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Queer and lesbian fertility: Planning kids as a cisgender woman in a same-sex couple

Queer and lesbian fertility: Planning kids as a cisgender woman in a same-sex couple

6 min read

In our Modern State of LGBTQ+ Fertility 2019 survey, 63% of LGBTQ+ respondents said that they were planning on having children at some point in the future. But, historically, information about fertility, conception, and parenting hasn’t been tailored to the needs of the LGBTQ+ community — that’s because most of fertility healthcare and family building has been focused solely on opposite-sex couples.

LGBTQ+ couples want information about fertility and treatment options, too — but many (36% of the cisgender lesbian or queer women we surveyed, in fact) feel hesitant and unclear about where to go for guidance.

To make the search for that important knowledge easier, Modern Fertility teamed up with Dr. Darcy Broughton of Pacific Northwest Fertility. You can watch our free informational session on YouTube (also embedded below).

This guide is best suited for cisgender queer and lesbian women who are looking to carry children themselves. (You can also check out this guide on family building options for transgender, gender-nonconforming, and nonbinary individuals.)

And if you’re a Modern Fertility customer who’s thinking about carrying a child (now or in the future), head to your dashboard and build your personalized fertility plan!

What you’ll learn:

  • The differences between anonymous sperm donors and known sperm donors
  • What to think about when choosing a donor
  • The methods of conception that use donor sperm
  • How to prepare if you’re trying to conceive
  • Why community is so important during this process

What are your options for getting donor sperm?

If you’re a cisgender lesbian or queer woman trying to get pregnant, you’ll need to choose how you feel most comfortable obtaining the sperm for insemination. Donor sperm can either come from an anonymous donor or a known donor.

These are the main differences between the two family planning options, according to Dr. Broughton:

Anonymous donor sperm

  • What that means: The sperm comes from a commercial sperm bank. (This is how the majority of people conceiving with donor sperm acquire their sperm — read more in our “What to Expect: Sperm Banks 101” article.)
  • Things to consider: Neither you nor your eventual child will know who the donor is, unless you opt for an “open donor.” In that case, your child will have the ability to contact the donor after they turn 18.

Known donor sperm

  • What that means: The sperm comes from someone you know — like a good friend or a family member.
  • Things to consider: Many fertility clinics and sperm banks require that a known donor’s sperm be analyzed for infectious diseases and sexually transmitted infections (STIs) before it’s ready for insemination. Oftentimes, the sperm will need to be retested six months after the initial analysis to make sure the sample still tests negative for STIs —  this means you should plan for a six-month quarantine of your donor’s sample at a sperm bank. Your donor may also need to be available for multiple collection sessions (aka banking sessions). Dr. Broughton recommends setting up a legal contract with your donor to clarify parental rights.

Dr. Broughton says that, on average, you can expect to pay about $500 to $1,000 per vial from a sperm bank. But to accurately estimate just how much you’ll spend, you’ll need to determine how many vials of sperm you’ll need. (More on that later.)

If you’re using a known donor, the sperm itself won’t have a charge, but going to a fertility clinic and storing the sperm at a bank can cost around $2,000 and up.

What should you think about when picking a sperm donor?

When choosing a donor, especially an anonymous one, the options can seem endless. Here’s the most crucial criteria to keep in mind, according to Dr. Broughton: “If something runs in your family that you’re potentially concerned about — a risk of a certain type of cancer or something like diabetes — it’s important to look at the donor and hopefully not have overlapping risk factors for those types of things.”

Dr. Broughton also recommends considering your cytomegalovirus (CMV) status — a common virus you can often carry without any symptoms — and your blood type. If you test CMV negative, explains Dr. Broughton, “it’s best if you choose a CMV-negative donor because CMV is not something we want people to contract in pregnancy, and there is a theoretical risk of getting it from CMV-positive donor sperm.”

If your blood type is negative, Dr. Broughton recommends choosing a negative donor. In that case, having a different blood type than your donor “influences the baby’s risk of anemia during development,” she says. If you don’t already know what your CMV status and blood type are, your doctor can identify them for you.

How many vials of sperm is enough?

