LGBTQ+ Fertility Options — A Complete Guide (2025)

Fertility Options by Family Type

LGBTQ+ family building has grown substantially as an area of reproductive medicine. The right pathway depends on your family structure, biology, and goals — not assumptions about gender or relationship structure. This guide covers every major pathway, including options for transgender and non-binary individuals who are often underserved by mainstream fertility resources. Here's a clear breakdown.

A note on language: throughout this article, we use anatomical descriptions ("people with ovaries," "people with testes") alongside traditional terms. We recognize that not every person who has ovaries identifies as a woman, and not every person who has testes identifies as a man. Fertility medicine is built on anatomy and physiology — but the humanity of each patient is never reducible to biology.

For Same-Sex Female Couples

Option 1: Donor Sperm IUI

The simplest and least expensive starting point for couples where both partners have uteri and at least one has functioning ovaries and open fallopian tubes.

How it works: One partner's cycle is timed (natural or with ovulation induction medications). Donor sperm — from a sperm bank or known donor — is washed and deposited into the uterus via a thin catheter.

Success rates: 8–20% per cycle depending on age, ovulatory status, and sperm quality. Most clinics recommend 3–4 cycles before escalating. (ASRM IUI guidelines) Most clinics recommend 3–4 cycles before considering escalation to IVF.

Cost: $300–$1,500 per IUI cycle (excluding sperm purchase, typically $500–$1,000 per vial). Browse IUI clinics near you to compare pricing and availability.

Who is a good candidate? Partners with regular ovulatory cycles, at least one open fallopian tube, no significant uterine abnormalities, and a partner with adequate ovarian reserve for their age. For anyone approaching 38 or older, moving directly to IVF may be more time-efficient.

Option 2: Donor Sperm IVF

When IUI is not appropriate — due to tubal factor, diminished ovarian reserve, older age, or prior IUI failure — IVF using donor sperm is the next step.

Success rates: Comparable to standard IVF for equivalent age. Per the CDC ART Surveillance data, live birth rates per egg retrieval for people using their own eggs are typically 40–55% for those under 38, declining with age. Donor sperm does not meaningfully change those odds — sperm quality from bank specimens is highly screened.

Cost: $12,000–$20,000 per cycle, plus sperm costs. Frozen embryo transfers from banked embryos run $3,000–$5,000 per transfer.

Option 3: Reciprocal IVF (Partner IVF)

One partner provides eggs (the genetic contributor); the other partner carries the pregnancy (the gestational carrier). Both partners are biologically involved in the process — making it a uniquely meaningful option for many couples.

How it works:

1. The egg-providing partner undergoes ovarian stimulation and egg retrieval
2. Retrieved eggs are fertilized with donor sperm in the embryology lab
3. Resulting embryo(s) are transferred to the uterus of the carrying partner

Who should provide eggs vs. carry? This is a personal and medical decision. Factors include each partner's ovarian reserve, uterine health, prior pregnancies, and personal preference. Some couples choose based on who has better fertility parameters; others on what feels most meaningful. A reproductive endocrinologist can review both partners' workups and provide guidance.

Success rates: Determined primarily by the egg-providing partner's age and egg quality. Per CDC ART data, if the egg provider is under 35, live birth rates per embryo transfer are typically 45–60%. Success rates decline with the egg provider's age, not the carrier's.

Cost: $15,000–$25,000+ including monitoring, retrieval, fertilization, and frozen embryo transfer. Some couples also choose preimplantation genetic testing (PGT-A) to screen embryos before transfer, adding $3,000–$6,000.

For Same-Sex Male Couples

Same-sex male couples — and any couple where neither partner has a uterus — require both an egg source and a gestational carrier (surrogate). This is more complex logistically, legally, and financially than other pathways, but thousands of families are built this way every year in the United States.

Step 1 — Egg Donor

Options include:

• Anonymous egg donor through an agency or clinic egg bank
• Known egg donor — a friend, family member, or someone recruited directly who has agreed to donate
• Frozen donor eggs from a commercial egg bank (faster, often lower cost, but less personalization in donor selection)

Egg donor age is the primary driver of IVF success. Most programs prefer donors under 32. Donors undergo extensive medical, genetic, and psychological screening before any cycle.

