Women's Health

When nontraditional families want to grow

Published: Nov. 10, 2023

For some couples, having a baby is an easy process. The male partner provides the sperm, and the female partner provides the egg and uterus. 

In same-sex relationships, however, the process is more complex. 

A lesbian relationship

In a lesbian relationship, the simplest path to conception is for one partner to undergo intrauterine insemination (IUI), using sperm from a known or anonymous donor. Prior to treatment, the partner planning to undergo insemination would undergo a quick and basic evaluation. The couple chooses a donor and, oftentimes, IUI can be performed that same month. 

Pregnancy rates approach 30% per month with this form of treatment. If the couple chooses to have another child in the future, the other partner might chose to provide the egg and carry the pregnancy, effectively making their children genetic half-siblings (assuming the same sperm donor is utilized).

Although IUI is fairly straightforward and less expensive, it doesn’t provide both partners a biological connection to the child. One partner has both the genetic and gestational relationship with the child. If both partners desire a biological connection to the child, the couple may elect to go through reciprocal in vitro fertilization (IVF), where one partner produces the egg, and the other carries the embryo that’s created. In essence, one partner retains the genetic connection while the other has the gestational connection. The process of IVF is more invasive and expensive, but for some couples, the benefits of this arrangement far outweigh any risks.

Gay male couples

As complicated as this might all seem, things are even more challenging for two men couples hoping to start a family. While there are now two sources of sperm, the couple is faced with finding both an egg donor and a gestational carrier. 

Some couples may have friends or family members willing to donate eggs or carry a pregnancy – or serve as a gestational carrier. Others may opt to use a donor or carrier agency. Once a couple has been matched with their donor and carrier, all of the involved individuals undergo health and fertility screening, and an IVF cycle is performed. One or both men can provide sperm to fertilize the eggs obtained from the donor. An embryo is then transferred into the gestational carrier. 

Reproductive laws vary by state, and there are generally contracts and lawyers involved for everyone’s protection. In Nebraska and Iowa, if a child’s gestational carrier is not the parent, the parents may need to go through an adoption process regardless of their genetic connection. It’s important to consult a legal expert to understand the legal implications and additional costs that may be incurred in this process. 

The good news is that success rates for couples using an egg donor are generally quite high – over 60%.

Transitioning individuals/couples

For couples in which one partner or both are transitioning – or for transitioning single adults – there are options for cryopreservation (freezing) eggs or sperm prior to beginning hormonal treatments. This process allows for a genetic connection to a future child and preserves fertility without immediately committing to a partner.

Although the cryopreservation process is largely safe and effective, it doesn’t always guarantee a successful pregnancy. It’s also important to consider the significant cost and time (usually a two-week process) associated with cryopreservation. 

Know your options

The only way to determine which path is best for you and your family is to learn about your options. If you identify as LGBTQ+ and are considering pregnancy, the team at Methodist Hospital Reproductive Health Specialists is ready to help you navigate that journey.

About the Author

Dr. Carolyn Maud Doherty always had an interest in medicine. She takes pride in the fact that patients can trust her to tell them exactly what their issues and options are.

“They know I’ll always give it to them straight,” she said. “And I think that’s important.”

She’s proud to be part of a health system that makes patient-care its top priority.


See more articles from Carolyn Maud Doherty, MD
Headshot of Reproductive Endocrinologist Carolyn Maud Doherty, MD, of Methodist Women's Hospital.