Granted, having babies as a same- or similar-gender couple or transgender individual can be complicated. There are logistical issues, legal hurdles, and financial obstacles that cisgender heterosexual couples rarely consider or ever need to deal with.
Fertility in LGBT Families
Just like heterosexual couples, some LGBT people will face infertility on top of “situational” infertility. Further, intersex individuals (some of whom identify with the LGBT community) may be infertile or have diminished fertility. Discrimination may also arise in your journey towards parenthood, though it should not prevent or stop you. All that said, lots of people in the LGBT community are raising kids. In 2019, almost 29% of people identifying themselves as LGBT reported raising children. In the United States, an estimated 3 million LGBT individuals have had a child, and an estimated 6 million children have an LGBT parent. Same-gender couples—when compared to heterosexual couples—are six times more likely to be raising foster children and four times more likely to be raising an adopted child. Data from the 2010 U.S. Census shows that 19% of same-gender households report raising children. This includes those raising biological, adopted, or foster children. At the most basic level, your options for having kids are either with the help of assisted reproductive technologies or through the adoption or foster care network. A gay or transgender person’s options for parenting include:
Adoption Co-parenting (a planned, platonic parenting relationship) Foster care Insemination with a sperm donor In vitro fertilization (with or without a gestational carrier) with an egg, sperm, or embryo donor Penis-in-vagina sex for relationships where one or both partners are trans Reciprocal IVF (one partner carries the baby, the other is the egg donor) Using a gestational carrier with an egg donor
These avenues are open to you whether you are single or partnered. They are also, in most cases, open to you even if you’re HIV-positive, as there are fertility procedures that significantly reduce the risk of HIV transmission to a child or gestational carrier. Lack of financial resources is the most likely barrier to some (but not all) of these paths to parenthood.
Third-Party Reproduction
Third-party reproduction refers to any fertility procedure where a “third person” is needed to provide eggs, sperm or embryos, or to be a gestational carrier for the intended parent(s). Any time third-party reproduction is being considered, there will be terms used to describe the relationship between the donor or carrier and the intended parent.
Known Donor/Known Gestational Carrier
This is when the donor or gestational carrier is someone previously known to you. It may be a friend, relative, or acquaintance. The person isn’t someone you found through an agency, ad, social media, or fertility clinic. There are advantages and disadvantages to having someone you know be your sperm or egg donor, or act as a gestational carrier. The experience can improve your relationship with the person—or damage it. There may also be increased legal risks (for example, a donor or gestational carrier fighting for parental rights), and possible future disagreements over how involved the donor or carrier should be in the life of your child. Meeting with a counselor and a lawyer familiar with the delicate nature of third-party reproduction is essential. Some fertility clinics will not work with a known donor until after psychological counseling and legal agreements have been completed.
Anonymous Donor
This has traditionally been the most common arrangement for egg and sperm donors. The donor does not know the recipient(s), and the intended parents have no identifying information about the donor. While you will likely get to see a photo of any potential donor, it’ll be a baby picture. There’s no contact between the donor and intended parents at all. This arrangement has felt safest for donors and intended parents, who both may be worried about legal or emotional complications after the birth—for example, worries that the donor will try to claim parental rights or worries that an intended parent will try to extract child support from the donor. However, many donor-conceived children wonder about their genetic origins. Intended parents may wonder about the person who helped them become a parent, and donors might wonder about the child they helped bring into the world. This has led to an increase in popularity for semi-open and open donor arrangements.
Semi-Open Donor
You’ll have more identifying information and limited contact with the donor with a semi-open arrangement. What this entails can vary greatly, but typically, the communication will be through an intermediary, such as the donor agency or a law firm. The donor may get information like whether or not the donation led to a pregnancy. Details like personal phone numbers, addresses, and place of occupation are not shared. Sometimes, with a semi-open arrangement, the donor-conceived child may be permitted to reach out to the donor. There may be restrictions in place, like it can only happen after the child is a legal adult.
Open Donor
With an open donor or gestational carrier arrangement, contact is often direct and ongoing. The donor and intended parents may meet in person and even attend some doctor appointments together. They will likely communicate with each other directly. With some open donor situations, the donor and intended parents decide to get together once a year or every few years. There is often a relationship of some sort built between the donor, the intended parents, and the donor-conceived child.
Sperm Donor Insemination
Insemination is when specially washed semen is transferred to a person’s cervix or uterus. Some lesbian couples, heterosexual couples where the man is transgender, and some people assigned female at birth may go this route to have a baby. The sperm donor may come from a sperm bank or may be a known donor.
