The decision to start a family is big no matter who you are, but queer and gender nonconforming folks face a whole other set of challenges. Healthcare providers don’t always know how to sensitively communicate or care for those who don’t fit clearly into a male/female box. But that doesn’t stop people in the LGBTQ+ community from starting families. The Modern State of LGBTQ+ Fertility study shows 63% of the LGBTQ+ community plan on having children, but 46% don’t feel comfortable discussing fertility with their healthcare providers. In an effort to empower aspiring queer parents who want to conceive, we compiled a list of key terms and family-planning resources. Understanding this information can help you ask the right questions and demand the best quality of care from your providers.
How hormone-tracking works
The first step of the family-planning process is typically hormone tracking or monitoring. The tracking process determines whether or not an individual will need hormone therapy to boost the likelihood of pregnancy or to aid in extracting and freezing eggs and sperm.
For people with penises and testes, the monitoring process can be fairly simple. A semen analysis is conducted by ejaculating into a specimen cup in order to measure the number of sperm per milliliter of semen. If the findings are inconclusive, a doctor may opt to conduct hormone testing through blood tests, or scrotal ultrasound to examine if the testicles and scrotum are working properly to aid healthy sperm production.
On the surface of the ovaries, there are small fluid-filled pouches called follicles. Every month, child-bearing ovary-owners may naturally produce estrogen, a hormone that encourages the production of eggs inside these follicles. Once a month, ovary-owners ovulate, which means that a mature egg travels from the ovary to the fallopian tubes to prepare for fertilization. Simple solutions, like hormone-tracking apps based on your menstrual cycle and at-home fertility tests, might be helpful in tracking your fertility.
Factors that might affect fertility
- Your environment. Given that LGBTQ+ individuals experience poverty, mental health issues, and general instability within the household at higher rates than our hetero peers, healthy production of hormones can be stunted. Don’t be so hard on yourself if your levels of egg production are not medically “normal” for your age.
- Your age. Starting at age 35, physicians and specialists will refer to ovaries and eggs as geriatric, meaning that the possibility for natural egg production and fertility are generally lower, regardless of overall health. Those who produce semen may be less fertile with age, too, though other factors such as lifestyle and environment play a bigger role.
- Reproductive disorders. Reproductive disorders like endometriosis or polycystic ovarian syndrome (PCOS) might affect your ovaries’ ability to naturally produce the hormones needed for egg production.
Fertility procedures for queer people, in simple terms
Since LGBTQ+ individuals experience dysphoria and trauma at higher rates than our hetero peers, it’s important to prioritize your mental health at every step of the fertility process. Mere Abrams LCSW, the collaborating researcher on the Modern State of LGBTQ+ Fertility study, tells O.school, “One way to prepare yourself and get a hint of what’s to come is to reflect on past experiences and feelings from other medical visits and procedures related to your reproductive system.”
7 common fertility procedures
- At-home insemination is a minimally invasive procedure that requires an insemination syringe, filled with semen, to be inserted into the vagina. At-home insemination kits are available online, and are recommended for use while the vagina is stimulated.
- A transvaginal ultrasound is used by doctors and fertility specialists to assess the health of your ovaries, follicles, and cervix in preparation for pregnancy or egg harvesting. While lying on your back with your legs open on stirrups, the physician will place a cold lubricant on the ultrasound probe, then instruct you to relax your pelvic muscles as they insert the probe to gather images.
- Intrauterine insemination (IUI) is an option available for people with vaginas who wish to be pregnant. The sperm donor’s semen is washed in a centrifuge so that the physician can collect a concentrated sample of sperm in a catheter, which is then injected into the vagina. The catheter is long enough to enter the cervix and uterus so that the sperm can be deposited as close to the egg as possible. Vaginal arousal before the procedure is recommended for best results. Some light cramping can be expected after the procedure, according to CNY Fertility.
