The prospect of welcoming a new baby is exciting for anyone, and modern Assisted Reproductive Technologies (ART) mean that the dream of building a family together is now a reality for more couples than ever. LGBT families have unique needs, and like all prospective parents, they often have many questions about what is possible, what is involved, and what they can expect. Some of these questions can only be answered in a consultation with your fertility professional, but we can make a start by covering the most common queries about LGBT family planning.

Q. What are my fertility options?

For lesbian couples

IUI. The simplest option is Intrauterine Insemination (IUI) with donor sperm. The terms IUI and artificial insemination are often used interchangeably. The difference is that artificial insemination may refer to any time that sperm is placed into a woman’s reproductive tract, regardless of the method or exact location. IUI refers to a more precise procedure, where the sperm has been specially treated to create a concentrated sample of the healthiest sperm. Those sperm are then placed directly into the uterus through a tiny catheter passed through the cervix. The procedure can be timed with ovulation in a woman’s natural cycle, or a fertility drug can be used to stimulate ovulation. Often one partner chooses to carry the pregnancy, but occasionally couples choose to share the experience of pregnancy, with both partners undergoing IUI at the same time.

IVF with sperm donor. A lesbian couple may choose IVF for many reasons, but one of the more popular reasons is because partner IVF allows both partners to collaborate in the creation of their child.  Also known as reciprocal IVF or egg sharing, this allows one partner can donate eggs and the other can carry the pregnancy. It is far from the only option, however. Each couple’s specific fertility needs will inform how they use IVF to achieve pregnancy.  We have seen many different IVF scenarios, such as:

• Using the eggs of one partner and fertilized by donor sperm, the embryo is implanted into the other partner.
• Using the eggs of one partner and fertilized by donor sperm, the embryo is implanted into a surrogate.
• Using donor eggs and donor sperm, the embryo is implanted into one partner.
• Using donor eggs and donor sperm, the embryo is implanted into a surrogate.
• Using eggs from both partners and donor sperm, the embryo is implanted into one partner. In this case the couple will probably not know which partner’s egg actually created the embryo.
• Using eggs from both partners and donor sperm, the embryos are implanted into both partners.

For gay couples

Traditional surrogacy with IUI/artificial insemination. In this scenario, the surrogate’s egg is fertilized through IUI/artificial insemination. The sperm from one or both partners or a donor may be used.

IVF, egg donation and gestational surrogate. There are several different ways which a gay couple can use IVF:

• Using the surrogate’s own egg and sperm from one or both partners, the fertilization occurs in the lab and the embryo is implanted into the surrogate.
• Using the surrogate’s own egg and donor sperm, the fertilization occurs in the lab and the embryo is implanted into the surrogate.
• Using donor eggs and sperm from one or both partners, the embryo is implanted into a gestational surrogate. This surrogate has no genetic relation to the baby.
• Using donor eggs and donor sperm, the embryo is implanted into a surrogate. This surrogate has no genetic relation to the baby.

Q. How do we get donor sperm?

For lesbian couples

Choosing a sperm donor is a very personal process, and each couple will approach the subject in their own way. There are two paths to getting donor sperm:

• Anonymous donor. In this case, you will choose a donor from a sperm bank. The bank will have profiles to preview with background information available, and all samples will be pre-screened.
• Known donor. Some women decide to use the sperm of an identified donor. This could be a close friend or relative or an altruistic stranger met through a matching website. If you choose a known donor, they will need to submit a sample to the clinic for sperm analysis to ensure that the sperm is healthy and fit for use in fertility treatments.

Q. How do we choose which partner carries the baby?

For lesbian couples

For some couples, there is an obvious answer to this question, but if not, you will probably have a series of conversations about which partner will carry the baby. It’s up to each couple to decide between themselves (if not using a surrogate), but there are some considerations which can guide your choice:

• Medical and gynecological history. The reproductive health of the partner who will be carrying the pregnancy is important. Healthy ovaries and eggs, especially if she will be using her own, and a healthy uterus will give you the best chance of success. An ideal gestational carrier should have no previous cesarean deliveries.
• Healthy lifestyle, no toxic habits. Overall health and fitness is a consideration, too, as reproductive technologies such as IVF may be less effective in women who are obese or substantially underweight. Smoking or other toxic habits will have an adverse affect on the pregnancy.

Q. How can we ensure that the baby has a biological relationship to both partners?

For lesbian couples

Same sex couples often have concerns about how the bonding and relationship between parents and baby may be affected by their biological relatedness (or lack thereof). While it is obvious that a genetic relationship is not necessary for family bonding, it is natural to want to be be biologically related to your child. There are several ways that lesbian couples may approach this issue:

• One partner carries and the other provides the eggs.
• Using eggs from both partner and donor sperm, embryo is implanted into one partner.
• Using eggs from both partners and donor sperm, embryos are implanted into both partners.

Q. What are my options for using a surrogate?

For gay couples

Surrogacy has revolutionized the fertility options open to gay couples. There are two basic paths for using a surrogate:

• Surrogate is the source of both egg and the uterus (she can get pregnant with IUI).
• Surrogate and egg donor are different (IVF is used).

