LGBTQ+ Family Building: Your Guide to Getting Started & Next Steps

Starting a family isn’t always easy, especially if you’re a member of the LGBTQ+ community. Whether you’re going through this journey solo or planning to have a child with a same-sex partner, knowing what to expect is key to achieving your family-building goals.

In this article:

• Getting Started With LGBTQ+ Family Building
• Fertility vs. Infertility: Why Definitions Matter
• Insurance Coverage for LGBTQ+ Fertility
• What is social infertility?
• What to Do Next
• Introduction to LGBTQ+ Fertility Testing
• Why can't I just do at-home fertility testing?
• How much does fertility testing cost?
• Does insurance cover genetic carrier screening?
• Fertility Testing for LGBTQ+ Women
• Fertility Testing for LGBTQ+ Men
• Fertility Treatment Pathways for LGBTQ+ Parents-to-Be

Getting Started With LGBTQ+ Family Building

In this guide, we’ll guide you through the initial steps involved in LGBTQ+ family building.

We'll share tips on how to find the right fertility specialist, explore the differences between traditional infertility and social infertility, break down the fertility testing process for individuals and couples, explore potential family-building pathways, and discuss insurance coverage for LGBTQ+ patients.

By the end, you'll walk away feeling more confident and prepared, knowing what to expect from this incredible (yet often daunting) journey. Let's dive in!

Fertility vs. Infertility: Why Definitions Matter

Before we get into the nitty gritty of LGBTQ+ family building, it’s important to understand the difference between two words you’re going to hear a lot—fertility and infertility. Unfortunately, the official descriptions for these terms are archaic, though still frequently used.

What is fertility?

The term fertility is fairly straightforward - it simply denotes a person’s biological ability to conceive and reproduce. Human reproduction involves a complex interplay between hormones, organs, and overall health. 

What is infertility?

Defining infertility is much more complex!

With infertility affecting 1 in 6 couples globally, the need for family-building assistance has become increasingly common. Yet the official definition of infertility has long been outdated, excluding millions in the LGBTQ+ community, single individuals, and others who desperately want to become parents.

Up until October 2023, infertility was defined by the American Society for Reproductive Medicine (ASRM) as "the failure to get pregnant within a year of having regular, unprotected intercourse or therapeutic donor insemination in women younger than 35, or within six months in women older than 35."

As a result, those in same-sex relationships, anyone who needed the help of a donor to grow their family, or those who didn't quite fit within the confines of the official definition received little to no fertility coverage from their insurers.

Redefining Infertility: A Sign of Progress

On October 15, 2023, the ASRM Practice Committee issued a new definition of infertility.

Infertility is a disease, condition, or status characterized by any of the following:

• The inability to achieve a successful pregnancy based on a patient’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or any combination of those factors.
• The need for medical intervention, including, but not limited to, the use of donor gametes or donor embryos in order to achieve a successful pregnancy either as an individual or with a partner.
• In patients having regular, unprotected intercourse and without any known etiology for either partner suggestive of impaired reproductive ability, evaluation should be initiated at 12 months when the female partner is under 35 years of age and at six months when the female partner is 35 years of age or older. 

Most importantly, ASRM adds, "Nothing in this definition shall be used to deny or delay treatment to any individual, regardless of relationship status or sexual orientation."

In simpler terms: The definition of infertility has now been expanded to include anyone needing medical interventions "in order to achieve a successful pregnancy either as an individual or with a partner," according to ASRM.

Insurance Coverage for LGBTQ+ Fertility

While most insurers tend to follow ASRM's current guidelines when deciding whether or not to approve certain procedures, many are still in the process of updating their policies to reflect ASRM's newest definition of infertility, announced in 2023.  

Depending on the insurance company, an "infertile" LGBTQ+ individual or couple may also be required to undergo multiple expensive procedures (such as intrauterine insemination, or IUI) before their insurer will consider covering another, more effective course of treatment (i.e. in vitro fertilization, or IVF).

