LGBT Family Planning

Our board-certified team helps men and women of any sexual orientation who dream of having a family. Gay, lesbian and transgender couples and individuals often need proven fertility treatments to become parents. We can help you through the array of emotional, medical and legal considerations. Select an option below to get started.

Family Planning for LGBT Patients

We offer our LGBT patients the same fertility options we offer all our patients, including sperm donation or freezing, intrauterine insemination (IUI), in vitro fertilization (IVF), egg donation or freezing and surrogacy. And we are especially attuned to the emotional and psychological needs of LGBT parents, and provide in-house counseling.

Family Building for Lesbian Couples

Female couples have numerous options to conceive and build a family. Any woman who would like to become pregnant should assess her overall health with a primary care physician or gynecologist before working with a board-certified reproductive endocrinologist infertility (REI) for assisted reproductive treatments and procedures.

Preparing for pregnancy

Fertility evaluations include a physical exam (with a pelvic exam) as well blood tests that measure hormone levels required for pregnancy. Other common fertility tests and procedures for lesbian couples include:

• Hysterosalpingogram (HSG) – an x-ray procedure that examines fallopian tube function and evaluates normal uterine cavity shape and size.
• Transvaginal ultrasound exam – evaluates the uterus and ovary functions required for conception.

All women over the age of 35 hoping to conceive typically undergo a basic fertility workup, including blood work to test for levels of the hormone estradiol and follicle-stimulating hormone (FSH). Anti-Mullerian hormone (AMH) may also be tested, which reveals ovarian reserve, as well as the number and quality of eggs.

How to conceive

Once the fertility health of the couple is established, there are three primary methods for lesbian couples hoping to conceive. The method selected depends on a variety of factors and questions, such as:

• Which partner will be genetically related to the baby?
• Who will physically carry the baby to term?
• Where will the sperm come from; will the couple use anonymous sperm from a sperm bank or known sperm from a relative or friend

Once a couple addresses the above considerations, they may choose the following methods for conception:

• Artificial insemination - A procedure that inserts sperm into the cervix or uterus. A woman must experience regular menstrual cycles to succeed with AI. The procedure is performed while a woman is ovulating to provide the best chance of conception.

In some cases, if a woman’s chances of conceiving are lower due to decreased fertility factors, such as age, an REI may perform superovulation and insemination. This method uses medicine to allow more than one egg to be released and then timing the inseminating injection of the sperm into the uterus.

• In-vitro fertilization with one partner’s egg and uterus - During in vitro fertilization (IVF), an REI stimulates the ovaries with injectable medications and hormones to release multiple eggs. The REI removes eggs from the designated partner during a surgical procedure. Sperm is then inseminated into the eggs in a laboratory in the hope that fertilization occurs. The resulting embryo(s) will be transferred into the uterus of the woman who supplied the eggs and will carry the child.

This form of IVF may be used in cases of lesbian couples who are having difficulty conceiving with AI.

• Reciprocal IVF - This procedures allows both partners to participate in the pregnancy. One partner donates her genes by supplying her eggs for IVF, while the other carries the resulting embryo in her womb. The procedure follows the same steps of in vitro fertilization with one partner’s egg and uterus, as described above.

Considerations of lesbian family building

The primary clinical consideration of planning for lesbians is deciding whether the baby will be genetically related to one or neither of the parents. But there are other factors, both legal and emotional, to contemplate when undergoing assisted reproductive procedures. Each state differs in the level of legal protections and considerations for same-sex couples using assisted reproductive technology. These considerations include the listing of same sex-partners on the birth certificate, surrogacy rights, egg and sperm donor situations, and privacy rights.

Colorado assisted reproductive law provides favorable protection when using both a known and unknown sperm donor, but working with an experienced attorney will ensure that each couple and partner receives the highest protection and legal understanding. Working with an attorney will also help address an agreed upon course of action if the couple were to separate in the future.

Emotional considerations weigh heavily on the decision to start or grow a family. Regardless of the sexual orientation of the couple, having children is a monumental life step. Speaking with a fertility counselor prepares couples to open a healthy line of communication as they begin to grow their family.

Family Building for Gay Male Couples

Bringing children into the world is a monumental life event that Advanced Reproductive Medicine is honored to help facilitate for couples—regardless of sexual orientation. Family building for gay males is complicated and involves several clinical, emotional and legal considerations. For male couples, there are two primary ways to have a child; traditional surrogacy with artificial insemination or using a gestational carrier.

Traditional surrogacy and artificial insemination

In a traditional surrogacy, sperm from one partner is implanted into a surrogate’s uterus with artificial insemination (AI). AI involves physician placement of the sperm. The surrogate may be a relative of one of the partner’s or an unknown surrogate.

Once a surrogate is identified, the male’s sperm will be evaluated for any possible fertility issues. If the partner has a low sperm count or motility issue, the artificial insemination procedure may include intrauterine insemination (IUI). IUI places the sperm into the woman’s cervix or uterus during ovulation. Intracytoplasmic sperm injection (ICSI), an even more advanced method of AI, includes injecting the sperm directly into an egg. ICSI requires egg retrieval and implantation in the uterus (womb) at an IVF lab.

Traditional surrogacy is less medically complex than other in vitro fertilization (IVF) procedures and this generally means lower associated costs for couples.

Gestational carrier

A gestational carrier is a woman who carries the pregnancy but is not biologically related to the child. If a couple uses a gestational carrier, they may select a non-related egg donor, introduce one of the male’s sperm and use IVF to implant an embryo into the gestational carrier. If the couple uses a related egg donor (for example, a sister of one male partner who will have his genes), then AI will be performed using sperm from the other male. In this situation, genes from both partners will be represented in the child.

