Written by Samuel Sims
Starting a family can be an exciting prospect, whatever your relationship status, sexuality, or gender identity. Developments in reproductive medicine mean there are more options than ever before to help you become a parent. However, LGBTQ+ people often have more things to take into consideration on their paths to parenthood, including the costs of fertility treatment and legal technicalities.
Don’t let that put you off, though. It's estimated that between 2 million and 3.7 million children in the U.S. have an LGBTQ+ parent. In the same way that cisgender, heterosexual families come in all shapes and sizes, LGBTQ+ families are just as diverse and beautiful.
Whether you're thinking of starting your own family or aren't sure of your family planning options as an LGBTQ+ person, we’re here to help with our expert guide.
Now that you’ve made the decision to become a parent, you’re probably wondering where to start. Well, the good news is that there are lots of fertility options available to you.
Have a read through our roundup of the most common below, then make an appointment with an LGBTQ+-inclusive fertility specialist to help find the right path for you. We’ve compiled a list of support services that can point you in the right direction at the end of this article.
One option for cis women and people with a uterus and ovaries is to fertilize your eggs with donated sperm. This sperm can either come from somebody you know or from an anonymous sperm donor who has donated their sperm to a sperm bank. Insemination, which is the process of transferring specially washed semen into the uterus, can then take place at home or a fertility clinic.
Briana Rudick, MD, who directs Columbia University Fertility Center's Third Party Reproduction Program, says both options have pros and cons: “Anonymous is easier logistically (just buy and send sperm), legally (you don’t need reproductive attorneys) and from a time perspective (using a known donor can take 5–8 months because the sperm should be quarantined). However, patients must have faith in the sperm bank they are using.
“Using a known sperm donor has extra challenges (like quarantining sperm while doing infectious disease testing of the sperm donor), getting legal agreements in place, and making sure that everyone is on the same page regarding rights and responsibilities.”
If you're planning pregnancy with a partner, then there's an option that Rudick describes as “really special.” Reciprocal IVF (R-IVF) 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.
R-IVF is also an option for trans and non-binary people undergoing hormone replacement therapy, but you may need to go through some preparatory procedures.
Trans men and non-binary people with ovaries can undergo egg retrieval while on testosterone therapy (T), or they can pause their treatment. They can then choose whether to fertilize their eggs right away or freeze them for use at a later date. Rudick explains that trans women and non-binary people with testes “should freeze sperm before taking estrogen since this can suppress sperm counts. If they have already started, it can take 3–6 months for sperm counts to recover.”
For LGBTQ+ people living with infertility, the good news is that having a child is still very possible. According to a 2018 study published in the journal Fertility and Sterility, the process of IVF has dramatically changed the medical landscape, enabling those who previously could not conceive to have children.
IVF involves taking hormonal medication to stimulate egg production. The eggs are then surgically removed from the follicles in the ovaries during an egg retrieval or egg collection before being fertilized with sperm in a dish. The resulting embryos are grown in a lab before being put back into the uterus during a fresh embryo transfer, hopefully resulting in a successful pregnancy.
Embryos can also be frozen to use at a later date (embryo cryopreservation). If you are part of a couple where both partners have ovaries and uteruses, such as a same-sex female couple or a trans man and a cis woman, the egg can be taken from one partner and placed inside the other partner’s body. This is called reciprocal IVF or R-IVF.
Intrauterine insemination (IUI) is often jokingly referred to in queer TV shows as the “turkey baster method.” It involves injecting sperm into the uterus at the time of ovulation using a soft catheter (no needle). You then wait to see if fertilization has occurred. According to Reproductive Facts, IUI is usually the first option for LGBTQ+ people wanting to have a baby because it’s significantly less expensive than IVF. However, the chances of success are, sadly, far lower.
If, for whatever reason, you or your partner cannot or do not want to carry a baby, then surrogacy is an option. A surrogate is someone who can carry a baby on your behalf.
There are two types of surrogacy:
- Traditional, when IUI is used to inseminate the surrogate’s egg with sperm
- Gestational, when IVF is used to fertilize a partner’s egg with sperm, and then the embryo is implanted into the surrogate’s uterus
Gestational surrogacy is the most popular method.
Though surrogacy is very popular and legally recognized and ethical in the U.S., seeking legal advice is highly recommended. Family Equality has a directory for all things LGBTQ+ surrogacy, including surrogacy agencies. Unfortunately, for those wanting a surrogate in the U.K., there are currently no financial programs or grants available.
Starting a family isn’t cheap, so you’ll need to do your research and work out the costs involved before you get started. These differ depending on the route you decide to take and where you live. Below, we’ve pulled together some example costs for people in the U.S.
In other countries, IVF costs will vary. For example, in the U.K., IVF can be free on the NHS. But, in reality, there are barriers to accessing NHS-funded IVF, including age and 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.
LGBTQ+ people face even more challenges. Many NHS trusts in England will require same-sex female couples to try to conceive six times via artificial insemination before possibly offering funding, according to Stonewall. They often have to pay for IUI privately to prove their infertility issues. Some clinics charge more than £2,000 per IUI cycle.
