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The Most Common Questions for LGBTQ+ Family Building

LGBTQ+ and starting a family? Here's what you need to know.

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The decision to expand a family with the help of a fertility specialist is a big step for most couples and individuals, and it usually follows a diagnosis of infertility. But for same-sex couples, seeing a fertility specialist is a necessary step even if there is no fertility problem. Whether it’s a sperm donor, an egg donor, or a gestational carrier, assistance is needed on their paths to parenthood.

It’s important to note that most patients going through fertility treatment will be offered a psychological consultation, but LGBTQ+ patients may have some additional considerations to ponder before getting started.

Here are the most common questions I’ve seen for LGBTQ+ couples and individuals looking to build their family:

Same-Sex Male Couples

1. “Whose sperm will we use?”

Same-sex male couples first need to decide who will donate their sperm. Some might have decided to only use one partner’s, some will decide to alternate, while others will decide to both donate and leave it up to the doctor to select based on viability. Regardless of the decision, it’s important to communicate and answer this question together. Whereas for a single male, it’ll only be his sperm so his main focus will be on the egg donor and gestational carrier.

2. “How do we select an egg donor?”

Both same-sex male couples and single males utilizing fertility treatment will need an egg donor. However, a common misconception is that they will be getting a replica of the donor. Instead, they will be getting genes from the trillions of combinations of genetic material in the donor’s entire gene pool. It’s important to know the egg donor’s family health history as much as possible so any health problems aren’t duplicated from the sperm provider.

3. “How do we select a gestational carrier?”

Another important step is selecting the person that’s going to carry the baby. Before selecting someone, seek legal counsel to better understand the legal issues per state and also understand the cost associated with a surrogate since it can be expensive. The ideal surrogate is someone who’s had a pregnancy and delivery without any complications and is emotionally and mentally healthy. The surrogate will go through a psychological evaluation and legal counsel before any final arrangements are made.

Same-Sex Female Couples

1. “How do we select a sperm donor?”

The advice for this question is similar to choosing an egg donor. It’s important to check out the health history of the sperm donor to make sure any health problems that already exist in the egg provider aren’t duplicated.

2. “Whose egg should we use?”

Many couples say that if they plan to have two or more children, they will alternate egg donation. Often, they elect to have the same sperm donor for both children, so the children will both share half of their genetic pool. Sometimes only one partner’s egg will be used based on the quantity and quality of her eggs, which the fertility specialist can help with. It’s also up to which partner is willing to go through the IVF process. For some, they rather not do the injections, go through the hormone changes, and egg retrieval. Make sure both understand the process since it may impact the decision.

3. “Who will carry the baby?”

Same-sex female couples have other decisions to work out as well. Since it's possible that both can be pregnant, some couples alternate pregnancies for more than one child. Others decide only one will be pregnant, and more than once if having multiple children. If that is the case, she will have a pregnancy with her own egg and donor sperm. Or she can have a pregnancy with her partner’s egg and donor sperm, which is also known as reciprocal IVF. This option is so inclusive that many partners prefer this arrangement. Regardless of the option, it’s important to discuss who’s going to carry and make sure both feel good about the decision.

The “Third Parent”

A very common question from all patients is whether the donor, for egg or sperm, should be known or anonymous. I’ve written another article that details the pros and cons of having a known donor and what additional questions to consider. For LGBTQ+ couples and single parents, the decision comes with special questions.

Two men often ask if they should use a known donor so the child will know their "mother." Similarly, two women will wonder if a friend should be a sperm donor so the child will know their "father." One of the most interesting aspects for me isn’t the mechanics of creating a family to be, but the mental images of their family to be. I find many are still using the mindset of their parents and grandparents.

My answer usually startles them. I remind them that they are the child’s parents, and this is the family they have waited for, fought for, and are now creating. Two fathers or mothers don’t need a "third" parent of the opposite sex. In fact, research has found that children of same-sex parents do just as well as children raised by different-sex parents when it comes to social interactions, cognitive development, school performance, and delinquent behavior1.

If the donor is playing a role in your family dynamic, make sure that’s clearly understood and stated before going through with the process. But there’s no need to make the donor a "mom" or "dad" unless that was going to be their role anyway. This same advice holds for single parents.

In the end, it’s up to you how you want to define your family and there’s no right or wrong answer. Regardless of what you choose, know there are so many different paths to parenthood.


[1] Kate Henley Averett. 2016. “The Gender Buffet: LGBTQ Parents Resisting Heteronormativity.” Gender & Society 30(2): 189-212.

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