LGBTQ+ Family Building Options: Assisted Reproduction
As long as there have been parents, there have been LGBTQ parents. Their presence hasn’t changed, but their visibility has.
In 2019, for the first time, the United States Census Bureau included data about households headed by same-sex couples in its annual “America’s Families and Living Arrangements” report. This data indicated 15% of 1.1 million same-sex couples in the United States had at least one child under 18 in their home. Today, Family Equality Council estimates that approximately 63% of LGBTQ individuals plan to have families via assisted reproductive technology, surrogacy, and/or adoption.
Evolving laws and shifting attitudes toward the LGBTQ community and same-sex couples directly impact how LGBTQ individuals form families and become parents. Today, same-sex couples have the legal right to marry in all 50 states and the LGBTQ community has access to healthcare providers, professional agencies, and social workers who are more informed and better prepared to navigate concerns specific to their community. Every day, awareness of the many paths to parenthood for LGBTQ individuals is growing with non-profit organizations and reproductive clinics, like Kindbody, committed to family equality and reproductive rights for all people.
How are LGBTQ Families Growing?
While adoption remains a well-known option for parenthood, assisted reproductive technology, or third-party reproduction, is growing in popularity in recent years. Assisted reproductive technology refers to any technology employed to conceive a child by means other than sexual intercourse.
To make a baby you need sperm, an egg, and a uterus. If one or more of these variables is missing from the equation, as is often the case for same-sex couples, assistance from a third party is necessary. We will explore some assisted reproductive arrangements below, and healthcare providers at Kindbody can provide you with more detailed information about the assisted reproduction options available to you and discuss the options that best meet your unique needs.
Same-Sex Female Couples or Single Bio-Women
Same-sex female couples or single women desiring to gestate a pregnancy require the assistance of a sperm donor. Sperm donors can be a known or anonymous party.
Anonymous donors can be selected by purchasing vials of sperm through a cryobank. If you choose to go the cryobank route, you will be provided with physical characteristics and background health information about the donor, and may also be provided with baby photos, essays, and other items. Some cryobanks now offer “open” or “identity-release” donors. This allows the child conceived with use of donor sperm to contact the cryobank when they are of legal age, if they choose to do so, to receive identifying information so they may connect with the donor. In our world of decreasing anonymity, this is becoming a very popular option. While purchasing vials of sperm can be expensive, the cryopreserved sperm has already been screened for infectious diseases including HIV, and has been analyzed for fertility and health purposes.
Family building with assistance from a known donor, such as a friend or relative of the parent not contributing the egg, is another option. When working with a known donor, it is imperative to consult with legal counsel to minimize risk regarding parental rights and to address expectations of all parties. It is also important to pay attention to the non-biological intended parent’s parental rights in donor arrangements.
Once sperm has been selected and obtained, the next decision is how to achieve pregnancy: via intrauterine insemination (“IUI”) or in vitro fertilization (“IVF”). IUI is a procedure done by a reproductive endocrinologist and has high success rates to achieve pregnancy. IVF is more invasive compared to IUI and involves hormone medications including injectibles, and egg retrieval. The egg is fertilizied outside of the womb and then the embryo is transferred to the uterus. IVF is more expensive than IUI.
A note on co-maternity or reciprocal IVF: For same-sex female couples, these terms are used to describe the situation where one parent contributes the egg and the other parent gestates the pregnancy. This arrangement necessitates that the non-gestating parent and bio-parent consult with legal counsel to ensure parental rights are properly secured for both parties.
Same-Sex Male Couples and Single Bio-Men
Same-sex male couples planning to use sperm from one or both partners require the assistance of both an egg donor and a gestational carrier or surrogate.
When selecting an egg donor, intended parents can choose to use “fresh eggs” or “frozen eggs.” Fresh eggs are obtained from a known donor stimulated for the specific purpose of donating eggs to the intended parents. Once an egg donor is selected, sometimes with the assistance of an agency, it usually takes 8-10 weeks before the egg retrieval can take place. intended parents can also choose to purchase frozen eggs from an egg bank. Frozen eggs have already been retrieved from an egg donor and are frozen until selected by intended parents.
Egg donation has amazing success rates for several reasons. For one, egg donation generally involves younger eggs. Secondly, modern technology enables the selection of the healthiest eggs, and genetic screening of embryos ensures the fitness of embryos prior to implantation.
A surrogate, or gestational carrier, carries a baby for another couple or individual with the agreement that the intended parents become the legal parents of the child. An embryo or embryos are made from the egg of a donor and the sperm of one or both of the intended parents, and then transferred to the uterus of the gestational carrier. Gestational carriers can be family members, friends, or an individual selected with the assistance of a surrogacy agency. Gestational carriers must meet a number of medical and legal requirements that vary by state and reproductive clinic prior to the embryo transfer.
Traditional surrogacy is an option in some states, but these arrangements are fraught with psychological, sociological and legal implications. A traditional surrogate is a woman who both contributes her egg and gestates the pregnancy.
It is imperative to consult with legal counsel before entering into any surrogacy arrangement to ensure your parental rights are legally established and protected.
For trans individuals contemplating their transition, it is a great idea to meet with a reproductive endocrinologist to explore your reproductive options. You may consider cryopreserving gametes before beginning hormone therapy or undergoing gender-affirming surgical procedures. This is a personal choice, as every transition is unique. Knowledge about your reproductive options will empower you to make fully informed personal decisions regarding your transition.
When exploring your options for parenthood, visiting a reproductive endocrinologist experienced in working with LGBTQ individuals and same-sex couples is a must. These healthcare practitioners are best suited to discuss the options specifically available to you as an individual or a couple, and can point you towards the best industry professionals to consult with on your path to parenthood.
Wherever you may be on your family planning journey, whether you’re ready to start your family now or just want to know your reproductive options, Kindbody is a great place to start. And whatever form your family may take, whether you self-identify as a mom-to-be or dad-to-be, whether you are single or in a committed relationship, a same-sex relationship, or married, Kindbody can be a trusted, dedicated resource.