LGBTQIA Family Building
LGBTQIA family building overview
Infertility medicine has changed the prospects for heterosexual couples with infertility issues, and it has also opened up the way for people with other sexual orientations to have families. We fully support the desires of all people to have a family, and we support LGBTQIA family building at our practice.
The LGBT (lesbian, gay, bisexual, transgender) term continues to evolve to better address the complexities of non-heterosexual identities, and we recognize LGBTQIA. Q stands for queer or questioning (of sexual orientation); I stands for intersex (people born with physical sex characteristics that do not fit typical definitions of male and female bodies); and A stands for asexual (one with no sexual feelings or desires).
LGBTQIA individuals and couples wishing to become parents through fertility treatment have various needs and options in creating a family. These choices can involve legal, financial, medical and psychological considerations, and we’ll help LGBTQIA couples and individuals with all those issues. The treatment options and how Loma Linda University Center for Fertility & IVF can help are described below.
Types of services for our LGBTQIA patients
Individuals of all sexual orientations may need fertility treatment to parent a child due to male or female infertility issues. The treatments that have been developed in fertility medicine to help these individuals are also very effective in assisting LGBTQIA individuals and couples become parents.
- In vitro fertilization (IVF), in which a female egg and male sperm are mingled in a laboratory to create an embryo that can be implanted in a woman’s uterus for pregnancy, is often a mainstay solution for LGBTQIA parents.
- Other assisted reproductive treatments may also aid in attaining pregnancy, such as intrauterine insemination (IUI), intracytoplasmic sperm injection (ICSI) and preimplantation genetic testing.
- Same sex couples will need third-party assistance to acquire needed donor sperm, eggs or embryos.
- Gay men and transgender couples often require surrogacy assistance, in which a woman agrees to be impregnated, either through IVF or insemination, and carry the child through birth. Traditional surrogacy means the woman who becomes pregnant and carries the child will be genetically related to the baby she then gives up. A gestational carrier surrogate becomes pregnant using someone else’s embryo created through IVF and implanted in her for pregnancy. She is not genetically related to the baby she delivers.
Our fertility specialists will discuss the treatment options with each LGBTQIA couple or individual. We will also discuss the processes of each option, including the costs, the chances of success and the potential risks. LLU Center for Fertility will perform a complete medical examination of each patient prior to such treatments to determine the individual’s fitness for participation. This may include female fertility testing and male fertility testing.
Fertility treatment options for lesbians
The first question many lesbian couples need to address is which of them will carry the child. When one partner gets pregnant using artificial insemination and donor sperm, she will carry the child and also be genetically related to it. But if both partners would like to be involved in the pregnancy, they can consider reciprocal IVF. In this procedure, one partner provides her eggs to be fertilized via IVF and the other has that embryo implanted in her womb to carry the pregnancy.
It is possible that a third woman may be used as a surrogate, who becomes pregnant using her own egg and donor sperm via IVF. This may occur due to neither of the lesbian women being able to nor wanting to carry a child. If a surrogate is used and is also the egg donor as well, neither of the intended parents will be genetically related to the child.
Similarly, lesbian couples may use a gestational carrier, which allows for one of the lesbian women to use IVF to create an embryo with her genes that is then implanted in the gestational carrier.
Once it’s decided which of the women will be impregnated, the next step is to decide where the sperm will come from. This could be a family member, a friend or an anonymous sperm donor. It is possible for one partner to have a male relative donate the sperm that fertilizes her partner’s egg, so the baby would be genetically related to both women. The next step is to select the type of treatment. The options are IVF or artificial insemination, usually IUI.
A single lesbian woman has the same options as described above regarding artificial insemination, IVF and using donor sperm or a surrogate. As with lesbian couples, she can carry the child herself.
We recommend lesbian couples becoming parents seek legal and psychological counseling by professionals who specialize in third-party reproduction issues (see section below).
Treatments for gay men
Same sex male couples or individuals are in a similar position as lesbians, in that they need third-party assistance for the female reproductive contribution. A surrogate is often recruited to carry the pregnancy. A gestational carrier may also be used, but then a donated embryo or donor egg fertilized through IVF will be needed.