When choosing a donor, you may also want to consider how many vials of sperm are available from a particular donor. Pacific Northwest Fertility advises that for people under age 40, it can typically take four to six months of intrauterine inseminations (IUI) to achieve pregnancy — meaning you’ll need at least enough sperm to get you through that time.

If you hope to conceive more children in the future using the same donor’s sperm, you may want to take this into account when initially purchasing vials. Dr. Broughton also recommends asking your sperm bank if they have a buyback program — if so, you might be able to purchase more vials upfront and then return any you don’t use for reimbursement.

It’s also important to consider how your donor’s sperm has been prepared based on what type of insemination method you will be using. These are the three types of vials:

  • IUI vials are designed for use with intrauterine insemination (IUI) at fertility clinics.
  • Assisted reproductive technology (ART) vials are used in fertility clinics for in-vitro fertilization (IVF). (These vials have less sperm than IUI and ICI vials.)
  • Intracervical insemination (ICI) vials are suited for at-home inseminations or vaginal inseminations. (These vials aren’t as frequently used within a doctor's office.)

What are the different methods of artificial insemination?

Now that we know how to think through acquiring sperm (and we threw a bunch of acronyms your way), let’s talk about the different ways the sperm donations are used to (hopefully) result in conception:

Intrauterine insemination (IUI)

  • What it is: Sperm is placed directly inside the uterus by a doctor or midwife. (The success rates are often higher than with ICI.) You can read more about IUI here.
  • How much it costs:  The costs of IUI vary depending on insurance coverage, but they’re typically about $300-$1,000 without insurance.

In-vitro fertilization (IVF) and reciprocal IVF

  • What it is: Embryos are created in a lab using your egg and a donor’s sperm and then implanted directly into your uterus. Some couples who have two sets of eggs and two sets of uteruses are interested in reciprocal IVF (aka “shared maternity”), which allows both partners to be involved in the biological parts of conception and pregnancy.
  • How much it costs: IVF can cost anywhere from $15,000 to $25,000 per cycle.

Intracervical insemination (ICI)

  • What it is: Sperm is inserted directly into the cervix, usually at home. At-home inseminations like ICI often use a known donor sample that’s fresh and unprocessed — that means it hasn’t been analyzed for diseases and genetic carriers by a fertility clinic and it hasn’t been stored by a sperm bank. (If you decide to use a commercial sperm bank to store sperm for ICI, you might be required to have a doctor sign off on shipment.)
  • How much it costs: Each round of ICI costs about $200 to $350 (including the kit and sperm banking).

What do you need to do to prepare for conception?

Many people also wonder what they can do to prepare themselves for successful conception. If you’re a Modern Fertility customer who’s thinking about carrying a child (now or in the future), head to your dashboard and build your personalized fertility plan!

Dr. Broughton shares her advice:

  • Maintain healthy habits: “We know things that impair fertility are endocrine disruptors — things like tobacco, excessive alcohol use. We have a little bit of data about marijuana affecting things … and excessive caffeine intake, too,” she says.
  • Get familiar with tracking ovulation: “If we’re timing inseminations off of ovulation prediction kits (a way of testing for luteinizing hormone in your urine, aka OPKs), which we often do, I will tell people to just buy a kit and start to practice as we get ready to do inseminations. Sperm is expensive and we want to make sure that we’re ready when we jump into the insemination process,” explains Dr. Broughton.

(If you're opting for surrogacy instead of carrying the child yourself, this advice can also be applied to your gestational carrier!)

Fertility, conception, and pregnancy are very personal processes that can be filled with lots of hope and lots of emotions. Most of us have expectations for how our journey to parenthood will look — and it can be frustrating and stressful to hit roadblocks. This is why it’s important to have support and affirmative resources that you can rely on during this journey.

Join the Modern Community and get real talk about what it’s like to use ART, and look for Facebook groups in your area where you can connect with other LGBTQ+ people who are navigating the path to parenthood.

Also, make sure to check out Modern Fertility’s list of resources for LGBTQ+ fertility and take your time finding providers who are informed about fertility choices for LGBTQ+ couples and families. We all deserve to feel supported and affirmed when we’re ready to begin that exciting and unpredictable journey to parenthood.

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Louise Head

Louise Head, is a brown queer sex educator and associate marriage and family therapist. She also writes about sex and women's health for Modern Fertility!

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