Step 2 — Gestational Carrier (Surrogate)

A gestational carrier (GC) carries the pregnancy but has no genetic relationship to the child — the embryo was created from donor eggs and your sperm, not her own eggs. This is distinct from traditional surrogacy, where the carrier is also the genetic mother. Traditional surrogacy is rarely practiced today due to significant legal and ethical complexity.

GC arrangements involve:

• Comprehensive medical and psychological screening of the GC
• Legal contracts (mandatory before any embryo transfer) — Laws vary significantly by state. Consult a reproductive attorney before signing any agreements.
• FDA-mandated infectious disease testing under 21 CFR § 1271
• Insurance planning — the GC needs her own health coverage plus a surrogacy-specific rider that covers the pregnancy

Cost of the full pathway (egg donation + surrogacy): $120,000–$180,000+ in the US, including agency fees, legal fees, medical costs, GC compensation, and insurance.

International surrogacy is pursued by some same-sex male couples due to cost — but legal frameworks vary dramatically by country. Only a few countries permit international commercial surrogacy for same-sex male couples with clear parental rights recognition in the US. Legal advice from a reproductive law attorney in both jurisdictions is essential before pursuing any international arrangement.

Which Partner's Sperm?

Both partners can contribute sperm to fertilize different batches of eggs, creating embryos from each partner. One embryo from each can be transferred in the same surrogacy arrangement, allowing both genetic parentage. Alternatively, one partner's sperm may be used for all embryos. This is a highly personal decision with no clinical preference either way.

Single Gay Men — A Complete Pathway Guide

Single gay men are often underrepresented in fertility resources. The reality is that the pathway is entirely achievable, if complex and costly. Single men require a gestational carrier and an egg donor — the same core components as same-sex male couples, but with the additional consideration of building a parenting network and support system as a solo parent by choice.

Full Process Overview

1. Choose an egg donor — through an agency, clinic egg bank, or known donor arrangement
2. Fertilize donated eggs with your sperm at a fertility clinic to create embryos
3. Select a gestational carrier through a surrogacy agency that specifically supports single men — not all agencies do
4. Execute legal contracts: a surrogacy agreement (protecting both parties) and a pre-birth order establishing your legal parentage before the baby is born — Laws vary significantly by state. Consult a reproductive attorney before signing any agreements.
5. Transfer an embryo to the gestational carrier after legal contracts are signed
6. GC carries the pregnancy — you are present at birth as the legal parent of record

Agency Selection for Single Men

Not all surrogacy agencies accept single men as intended parents. When reaching out to agencies, be explicit about your status from the first inquiry. Agencies with documented experience working with single gay men include Extraordinary Conceptions and Simple Surrogacy. Average agency fee for surrogacy matching and case management runs $25,000–$45,000, separate from GC compensation and medical costs.

Cost Breakdown for Single Men

These figures reflect US-based arrangements as of 2025. Costs vary significantly by state, agency, clinic, and individual circumstances.

State Legal Considerations

Gestational surrogacy enforceability varies by state:

• Surrogacy-friendly states (enforceable, pre-birth orders available): California, Nevada, Washington, Maine, Connecticut, Colorado, and others
• Restricted or prohibited states: Michigan imposes criminal penalties for compensated surrogacy; Louisiana limits surrogacy contracts to heterosexual married couples

Before selecting a gestational carrier, ensure the arrangement will be executed in a surrogacy-friendly jurisdiction. Review the Family Equality state-by-state surrogacy guide for current state law summaries. Laws vary significantly by state. Consult a reproductive attorney before signing any agreements.

Psychological Support and Community

Single gay men face unique pressures in family building: societal judgment, disclosure decisions (when and how to tell your child about their origins), and building a parenting network without a co-parent. The nonprofit Men Having Babies provides support, financial assistance programs, and community connection specifically for gay men pursuing surrogacy — including an annual conference and a financial assistance program for lower-income applicants.

For Single Parents by Choice

Single Women

Single women pursuing parenthood typically begin with donor sperm IUI if they have regular ovulatory cycles and at least one open fallopian tube — or proceed directly to donor sperm IVF if they are over 37, have diminished ovarian reserve, or have a history of pelvic disease.

Women who are not yet ready to conceive but want to preserve future options should consider egg freezing — ideally before age 35 for optimal outcomes. Egg freezing allows a single woman to pause her biological clock without requiring a partner or sperm donor immediately.

