Written by Sophie Wilson
Making the decision to start a family can be exciting and daunting, whatever your sexual orientation, gender identity, or relationship status. That said, thanks to developments in fertility treatment, there are now more options than ever before for LGBTQ+ couples and solo parents to have a child. And figures show that increasing numbers of us are exploring these options.
According to the Human Fertilisation & Embryology Authority (HFEA), 4 percent of all fertility treatment cycles in the U.K. involved LGBTQ+ people in 2019, a fourfold increase from 2009, when that number was just 1 percent. Similarly, a 2019 Office for National Statistics report that looked at the trends in living arrangements of families and single people across the U.K. also found that the number of families with married, same-sex parents had increased fourfold between 2015 and 2018. In the U.S., Family Equality estimates that around 3.7 million children have an LGBTQ+ parent.
However, no two families are the same, and this also applies to LGBTQ+ families. It’s tricky to drill down into exactly which methods LGBTQ+ people use to conceive because stats are scarce, but let’s start with In Vitro Fertilization (IVF) since it’s a fertility treatment most of us recognize.
Below, you’ll find an expert guide to LGBTQ+ IVF, including medical and financial considerations to think about when creating a fertility plan.
Before you decide whether IVF is the right choice for you, it’s useful to know exactly what the treatment entails.
IVF is just one fertility method that can help people who are struggling to conceive naturally have a baby. Put simply, eggs are fertilized by sperm cells in a lab during an “IVF cycle” in the hope of creating embryos.
In reality, there are several stages to an IVF cycle. First, the partner whose eggs will be used takes hormonal medication prescribed by a fertility clinic to boost their egg supply. Usually, one egg is released during ovulation each cycle, but, during IVF, the medication stimulates the follicles in the ovaries to release as many as possible.
Regular ultrasound scans check the size of the follicles, along with the thickness of the uterine lining (important for embryo transfer, below). Not all follicles will contain an egg, so the hope is to stimulate as many as possible to increase the chances of egg production. Once the clinic is happy with the follicles, a trigger shot of medication prevents premature ovulation.
The eggs are then removed from the ovaries at the clinic during what’s called “egg collection” — a surgical procedure performed under sedation that usually takes 30 minutes to an hour. In the clinic’s lab, the eggs are mixed with sperm cells to fertilize them in the hope of creating embryos that can be used straight away in a fresh cycle or frozen for use at a later date.
One (or two) of these embryos is then transferred back into the uterus (or your partner’s uterus if you’re doing reciprocal IVF, more on that below) during “embryo transfer.” A pregnancy test is then taken two weeks after the embryo transfer to see if the treatment has been successful.
IVF is usually recommended when other routes to conception have already been attempted, but some couples may choose IVF first due to its effectiveness or factors like health and age. In recent years, IVF has become increasingly popular among LGBTQ+ partnerships where one or both partners have ovaries — thanks in part to reciprocal IVF.
Dr. Darcy Broughton, the co-director of the Center for LGBTQ+ Family Building at Pacific NW Fertility (PNWF) in Seattle, describes IVF as “more than a last resort. It can be an empowering family-building strategy, especially for couples starting their family later in life.”
So where should you start if you’re considering IVF? We’d recommend finding an LGBTQ+-inclusive doctor who can talk you through all of your fertility options. We’ve compiled a list of support services that can help at the end of this article.
If you are looking into fertility treatment as part of your family planning, the good news is there are a number of options open to you.
The first is intracervical insemination (ICI). This is when donated sperm cells are inserted into the uterus via the vagina using timed ovulation to make sure you’re at your most fertile. Some couples might try this first before exploring other fertility options because ICI is less expensive than IVF (you don’t need the sperm to be washed in a clinic) and can be done at home. However, ICI doesn’t work for everyone and has a relatively low success rate. If you try ICI and it fails to work, it might be time to consider other fertility treatments, like IUI or IVF.
Intrauterine insemination (IUI) is another option for prospective parents. This is where washed sperm cells from a donor are injected into the uterus during timed ovulation at a clinic. You then wait to find out if the egg has been fertilized naturally. A big selling point to IUI is that it’s less expensive and less invasive than IVF. However, it’s also less effective. According to the HFEA, success rates for IUI are generally around a third of those for IVF.
While having so many options available to you is a good thing, it’s also OK to feel overwhelmed by the amount of information that accompanies them. Speak to your doctor, or healthcare professional, so they can guide you through the right treatment plan for you and answer any questions.
No two people's family planning journeys are the same, but we do know that IVF can present a number of opportunities for LGBTQ+ people who want to become parents.
“There are many reasons people choose IVF, including blocked tubes, unsuccessful outcomes with low-tech treatment like IUI, poor sperm parameters, or endometriosis,” explains Dr. Broughton.
“Some people opt for IVF instead of IUI due to its higher success rates and fertility preservation. Some people trying to conceive will choose IVF in order to freeze embryos for future family building, which is called embryo banking.”