The good news? While coverage of fertility treatment can vary wildly for LGBTQ+ parents-to-be, fertility testing (sometimes referred to as a diagnostic cycle) is usually covered by insurance, and financial grants do exist to help pay for IVF out-of-pocket.

What is social infertility?

LGBTQ+ "infertility" ultimately means that a person is unable to conceive on their own, with their partner, and/or carry a pregnancy. This is often referred to as social infertility. It does not necessarily mean that there are biological, anatomical, or hormonal issues that would constitute traditional "infertility." 

Social infertility is a term used to describe a situation where someone desires children but cannot achieve pregnancy through sexual intercourse due to social circumstances, not due to biological issues. It's particularly relevant for the LGBTQ+ community.

Here's how social infertility relates to LGBTQ+ individuals:

• Same-sex cis male couples can't conceive together biologically but can have a baby with the help of pathways such as egg donation and surrogacy, which fall under assisted reproductive technologies (ART).
• Same-sex cis female couples typically require donor sperm and some form of fertility treatment (such as IUI or IVF) to conceive a biological child.
• Transgender individuals: Fertility can be impacted by hormone therapy or surgeries related to gender transition. Additionally, some transgender individuals may not want to (or be able to) conceive using their own gametes (eggs or sperm) and may require donor options. Others may have frozen eggs or sperm before transitioning, which can be utilized in the biological family-building process. 

The term "social infertility" acknowledges the desire to have children and the challenges faced by LGBTQ+ individuals due to their sexual orientation or gender identity, rather than focusing solely on biological limitations.

It also highlights the need for inclusive access to fertility treatments and resources like sperm or egg donation and surrogacy, which can help them build families.

Biological Fertility Challenges

While LGBTQ+ parents-to-be don’t automatically fit the traditional definition of "infertility," experiencing one or more of the following fertility-related conditions can make your family-building journey more difficult:

• Polycystic ovary syndrome (PCOS)
• Endometriosis
• Male factor infertility
• Diminished ovarian reserve (DOR)
• Congenital uterine anomalies
• Thyroid conditions
• Tubal factor infertility

When you choose to work with a fertility specialist, they will perform a full assessment of your current fertility markers and be able to diagnose any of the above issues, then consider those additional obstacles when developing your treatment plan.

This is just one of the many reasons that your fertility specialist plays such an important role in your family-building story.

What to Do Next

Now that we've covered the basics of what LGBTQ+ "infertility" is (and isn't), let's discuss some actionable steps you can take on your path to parenthood.

Whether you’re single or part of a same-sex couple, your family-building journey will likely begin in the same place—the office of a fertility specialist. If you’re wondering where to start, a great place to begin is by evaluating your local fertility practices to see which one will be the best fit for your needs.

Choose Your Fertility Clinic

Even if you think you don't have any existing fertility issues, working with a reproductive endocrinologist to expand your family is invaluable - and can spell the difference between years of failed attempts and holding a baby in your arms sooner.

Selecting a provider who’s not only LGBTQ+ friendly but also has a proven track record of success and a clear understanding of the unique challenges of LGBTQ+ family building is key.

You want to feel fully understood and supported during the entire process. Little details like inclusive bathroom signage, patient paperwork, and imagery in the waiting room can make you feel more welcome and confident when you visit your clinic. Feeling that your preferences are respected and any concerns are heard by your Care Team is equally important.

The Human Rights Campaign Foundation offers a searchable database of LGBTQ+ inclusive healthcare providers, which can be a great place to begin your search.

How often will you need to visit your fertility clinic?

• If you’re a mom-to-be: Find a practice that’s close to home if at all possible. You’ll need to attend frequent monitoring appointments to evaluate your hormone levels and uterus (sometimes every other day for a few weeks at a time).
• If you’re a dad-to-be: Your fertility practice can be further away since you won’t need to be in the office very often and can usually use email or other forms of telecommunication to complete most of your journey virtually.

Feel more prepared:

Grab our free, downloadable fertility consultation worksheet to help you make the most of your first appointment with a fertility specialist.

