Reproductive technologies may be used for people with a uterus who want to be pregnant, give birth, and/or provide human milk to feed their child, and for individuals with functioning ovaries who want to be genetically related to their  child.

Donor Insemination

Donor insemination is a medical procedure where a health care provider, usually a fertility specialist, inserts donor sperm into the uterus at the time of ovulation. Donor insemination can happen with or without fertility drugs. This is an option if you have a uterus and functioning ovaries. Check with your fertility specialist and your oncologist about how your cancer history impacts your chances of getting pregnant and the safety of carrying a pregnancy.

Reciprocal IVF

Reciprocal IVF is an increasingly popular option for two partners born with ovaries to contribute to the gestation process. Here one person provides the eggs that will be turned into embryos that another person will carry as the pregnancy.  In this option, one partner provides the eggs and the other partner carries the pregnancy. This allows the couple to have a child together (with the addition of sperm) via a combined genetic and biological link.

Once a couple has decided to use reciprocal IVF, the process is almost identical to standard IVF. The Family-Building Options page has more information about the standard IVF process

Reciprocal IVF may also be called partner IVF, co-maternity, partner-assisted reproduction, or reception of oocytes from partner (ROPA).

If you are considering Reciprocal IVF, you may want to think about these questions:

• Who will be the egg donor?
• Who will carry the pregnancy?
• Will you be using an anonymous or known sperm donor?

You may also want to consult a reproductive attorney to help you determine the legalities of parentage within your state of residence.

Deciding Who Carries the Pregnancy and Who Contributes the Eggs

During your consultation with a fertility specialist, you will learn about a number of factors to help you optimize chances of fertility success. A fertility evaluation will help you decide who may be the best person to provide the eggs and who should carry the pregnancy based on health and fertility factors. Of course, your own desires to experience pregnancy and to be genetically related to the baby are also important

The most common health-related factors to consider are:

• Age of the person providing eggs
• Age of the person carrying the pregnancy
• General health and medical history
• Family medical and reproductive history
• Plans for future pregnancies
• Number of children desired

It is important your doctor is aware of your cancer history and any cancer-related health risks. You may be limited in your ability to provide eggs and/or carry a pregnancy due to your cancer history. Your fertility specialist will help you determine this.

Choosing a Sperm Donor

A sperm donor is a person who donates sperm to help another person become pregnant.

You can choose a sperm donor in different ways.

Known Donor

A known donor is a person who donates sperm and whose identity is known at the time of donation.

A known donor could also mean using a semen sample from someone that you know. Some couples want their child to be able to contact or know their other genetic contributor. Couples that want their child to have a genetic connection via both egg and sperm contribution to the pregnancy  may use the sperm of a male relative, such as the brother or cousin of the non-genetic parent. 

Using sperm from a known donor is usually less expensive compared to unknown sperm donors if the sperm does not need to be purchased. Most medical clinics recommend patients have their potential donor meet with a mental health professional and an attorney who is specialized in this area, in order to ensure that all legal issues are handled properly.

Open Identity Donor

Also known as Identity Release Donor or Willing-to-be-known Donor. This is a donor who donated sperm with the intention of having his or her identity and contact information released to the child the donation created when the child turns 18.

Unknown Donor

An unknown donor, or closed-identity donor, is a person who donates sperm through a sperm bank and chooses to keep their identity anonymous permanently. Information about the donor’s physical traits, medical history, career, and other factors may be available depending on the sperm bank. Some sperm banks no longer offer an anonymous option.

The cost of sperm donation varies across the country, but a vial of sperm generally ranges from $500 to $2000. If the first attempt to use the sperm via IUI or IVF is unsuccessful, you may need to buy more than one vial. Depending on the number of intended children, desire for consistent genetics of children, and availability of sperm, you may also want to buy more than one vial at once.

Reproductive Options for Transgender and Nonbinary People Assigned Female At Birth

Transgender and nonbinary people who are interested in or have undergone gender-affirming medical and/or surgical treatments face unique considerations with regard to family building. Gender-affirming treatment, including medical and hormone therapy and surgery, can impair or permanently alter your fertility and reproductive potential. 

Transgender and nonbinary people assigned female at birth who have not undergone gender-affirming hormone therapy or surgery may want to consider fertility preservation if there is a desire to be genetically related to a child in the future. This includes egg and/or embryo freezing. Both require ovarian stimulation and transvaginal or transrectal ultrasounds, and the person may experience a heavy menstrual cycle after the egg retrieval procedure. This may be uncomfortable or distressing for some people. 

For transgender and nonbinary people who have started hormone therapy with testosterone or ovarian suppression, it is possible to stop hormones temporarily to allow egg production in the body to resume. You can then complete an egg stimulation cycle to retrieve eggs that can be used to have a child that is genetically related to you. Clinics differ in the amount of time they require patients to stop hormone replacement therapy prior to ovarian stimulation and egg retrieval ranging from 1-6 months. Your doctor will help guide you through the appropriate evaluation and time frame for your circumstances. Stopping hormones, even temporarily, can be distressing for many people. 