Single Men

Single men require both an egg donor and a gestational carrier — the same pathway as same-sex male couples. The process is identical in its core steps; see the detailed pathway guide above.

Transgender and Non-Binary Fertility Options

This section addresses one of the most significant gaps in mainstream fertility guidance. Transgender and non-binary individuals face distinct fertility considerations tied to the timing of gender-affirming hormone therapy and surgical transition. The key message: fertility preservation options exist, and they are most effective when pursued early — ideally before beginning hormone therapy.

Trans Men and AFAB Individuals — Fertility Preservation Before Testosterone

Testosterone therapy (T) causes menstrual cessation and over time may affect egg quality and ovarian reserve. However, fertility may be restorable after stopping testosterone, and many trans men have successfully preserved eggs or carried pregnancies after pausing T.

Current clinical evidence suggests:

• Egg freezing is most straightforward when done before starting testosterone
• For those already on T, pausing therapy and allowing menstrual cycles to resume (typically 2–6 months) is generally required before ovarian stimulation
• A 2019 study by Wallace et al. published in Fertility and Sterility found that transgender men undergoing ovarian stimulation after stopping testosterone had comparable egg yields and quality to cisgender women of similar age when properly timed (PubMed: 31430833)
• Uterus-intact trans men who have not undergone hysterectomy can also choose to carry a pregnancy themselves after pausing testosterone

The egg freezing process for trans men:

1. Pause testosterone therapy with guidance from both your endocrinologist and a reproductive endocrinologist (RE)
2. Allow the menstrual cycle to resume — typically 2–6 months, though this varies
3. Undergo ovarian stimulation with injectable gonadotropins (10–14 days)
4. Egg retrieval under light sedation
5. Eggs are vitrified (flash-frozen) and stored

What to expect emotionally and physically: Pausing testosterone and resuming a menstrual cycle can be distressing for many trans men. An affirming RE will acknowledge this directly, use your preferred name and pronouns throughout the process, and work to minimize the duration of the pause. Psychological support during this time is important — ask your clinic whether they have LGBTQ+-affirming counselors on staff or on referral.

The WPATH Standards of Care v8 explicitly recommends that healthcare providers discuss fertility preservation with transgender patients before initiating gender-affirming hormone therapy or surgery. If your provider did not have this conversation, it is not too late to seek a consultation.

Cost of egg freezing: Generally $6,000–$12,000 per cycle for retrieval and first year of storage, plus $500–$800/year for ongoing storage. See our guide on egg freezing for a full breakdown.

Additional resources: Family Equality fertility preservation guide includes specific guidance for trans and non-binary individuals.

Trans Women and AMAB Individuals — Fertility Preservation Before Feminizing Hormones

Estrogen therapy and anti-androgen medications suppress sperm production, and this suppression may be permanent with prolonged use. Sperm banking before beginning hormone therapy is strongly recommended for any trans woman or AMAB non-binary person who may want biological children in the future.

What the evidence shows:

• Sperm quality decline begins within weeks of starting estrogen therapy
• Reversal of suppression after stopping hormones is possible but not guaranteed — and the timeline for recovery is unpredictable
• Even a few months of hormone exposure may have long-term effects on fertility
• A 2019 study by Chen et al. found that a significant proportion of transgender women who discontinued hormone therapy had persistently impaired spermatogenesis (PubMed: 31734209)

Sperm banking process:

• Collection is via ejaculated sample at a clinic or sperm bank — a straightforward, non-invasive process
• Samples are analyzed for count, motility, and morphology, then cryopreserved
• Cost: $500–$2,000 for the collection and initial processing, plus $300–$600/year for ongoing storage
• Multiple samples can be banked to maximize the number of usable vials

After transition: For trans women who did not bank sperm before hormone therapy, testicular sperm extraction (micro-TESE) may still be an option in some cases — even after hormone-related suppression. Success rates are lower and less predictable, but the procedure has been used successfully. This requires evaluation by a urologist specializing in male factor infertility working alongside an RE.

Building a family after transition: Trans women can build families using their cryopreserved sperm with a partner who can carry a pregnancy, a known donor egg source, or a gestational carrier. The legal parentage pathways are the same as those for cisgender men using sperm banking. Laws vary significantly by state. Consult a reproductive attorney before signing any agreements.