Prepare for Your First Consultation

While some patients meet their fertility specialist face-to-face the first time, others are introduced virtually - and follow-up appointments are often also virtual (typically via Zoom or other HIPAA-compliant telehealth platforms). 

Remember: Make the most of your consultation by preparing ahead of time! 

If you (and/or your partner) have completed any previous fertility testing, were referred by another doctor, or have any relevant medical history, jot it down before your consultation - with all the new information you'll be learning, it can be easy to forget to share these important details.

Here's what to bring to your first consultation (or send to your fertility clinic team in advance of your appointment, so the doctor can review any pertinent details):

• Medical history
• Previous test results
• Family history
• Insurance information (if applicable)
• Fertility Consultation Guide 

After discussing your goals, as well as your medical and family histories, your fertility doctor will enlighten you about the ins and outs of the journey ahead. They will also arrange for you to schedule some initial fertility testing.

Lastly, your fertility specialist will explain the various treatment options available to you (and/or your partner) and begin to outline a personalized plan (which can then be adjusted based on your fertility testing results).

Introduction to LGBTQ+ Fertility Testing

Fertility testing allows your healthcare provider to develop a tailored treatment plan that will increase your chances of success.

Armed with information discovered through these diagnostic tests, you’ll also be able to better predict the exact costs associated with your family-building journey. This is a helpful tool when creating a budget. 

Undergoing these tests and getting expert advice from a fertility specialist is essential to creating an effective family-building plan. Although it may be tempting to design your own path to creating a family, it’s typically safer (and likely much more successful) to follow the guidance of a professional. 

Remember: Even if you have no known fertility issues, diagnostic testing can reveal underlying factors that would impact your chances of a successful pregnancy.

Why can't I just do at-home fertility testing?

While the availability of at-home fertility testing kits (such as Modern Fertility or SpermCheck) has increased exponentially in recent years, fertility testing at a physical clinic is still considered superior to at-home tests for several reasons:

1. Comprehensive assessment: Clinics offer a wider range of tests beyond just ovulation prediction. They can assess hormone levels, sperm health, ovarian reserve, and tubal patency, providing a more complete picture of fertility health.

2. Accuracy and reliability: Clinic tests are typically more accurate and reliable due to controlled laboratory conditions and experienced technicians. At-home tests can be affected by user error and may not be as precise.

3. Personalized interpretation: Fertility specialists can interpret the test results in the context of an individual's medical history and provide personalized recommendations for treatment or lifestyle changes.

4. Diagnosis of underlying issues: Clinic tests can help diagnose underlying fertility issues like polycystic ovary syndrome (PCOS), endometriosis, or sperm abnormalities, which at-home tests cannot detect. 

The takeaway: While at-home tests can be a convenient starting point, they should not be considered a substitute for comprehensive fertility testing at a clinic. If you are concerned about your fertility, it is best to consult with a fertility specialist for personalized evaluation and guidance.

When it comes to genetic carrier screening, the tests performed by a fertility clinic go far beyond the at-home tests offered by companies like 23andMe. It offers your provider clear, detailed insights into your full genetic makeup. 

How much does fertility testing cost?

Depending on various factors related to your treatment path, you can typically expect to pay anywhere from $2,000 to $4,000 for fertility testing at a clinic (without any insurance coverage being applied).

However, most people with insurance coverage will not have any out-of-pocket costs (or only minimal financial responsibility) for these tests.

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Which fertility tests will I need?

Depending on your sex assigned at birth and relationship status, you (and your partner, if applicable) will need to undergo different types of tests to get a complete picture of your current fertility and any potential obstacles. 

We'll break down the standard, sex-specific fertility tests you can expect to undergo below.

However, genetic carrier screening is typically recommended for both dads and moms-to-be. Completed by testing blood or saliva, genetic carrier screening determines whether or not an individual carries a change in one of their genes and if they are at increased risk of having a child affected with a genetic disease. 

Test results are typically available within two to three weeks.

The takeaway: Genetic counseling is an essential part of the fertility process, and this information is especially important to have when selecting a sperm or egg donor.  