If you are planning to use your own eggs to have a child, you will have to undergo an ovarian stimulation process. This involves taking estrogen-based hormone injections for about 10 days to stimulate a group of eggs in your ovaries to mature. These injections typically do not cause an increase in chest tissue or impact vocal tone or beard growth (if testosterone has been taken prior to the process), but additional therapies can help suppress the impact of estrogen throughout the body. Eggs that are retrieved from the ovaries after stimulation may be frozen or combined with sperm from a partner or donor to make embryos and then frozen. Embryos can be implanted in a partner or a gestational carrier (i.e., surrogacy) for pregnancy.

Transgender and nonbinary people who have undergone surgery to remove their ovaries or uterus will be more limited in their reproductive options. After removing the ovaries, your body no longer has eggs that can be used to make embryos. After removing the uterus, you are no longer able to carry a pregnancy. 

Although pregnancy is often a time of joy and excitement, it can also cause unsettling feelings about gender identity and societal norms and pressures. It can feel lonely for transgender men and nonbinary people who are pregnant because of society’s view of pregnant people as women. Interacting with the medical system throughout the pregnancy, and at the time of labor and delivery especially, may be uncomfortable for transgender and nonbinary people. 

Adoption laws for LGBTQ+ individuals vary from state to state. Some states have laws or policies that prohibit discrimination based on sexual orientation and gender identity, but other states do not have such protections. Some states allow state-licensed private child welfare agencies to refuse to place foster children with LGBTQ+ people and same-sex couples, if doing so conflicts with the agency’s religious beliefs.

If you wish to build your family through adoption or fostering, it is important that you work with an adoption agency or an adoption attorney that specializes in adoption by LGBTQ+ persons and understands the laws in your state of residence as well as in the state or country in which your child is born and from which he or she will be adopted.

See the Resources below for links to organizations that specialize in helping LGBTQ+ individuals and couples build their families.  

Whether you are planning to use reproductive medicine or pursue adoption to have a child, it is important to find an LGBTQ-friendly clinic or agency to work with. 

These tips were adapted from the book, LGBTQ+ Family Building: A Guide for Prospective Parents, to find an LGBTQ-friendly agency or clinic:

• For fertility clinics, look for a statement on their websites about anti-discrimination and support of LGBTQ+ family building
• For adoption agencies, look at the mission statement for an explicit anti-discrimination clause about placing children with same-gender couples or LGBTQ+-identified people. If you or your partner is transgender or gender diverse, you may want to look for explicit mention of non-discrimination by gender identity and expression. 
• Look at the images and language on their websites and brochures. Are individuals with a range of gender expressions and same-gender couples represented? Does the website have content devoted to LGBTQ+ family building? Are they inclusive and welcoming? How do they make you feel?
• Evaluate the paperwork of the adoption agency or the clinic forms. What type of language is used? Is it inclusive of different types of relationships, such as ‘Prospective Parent 1’ and ‘Prospective Parent 2’? Or is the language gendered, referring to ‘motherhood’ and ‘fatherhood’? Do you have the option of selecting genders for intended parents and/or partners beyond woman and man? For clinics and office spaces, does the waiting room contain materials and health information that is inclusive of LGBTQ+ family building? 
• Find social media pages and groups for LGBTQ+ family building and see what agencies and clinics are mentioned in a positive light. Connect with online communities that may be able to answer questions and offer resources.
• Call agencies or clinics and ask if they work with LGBTQ+ people. For adoption agencies, you can ask for referrals of current or former clients you can contact to learn about their experiences. This is not allowed with medical clinics for privacy purposes. 

Find information that is specifically for LGBTQ+ prospective parents including state-by-state laws.

LGBTQ+ Family Building: A Guide for Prospective Parents
This book is an authoritative, comprehensive, and easy‑to‑read guide to parenthood and family building for LGBTQ+ people.

Baby Making for Everybody: Family Building and Fertility for LGBTQ+ and Solo Parents
This book offers detailed, gender-affirming, body-positive advice on pursuing parenthood as queer and solo people. It is a step-by-step guide for every aspect of the family building process.

Queer Conception: The Complete Fertility Guide for Queer and Trans Parents-to-Be
This book is a fertility guide for queer family seeking pregnancy, written by queer and trans midwife Kristin Liam Kali. It’s also the first evidence-based, transgender inclusive, and body-positive fertility resource for the LGBTQ+ community.

Family Equality Council
Organization whose mission is to advance legal and lived equality for LGBTQ+ families, and for those who wish to form them.

• Path2Parenthood program provides information and resources for the LGBTQ+ community interested in growing their families including grants and state family law guides.
• Directory of LGBTQ+ friendly and affirming family-building providers, including fertility clinics, cryobanks, midwives, doulas, surrogacy clinics, and more.

Movement Advancement Project
“Equality Maps” provide information about the laws in each state governing foster care and adoption.

Adoptive Families
Includes state-by-state information about laws regarding LGBTQ+ and same-sex couple adoption.

FertilityIQ has information about family building for the LGBTQ+ Community

• Fertility for Lesbian Women Becoming Moms
• Family-building Options for Transgender People
• Trans Masculine Fertility
• Trans Feminine Fertility
• Adoption for Single and LGBTQ+ Parents