Q. How do we get donor eggs?

For gay couples

• Anonymous donor. If you decide to go with an anonymous donor, it is important to choose a reputable egg donor agency. Your fertility clinic should be able to point you in the right direction.
• Known donor. You can also use the eggs of someone you know, such as a close friend or family member. The process of retrieving eggs from a woman’s body generally takes several weeks, a course of fertility drugs, and a short outpatient procedure performed under sedation, so it is a significant commitment for your donor, and they will have to be comfortable with working closely with your fertility clinic.

Q. How can we ensure that the baby has a biological relationship to both partners?

For gay couples

There are two choices here:

• Combine sperm of each partner with separate batches of donor eggs. This process could result in twins with same biological mother but separate dads. If one child is born, you always have the option of using a DNA test to determine which partner is the father.
• One of the partners’ female relatives could serve as an egg donor and fertilized by the sperm of the other partner. This option ensures that both partners share their genetic heritage with their child.

Q. What is the cost for LGBT couples to have a child?

Because each couple’s situation  is different, it is impossible to estimate the total cost without knowing the specific details of your case. There are many factors which can affect the price of your fertility treatments.

• Type of treatment. The costs involved in an IUI cycle, for example, are much less than the costs for IVF, because IVF requires more visits, more tests, more specialized lab work, and more intensive procedures. The number of cycles required to achieve pregnancy will also affect the total cost.
• Third party agency costs. Aside from the costs of the fertility treatments themselves, you will need to pay your sperm bank or egg donor agency and/or surrogate agency. While donors and surrogates are volunteers acting altruistically, you are required to cover costs, which can vary widely. Obtaining donor eggs is much more expensive than obtaining a sperm sample, and the costs for a gestational surrogate are usually substantial.
• Egg/Embryo freezing and storage costs. These may be charged by your fertility clinic or a third party agency.
• Diagnostic testing and office visits. This includes tests for you and/or your donors such as checking ovarian reserve or performing sperm analysis.
• Medications for egg donor and recipient. Fertility medications are generally sold by pharmacies, not your clinic, and are usually not included in the cost of an IUI or IVF cycle.
• Legal fees. In many states, LGBT families have special legal considerations which will require the services of a lawyer.

Q. What are the legal considerations for LGBT families?

Securing the legal ties between your family is not always as easy or automatic as it should be, but it is a vitally important step in family planning for same-sex couples. The lack of legal recognition can have serious consequences for children, such as lack of access to healthcare, or later custody disputes. These are the some of the steps you should keep in mind as you begin the process:

• It’s important to retain an attorney who specializes in reproductive law to draft agreements between parties (you, your partner, any known donors and/or your surrogate) and obtain advice on your rights and protections, which can vary greatly from state to state.
• Make sure the forms you sign reflect the status of same-sex partners. 
• In the case where one parent is the biological parent, other parent may be able to become a legal second parent through step-parent or second parent adoption not all states allow this; make sure to check the laws of your state for your options.
• According to the ACLU if you live in California, your rights as the non-biological parent are assured: “In California, if you are married to or in a domestic partnership with the person who gives birth when your child is born, you should be fully respected as a parent. But we still strongly recommend that you confirm your legal rights through an adoption or other court judgment, because not all states fully respect non-biological parents. An adoption or court order has to be recognized in every state, even if they have different laws, so it is the best way to make sure that your parental rights will be protected.”
  • California expressly permits second parent adoptions statewide, and the statute also permits step-parent adoptions by registered domestic partners. State law uses same parentage presumptions for adults in same-sex and different-sex relationships who have and/or raised children together. In surrogacy cases, things are a little different. A birth certificate does not establish parentage, that is done via court order or pre-birth parentage order.

The medical and legal landscape for LGBT families has changed so much in the last few years, and what was once rare and exceptional is now happily commonplace. Same-sex couples are now routinely seeking out fertility treatments to help them create their families, and it is an honor and a privilege to help them bring their babies home.

June is Pride Month, and as the celebrations kick off around the country, we’re shining a light on the fertility treatment options available to LGBT couples, families, and individuals. We know that the path to parenthood isn’t always simple, and that members of the LGBT community often face many issues and challenges along the way. All of us at SCRC are committed to equality in reproductive choices and treatment for LGBT families.

Creating sensitive treatment plans for the varied needs of LGBT couples and individuals is one of our specialties, and we make it a point to attend events like the Men Having Babies conference to help inform families of all their family building options. Among our fertility experts, Dr. Ghadir in particular has been recognized for his advocacy in the community. He is a supporter of the Family Equality Council and often speaks to the LGBT media about fertility choices, including The Fight, The Mirror, Frontiers LA, The Bay Area Reporter, South Florida Gay News, and 429 Magazine.

We strongly believe that everyone deserves to create the family of their dreams, and one of the greatest joys of working in the field of reproductive medicine is watching how cutting-edge fertility treatments have opened doors for the LGBT community. The prospect of welcoming a new baby is exciting for anyone, and modern Assisted Reproductive Technologies (ART) mean that the dream of building a family together is now a reality for more couples than ever. It’s our privilege to play a part in making dreams come true with the help of the latest technology, treatments, and research.

LGBT families have unique needs, and like all prospective parents, they often have many questions about what is possible, what is involved, and what they can expect. Some of these questions can only be answered in a consultation with your fertility professional, but we can make a start by covering the most common queries about LGBT family planning.

From everyone at SCRC, Happy Pride!