LGBTQ+ Family Building

Since the founding of our practice, we have held a strong ethical belief that all patients deserve our thoughtful, cost-effective, and honest medical care, no matter their marital status, sexual orientation, or gender identity.

Deciding to take the first steps on the path to parenthood is an exciting time for partners and individuals! At Atlanta Center for Reproductive Medicine (ACRM), we are sensitive to the unique needs of our lesbian, gay, bisexual, transgender, and gender nonconforming patients and to the special needs they may have in family building.

Various options for building a family exist and range from the use of donor sperm to donor eggs to a gestational carrier. All are available at ACRM.

Family Building Options for Female Partners

Cisgender female partners seeking medical assistance to become pregnant should first complete a fertility work-up to help establish the most appropriate treatment plan. With lesbian partners, testing depends on who will donate egg(s) and who will carry the pregnancy (frequently, but not always, the same person).

The next step towards treatment is the selection of a sperm donor. Sperm donors may be anonymous and chosen from an accredited sperm bank, or the donor may be known to the couple.

Treatment will then either involve intrauterine insemination (IUI) or in vitro fertilization (IVF):

  • Intrauterine Insemination (IUI): Intrauterine Insemination (IUI), is a treatment where sperm from the selected donor is placed directly into a woman's uterus around the time of ovulation. This may be done in a natural (non-medicated) cycle or performed in a cycle using oral fertility medications.
  • In Vitro Fertilization (IVF): In Vitro Fertilization (IVF) is the fertilization of an egg by sperm outside of the body and in an IVF lab. Once fertilization has occurred, and normal embryo development is confirmed, an embryo is transferred into the uterus. A female couple may choose to have one partner provide the egg, and the other partner carry the pregnancy. This is referred to as "reciprocal IVF” and provides a way for both partners to feel actively involved in the treatment process.

In some cases, female partners may need donor eggs to conceive. Donors may be anonymous or be friends or family members.

Family Building Options for Male Partners

Male partners seeking medical assistance to become parents should first complete a semen analysis to assess the sperm. The sperm from one or both partners can be used for treatments. The next step is the selection of an egg donor and gestational carrier (GC):

  • Donor Egg Program: At ACRM, the Donor Egg Program staff is dedicated to working with patients whose family building requires the use of an egg donor. This includes same-sex couples or single males. Our dedicated team can assist you in finding an egg donor match through ACRM's rigorously screened donor pool or via a national donor egg agency. You may also opt to pick a donor that you know and is willing to go through the egg retrieval process.
  • Gestational Carrier (GC): A gestational carrier is a woman that will carry and deliver a child for another couple or person. When a gestational carrier is used, eggs and sperm are combined via IVF to make embryos. Those embryos are then transferred into the gestational carrier’s uterus. The carrier has no genetic or legal tie to the resulting offspring. ACRM is partnered with several nationally recognized agencies and can be a prime resource in helping you find your gestational carrier. We also provide any medical procedures associated with gestational carrier usage.

Family Building Options for Transgender Partners

Transgender and gender nonconforming members of the LGBTQ+ community have many options when it comes to family planning.

Due to hormone therapy's impact on gonadal (eggs and sperm) function and gonadotropin (hormone) levels, transgender individuals must discontinue hormone therapy before embarking on their reproductive journey. An ACRM physician will be able to evaluate your unique circumstances and guide you through your treatment options.

Should you decide to begin your reproductive journey later in life, fertility preservation is a great option.

Fertility Preservation

Fertility preservation is one of the best options for future reproductive possibilities; however, it is often underutilized. In a survey of 121 transwomen, 51% would have strongly considered or undergone sperm cryopreservation if they have been given the option by a provider (source and study).

To better understand what fertility preservation entails, here’s what you need to know:

  • For bodies that make sperm: A sperm sample will be collected, whether through ejaculation, testicular extraction, or electroejaculation (EEJ). The sample is then frozen and stored (cryopreservation), until it is able to be thawed and used via IUI, IVF, or at-home insemination.
  • For bodies with uteruses: Estrogen-based hormones will need to be taken to stimulate ovaries to produce multiple eggs. Once ready for retrieval, the eggs are extracted, frozen and stored (cryopreservation), until ready for use in the future.

If you are reading this and did not preserve your fertility prior to gender-affirming medical or surgical treatments, do not lose hope. Each person and circumstance is unique, so your best next step is to schedule an appointment with one of our reproductive endocrinologists to understand the options available to you.

Fertility Treatment Options for People Assigned Female at Birth

Prolonged testosterone use does not seem to negatively impact conception, pregnancy experiences, or childbirth outcomes. In fact, an 8 year study suggests trans men were able to achieve similar results as cisgender patients.

However, if an individual has decided to undergo surgery to remove their ovaries and did not preserve their eggs beforehand, fertility will be compromised.

During your appointment, an ACRM reproductive endocrinologist will walk you through your reproductive options, which may include:

  • Unassisted conception with a partner.
  • IUI, with sperm from a partner or a donor.
  • IVF, with sperm from a partner or a donor, or by providing eggs to a partner.

There are additional things to consider when deciding whether or not to move forward with fertility treatment — for example, the emotional and physical effects of going off testosterone, and hormones and lactation (chest feeding) during the postpartum period. We are here to help guide and support you through this process.

Fertility Treatment Options for People Assigned Male at Birth

Unfortunately, there is very little data about the effects of estrogen on sperm production. In some cases, individuals are able to produce sperm after coming off estrogen, while others may experience permanent damage in sperm production.

Additionally, if an individual has undergone “bottom surgery,” or removal of the testicles, and did not preserve their sperm beforehand, fertility will be compromised.

During your appointment, an ACRM reproductive endocrinologist will walk you through your reproductive options, which may include:

  • Unassisted conception with a partner.
  • IUI with a partner who has a uterus.
  • IVF with a partner who has a uterus or gestational carrier.

Adoption

At any point along your journey to parenthood, you may decide that adoption is the best choice for you or for you and your partner. ACRM works closely with many adoption agencies and can be a resource in guiding you to the right resources to help you build your family.

Legal

When third-party reproduction (donor sperm, donor egg, or gestational carrier) is used, there are important legal issues that should be considered and addressed, including establishing legal parentage. ACRM can refer you to several law firms that specialize in third-party reproductive law and that have attorneys who have years of experience in this very special area of legal practice.

For more information about LGBTQ+ family building options, contact Atlanta Center for Reproductive Medicine today, 678-841-1089.

Proud to partner with Future Family and Connecting Rainbows.