donation can be a great option but much more expensive and time-consuming than obtaining sperm from a sperm bank because the sperm must be frozen for 6 months and the donor retested prior to being able to be used and the known donor must sign legal agreements clarifying his donor status with the intended parents). In general, female same-sex couples will need donor sperm for the fertilization of an egg, and male same-sex couples will need a donor egg to fertilize with one partner’s sperm. The extra step required here would be working with a surrogate or gestational carrier to carry and deliver the child (a traditional surrogate gives eggs and the use of her uterus and these types of arrangements are not legally binding in the USA). 

These options may seem intimidating or confusing, but the more you know, the better. I encourage you to spend as much time as you need with your doctors to discuss all of your options so you can make the best decision possible for your future family. In addition to the medical aspects of conceiving using donor eggs and a gestational carrier, there are many logistic, psychologic, social and legal aspects that must be addressed in order to make sure that there is a healthy pregnancy and healthy baby and that the rights of all parties involved are protected. This can make the process of conceiving this way expensive, but the expense is well worth it. Traveling abroad for these services may seem like it can save money up front but if you do not have an expert team, the risks can be significant. Some US couples that have chosen this route have faced significant barriers with establishing parental custody and being able to bring their children back to the US among other issues. It is important to have an experienced team at your IVF program to help you with all these aspects.

Fertility Treatment is Not the Only Option

Although there is a multitude of fertility treatment options and paths for LGBTQ+ individuals looking to start a family, adoption is a very appealing choice for many couples. Adoption can be a lengthy and demanding process, but it allows children of all ages to enter loving, supportive homes and join a permanent family. The adoption process is generally the same for same-sex parents as it is for heterosexual parents, but I would encourage you to do your research and choose an adoption agency that is known to be welcoming to LGBTQ+ couples. Whether you choose the route of fertility treatment or adoption, the more you know and are prepared, the better.

As a reproductive endocrinologist, I strive to keep my patients (and anyone hoping to start a family) informed about all of the options available to them. If you have any questions about LGBTQ+ family planning, please don’t hesitate to reach out to me and ask me whatever is on your mind. I look forward to hearing from you!

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