LGBTQ+ paths to parenthood
Intrauterine Insemination (IUI) for Lesbians and Trans People
Intrauterine insemination (IUI) is a fertility treatment used by single women, trans men, lesbian couples, and women in straight relationships struggling to get pregnant naturally. For single women and lesbian couples (and some straight women and trans men), the process is completed with donor sperm.
The donor can be a known individual (a close friend or non-blood-related family member) or an anonymous donor. However, in many countries, such as the UK, Canada, and Australia, any resulting child has the right to find out more information about their sperm donor upon their 18th birthday.
Donors are recruited by sperm banks via online advertisements, magazines, and word of mouth among medical professionals who have donors available to them. In the UK, they can only be paid up to £35 per clinic visit. You can often request certain physical characteristics, such as eye and hair colour and height; sometimes, you can even check out their hobbies, education level, and family health history.
Once a lesbian couple has the sperm they wish to use, they can start the process of IUI. If using a donor known to them, some people attempt insemination at home using specialised syringes. If using donor sperm, the clinic will schedule an IUI procedure, which can be done with fertility-enhancing medications or without.
During the procedure, the doctor uses a thin catheter to place the sperm into the uterus, which should increase the chances of success. While IUI is less invasive (and less expensive) than IVF, it is not the right choice for everyone.
Many lesbians have never tried to conceive naturally and may not know that they have underlying fertility issues, such as a low ovarian reserve. These are often diagnosed after multiple failed IUIs. If this occurs, the best course of action may be IVF treatments.
Single women often choose IUI because it is far less invasive than IVF, requiring fewer (if any) hormonal medications and fewer scans. However, for women with endometriosis, PCOS, a low ovarian reserve, or other fertility issues, IVF is often a more successful option.
IVF for Lesbians and Trans People
Some women and AFAB trans people might try to undergo IUI at first, only to find that their bodies are not responding well to treatment. In these cases, they may decide to try IVF instead. Some lesbians and trans people may elect to use donor eggs for a variety of reasons – they may have a low egg reserve, past damage from medical treatments, or they fear passing on a genetic disease.
IVF stands for in vitro fertilisation, also known as ‘lab assisted conception. During this process, the patient takes hormonal injections to stimulate them to produce multiple eggs in each cycle. Next, doctors retrieve these eggs with a needle guided by transvaginal ultrasound.
Once the eggs are retrieved, if there is at least one mature egg, the lab technicians will place them in a petri dish with washed sperm cells from a donor or inject sperm directly into the eggs via ICSI (intracytoplasmic sperm injection). The following day they assess the number of eggs that have been successfully fertilised.
Over the next few days, the lab closely monitors their progress, and by day 5 or 6 they can either transfer one of the surviving embryos (if any) into the patient’s womb or “freeze all” for later use. Additional embryos can be cryogenically frozen for up to 10 years in the UK, although there is a movement to end these time limits.
It’s important to note that IVF is not a ‘cure all’ for infertility, and success rates do decrease with age. Speak with your doctor for more information about whether IUI or IVF is best for your needs.
Surrogacy for Gay Men and Trans People
If neither person in a relationship has a functioning uterus and/or ovaries, there are still ways to conceive a genetically linked child. Surrogacy is complex, but many people have success navigating the process and go on to have the family they dreamed of.
Surrogacy is the only option for certain couples to have a baby together, including gay men, transgender or non-binary people without a functioning uterus, and transgender or non-binary people for whom carrying a child would cause gender dysphoria.
There are two types of surrogates – traditional and gestational
With a traditional surrogate, the baby is conceived with the surrogate’s own eggs, and she carries the baby to term as well. This form of surrogacy is possible with intercourse, home insemination, medical IUI, or IVF. Before the advent of IVF, this was the only form of surrogacy possible, but today it is often discouraged because of the emotional and legal complexities.
With gestational surrogacy, the baby is conceived with donor eggs and the sperm of the father and then carried by a separate surrogate. This form of surrogacy is only possible with IVF, as the eggs must be retrieved from the donor and then fertilised in a lab setting before the embryo can be implanted into the carrier.
It’s important to note that the laws around surrogacy are different in every country and often from state to state/province to province. In the UK, surrogates must not be paid any more than their expenses, and they are the legal parent of the child at birth. Official court paperwork must be filed to transfer the legal rights to the intended parents – you would have to ‘legally adopt” your own child.
This is not the case in every country – it is crucial that you understand local surrogacy laws to the letter. If you are considering surrogacy to have a baby anywhere in the world, you need a lawyer to help you through the legal documentation.
Co-Parenting with Another Couple or Person
The LGBTQ+ community have long been creating their own co-parenting arrangements, but today’s fertility treatments can make the process easier for everyone.
In a co-parenting arrangement, people agree to conceive and raise a child together even though they are not in an intimate romantic relationship. They are often close friends, or perhaps even non-blood related family members. Since there is no romantic relationship to break down at the core of the family dynamic, some co-parenting arrangements are more stable than traditional families.
In some cases, both parties are single, while in other cases, two couples enter into the arrangement together. As long as one individual has a functioning uterus and ovaries and one individual has an adequate sperm count, they could conceive via home insemination or with IUI.
If the parties involved do not meet these criteria, they can still conceive a child, but they will need help from science. Any or all of the options above can help them have a baby, including donor sperm, donor eggs, and a gestational surrogate.
Even if you know and trust the other party (or parties) in an LGBTQ+ co-parenting arrangement, it is a good idea to consult a lawyer to ensure that all legalities are sorted. This includes financial concerns, legal custody arrangements, and estate planning.
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