Ally, 36, and her wife, 40, from Chicago know firsthand what going through IVF is like. Their fertility journey has been long but, fortunately, successful. Ally is now 28 weeks pregnant, thanks to IVF. But she wasn’t planning on carrying their child initially.
Ally’s wife tried two rounds of at-home inseminations (ICI) before opting for IVF. When she didn’t conceive through IVF, Ally started to prepare for egg stimulation so she could begin her own cycle.
“The IVF process is full of so many ups and downs that come from daily blood checks and checking follicle size,” she says. “I’ve learned that doctors can be overly optimistic, so you need to manage your own expectations.”
The process can be emotionally difficult for everyone involved. “I’d suggest partners walk through what their emotional needs are and make sure you keep yourselves busy out of the process [if you’re not the one having treatment],” Ally adds.
One of the barriers to accessing IVF is cost. In the U.S., one round of IVF can cost $12,000–$15,000, plus medication (up to $6,000). Add a potential egg donor, and costs spiral to upwards of $30,000. Unfortunately, reciprocal IVF is also expensive. Both you and your partner will need to take medication to prepare for the treatment, which can set you back up to $8,000.
Don’t be put off by cost — financial aid and support programs are in place to support LGBTQ+ people looking to conceive through IVF. However, access can vary depending on where you live.
In the U.K., LGBTQ+ parents may face what’s known as a “postcode (or ZIP code) lottery.” That means qualifying criteria and provision for NHS fertility treatment differs from area to area, regardless of who is trying to access treatment.
Same-sex female couples in England are particularly disadvantaged by the differing rules. They often have to pay for IUI privately to prove their infertility issues and qualify for NHS-funded IVF. Some clinics charge more than £2,000 per IUI cycle.
Reciprocal IVF (R-IVF) is a popular option for LGBTQ+ couples, especially when both partners have ovaries and a uterus, including some trans men. This method involves one partner donating eggs to make embryos for the other to carry so that one partner is the genetic parent, and the other partner is the biological parent, making parenthood a shared experience from the start.
Often, LGBTQ+ couples feel R-IVF is the closest they can get to having a child who is genetically both of theirs, especially since you can opt for this treatment whether you need IVF for medical reasons or not.
The process of R-IVF is very similar to IVF. First up, eggs are extracted and mixed with sperm cells in a lab. However, instead of the fertilized egg(s) being reinserted back into the person they initially came from, they are inserted into the uterus of the egg donor’s partner so they can carry. Just remember that because both partners are involved here, they’ll each need to take their own fertility medication.
James, 39, is a trans man from California who has been on testosterone since 2003. Originally, he wasn’t sure if his reproductive organs would still be healthy and functioning, but his wife, Natalie, is now 22 weeks pregnant with a baby they conceived through R-IVF.
“Doing R-IVF feels as close as we can get to having a child that is genetically both of ours,” James tells Flo. When they found out Natalie’s BMI was above the cut-off for the anesthesiology team to retrieve her eggs, the couple decided to pursue R-IVF. James’s tests and scans showed his reproductive organs were fully functioning after just a few months off hormones.
“I remember signing a piece of paper [when I started testosterone] that acknowledged I could be losing my ability to procreate forever,” he says.
“I didn’t think that a 39-year-old who had been on T for 18 years had much of a shot of being able to produce viable eggs. I think a lot of trans men think that their ovaries and uterus disintegrate due to testosterone. While there is some evidence of some atrophy while actively on hormones, for me, given some time off T, everything still functioned. I would advise any trans men who want children and who think that their window has passed to see a fertility doctor or OB-GYN and get testing done.”
LGBTQ+ family planning can feel a little bit daunting at first, so it’s key that you find a doctor who listens to you, respects you, and has a good knowledge of LGBTQ+ issues, especially since research has highlighted that many LGBTQ+ people have faced discrimination while accessing health care.
Some clinics specialize in LGBTQ+ treatment, such as London Women’s Clinic in the U.K. Others, like PNWF in the U.S., have specialized centers for LGBTQ+ family-building, which is a good sign to look out for, but not necessarily required. Some clinics also provide counseling that considers specific challenges that LGBTQ+ families might face, such as legal questions around sperm donors and legal parenthood. Researching and inquiring at different clinics can help you find one that is just right for you. The GLMA website has a helpful list of LGBTQ+-inclusive clinics and physicians in the U.S.
It may also be worth seeking word-of-mouth recommendations from friends and your community or joining online groups or forums that focus on LGBTQ+ couples and fertility.
For more information, resources, and support around LGBTQ+ parental health care, you can visit:
Please note these resources are just for reference and are in no way associated with Flo
Pacific Fertility Center
Southern California Reproductive Center
Utah Fertility Clinic
Fertility Center of Las Vegas
UCSF Center Of Excellence For Transgender Health
If you’ve been affected by anything in this piece or are struggling with your mental health and would like to speak to someone, Flo has gathered links to support services that might be helpful. Please visit this page for helplines in different countries.