Queer-Friendly Conception Options for Hopeful Parents-To-Be
When my first same-sex relationship ended, my first thought was that now I would have the chance to become a mother in the future. This had nothing to do with my partner being a woman, but rather, that she didn't want to have children. I had accepted being with her meant I wouldn't be a parent. When our relationship ended, I realized not having children is a deal-breaker for me.
As I was in my early 30s and suddenly single, I decided to look into freezing my eggs. A few years ago, I would have never considered freezing my eggs or IVF. I was still in the closet and hadn't accepted that when I start a family, it may be with a woman or nonbinary person—and we may need fertility assistance to conceive.
The path to LGBTQIA+ assisted reproduction isn't a straight path—often medical procedures and third parties are involved. Partners who want to start a family together but have the same reproductive organs can't have an unplanned baby. Queer family planning takes time, money and an emotional toll.
So how can a queer family conceive? There are many options, and I talked to the experts to find out the details.
Pregnancy when both partners have vaginas
There are several ways for partners with vaginas to have a baby, including intrauterine insemination (IUI) or in vitro fertilization (IVF) with a donor sperm.
People looking for donor sperm can find it either through a sperm bank or a known sperm donor, explained Cynthia Murdock, M.D., a reproductive endocrinologist at Reproductive Medicine Associates of Connecticut. Couples sometimes consider a sperm donor that shares DNA with one partner, such as a biological brother, noted Lynda Spann, Ph.D., founder of The Lesbian Couples Institute in Colorado.
Co-IVF (reciprocal IVF) is a shared conception method in which "both partners share a biological connection with their baby," Spann said. "Eggs are extracted from one person, inseminated with donor sperm to create an embryo, and then the embryo is implanted in the other person's uterus to carry the pregnancy."
Another option is INVOcell, an intravaginal culture (IVC) system. With IVC, a small medical-grade plastic device holding sperm and eggs is placed inside the vagina for fertilization. Instead of with typical IVF, where the embryo will fertilize and develop inside a lab, the embryo is fertilized and then incubates inside the INVOcell device for a period of five days.
"This is the only treatment where partners with vaginas can 'carry' the same pregnancy," said Sara Mucowski, M.D., a reproductive endocrinologist at Dallas IVF. "Use Partner A's eggs and uterus, and Partner B carries the pregnancy in the earliest stages by providing the vagina that 'incubates' from fertilization up until embryo transfer to Partner A's uterus."
Parenthood for two partners with penises
For two partners with penises, an egg donor and a gestational surrogate are needed to have a biological child. "Egg donors can be found through a frozen egg bank, IVF clinic or an egg donor agency," Murdock said.
There are options for couples who want to let fate decide which partner will have genetic offspring. "Couples may choose to have half of their donated eggs fertilized with Partner A's sperm and the other half fertilized with Partner B's sperm. One of the resulting embryos is then placed into the gestational carrier's uterus," Murdock said.
There are a few things to consider when choosing a surrogate. Some couples may choose to find a surrogate through an agency, while others will choose someone they know. Either way, a thorough examination has to be done to ensure the chosen surrogate is a viable option. "There will be a review of any prior pregnancy history, infectious disease testing, general health examination, and psychiatric testing prior to determining whether someone is a good candidate for being a gestational carrier," Mucowski said.
Affording conception treatments
For anyone looking to use IVF or other fertility options to build a family, the costs can be disheartening. Paying out of pocket for IVF can cost anywhere from $12,000 to $30,000 (or more), and for a lot of people, those sorts of bills are impossible to cover. While some insurance plans cover fertility options, there are additional hurdles for queer families.
Unfortunately, most health insurance companies don't cover the cost of family planning for queer couples. This sometimes means excluding necessary steps for queer parents, such as surrogacy and sperm donors, from the coverage. If your employer-provided insurance only covers straight couples, Murdock advises you "advocate for improved coverage by discussing it with your employer and explain that it's discriminatory for them to cover family planning for straight couples and not queer couples."
Those looking for help with affordable conception options should look for LGBTQIA+-friendly fertility clinics. There are organizations created just for queer couples, such as Gay Parents To Be and LGBT Fertility, that can help you navigate the fertility world, and many clinics cater equally to straight and queer people. Also, look into joining support groups. Connecting with other queer people who've successfully grown a family can give you the support you need.
Consider adoption
IVF and IUI aren't the only options for queer couples. Adoption is a wonderful way to start a family. Murdock warns, however, that adoption isn't necessarily cheaper or easier than other fertility options.
"There's a lot to explore before committing to this complex path to parenthood," she explained. "Most adoptions are private and can be an expensive process requiring legal representation. Going the route of foster care to adoption is another option."
Necessary legal protection
LGBTQ folks planning to have children need to confirm their families are protected legally. "Being on a birth certificate isn't enough," Amira Hasenbush, attorney at law at All Family Legal in California said. There are extra steps to protect queer families.
"Get an adoption judgment or a parentage judgment to protect their rights," Hasenbush advised. "This depends on where they live, whether the child was born via surrogacy or one of the parents carried the pregnancy, and a variety of other factors."
When finding donors, it's crucial to understand what state laws dictate—especially when using a known donor. Have legal documents that state the parental rights and lack thereof of the known sperm or egg donor.
"Obtain legal counsel to help prevent any future legal issues with the donor over parenting rights and obligations," Spann suggested. Mucowski added that in some states, a sperm provider is only considered a donor if the insemination is done under the care of a physician.
In the end, a family is a family, no matter how it's made. And queer couples deserve the experience of parenthood just like anyone else.
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