Where It’s Done
Insemination can take place at a fertility clinic, or, in some cases, a midwife can conduct an insemination procedure at home. Home insemination is a possibility, but with some important cautions and caveats. There can be serious legal and medical risks with home insemination.
Cost
The cost of insemination and a sperm donor can range anywhere from several hundred dollars to several thousand dollars. It depends on how many tries you need before you achieve success and also what kind of insemination procedure is used. At-home insemination will be less expensive, but is more likely to fail, and has legal and medical risks (especially with a known donor). When it comes to fertility clinic procedures, intracervical insemination (ICI) is less expensive than intrauterine insemination (IUI), but IUI has better success rates. Remember that cisgender heterosexual couples having sexual intercourse may require many months to get pregnant. Taking up to a year isn’t common, but it’s not abnormal either. When you’re paying for every vial of sperm in a donor situation, the costs can add up quickly.
Parental Rights
Be very careful about going forward with a do-it-yourself at-home donor insemination with a known donor. Insemination that takes places outside of a fertility clinic, in many states, will automatically assign parenthood to the male sperm donor, even if no sexual intercourse took place and even if there were legal agreements set up ahead of time.
Medical Risks
There can also be medical risks with a donor arrangement at home with a friend. Sperm donors go through rigorous screening and medical testing (such as checking for genetic issues), but with a friend, these safeguards won’t exist. If you’re using a known donor, there is a quarantine process of up to six months that could delay your cycle. If you’re getting sperm from a sperm bank, check with your clinic that it’s an approved bank to use. For example, in New York state you must use a state-licensed bank.
Deciding Who Will Carry the Baby
If you are pursuing insemination, a big decision to be made—besides choosing the sperm donor—is who will carry the baby. There is no wrong way to decide this, but some possible options include:
Whoever is most likely to have success (based on fertility history or testing)Whoever wants to experience pregnancy and birth most (not everyone is interested in being pregnant; sometimes one partner will have already experienced pregnancy)If planning on having more than one child, making a decision to take turns (though you still need to decide who goes first)Inseminating both partners each month, and whoever gets pregnant carries the baby (though you could end up with “twins”)
In Vitro Fertilization
In vitro fertilization (IVF) to consider is when eggs are harvested from a person’s ovaries (this could be one of the intended parents, or a donor). Then, in a lab, those eggs are put together with sperm from either a donor or an intended parent. If all goes well, you get a few embryos, and one or two of those embryos can be transferred to someone’s uterus (once again: this could be an intended parent or a gestational carrier). Any extra embryos can be cryopreserved for the future.
Reciprocal IVF
Reciprocal IVF is an option for couples where both partners have a uterus and both want to have a part in the biological process of having a baby. One partner has the egg stimulation and retrieval, while the other partner has the embryo(s) transferred to their uterus. One parent will be genetically related to the baby, while the other will have given birth to the child. The decision of who will contribute the eggs and who will carry the child may be a personal one or a medical one. For example, if one parent is much younger or has better fertility, they would probably be the best one to contribute the eggs. Age isn’t as much of a factor when it comes to carrying the baby. Reciprocal IVF can range anywhere from $15,000 to 30,000. Multiple cycles may be required to achieve success. However, if there are cryopreserved embryos from an unsuccessful cycle, a frozen embryo transfer cycle will cost significantly less than a full IVF cycle—usually something around $3,000 to $5,000.
Beyond IVF fees, expect to pay legal fees. Establishing parenthood may not be as straightforward as you might expect. For example, the parent who contributed their eggs may need to legally adopt the child, even though the baby is their genetic offspring.
IVF With an Embryo Donor
IVF with an embryo donor is another option for multiple types of LGBT parents. The baby will not be genetically related to the intended parent(s). The embryo can either be transferred to the parent who is able to carry the pregnancy or to a gestational carrier. Cisgender heterosexual couples may want the intended father to be genetically related to the baby (if possible), so using an egg donor with the intended father’s sperm makes sense. However, for some LGBT couples who require both an egg donor and a sperm donor, using an embryo donor can be a good solution. It can also be significantly cheaper than conventional IVF or IVF with an egg donor. Conventional IVF with your own eggs is usually around $15,000 to $20,000 per cycle. IVF with an egg donor can cost anywhere from $30,000 to $40,000 per cycle. Depending on the clinic, location, and egg donor agency, costs can go even higher. One drawback of embryo donation is that you won’t be choosing a sperm or egg donor, since that phase of treatment is completed. Donated embryos often come from couples who struggled to conceive, so the success odds may also be slightly lower than using an egg donor. It very much depends on the donor.
Egg/Embryo Donor With Gestational Carrier
Sometimes a gestational carrier carries a baby for an intended parent or parents. This may be the right option for couples where neither partner can carry the baby for biological, hormonal, personal and/or medical reasons.
