It's a journey well worth taking.
While there are multiple ways LGBTQ families can grow, including adoption and gestational carriers, as a midwife I specialize in helping LGBTQ families grow through pregnancy. I primarily work with women, gender-nonconforming or transgender people who are either single or partnered with somebody whose body doesn't produce sperm.
While there are some extra hurdles to overcome in building your queer family through pregnancy, it is a journey well worth taking.
Here is a step-by-step, actionable guide for LGBTQ families interested in building your family through conception.
Step 1: Choose a donor
If you are single or your partner's body doesn't produce sperm, the first step in making a baby is choosing a donor. There are two paths for obtaining donor sperm: from someone you know, or from a sperm bank.
A known donor is somebody in your community—a friend, your partner's family member or an acquaintance—whose viewpoints about being a sperm donor align with what you want for your family. Many people value the ability to meet their donor in person, getting a sense of who they are before embarking on creating a child. However, there are some legal factors to consider when choosing a known donor—more on that below. You'll also want to make sure you're knowledgeable about your donor's health habits, medical history and overall well-being. Here's a helpful list of questions to ask a potential known donor.
An unknown, or anonymous donor is someone you can find through a sperm bank. Sperm banks offer a wide array of donors you can search for by various criteria. Some people prefer the relative anonymity—and legal simplicity—of getting sperm from a bank.
Step 2: Get your legal stuff in order
Once you choose your donor, it is important to get your paperwork in order before beginning your inseminations.
If you opt for a known donor, I recommend consulting a lawyer who specializes in working with LGBTQ families in your state. Although same-sex marriage is legal nationwide, each state has different laws concerning donor sperm and LGBTQ families. NCLR provides a great resource list of LGBTQ-focused lawyers across the United States. You'll also want to make sure you have a contract that spells out specifics—here's a sample of a contract you will want to sign with your known donor.
It's also important to research the laws in your state regarding legal parentage procedures after the baby is born, whether you are working with a known donor or a sperm bank. In many places, it's an advantage to be legally married before your baby is born—it can make the second parent adoption process much simpler.
Step 3: Track your ovulation
For me, this is the fun stuff! As a midwife specializing in LGBTQ insemination, I spend hours each week consulting people on how to track their fertility.
Since you need to plan ahead to procure the sperm before you inseminate, it's extremely helpful, especially when using frozen sperm from a bank, to have a regular menstrual cycle with a predictable ovulation window. For people with irregular cycles, I recommend weekly acupuncture (or acupuncture as often as possible) combined with the herb Vitex to help regulate your hormonal cycle.
Once your period is regular, coming between 26-34 days every month, you can start tracking your ovulation.
Most people ovulate about 14 days before the first day of your period. So, if your cycle is generally 28 days, your ovulation would occur on day 14 of your cycle. I recommend using any or all of the following methods to get a clearer sense of your ovulation:
Ovulation predictor kits
Ovulation predictor kits (OPKs) are a very simple way to track when your body is producing the luteinizing hormone (LH), the hormone produced right before ovulation. There are tons of different kits on the market, but all do essentially the same thing: they measure the amount of LH in your urine. When you're approaching your expected ovulation window, test twice a day (morning and evening) to get the most specific results. Once you get a positive on the ovulation predictor kit, your body will most likely release an egg within 12 to 36 hours.
During the days leading up to ovulation, our bodies produce a different kind of cervical mucus than we do at other times during our cycles. Fertile mucus is often clear and stretchy, and helps transport sperm from the outside of your cervix to the inside of your uterus. For people using frozen sperm from a bank, cervical mucus doesn't actually aid in the process of conception—but it can help you figure out when you are ovulating.
Monitoring basal body temperature
Another way to monitor your fertility is to take your basal body temperature (BBT) with a specialized thermometer. When we ovulate, our temperature rises slightly, which indicates an ideal time for insemination. Be aware, though, that tracking your BBT only works for people who have regular sleep schedules and who aren't experiencing sleep disturbances. For my clients who have young children or work the night shift, I usually recommend using alternate methods to track their ovulation.
Visualizing the cervix with a speculum
When we ovulate, the opening of our cervix visibly enlarges to allow for easier passage of sperm. That's why for many clients, I recommend purchasing a speculum and using it to visualize their own cervix (here's an article that explains exactly how to use a speculum at home, including what to look for). This can also be a fascinating way for partners to get involved in the tracking process.
Step 4: Insemination
Once you have a sense of when you ovulate, you are ready to start inseminations. If you are using frozen sperm from a bank, I recommend having your sperm shipped to you about three days before you expect to ovulate in preparation for your intrauterine insemination (IUI). If you have a known donor, it can be helpful to let them know a few days ahead of your expected insemination for their own planning purposes.
There are two main ways to inseminate: You can do it yourself via an intracervical or a vaginal insemination, or with the help of a midwife or doctor who can perform an IUI.
If you are using sperm from a known donor, it's easy to do the inseminations at home with no outside help. Once you get your positive ovulation test, you can plan to inseminate anywhere within that 12 to 36 hour window. When doing one insemination, I recommend about 24 hours after the positive OPK for most people. However, if you are over 35 years old, some evidence suggests that inseminating closer to 12 hours after your positive OPK increases your chances of conception.
Doing an at-home insemination with a known donor is simple: just get the sperm up there any way you can. Many people use a needle-less syringe or a menstrual cup to place the sperm as close to the cervix as possible. It can be helpful to have an orgasm soon after the insemination, because the muscular actions caused by orgasm help your cervix bring more of the sperm into your uterus.
If you are using frozen sperm that has already been washed and prepared for IUI from a sperm bank, I strongly recommend getting a professional to help you with the insemination. An intrauterine insemination is a simple procedure that involves using a sterile catheter to transport the sperm through the cervix and directly into your uterus. Many midwives do IUIs in the comfort of your home, or you can contact a fertility clinic near you to plan the procedure.
You can choose between doing one or two inseminations during each ovulation cycle. Doing two inseminations doesn't actually double your chances of getting pregnant, and especially if you are purchasing sperm from a bank, the prices add up. But two inseminations does enable you to cover a wider ovulation window, which does increase your chances of conception.
If using sperm from a bank, I recommend doing your first insemination about 12 hours after your positive OPK, and another 12 hours after that. If using a known donor, doing your first insemination right after getting your positive, then the next 24 hours after that has the highest success rates.
It's always helpful to rest for 20 minutes after doing any type of insemination, and using that time to connect with yourself and your partner, or visualize sperm meeting egg and growing into your future child.
Good luck, fam!
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