Non-Binary and Gender Non-Conforming Individuals

Non-binary and gender non-conforming individuals have highly varied fertility considerations depending on their anatomy, hormone history, and whether they have undergone gender-affirming surgery. The pathways available to any individual depend on which reproductive organs are present and functional — not on gender identity.

Key principles:

• Non-binary people may use any combination of the pathways described in this guide
• Someone with ovaries and a uterus can pursue IUI, IVF, egg freezing, or pregnancy — regardless of gender identity
• Someone with testes can bank sperm — regardless of gender identity
• Surgical transition (oophorectomy, hysterectomy, orchiectomy) permanently removes fertility options, making pre-surgical preservation critically important

Language and clinical environment: Non-binary patients deserve clinical environments that do not force them into binary categories. When evaluating a fertility clinic, check whether their intake forms include a preferred name field separate from legal name, pronoun options, and non-binary gender identity options. Ask staff directly how they will address you. An affirming clinic will not require you to justify your identity to receive care.

Family Equality maintains resources specifically for non-binary individuals navigating fertility and family building.

Known Donor Arrangements

Using a known sperm or egg donor — a friend, family member, or someone you've recruited directly — is medically and legally possible but requires additional steps beyond anonymous bank donation:

• FDA-mandated quarantine period for fresh known donor sperm: 6 months with re-testing at the end of the period — unless the recipient signs a waiver for directed donation. This quarantine requirement is established under FDA 21 CFR § 1271, which governs human cells, tissues, and cellular and tissue-based products.
• Legal agreements between donor and recipient(s) establishing that the donor waives parental rights (or, in some known co-parenting arrangements, establishing what rights are retained) — Laws vary significantly by state. Consult a reproductive attorney before signing any agreements.
• Medical and psychological screening of the donor
• Genetic carrier screening to assess compatibility and reduce the risk of passing on inherited conditions

Some individuals and couples find known donation deeply meaningful — it can preserve a genetic connection to a family friend or allow one partner's sibling to provide eggs, for example. Others prefer the clarity and legal simplicity of anonymous donation. Both are legitimate choices, and neither is inherently superior.

Finding an LGBTQ+ Affirming Fertility Clinic

Not all fertility clinics are equally experienced or welcoming. The difference between a clinic that tolerates LGBTQ+ patients and one that is genuinely affirming and experienced can significantly affect your emotional wellbeing and clinical outcomes. When choosing a fertility clinic, LGBTQ+ patients should apply additional criteria. Our LGBTQ+ fertility clinic directory lets you filter for LGBTQ+-inclusive specialists across all 50 states.

How to Verify a Clinic Is Truly LGBTQ+ Affirming

1. HRC Healthcare Equality Index — The Human Rights Campaign surveys hospitals and health systems annually on LGBTQ+ inclusivity practices. A high HEI score indicates institutional commitment, not just individual provider goodwill.

2. GLMA Physician Directory — GLMA (formerly the Gay and Lesbian Medical Association) maintains a directory of LGBTQ+ health-competent providers, including reproductive endocrinologists.

3. Ask directly: "How many same-sex couples or single LGBTQ+ individuals did you treat last year? Do you have LGBTQ+-specific patient navigators or coordinators?" A clinic with real experience will have specific, confident answers.

4. Check intake forms: Do they use inclusive language? Is there a field for preferred name separate from legal name? Are pronoun options included? Are partner fields gender-neutral? These details signal how patients will actually be treated.

5. RESOLVE's Fertility Provider Map — includes patient reviews and can be filtered for practices experienced with LGBTQ+ patients.

6. Read patient reviews specifically from LGBTQ+ patients on Google, Yelp, and LGBTQ+ family forums. What do they say about how staff addressed them? Were their partners or co-parents treated as full participants?

Additional community resources: Family Equality, RESOLVE, HRC.

On Fertlo, clinic profiles include an LGBTQ+ affirming flag where we have verified this through service data and patient-reported experience.