Does insurance cover genetic carrier screening?

Insurance companies typically cover basic carrier screening, which tests for a few genetic disorders that are recommended for everyone or recommended for people with specific ancestries. Insurance companies are less likely to cover expanded carrier screening, which screens for over 100 genetic conditions. 

Fertility Testing for LGBTQ+ Women

Common fertility tests for women, trans men, or individuals with a uterus and ovaries include:

Transvaginal Ultrasound

This internal ultrasound is used to evaluate the uterus and ovarian follicle count (a marker of ovarian reserve), as well as diagnose ovarian cysts or uterine pathology (fibroids, polyps, or uterine malformations).

AMH (Anti-Mullerian Hormone) Testing

An easily completed blood test, AMH is a baseline fertility evaluation that can be a marker of current ovarian reserve and overall fertility.

Cycle Day 3 Testing

This refers to a round of fertility testing typically conducted on the third day of the menstrual cycle, which includes the following evaluations:

• FSH (follicle stimulating hormone) – Can help diagnose difficulties with sexual development, menstruation, and fertility (i.e. PCOS, ovarian cysts, irregular vaginal bleeding, and infertility).
• LH (luteinizing hormone) – Overly high levels of this hormone can indicate disorders such as ovarian failure and polycystic ovary syndrome (PCOS).
• E2 (estradiol) – A vital form of estrogen, estradiol is essential for proper growth of the breasts, uterus, fallopian tubes, vagina, and outer genitals.

Day 21 Testing

You can expect to have your progesterone and estradiol levels checked around the 21st day of your menstrual cycle. Your fertility specialist will also likely examine the thickness of your uterine lining (i.e. endometrium). All of these factors offer signs of your body’s readiness to become pregnant and carry a child to term.

Other Diagnostic Procedures

Your doctor may also recommend more in-depth assessments of the uterus and ovaries, such as a hysterosalpingogram (HSG), saline sonogram (SHG), or hysteroscopy.

Fertility Testing for LGBTQ+ Men

The primary fertility test for men, trans women, or individuals with testes is semen analysis.

This easily completed test is often covered by insurance. You’ll obtain results within days. Sperm health can be impacted by factors like age, steroid or hormone use, medication use, smoking (tobacco or marijuana), or alcohol consumption. 

Fertility Treatment Pathways for LGBTQ+ Parents-to-Be

Now that you know what to expect from fertility testing, it’s time to focus on what comes next. For those wishing to have a genetically-linked (biological) child, there are a few different fertility treatment pathways available:

For moms-to-be: Depending on your fertility testing results and desire to carry a pregnancy, your provider may recommend you embark on a journey with IUI, IVF, or even reciprocal IVF.

Gestational surrogacy may also be an option if you or your partner are unable to (or don't wish to) carry a pregnancy.

For dads-to-be: Your fertility specialist will speak with you about the results of your semen analysis, which will allow you to either continue with your family-building journey or make some lifestyle modifications to increase sperm quality and/or quantity.

Dads-to-be in same-sex relationships will need to work with an egg donor and a gestational carrier to have a baby through surrogacy. 

Note: For trans parents-to-be with previously frozen sperm or eggs, your provider will discuss the process of thawing and utilizing those gametes to grow your family.

Take action now:

Increase your chances of a healthy pregnancy with our expert-backed 90-Day Preconception Checklist.

Ready to take the next step?

Now that you've learned what to expect as you embark on your LGBTQ+ family-building journey, we encourage you to read stories from previous patients or explore additional resources on IUI, IVF, surrogacy, and donor conception.  

Want to talk to a fertility specialist? Our experts are available to answer any additional questions you may have about LGBTQ+ fertility testing or family building. All you need to do is fill out a quick form and an Illume team member will reach out within 48 hours to get your initial consultation scheduled.

Whether you choose to work with our team here at Illume Fertility or another provider, we hope that this guide to LGBTQ+ family building has helped you feel more confident and empowered about the journey ahead of you!