Considerations of family building for gay couples

The primary clinical consideration that male couples must consider is deciding which father will be genetically related to the child and who will carry the child to term. But there are other issues to address before undergoing a surrogacy or gestational pregnancy.

Couples undergoing third-party reproductive techniques are highly encouraged to speak with a psychologist to discuss possible circumstances unique to using a surrogate or gestational carrier. For example, how will the couple deal with any arising issues from the surrogate? In rare cases, some surrogates unrelated to the couple find it hard to separate from the baby and want to continue to see and have a relationship with the child they carried.

Regardless of a couple’s sexual orientation, having children is a large and emotional life step. Speaking with a fertility counselor prepares all couples to begin and maintain an open line of communication as their family grows.

Any couple undergoing third-party reproductive technologies should also consult with an experienced attorney who can ensure that each party receives the highest protection and legal understanding throughout the IVF process. Each state provides different legal interpretations for same-sex couples so it’s important to know your rights. These considerations may include the birth certificate naming, surrogacy rights, egg and sperm donor situations and privacy rights.

Family Building for Transgender Individuals & Couples

Transgender individuals and couples face the same medical, emotional and financial challenges as all other fertility patients. Just like other fertility patients, transgender men, women or couples may require special consideration due to the need for third-party help. This may involve a surrogate mother or a gestational carrier to carry a pregnancy or a donor to provide sperm, eggs or embryos.

The type of fertility treatments depend on the reproductive capabilities of the people involved, as well as on the makeup of the transgender couple. For example, a transgender female with reproductive capability may not need a sperm donor, and a transgender male may be able to carry his own child.

In addition to these options, transgender individuals seeking gender reassignment may want to consider fertility preservation. For example, transgender women may wish to freeze their sperm before having gender confirmation surgery.

Following are the third-party reproductive techniques that may be appropriate for a transgender person or couple seeking to have a child and to be involved in the pregnancy and birth.

• Surrogacy and artificial insemination - In traditional surrogacy, a woman agrees to carry a child for parents who are incapable of doing so themselves. In the case of an intended transgender parent or couple who only have male reproductive capabilities, a surrogate will be required to become pregnant and deliver a child. The intended transgender parent can provide the sperm. The surrogate’s genes transfer to the child along with the genes of the transgender parent who provided the sperm.

If the surrogate is to be artificially inseminated, sperm may be provided by a transgender women and inserted via artificial insemination into the vagina, by way of intrauterine insemination (IUI), or through intracytoplasmic sperm injection (ICSI), in which the sperm is directly injected into the female egg. ICSI must be done via in vitro fertilization (IVF), a laboratory process of fertilizing an egg with sperm outside the woman’s body. Both IUI and ICSI increase the chances of a successful pregnancy.

• Gestational carrier and egg/embryo donation - Similar to a surrogate, a gestational carrier is a woman who agrees to carry a pregnancy and deliver a child for an intended parent/couple. However, it is not her egg that will be fertilized, but an egg donated by another woman. It can also be an embryo (a fertilized egg) that is donated, generally after it has been retrieved, fertilized via IVF and frozen for future implantation.

The donated embryo, or the donated egg that has been fertilized via IVF, is then implanted in the gestational carrier womb via IVF. Thus the gestational carrier will not provide any of her genes to the subsequent child she carries and delivers.

One of the intended transgender parents (if both are biologically male) can provide the sperm to fertilize the donated egg. Egg donors can be someone the intended parent(s) know or may be anonymous and most likely located through an egg donation service or a fertility clinic. Generally, the resulting child will have the genes of the transgender parent who donated the sperm and the genes of the woman who donated the egg.

A close relative of one of the intended transgender parents can also be the egg donor and the other intended transgender parent can furnish the sperm. The resulting child would have the genes of both transgender parents: of the parent providing the sperm and of the other intended transgender parent because his female relative’s genes are passed on to the resulting child in the egg she has donated. After the egg is fertilized via IVF, it will be implanted into the gestational carrier for pregnancy and birth.

Counseling for transgender parents

Such complex parenting situations involve unique emotional and psychological issues for intended parents, surrogates, gestational carriers and for egg or embryo donors. Transgender parents should receive thorough counseling on the emotional and legal aspects of family building.

Transgender parents face the same issues as any parents who use a third party for reproduction. These psychological concerns include:

• Raising a child who is not genetically related
• Guiding the child as he or she develops an identity
• Helping children understand how they were conceived
• Determining appropriate information to provide about a child’s donor (egg, sperm), surrogate or gestational carrier.

Transgender parents may face other specific situations that can be challenging. For example, a parent who provided sperm and fathered a child as a man can later become the child’s mother. Or the mother may later become the father. The specifics will vary from case to case, depending on who the mother and father are, whether or not there is a second parent, that parent’s gender, and other variables that present with different transgender combinations.

Our staff psychologists are experts at sorting out these issues and helping individuals manage them. They are well versed in the various issues involving third-party reproductive treatments that may include egg donation, surrogate pregnancy or gestational carriers. Their counsel on thorny genetic issues and helping patients cope with non-traditional means of parenting are very beneficial to transgender people or couples in need of fertility services.

Legal issues also need to be addressed and well understood by all parties. For example, details about visitation rights of a surrogate mother or gestational carrier need to be resolved before any medical procedures occur. States have different laws about recognizing parenthood and the guidelines that must be met, and these legal issues should be well understood by all parties. Our psychologists can offer suggestions on obtaining legal counsel.

Transgender men and women interested in exploring parenting can also find helpful links to resources on the Infertility Network’s website.