However, for those in Scotland, the odds are more in your favor, with all couples having access to three rounds of IVF if they meet nationally agreed NHS criteria.
If you opt for sperm donation and egg fertilization at home, it can cost as little as $25 per attempt. But, as Rudick points out, medically testing the sperm is encouraged, which will need to be done at a clinic. This pushes the cost up to around $300. Purchasing anonymous sperm through a sperm bank will cost more — $300–$1,500 per 0.5 cc vial. Using more than one vial per menstrual cycle is encouraged to increase the likelihood of achieving pregnancy. This can mean that even though egg fertilization is classed as one of the more affordable options, it can wind up being quite expensive.
If you choose to go down the IVF route, then there are additional costs to consider. IVF can cost $12,000–$15,000 per fresh embryo cycle, plus an additional $1,500–$6,000 for medications. Subsequent attempts that include Frozen Embryo Transfers (FET) average $4,000–$7,000 per cycle. If an egg donor is needed, costs can increase by up to $30,000. You’ll also need to access a fertility doctor. Due to the high price of IVF, some LGBTQ+ people are priced out of it being an option.
If you decide that R-IVF is the right option for you and your partner, then you’ll both need medication. This can cost $3,000–$8,000 per cycle.
Significantly less expensive than IVF, the cost for IUI ranges from $250 to $4,000 per cycle.
Because surrogacy involves another person, it can be incredibly expensive. Gestational surrogacy costs start at around $60,000 and can reach $150,000 or more. It is important to note that gestational surrogacy is not available in every U.S. state. The costs of gestational surrogacy can also increase if the surrogate experiences medical complications during pregnancy, delivery, or after giving birth (postpartum).
Traditional surrogacy costs vary dramatically based on a number of factors, including the method of conception used (home insemination versus hospital/lab insemination); the medical costs of the surrogate; and the legal fees associated with establishing parentage. That said, the fees for traditional surrogacy tend to be lower than for gestational surrogacy since IVF is typically not required.
Unfortunately, the costs involved in starting a family do act as a deterrent for many LGBTQ+ people, and if this is you, you are not alone. There are, however, numerous family-building grants available to U.S. residents who cannot afford fertility treatments. One organization worth looking into is BabyQuest Foundation. They provide financial assistance to those who can’t afford IUI, IVF, egg donation, or surrogacy.
Since surrogacy is often the most expensive option, it’s not uncommon for people who go down this road — including many cisgender gay men — to struggle to start a family if they do not choose to adopt or foster. A 2020 survey published by Fertility and Sterility reported that financial issues were significant considerations in gay and bi men’s family-building decisions.
More financial support is widely available to those who are living with infertility, but this can be limited to cis women and people with a uterus. One organization that offers assistance to gay men and trans women is Men Having Babies. For more information, including the eligibility criteria, visit their Gay Parenting Assistance Program.
Don’t let this put you off, though. Many LGBTQ+ people are fighting for support with petitions for fertility equality. There are also communities of like-minded individuals and couples who support those wanting to or starting their parenting journey, such as Proud 2B Parents. The NHS can also direct you to a range of mental health support services.
Elsewhere, Australia’s Rainbow Families has programs that offer advice and support. They provide information on all your options, whatever your preferred route to conception. In Canada, Sherbourne Health offers a parenting network that serves the unique needs of LGBTQ+ parents and those who are considering parenthood.
When you're thinking about family planning, finding a lawyer may not be the first thing that comes to mind. However, they play a key role for many LGBTQ+ people who are having a baby.
Whether you’re using a known sperm donor or opting for surrogacy, in a couple or single, legal guidance is essential if you’re planning on pursuing parenthood as an LGBTQ+ person.
Janene Oleaga Kurta, an assisted reproductive technology attorney, explains why: “Attorneys will advise regarding different paths to parenthood, draft legally binding contracts, and ensure legal parentage is secured.”
Amira Hasenbush, founder of All Family Legal in California, says the recent case of Gatsby v. Gatsby is an important reminder of how important this side of family planning is. “A case just came down from the Supreme Court of Idaho not recognizing a non-biological mom in a married lesbian couple because they did not follow the legal requirements to the letter, even though they signed a contract with their sperm donor,” she explains.
Please do not be deterred by what may feel like a long, difficult, and expensive journey to parenthood. LGBTQ+ people have every right to fulfill their dreams of raising a child — or children — so don’t let anybody tell you otherwise.
“I have had so many LGBTQ+ patients in tears at their graduating pregnancy ultrasound telling me that they never thought this was possible for them,” Rudick says. “They never thought they could be parents or have a family because they were LGBTQ+. I just say, ‘It is possible, and you are doing it. So there.’”
The financial aspect of becoming a parent can often feel like the biggest obstacle. But with support in the form of grants now available for many, there’s more hope than ever before.
Please note these resources are just for reference and are in no way associated with Flo
Pacific Fertility Center
Southern California Reproductive Center
Human Fertilization and Embryology Authority
Gender Inclusive Perinatal Guide
New Family Social
Your Community Health
Pacific Center For Reproductive Medicine
Trans Care BC
Rainbow Health Ontario
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.