Looking to start a family as an LGBTQ+ person? Here's what you need to know.
For most LGBTQ+ people, the experience of raising a family is no different from anyone else. Yet, the journey to planning and building your future family can take many unique forms. Most of the time, this involves assistance from a multidisciplinary team.
Raising awareness, sharing accurate information and increasing representation of LGBTQ+ family-building pathways is critical to educating potential patients and loved ones of the LGBTQ+ community.
Here are some common myths about LGBTQ+ parenting:
Myth 1: Adoption is the only way for LGBTQ+ people and couples to have children.
Many LGBTQ+ individuals and couples pursue adoption using an adoption agency or foster-to-adopt programs. Yet, as a Board-Certified Reproductive Endocrinologist who specializes in LGBTQ+ family-planning, and as a dad who built my own family through an In-Vitro Fertilization (IVF) egg donation with a surrogacy journey, I am happy to report that there are biological parenting pathways for the LGBTQ+ community; including surrogacy and gestational carrying with donor eggs and sperm.
Surrogacy or gestational carrying is an arrangement whereby a woman agrees to become pregnant, carry the pregnancy to term, and give birth to a child or children on behalf of another person or couple. After birth, the surrogate's role is complete and the individual or couple becomes the legal parent or parents to the newborn(s).
Myth 2: Both intended parents in a same-sex relationship can provide genes to conceive a child.
Biological family-building for LGBTQ+ same-sex couples means that only one of the parents provides genes at a time. It is not possible, despite what you may read on "Dr. Google" for both same-sex partners to provide genes that conceive the child. Understand that most LGBTQ+ families involve the use of a sperm or egg donor who contributes their genetics to the child, also known as a "gamete donor."
Now, there are ways for both parents in a same-sex relationship to be genetically related to the child: For couples in a same-sex relationship where one parent is contributing gametes (eggs or sperm), using egg or sperm from a relative allows the other parent to contribute genes from their family tree.
For same-sex female couples, if partner A is hoping to use her eggs and partner B has a brother who is able and willing to be a sperm donor, this could be a great way to link your child to both parents' family trees.
This goes for same-sex male couples—if one partner has a sister who is of an appropriate age and health to be an egg donor, the other partner may be the genetically intended father.
These familial known donations can be quite complicated and may require extra counseling, but can be done.
Remember, even known sperm and egg donors must undergo a screening process before becoming a donor. Your family building team (which will include a licensed mental health professional) will help you navigate this process.
Myth 3: All sperm or egg donors must be anonymous.
For LGBTQ+ cisgender single females or couples, a sperm donor can be known or anonymous. Sperm donors can be a friend or even a blood relative. Known sperm donors will be required to have blood work, semen analysis, a physical exam and a visit with an experienced mental health professional to ensure the sperm donor is medically cleared, psychologically sound and educated on the process of becoming a sperm donor. Additionally, a reproductive attorney is necessary to protect parental rights and the donor's responsibilities to the child.
Alternatively, a person or a couple can choose a donor from a sperm bank. Sperm banks are licensed facilities and have both anonymous sperm donors and those who are willing to be known.
Before beginning the process of selecting a sperm donor, the intended parent(s) should speak to their physician in order to identify reputable sperm banks and to find out the process to ensure a safe transfer of the donor sperm. Profiles of the sperm donors can be viewed online, and specimens, once selected, can be purchased and sent to a doctor's office.
For LBGTQ+ cisgender single men or couples, the egg donor is sometimes known: a sister, or maybe a relative or friend of one of the intended fathers. When the choice is to utilize a known sperm or egg donor, it is important for all parties involved to obtain legal counsel and have contracts executed to protect the rights of the intended parents, the donor and, of course, the unborn child.
Egg donors undergo screenings for general health and fertility, mental illness, infectious diseases and substance abuse. Additionally, they undergo counseling regarding their genetics and responsibility as an egg donor to the child to be.
Egg donation is not a risk-free process as the donor must take days of fertility medications and have a procedure to extract the eggs from her body. Many intended fathers get to know their egg donor as long as this is desirable by both parties and in these cases, a legal contract is recommended as well.
Myth 4: You should base your choice of sperm or egg donor on looks alone.
Choosing a sperm or egg donor is a very personal choice and process. LGBTQ+ parents and infertility patients who need sperm or egg donors are faced with a choice of who will be the genetic donor—this is a significant factor in how their child grows to adulthood. Looks, ethnicity, religious affiliation, traits, familial health and the opportunity for future contact by the parents or child all need to be considered.
There is a sense of both an opportunity and a burden to find "the perfect donor" that represents a combination of each partner and whose profile, photos and written word will be shared with their future child; a person whom their child may someday seek out and meet.
Myth 5: A surrogate, also known as a gestational carrier, is related to the child she carries.
Surrogacy is a beautiful expression of our humanity where one family brings the gift of life to another family. It is the single greatest expression of human sharing I know. Gestational carriers are not genetically related to the embryo. Surrogates only enter the relationship with a desire to help the intended parents build their family, with no expectations of parental rights or responsibility. These women represent a highly screened portion of the population, screened by surrogacy professionals, attorneys, mental health professionals and by a physician. In fact, only about 3% of women who apply make it through screening. These are women who have had children previously and are willing to carry a pregnancy for another family-to-be.
The vast majority of surrogates are married and feel their family is complete. While they are financially compensated, they are excluded if they are not financially sound without this compensation.
Intended parents and surrogates are often connected by a surrogacy agency, though sometimes the person is a family member or a close friend. Once connected, both the gestational carrier and the intended parents undergo counseling to make sure all parties are clear about the different steps of this journey together. Then the intended parents enter into a legal, contractual relationship with a gestational surrogate.
Myth 6: For cisgender, same-sex male couples using a gestational carrier, as long as the intended parents live in a surrogacy-friendly state, their rights and the rights of their baby will be protected.
The legal aspects of a surrogacy journey are very real and important to consider. While same-sex marriage is legal in the United States, the legality of compensating a surrogate and completing birth certificates and parentage assignments varies from state to state. The intended parent(s) utilize a team of reproductive attorneys in multiple states to complete a preconception-contract with the surrogate.
The necessary state-specific, legalities to have the intended parents' names appear on the birth certificate must be considered. Most reproductive attorneys recommend additional legal protections, such as a second parent adoption by the non-biological parent to further protect their parental rights.
Myth Number 7: There are no biological family-building options for trans persons.
For people considering transitioning, one of the most important things to consider is cryopreservation of either eggs or sperm, prior to the start of hormone blockers. These preserved sperm or eggs can be used in the future to help complete a biological family-building journey.
Additionally, trans persons who have used medications to transition to their gender identity can work with a physician to regain their reproductive capacity. While this is a complicated and extremely personalized process, it is something that experienced medical professionals can help with. Trans persons can be biological parents.
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