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 deserve information about fertility and treatment options, but many 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 at the end of this post).
This guide is best suited for cisgender queer and lesbian couples 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 from this guide to LGBTQ+ fertility
- 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 person with ovaries 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, and couples opt for what works best for their fertility journeys. These are the main differences between the two family planning options, according to Dr. Broughton:
Anonymous donor sperm:
- What is anonymous donor sperm? 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 is known donor sperm? 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).
How much does donor sperm cost?
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:
- Medical history: “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.”
- CMV status: 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.”
- Blood type: 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.
Do you have to think about the parental rights of donors?
If you don't want your child to have a relationship with your anonymous sperm donor, sperm banks will handle the legal paperwork to eliminate an anonymous donor’s parental rights and responsibilities.
If you’re using sperm from a known donor, Dr. Broughton recommends setting up a legal contract with your donor to clarify parental rights based on your decisions. This will help you avoid any conflicts regarding things like child support and guardianship down the line.
How many vials of sperm is enough to conceive a baby?
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 clinics with a fertility specialist 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 couples opt to use sperm donations to try to (hopefully) conceive:
- What is IUI? Sperm is placed directly inside the uterus with a thin, flexible tube. (The success rates are often higher than with ICI.) You can read more about IUI here.
- Where the procedure takes place: IUI is typically done in a clinic by an OB-GYN or fertility specialist, but it can also be done by a midwife in your own home (though there isn't a lot of data for at-home insemination success rates).
- How much IUI costs: The costs of IUI vary depending on insurance coverage, but each cycle can be anywhere from a few hundred dollars to $2,000 without insurance.
In vitro fertilization (IVF) and reciprocal IVF:
- What is IVF or reciprocal IVF? Embryos are created in a lab using your or your partner’s egg and a donor’s sperm, then implanted directly into your or your partner’s 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. (A procedure called in vitro gametogenesis, or IVG, is still being studied, and can potentially use stem cells from two same-sex partners to create sperm and egg cells.)
- How much IVF costs: Dr. Broughton explains that IVF can cost anywhere from $15,000 to $25,000 per cycle.
IVF with embryo donors:
- What is IVF with embryo donors? This procedure has the same process as IVF, but a donor embryo is implanted into your or your partner’s uterus if you’ve been unable to conceive using your own eggs or embryos. Donor embryos typically come from other couples who stored more embryos than they used to get pregnant with IVF.
- How much IVF with embryo donors costs: Embryo donation can cost between $2,500 and $4,000, in addition to the $15,000 to $25,000 cost per IVF cycle.
Intracervical insemination (ICI):
- What is ICI? 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 ICI costs: Each round of ICI costs about $200 to $350 (including the kit and sperm banking).
- What is surrogacy? A gestational carrier, also known as a surrogate, undergoes an IVF cycle to conceive your child. A fertility specialist uses a donor egg, your egg, or your partner’s egg and donor sperm for the conception, while the surrogate carries the pregnancy.
- How much surrogacy costs: The cost of surrogacy can range from $100,000 to $150,000 (not including additional costs for using donor eggs and/or sperm).
What is the most common fertility treatment for lesbian couples?
The fertility treatment that you and your partner choose completely depends on your needs and your health, but IVF is the treatment that lesbian couples most commonly opt for, with reciprocal IVF especially gaining popularity.
What do same-sex couples need to do to prepare for pregnancy?
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, and consider taking these steps:
1. Maintain healthy habits: Avoid the things within your control that may impact your fertility. “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,” Dr. Broughton says.
2. Get familiar with tracking ovulation: “If we’re timing inseminations off of ovulation predictor 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,” Dr. Broughton says. “Sperm is expensive and we want to make sure that we’re ready when we jump into the insemination process.” (If you're opting for surrogacy instead of carrying the child yourself, this advice can also be applied to your gestational carrier!)
3. Talk with your partner about who will carry the pregnancy: Every couple is different — if you and your partner both have ovaries, talking openly and honestly about who wants to be the birthing parent is key. The answer may be easy for some, especially if one partner already knows they don't want to be a birthing parent, but other couples may have a more complicated path to answering this question. Couples may want to consider factors like reproductive health and family medical history as part of this decision.
4. Seek out support: 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. Lesbian Pregnancy, Conception, and Fertility on Facebook and @wovenbodies on Instagram are also great LGBTQ+-fertility communities to connect with.
Need LGBTQ+-affirming resources? We've got you
LGBTQ+-affirming healthcare providers:
- GLMA: Health Professionals Advancing LGBTQ Equality
- OutCare Public LGBTQ Healthcare Resources
- CDC: Lesbian, Gay, Bisexual, and Transgender Health Services
- The LGBTQ+ Family Building Directory
More resources to add to your reading list: