As a queer couple, starting a family comes with many exciting and important decisions. Who will carry the baby? Should you choose IUI, IVF, or reciprocal IVF? Will you use a known donor or a sperm bank? There are a lot of options to consider but simplifying the process into clear actionable steps make it more manageable.
This post offers an overview of the first steps and key considerations when starting your fertility journey. For a deep dive into the journey to conception, I highly recommend the book Queer Conception. I listened to it while preparing to start my own family, and it’s packed with valuable info. *This link is an affiliate link. I may earn a commission if you decide to make a purchase through my links, at no cost to you.*
Now, let’s dive into the initial steps to help you begin your fertility journey and provide a clear roadmap!
Table of Contents
1. Decide who is carrying
This may seem like an easy decision for some, but that isn’t always the case! One of you may have always dreamed of carrying a child and experiencing child birth. Maybe the both of you are hoping to carry one day! On the flip side, what if neither of you ever envisioned getting pregnant? This is one of the first questions that pop up for queer couples, and it is not always an easy answer!
Either way, deciding who will carry a child is deeply personal and can involve practical, emotional, and medical considerations. While personal preference may be the only deciding factor for some, other couples may have to think about each partners health, age, and fertility status.
2. Start tracking your cycle
Timing insemination is crucial when trying to conceive (TTC), especially for queer couples. We don’t have the luxury to try every day during our fertile window like heterosexual couples. Also, if you’re using frozen sperm, each sample is expensive so insemination attempts can add up quick!
Start tracking your menstrual cycle ASAP. There are a lot of free apps available to record your period and symptoms. This will allow you to determine if you have regular cycles every month.
To learn about when you’re ovulating, you will need to get an ovulation predictor kit (OPK). The sooner you’re considering trying for a baby, the sooner I would get an OPK! Even if pregnancy isn’t in your immediate plans, tracking ovulation over time helps you gather more data to provide insights about your cycle. By learning these patterns, you can better determine the optimal timing for your insemination.
3. Get genetic and preconception testing
Everyone should get a preconception checkup to ensure your body is ready for pregnancy. This typically involves a pap smear and blood tests to assess your complete blood count, determine your blood type, and screen for antibodies.
Additionally, everyone planning to use their own gametes (eggs or sperm) needs to undergo genetic testing to identify if you have any inheritable genetic conditions. This enables you to exclude donors that carry the same recessive mutations as the gamete provider. We used Natera for our genetic test.
You may decide to get more labs and procedures done to learn more about your fertility health. This usually consists of a transvaginal ultrasound and additional lab work to assess for labs like Anti-Müllerian Hormone (AMH). For example, AMH levels can help determine your egg count. Usually a high AMH indicates a good ovarian reserve, while lower levels suggest a reduced reserve. Factors like this could impact fertility treatment planning.
While straight couples may not opt for fertility assessments before trying to conceive, queer couples likely have more financial risk involved in the process. By determining if there are any fertility issues up front, you can adjust treatment plans to match your needs.
4. Decide the right fertility treatment for you
The right option is different for everyone and it may change throughout the process. The fertility assessment or preconception workup in Step 3 will help you create a personalized plan for your needs. Guidance from a provider will help to identify the best treatment options for you by considering factors such as your age, health, and insurance coverage. Let’s look at four common types of fertility treatments!
Intracervical Insemination (ICI)
- The sperm is inserted directly into the cervix.
- This process can be done at home or in a clinic and either ICI vials or IUI vials can be used.
- ICI vials are “unwashed” meaning the natural fluids from the ejaculate have not been filtered out.
- You might be a good candidate for ICI if you have no known fertility issues and are younger than 35.
Intrauterine Insemination (IUI)
- The sperm is inserted directly into the uterus.
- This process must be performed in a clinic. You can not perform IUI at home.
- Only IUI vials can be used for the procedure because they’re washed.
- These vials are more expensive due to the extra steps involved.
- IUI has a higher success rate due to factors such as bypassing the cervix and placing it closer to the egg providing the sperm a shorter distance to travel.
- Since IUI offers a better chance of achieving pregnancy compared to ICI, some queer couples opt to begin with this method. Additionally, fertility medications can be paired with the insemination process to optimize timing.
In Vitro Fertilization (IVF)
IVF offers the highest success rate but is also the most invasive and costly. The process usually requires daily hormone injections to stimulate the growth of multiple follicles, which are then retrieved in a medical setting. The eggs are fertilized with donor sperm, and once embryos develop, they are transferred into the uterus.
Reciprocal IVF (RIVF)
For this fertility treatment one partner provides the eggs, which are fertilized with donor sperm, and the resulting embryos are implanted into the other partner’s uterus. This process allows both partners to have a biological connection to the child.
Can two women or individuals assigned female at birth (AFAB) have a baby with shared genes? No, the genetics of a baby can not be shared between two women or AFAB individuals. While this would be awesome, male sperm and a female egg are required.
However, RIVF does allows both partners to share the experience in a unique way. Although the gestational parent (GP) does not share DNA with the child, they have the opportunity to form a deep bond during the pregnancy.
Additionally, another interesting factor at play with RIVF is epigenetics, which is the process where some genes are turned on or off due to environmental factors. In other words, the GP will influence gene expression of their child.
5. Find a sperm donor
A huge part in building a family as a queer couple will be finding the right sperm donor.
One of the big questions when deciding on a donor will be if you want to use a known donor or a donor from a sperm bank. There are pros and cons to both options.
Known Donor
Using a family member of the non-birthing parent
If it’s important for both you and your partner to share a genetic connection with your child, you might consider using a family member from the non-gestational partner’s side as the donor. Common choices include a brother or cousin of the non-birthing partner. However, if both you and your partner plan to carry a child, this option would require selecting two different donors.
Using a friend as your sperm donor
Aside from choosing a family member as a sperm donor, you might also consider a close friend. A benefit of a friend versus family member is that if you both want to carry, each parent could use the donor. This would make your children half-siblings since they share half of their genes with the donor.
Communication and legal agreements
Regardless of your choice, it’s crucial to clearly communicate intentions and expectations to avoid misunderstandings. Solidifying these agreements with detailed legal documentation is essential to ensure that both parties are protected and on the same page. You will need to get a lawyer to help with this step.
Matching Service
Another option is using Seed Scout to match you with a known donor. They help you find a donor based your preferences and provide assistance with clinics, lawyers, and mental health professionals to guide you through the process.
Types of donors offered at sperm banks
There are a lot of sperm banks, and they all have variations in prices, selection, family limits, etc. Using donor sperm from a bank is a simpler process. They already have genetic information provided on their profiles and you don’t have to go through the legal process with a donor. You select a donor online and their sperm can be shipped to your home or clinic for insemination. However, the family limit for some banks can be as high as 30 families per donor. Compare sperm banks to see which banks align with your goals such as costs and family limits.
Anonymous sperm donors
- Anonymous donors are what they sound like…. no information is provided and they maintain their privacy. A lot of countries have made anonymous donation illegal such as Australia, Germany, Italy, and the United Kingdom.
ID disclosure sperm donors
- Donors that are ID disclosure have allowed the sperm bank to release their identifying information once their offspring turn 18.
Open-identity sperm donors
- Donors that are open-identity, agree to at least one form of contact ONE time when the donor conceived child turns 18 years old. This does not mean the donors are required to have any long term contact.
Conclusion
As a queer couple, we have a lot of information to sort through so that we can make the best decisions to build our family. Navigating this process is exciting but overwhelming!
Using this 5 step process provides an initial roadmap for your fertility journey and family building.
- Decide who is carrying the baby
- Start tracking your cycle
- Get genetic and preconception testing
- Decide which fertility treatment to pursue
- Find a sperm donor
Every path to parenthood is unique, and your experience will be shaped by your personal choices.
May your path forward be filled with support and excitement!
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