Insurance Coverage for LGBTQ+ Patients

Fertility insurance coverage is improving but remains inconsistent for LGBTQ+ patients. Key issues:

• Many state mandates require a diagnosis of "infertility" defined as inability to conceive after 12 months of unprotected heterosexual intercourse — a definition that LGBTQ+ individuals and couples may not technically meet by circumstance alone, not biology
• Some states and employers have broadened coverage language to include "inability to conceive due to the structure of one's relationship" or similar inclusive framings
• Surrogacy medical costs are rarely covered by standard health insurance; GC compensation is never covered
• Employer-sponsored fertility benefits have grown substantially — many Fortune 500 companies in technology, finance, and healthcare now offer LGBTQ+-inclusive fertility benefits regardless of state mandate

States With Broadened IVF Coverage Language (as of 2025)

The following states have fertility insurance mandates that, through either explicit language or regulatory guidance, extend coverage to LGBTQ+ patients:

California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New Jersey, New York

Coverage specifics, benefit limits, and employer exceptions vary. Review your plan documents carefully and ask your HR department explicitly about LGBTQ+ applicability. For a full state-by-state breakdown, see RESOLVE's infertility coverage by state guide.

Practical tips for navigating insurance:

• Request a pre-authorization review before starting any cycle — in writing
• Ask your clinic's financial coordinator whether they have experience getting coverage for same-sex couple or single-parent cycles
• If denied, ask about the appeals process; some denials are overturned with a letter from your physician documenting medical necessity
• Check whether your plan covers genetic carrier screening, sperm washing, embryology fees, and cryopreservation separately — these line items are sometimes covered even when the cycle itself is not

Legal Considerations

Family building for LGBTQ+ individuals involves legal complexity that medical staff are not qualified to advise on. The legal landscape for donor conception, surrogacy, and parentage varies dramatically by state, and in some cases by county. Consult a reproductive law attorney before:

• Using a gestational carrier of any kind — traditional or gestational
• Using a known egg or sperm donor
• Pursuing reciprocal IVF (legal parentage of both partners should be established explicitly — in some states, the non-gestating partner must adopt)
• Pursuing any international treatment involving cross-border donation or surrogacy
• Finalizing a pre-birth order or adoption after birth

Laws vary significantly by state. Consult a reproductive attorney before signing any agreements.

The Family Equality surrogacy laws by state guide is a useful starting point, but it is not a substitute for legal advice tailored to your situation.

Frequently Asked Questions

Can a transgender man carry a pregnancy? Yes — trans men who have not undergone hysterectomy can carry pregnancies. This typically requires pausing testosterone therapy during conception attempts and throughout pregnancy. It has been done successfully by many trans men, and the outcomes for both parent and child appear comparable to cisgender pregnancies when managed by an experienced care team.

Does hormone therapy permanently affect fertility? It may. Both testosterone therapy in AFAB individuals and estrogen/anti-androgen therapy in AMAB individuals can suppress fertility, and the effects may not be fully reversible. This is why fertility preservation before starting hormone therapy is so strongly recommended. If you are already on hormones and have not preserved fertility, speak with a reproductive endocrinologist about your options — they are not necessarily zero.

What is the difference between a gestational carrier and a traditional surrogate? A gestational carrier has no genetic relationship to the child she carries — the embryo is created from separate egg and sperm sources. A traditional surrogate uses her own eggs, making her the genetic mother. Traditional surrogacy is rare today and legally much more complex. Most surrogacy arrangements in the US are gestational.

What is reciprocal IVF, and is it right for us? Reciprocal IVF allows both partners in a same-sex female couple to be biologically involved — one provides eggs, the other carries the pregnancy. Whether it's the right choice depends on each partner's fertility parameters, personal meaning, and cost considerations (it is more expensive than standard donor sperm IVF).

How do we choose which partner provides eggs vs. carries the pregnancy in reciprocal IVF? This is both a medical and personal decision. Medically, the partner with the better ovarian reserve and egg quality typically provides eggs to maximize success rates. The partner with better uterine health carries. Many couples also factor in personal meaning — who feels more drawn to each role. Your RE can review both partners and offer a clinical recommendation.

This article was medically reviewed by Dr. Cristian Jesam, MD — Reproductive Medicine Specialist, Instituto Chileno de Medicina Reproductiva (ICMER), Santiago; Associate Professor, Reproductive Medicine Unit, Universidad de Chile. Specialist in LGBTQ+ family building and single-parent fertility. Last reviewed April 2025.