Sometimes the surrogate can be a family member or friend of the gay couple. For example, if both partners would like to be genetically related to the child, one partner could ask a female family member to act as the egg donor or surrogate, while the other partner could provide the sperm used to impregnate the carrier of the pregnancy through IVF or artificial insemination. The resulting child would have the genes of the man supplying the sperm and the family genes of the male whose female relative contributed her genes as either the egg donor or surrogate.
The gay couple must also decide which of their sperm will be used for impregnating the surrogate. We will then evaluate the man’s sperm to make sure there are no issues with sperm quality.
If there is an issue with sperm count, shape or movement, the type of artificial insemination used might be intrauterine insemination (IUI). During an IUI, a doctor places the sperm inside the woman’s uterus and not just in the cervix, boosting the chances of success. In addition, if IVF is used, ICSI may be recommended to place the sperm inside the cytoplasm of the female egg to increase chances of fertilization.
If IVF is used to create an embryo, as opposed to artificial insemination of a traditional surrogate, it’s possible for both men to contribute their sperm. Both samples can be mingled with the egg. A genetic test later can identify whose sperm fertilized the egg.
We recommend gay couples or individuals seek legal advice and counseling (see section below) when they begin considering a family building plan.
Fertility treatments for bisexual couples or individuals
If a bisexual couple consists of two men or two women, they will need the same kind of reproductive services offered for gay or lesbian couples. Bisexual couples that consist of a man and a woman will not require our services unless one or both have infertility issues. Medical or genetic issues in one of the partners of the bisexual couple would also require assisted reproductive technologies.
Counseling is recommended for bisexuals who wish to become parents (see below section).
Options for transgender couples or individuals
Transgender couples and individuals may need the third-party reproductive assistance described above to become parents. These are egg, sperm or embryo donation, a traditional surrogate or a gestational carrier.
The fertility treatment procedures of IVF, ICSI, IUI and fertility testing may also be necessary, depending on the makeup of the transgender couple and any infertility issues of the individuals.
For example, a couple that has two transgender women will require third-party female reproductive assistance in the form of a surrogate to carry the pregnancy. If one of the transgender women does not want to serve in the role of a male and supply the sperm for the surrogate’s pregnancy, a sperm donor will also be needed. But one of the transgender women can elect to father the child with her sperm.
Similarly, a couple of transgender men will need the assistance of a sperm donor. If neither one of the transgender men wants to serve as the carrier of the pregnancy, the couple will also require a surrogate or gestational carrier. If one of the transgender men so desires, he can carry the child.
Another factor is if either of the transgender partners or individuals will undergo sex reassignment surgery. A transgender man can elect to preserve his eggs before sex reassignment surgery so the couple can use them later in IVF to achieve pregnancy. A transgender woman can also preserve her sperm before sex reassignment surgery to use later to achieve pregnancy with assisted reproductive services.
We recommend transgender couples and individuals receive psychological counseling and legal advice before undergoing any fertility treatments.
Why counseling is important for LGBTQIA parents
We recommend infertility counseling with an expert on third-party reproduction for all our patients seeking parenthood through fertility treatments and services. LGBTQIA individuals and couples can face unique emotional and psychological issues, as well as many of the same challenges heterosexual couples do. LLU Center for Fertility refers our patients to professional counselors in the area.
In many instances, legal counseling is also a good idea, if not essential, to help LGBTQIA people through the various emotional and legal issues they can face. Using a traditional surrogate or a gestational carrier involves very specific legal issues and rights that must be addressed before the process begins.
In addition to surrogacy, donation of egg, embryo and sperm can also involve emotional concerns for LGBTQIA couples and individuals, such as concepts of parenthood and sexual identification. This can be particularly important for transgender people pursuing sex reassignment surgery.
Some practical matters also need to be addressed before electing to have children with third-party assistance. This can include whether or not to inform the subsequent child of the donation or surrogacy, or how to handle the prospect of the child meeting the donor or surrogate in the future.
We will address these issues when we first meet with prospective LGBTQIA parents and again when we know the type of infertility services they choose. Emotional counseling before and throughout the process can make a huge difference in the psychological health of our fertility patients, including those with LGBTQIA orientations.