Reproductive Choices Today for Men, Women and Transgender Families

Dr. Ralf Zimmermann with Neway Fertility Explains the Many LGBT Fertility Options and Offers Tips on Maximizing Family-Planning Efforts.

Building a family should be an equal-opportunity experience. And for increasing numbers of LGBT (lesbian, gay, bisexual and transgender) people, having babies is possible with the ever-widening array of fertility options today, according to fertility specialist Ralf Zimmermann, MD, Medical Director of Neway Fertility.

“In decades past, adoption – or using a sperm donor, for lesbian women – were the only accessible ways to have children,” says Dr. Zimmermann, formerly on the faculty of Columbia University’s Division of Reproductive Endocrinology and Infertility. “But reproductive choices for two women, two men or transgender individuals have exploded in recent years, offering quicker, more effective methods for fulfilling what may be a lifelong dream.”

What are your fertility options if you’re LGBT? A lot more than might be expected, says Dr. Zimmermann. Some choices overlap among different genders and types of couples, but here’s the breakdown:

For two women

  • Intrauterine insemination (IUI): Sperm is injected directly into the uterus, with many women also inducing ovulation using either oral or injectable medications.
  • In vitro fertilization (IVF): Egg is fertilized in a petri dish and implanted in one of the mothers, with ovulation-stimulating medications sometimes used as well.
  • Reciprocal IVF: Eggs from one mother are retrieved via IVF and then placed into the partnering mother’s uterus to allow both mothers an equal role in the birth of their new baby.
  • Sperm donor: An important first step after choosing a treatment is selecting a sperm donor, who can be a family friend, relative (of the other female partner), or from a sperm bank.
  • Egg donor & surrogacy: Depending on the women’s health issues and needs, using donor eggs and/or a gestational surrogate may be the right option. An egg donor can be a family friend, relative, or from an egg bank. A surrogate may be a family friend, relative, or someone selected through an agency.
  • Fertility testing: Regardless of treatment choice, a fertility work-up is always a smart idea, Dr. Zimmermann explains. “An initial consultation should include a detailed fertility and gynecologic history along with information about life and work plans,” he adds. “Testing may include blood work and a vaginal ultrasound to help determine your egg potential and overall fertility picture.”

For two men

  • Egg donor & surrogacy: Selecting an egg donor is the first step in the reproductive process for two dads-to-be, Dr. Zimmermann says. She can be a family friend, relative or an anonymous donor chosen from an egg bank. A surrogate may be a family friend, relative, or someone selected through an agency.
  • Sperm donation: Several options exist for the source of the sperm, Dr. Zimmermann says. One father can be the sole provider of the sperm; both fathers can provide sperm; or men can choose an entirely separate sperm source from a friend, a relative, or a sperm bank.

For transgender families
Whether you’re single or partnered and don’t wish to conceive before transitioning or beginning any hormonal treatment – but still want to preserve your fertility possibilities – Dr. Zimmermann says your choices include:

Male to female transition

  • Sperm freezing: Sperm can be stored until you’re ready to use.
  • Intrauterine insemination (IUI): Fresh or thawed sperm can be injected via IUI into a female partner.
  • In vitro fertilization (IVF): Fresh or thawed sperm can be used to fertilize the egg from a female partner, egg donor and/or gestational surrogate.

Female to male transition

  • Egg freezing: Whether ovulation-stimulating medications are used or through a natural menstrual cycle, your eggs can be retrieved, frozen and stored for future use.
  • Embryo freezing: Fresh or thawed eggs can be fertilized with sperm from either a male partner or sperm donor.
  • Intrauterine insemination (IUI): Donor sperm can be placed directly inside the uterus to facilitate fertilization.
  • In vitro fertilization (IVF): Eggs are retrieved and fertilized with donor sperm.
  • Reciprocal IVF: One female partner’s eggs are retrieved, fertilized by donor sperm, and placed into the other female’s uterus.
  • Timed intercourse: Monitoring throughout your menstrual cycle can determine the best timing to have intercourse.

“No matter how an LGBT individual or couple choose to build their family, it’s reassuring to know so many choices now exist,” says Dr. Zimmerman, who brings a unique psychological perspective to his practice due to residencies in obstetrics and gynecology as well as psychiatry. “Everyone should be able to have the family they’ve always desired.”

Neway Fertility is one of New York’s leading fertility centers specializing in customized and effective fertility treatments.

Ralf Zimmermann, MD, is a board-certified reproductive endocrinologist and medical director of Neway Fertility in New York City.