LGBTQ+ And Fertility: Where To Start

When an LGBTQ+ couple walks into my office to discuss having a child, we’re not just talking about medical procedures—we’re mapping out a dream. As a reproductive endocrinologist, it’s my privilege to help them turn that dream into a reality.

At the heart of every fertility journey is a desire for connection—to a partner, to a future child, and to the process itself. When I meet with LGBTQ+ couples, I make it clear that this isn’t just about treatments—it’s about creating a plan that reflects their unique vision of family.

There are many fertility options available, depending on a couple’s needs. Whether you’re exploring donor sperm, reciprocal IVF, surrogacy, or egg freezing, every family’s story begins with a conversation. Here’s how I answer their questions, and guide them through the options, as well as the emotions that come with embarking on their fertility journey.

Can we use donor sperm?

For couples in which one partner has a uterus, the first question is often about donor sperm. Together, we discuss two main sources: anonymous sperm donors from a sperm bank or a directed donation from a friend or family member. Both options include thorough infectious disease screening to ensure safety.

Donor sperm can be used for intrauterine insemination (IUI), a procedure where the sperm is placed directly into the uterus during the most fertile part of the menstrual cycle. For some, this straightforward process works beautifully. For others, especially those with medical concerns like blocked fallopian tubes or endometriosis, we may explore in vitro fertilization (IVF). This involves creating embryos in a lab with the donor sperm and transferring them into the uterus for implantation.

Can we both be involved?

When same-sex female couples express a desire to share the pregnancy experience, reciprocal IVF often becomes part of our conversation. This approach allows one partner to provide the eggs while the other carries the pregnancy. I’ve seen couples who shared that the egg provider cherished the knowledge that her child shared her genetics, while her partner found deep joy in carrying their baby. Reciprocal IVF creates a shared experience that’s unique to LGBTQ+ family-building. It’s a beautiful way for both partners to feel equally connected to the process.

What do you recommend for male couples?

For male couples, we turn our focus to donor eggs and surrogacy. Egg donors can be anonymous or a known individual, such as a friend or family member. After the eggs are retrieved (or selected from an egg bank), they’re fertilized with one or both partners’ sperm, depending on the couple’s preferences.

Once embryos are created, the next step is finding a gestational surrogate to carry the pregnancy. Surrogacy is a complex process, involving medical, legal, and emotional considerations. However, I’ve seen the incredible bonds that form between surrogates and intended parents, and I encourage couples to lean on support networks and surrogacy agencies to guide them through.

How we preserve our options?

For transgender individuals or others who may not be ready to start a family, egg freezing is an empowering choice. This process involves stimulating the ovaries to retrieve eggs, which are then frozen and stored for future use.

I’ve worked with many transgender men who chose to freeze their eggs before beginning hormone therapy. It’s a proactive step that keeps the door open for genetic parenthood down the road. These conversations often highlight the importance of aligning reproductive goals with other life transitions.

Parenthood may look a little different for everyone, but the love and commitment that define it are universal. Find a fertility specialist that listens to your hopes and goals, who makes you feel comfortable and heard, and who you feel confident can guide you through this beautiful journey.

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