There are already a vast number of potential roadblocks for a couple trying to conceive when the couple consists of both someone with sperm AND someone with ovaries. But the journey of conception for LGBTQ+ relationships can pose an even longer list of potential complications, from medical to logistical to legal. But as anyone good parents will tell you, that moment of finally holding your baby makes it all worth it.

While adoption and foster care are certainly popular options, biological children are still an option for couples where both members have ovaries or sperm (referred to for the duration of this article as AFAB or AMAB). While the following list is a bit of an oversimplification, the basic questions include:

• Where are you getting the sperm?
• In the case of an AFAB couple, how are you getting the sperm where it needs to be?
• Where are you getting the egg?
• Who’s carrying the egg?
• How much do these choices cost, and will insurance cover it?
  

It’s daunting, there’s no doubt about that. But daunting doesn’t mean insurmountable.

The Sperm

For an AMAB couple, the decision comes down to who provides the sperm. Oftentime both members of a couple will provide sperm, each fertilizing half of the eggs. For an AFAB couple, a sperm donor will fall into one of three categories: known, open, and anonymous.

Known Donors

A couple might choose to have a known sperm donor for a number of reasons. For one thing, if the donor is a relative of one of the people in the relationship, that can be a surefire way to ensure that both parents are biologically related to the baby. A couple may also choose a donor who they know because of certain traits they want to pass on to the child, anything from visual reasons (so that the child may look like the non-carrying parent) to reasons relating to medical history.

A known donor is also a cheaper option, as the couple won’t have to pay the fees associated with sperm banks. Unfortunately, not using sperm banks can also lead to some problems. For one, sperm banks test for things like disease and fertility, tests which can be conducted without a sperm bank, albeit with a bit more hassle. For another, a couple who doesn’t use a sperm bank run the risk of facing legal issues with child custody. It is vital to have a contract with the donor, and to make sure you’re operating in a state where donor contracts are legally enforceable.

Open or Anonymous Donors

Donors from sperm banks will either be anonymous or open, a label that denotes whether or not the sperm bank will legally be able to disclose the donor’s identity. Working through a sperm bank theoretically ensures screening for psychological, medical, and genetic categories, although it is prudent to check the bank’s standards concerning such matters. The couple also has legal protection concerning the status of the donor as a parent.

It is important to note that a child conceived with the help of a sperm bank may have half siblings they are unaware of. It can be particularly difficult to know for sure in cases of an anonymous donor. While it is entirely up to the parents whether or not to disclose this to a child, the possibility of unknown siblings is certainly something to keep in mind.

Sperm banks generally charge somewhere between $500 and $1000 per vial, and the sperm is typically frozen, which can lower the chances of conception.

The Process

Once you know where the sperm is coming from, you have to figure out how it’s getting to the egg. AMAB couples pursuing surrogacy do not typically have to deal with this question, but AFAB couples there are a variety of options, including:

• Intrauterine Insemination
• Intracervical Insemination
• In-Vitro Fertilization
• Reciprocal In-Vitro Fertilization

Intrauterine Insemination (IUI)

IUI places sperm directly into the uterus, making conception slightly more likely as the sperm has less distance to travel. This process is sometimes done with medication like Clomid, Gonadotropins, or Ovidrel, which can cost upward of $2000, putting the overall cost of IUI at $500-$4000 a cycle.

Intracervical Insemination (ICI)

ICI is more cost-effective than IUI and can be done at home, but success rates are lower. ICI kits (costing roughly $200-$350 a round) place the sperm into the cervix. This method is colloquially known as the “turkey baster” method, although using a syringe or official kit is preferable.

In-Vitro Fertilization (IVF), Reciprocal or Otherwise

In IVF, eggs are fertilized outside of the uterus before being reintroduced into the reproductive system. IVF can cost anywhere from $9,000 to $20,000 per round, but also has a notably higher success rate than other methods.

Whereas in standard IVF the eggs are removed from and then returned to the same uterus, Reciprocal IVF takes the eggs from one person’s uterus and places them in the other’s. This way, the child is a biological product of both parents.

The Carrier

An AFAB couple might decide who’s going to carry the baby based on any number of factors. Who wants to be pregnant? Would either person feel dysphoria carrying a baby due to their gender, or is that a non-issue? Who has a family history of easy pregnancy? The deliberation varies from couple to couple.

For AMAB couples, the main discussion is usually whether to choose a carrier or go through an official surrogacy service. A carrier that the couple knows might be a good reason for the same reasons that a known donor might be a good reason: known family history and genetics, personal connection, etc. But whether a couple chooses to have a carrier they know or a carrier they find through an official company, it is important to ensure the surrogacy happens in a state where surrogacy contracts are legally enforceable. An official surrogacy company means less risk of legal issues concerning custody. On the other hand, the $50,000+ cost of official surrogacy may not be within every couple’s financial means.

Insurance and Issues

Many LGBTQ+ couples face issues with conception when it comes to insurance and costs. Many health insurance policies refuse financial aid for conception to couples until they have been trying to conceive for at least a year, even if the people in the couple both have ovaries or sperm. Insurance companies also tend not to cover the hormone and fertility tests these couples need along the way. Many couples feel frustrated having to choose between spending money on kits and processes and spending money on doctor assistance. There’s also the matter of getting the government to recognize both parents as having legal custody.

Resources

Yes, there are complications, and yes, conception as a member of the LGBTQ+ community can make it seem like the world is working against you. But thankfully, there are resources to help. Modern Fertility, for example, has a whole list of helpful resources to support LGBTQ+ couples trying to conceive.

For every issue, there’s someone to reach out to. Be proud, be parents, be part of a loving community.