We believe that everyone has the right to become a parent and have been proudly serving the LGBTQIA+ community for more than 20 years. We also understand that the fertility journey for same-sex couples looks a little different. That’s because having a biological child as a same-sex couple requires using one or multiple third-party reproductive options. To help couples plan for treatment, Dr. Hirshfeld-Cytron answers the five top questions she receives about LGBTQIA+ family building.
1) What will my treatment plan look like?
There are several treatment options, and the path that each couple chooses will depend largely on personal choices and preferences. For your care team to determine which services best meet your needs, there are some things you want to start thinking about before your initial consultation.
Lesbian couples planning fertility treatment should consider:
- Who will carry the baby?
- Who will provide the eggs?
- Is a sperm donor needed or do you have a known donor you would like to use?
- Does one or both partners want to be part of the process?
- Does either partner have underlying health issues that can affect the process?
Lesbian couples have the opportunity to make the pregnancy a truly shared experience through reciprocal IVF. With reciprocal IVF, one partner provides the egg and the other partner carries the pregnancy. In other instances, one or both partners undergo intrauterine insemination (IUI), which means one or both partners will provide the egg and carry the pregnancy. Choosing who will be inseminated is largely dependent on the couple’s goals (such as desired family size) but can also be influenced by age and health status.
Gay couples planning fertility treatment should consider:
- Who will provide the sperm?
- Is an egg donor needed or do you have a known donor you would like to use?
- Is the gestational carrier someone known or will it be someone identified through an agency?
Depending on desired family size, gay couples have the opportunity to utilize dual insemination wherein each partner provides sperm that can be used to create an embryo which will then be transferred to the gestational carrier to carry the pregnancy.
2) How do I know the donor I choose is safe for my baby?
There is a screening process for all sperm donors, egg donors, and gestational carriers. Screening includes a review of family history, medical testing, and psychological testing. The donor may also undergo genetic testing.
All egg and sperm donors need to be cleared by the FDA to ensure the individual doesn’t have any physical or mental illness that could pose a risk to the baby or gestational carrier. This process is already taken care of if you are using an egg or sperm bank but will need to be completed if you are using a known donor. Psychological evaluation is also required for the known donor and the couple to ensure the relationship is preserved after the birth of the child.
Gestational carriers chosen through an agency will be screened to ensure the surrogate has held a healthy pregnancy. Couples also have the option to include details in legal contracts regarding the expected behavior of the carrier to ensure a healthy pregnancy for added security.
3) How do we ensure that we are the legal guardians of our child?
Legal contracts are put in place to ensure that intended parents are the legal guardians of the child once it is born and that donors and gestational carriers do not hold any legal medical or financial responsibility for the child.
When using a known donor, the donor and couple are advised to have separate legal counsel and sign a legal contract that defines the financial obligations and rights of the donor with respect to the donated egg, sperm, embryo, or uterus.
When using a gestational carrier in Illinois, the surrogacy contract is enforceable through the Gestational Surrogacy Act. Although Illinois is a surrogacy-friendly state with a very detailed process for establishing legal guardianship between a child and its intended parents when using a gestational surrogate, not all state laws offer so much protection for intended parents. In some states intended parents are required to go through an adoption process after the gestational carrier has delivered the child.
Because laws regarding third-party reproduction are complicated and differ from state to state, we strongly recommend that you work only with attorneys who have a background in reproductive law in your individual state to ensure your parental rights are properly protected.
4) How much does treatment cost?
Costs will vary depending on your treatment plan and insurance coverage. Treatment can be more expensive for same-sex male couples because of the cost of the donor and surrogate.
As a same-sex couple in Illinois, you may have more insurance options than in the past because of HB 3709 which went into effect on January 1, 2022. The bill updates Illinois’ previous infertility insurance law, increasing coverage to be more inclusive for LGBTQ+ families. We encourage you to talk to your insurance provider if you think the change could benefit you.
5) I’m transgender. Can I still have a biological child after transitioning?
Transgender individuals who are transitioning through hormone treatments can preserve their fertility future by freezing eggs or sperm. It’s incredibly disruptive to stop hormone therapies to try to have a genetically connected child, so fertility preservation should ideally occur prior to hormone therapy or surgery.
Taking the Next Step on Your Fertility Journey
Planning to grow your family is a really exciting time, but we know that it can seem overwhelming when there are so many decisions to make and details to iron out. Now that you have answers to these top five questions, we hope you feel more empowered to begin your family-building journey. It’s important to keep the end goal in mind and remember that every path to parenthood is unique and we are here to help you every step of the way. Take the first step towards growing your family by scheduling a consultation.
Medical contribution by Jennifer Hirshfeld-Cytron, M.D.
Dr. Hirshfeld-Cytron is board certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility and has been practicing medicine since 2004. She completed her Obstetrics and Gynecology residency at the University of Chicago, and then completed her three-year fellowship in Reproductive Endocrinology and Infertility at Northwestern.