Finding a Gestational Carrier
A gestational carrier may be someone the couple or person knows, or they may be found through a fertility clinic or agency. Just like with choosing an egg or sperm donor, there are advantages and disadvantages to having someone you know be a gestational carrier. This is something to carefully consider with the help of a counselor. For couples where neither parent has eggs or can use their eggs, they will also need to find an egg donor. You might think you can just do an insemination procedure with the gestational carrier, which would be less expensive. However, there are legal and possible psychological risks when the gestational carrier is also the egg donor.
Deciding Whose Sperm to Use
Assuming both partners can produce sperm, the couple will need to decide which will contribute the sperm. There are different ways to go about making this decision, including factoring in age. For example, if one parent is much younger than the other, you might go with the younger parent, since there are genetic risks with sperm from older individuals. In some cases, couples attempt to mix the sperm of one parent with half the eggs, and the sperm of the other parent with the other half of eggs. High-quality embryos that are suitable for transfer to the gestational carrier are not guaranteed. But, you could get embryos conceived with both parents’ sperm. The “extra” embryos could be cryopreserved and used to have a second child in the future.
Cost
Using a gestational carrier and an egg donor is extremely expensive, costing anywhere from $70,000 to $150,000. Costs will be lower if you can use a known carrier or egg donor, or if you decide to use an embryo donor with a gestational carrier, but if you use an embryo donor, neither parent will have a genetic connection to the child. No matter how you move forward, this option is going to be pricey.
Having a Genetic Connection
There actually is a way both parents in a same-gender relationship can have a genetic connection to their child. It works like this: one partner provides one gamete (egg or sperm, as the case may be). The other partner has a sibling or cousin provide the other gamete. While the second intended parent isn’t the genetic parent, they do have a genetic connection to the child. To illustrate how this may work, let’s say we have a cisgender lesbian couple, Anne and Zoe. Let’s say Anne is the one who plans to carry the baby and get pregnant. One of Zoe’s siblings or cousins would be the sperm donor. The sibling or cousin would not be the intended parent—they are only the donor. Zoe would be the second parent, along with Anne. Or, let’s say we have a gay cisgender couple, Alex and Zack. If Zack provides the sperm, one of Alex’s relatives may act as the egg donor. The gestational carrier may be the egg donor or someone else, depending on the situation. Again, Alex’s relative wouldn’t be the legal parent. Alex would be the intended father, along with Zack. As with everything, there are advantages and disadvantages to this option. For one, it requires that one partner has a sibling or cousin who is interested and willing to be an egg or sperm donor. Secondly, having an understanding that the donor will not be a parent or have any parental rights or responsibilities (even though they are a relative) can be complicated.
Co-Parenting
Co-parenting is when two or more people decide to have a child and raise that child together, usually outside the context of marriage. Of course, only two can be the genetic parents, but in a co-parenting situation, multiple adults may parent together. The phrase “co-parenting” is most commonly used in the context of divorce—a divorced couple that shares custody may co-parent the children together. However, in the context of LBGT family building, co-parenting is planned ahead of time, before a child exists. Note that planned co-parenting is not exclusive to LGBT families, and could apply to polyamorous families, as well as other family structures. In a co-parenting situation, assuming there are no fertility problems, the egg donor, sperm donor, and gestational carrier (who may also be the egg donor, in this case) are all intended parents. A co-parenting arrangement may be made up of:
A single cis man and a single cis womanA lesbian couple and a single manTwo same/similar gender couplesA three or more partner relationshipSome other combination of people
Co-parenting is not the same as a “known” gestational carrier or donor situation. With known carriers and donors—even if an ongoing relationship takes place between the intended parents and the donor/gestational carrier—the carrier/donor is not a parent. They take no legal, financial, or emotional responsibilities for the child. If anything, they are more like an honorary aunt or uncle. With co-parenting, all those involved in the arrangement are intended parents. They may or may not all decide to live together. They may not even live close to each other. But they share parenting responsibilities and rights in some way. Entering into a co-parenting relationship is a huge decision. You are agreeing to be connected to the child and the other parent(s) for life, at least in some way. The decision is more binding than marriage to a romantic partner in that there is always divorce after marriage—but once there is a child or children involved, maintaining some degree of ongoing communication is a must. Some co-parenting arrangements may include sex for the sake of conception. However, more typically, a fertility procedure like insemination is used. For example, with a cisgender lesbian couple and a single trans woman—three intended co-parents, in this case—our single parent will provide the sperm and a fertility doctor performs an insemination procedure with that sperm to hopefully get the intended co-parent pregnant. The legalities of co-parenting are complex and will vary depending on where you live. Who can be on the birth certificate? Can more than two parents be named? Also, note that having your name on the birth certificate doesn’t necessarily give you parenting rights. What about legal guardianship? If a sperm donor co-parent is involved, will they need to legally adopt the child to have legal parenting rights? Meeting with a lawyer prior to taking steps to have a baby with a co-parent(s) is essential. Informal agreements are not enough. Should your co-parenting relationship falter in the future, you don’t want any questions as to your visitation and parental rights to your child.
Transgender Parenting Options
Transgender individuals who have had hormonal and surgical medical intervention may face additional challenges when it comes to having a genetic child. Taking hormones can negatively impact fertility for all genders. These negative repercussions can continue even if hormone treatments are discontinued or paused. However, this doesn’t mean those who want gender-affirming medical procedures can’t have genetic children in the future. Those assigned female at birth may even be able to carry a child after hormones and surgery if they want. Ideally, future fertility options should be discussed before any gender dysphoria treatments are started. For transgender people assigned male at birth, this may mean cryopreservation of sperm. For transgender people who were assigned female at birth, this may mean egg freezing. A skilled specialist can review your medical records, do some basic fertility testing (if needed), and help you consider all your options. Also, remember, having a child with the help of an egg donor, sperm donor, and/or gestational carrier is an option if finances allow.
Adoption and Foster Care
Adoption and foster care are popular choices for LGBT individuals and couples. Some people are under the misconception that same/similar gender couples and trans people can’t adopt or apply to be foster parents, but this is untrue. “Don’t be afraid to pursue adoption!” says Mark Barbagiovanni, a social worker who specializes in assisting hopeful adoptive parents. Mark and his husband have an adopted child of their own. “There is an amazing community of LGBTQ families on social media from all around the world.” There are a variety of paths to adoption, some costing thousands of dollars and others costing very little. You may seek adoption through a private agency, through the state, or privately person-to-person, in what is known as “self-matching” adoption. It’s also possible to adopt through the foster care system. “Adoption has so many different components, so in regard to cost and type of adoption, there are many options to build your family,” explains Barbagiovanni.
Facing Potential Discrimination
Domestic adoption is often the best option for LGBT couples, as many international adoption agencies discriminate against LGBT individuals. Depending on where you live, you may also come against discrimination and legal hurdles. But don’t let that stop you. “Unfortunately, legislation is always changing,” says Barbagiovanni. “For those pursuing an independent adoption, they can run into people who will discriminate and be unfriendly. There are also people who are just against adoption in general.” “An LGBTQ person should seek out a professional that is known to work with this population. Many adoption professionals will advertise that they welcome LGBTQ families,” suggests Barbagiovanni.
Self-Matching Adoption
In addition to going through an agency or government program, LGBT couples may want to look into what is known as self-matching adoption. This is when a private agency or individual, along with an adoption lawyer, conducts a home study. Then, you use social media, word of mouth, and print advertising to let the world know you’re interested in becoming an adoptive parent. “There are several companies and individual adoption professionals, such as myself, who offer a marketing package for prospective adoptive parents,” says Barbagiovanni. “There are many benefits to using social media as an adoption marketing tool. It’s budget-friendly and on a journey that offers very little control for waiting families, using social media lets them have some control over their matching to an expectant parent.” You may be concerned about adopting an older child—as opposed to a baby—that the child has already been socialized against LGBT people. Barbagiovanni explains this might only be a potential problem when adopting from countries with little or no legal protections for LGBT people or through the foster care system. However, if you want to adopt from foster care, you shouldn’t let this fear stop you from trying. “Hate and prejudice can start at a very early age depending on how the child has been raised thus far,” says Barbagiovanni. “In my experience, the child’s social worker will know the type of family that will be a good match for the child. There is a team of professionals that choose the family for any child in foster care. So, this shouldn’t be a problem.” Others may be concerned that single men or gay male couples would have a harder time adopting just because they are men, but this may not be true. “For gay male singles/couples, we have it particularly easier in the matching process, as there is no other mom ‘replacing’ the child’s birth mother and often get chosen quicker.”
Foster Care
Foster care parenting—with no intention of adoption—is another option for LGBT singles and couples to parent a child. The goal with foster care is to eventually reunite the child with their original parent(s) after they get past difficult times. Few foster care children go on to be adopted. With foster care, your relationship with the child is likely time-limited, and you will need to say goodbye eventually. Also, sometimes, the biological parents will not allow continued contact with a previous foster care parent, and this can be emotionally difficult. All that said, foster care is a wonderful way to play an important role in a child’s life. As with adoption, looking for foster care agencies or social workers that advertise being LGBT-friendly is a good idea.