- Ovarian stimulation is typically the first step in egg-harvesting or in-vitro fertilization. Hormone medications prescribed by physicians are administered at home with injections. Hormone levels are monitored throughout the process with blood tests and transvaginal ultrasounds.
- Egg retrieval and harvesting is conducted at the peak of your ovulation cycle, typically after completing a cycle of ovarian stimulation. Egg retrieval happens under sedation, typically at a clinic or doctor’s office. A transvaginal ultrasound probe is inserted into the vagina to identify mature follicles. A thin needle is then inserted through the vagina to extract eggs from those follicles. The needle is connected to a suction device, which collects the egg from the follicle. Up to 15 eggs can be retrieved per cycle.
Cramping, spotting and bloating are typical sensations following the process of egg retrieval. According to Mayo Clinic, feelings of fullness or pressure might last for a few days or weeks because the ovaries remain enlarged after the process. A resting period of a few days is typically recommended after the procedure.
- Egg or embryo freezing, also known as cryopreservation, happens immediately after the eggs are collected from the ovaries. According to Mayo Clinic, unfertilized eggs are typically harder to preserve than fertilized ones (an embryo). It’s important to note that egg storage is a separate cost from the egg retrieval process. You can read our guide on egg freezing to learn about some of the costs and if it’s right for you.
GNC and trans individuals who are considering gender-affirming surgery or undergoing hormone therapy should consult their doctors or gender specialists about storing and freezing eggs or sperm to support future fertility processes. Abrams tells O.school, “Some people elect to preserve fertility and explore family planning options before starting hormone therapy or undergoing gender-affirming surgeries, while others opt to wait until after. It’s important to remember that no matter where you are in your gender journey, there are and will be fertility and family-building options available to you.”
- In vitro fertilization (IVF) typically takes four weeks, involving many of the procedures described above. An IVF cycle includes ovarian stimulation, egg retrieval, and embryo transfer. After egg retrieval, the eggs are inseminated and the resulting embryos are grown in an incubator that mimics the womb’s natural environment.
The embryos can be transferred into the endometrial lining of the uterus 2 to 7 days after they are fertilized. Meanwhile, the carrier may be required to take additional supplements of progesterone, a hormone that helps the uterus’ lining develop into the embryo’s most receptive environment. The embryos are inserted into a catheter with some transfer fluid with the guidance of an abdominal ultrasound. Multiple embryos are usually transferred in one cycle to increase chances of pregnancy. Two weeks following the procedure, a pregnancy test (blood or urine) will determine whether or not the cycle has worked.
Note that while most of these listed procedures require the help of medical professionals, there are at-home and holistic practices available, too.
Affordable, queer-friendly and gender-affirming family-planning resources
At a modest price tag of $159, Modern Fertility is one of the most affordable at-home hormone testing offerings on the market. They send you a blood testing kit in the mail with simple instructions. You can mail your blood sample back to them, or drop the sample off at a Quest Diagnostics Lab. Your results are reviewed by a physician and shared with you in an easy-to-read app. Their services also include a free one-on-one consultation with a fertility nurse and access to their online community and discussion boards for more family-planning tips.
Before starting the IUI or egg-harvesting process, some folks might feel more comfortable trying at-home insemination. Mosie Baby sells The Mosie Kit for $89, which includes two syringes and a collection cup. Using the code OVULATE at checkout, The Mosie Kit comes with a free Ovulation Predictor Kit to coordinate the insemination process with your ovulation.
CNY Fertility and Preserve
According to CNY Fertility’s website, their mission is to provide “the most comprehensive and accessible high-quality fertility solutions” at a fair price. Pricing for one cycle of IVF and egg freezing are $3,900 each, without the cost of monitoring and medications. An IUI is also priced at $450.
Planned Parenthood’s staff are educated in providing gender-affirming health services, plus they offer fertility treatments at a fraction of the cost of other services. Connect with your local clinics for more information.
Future Family is a financial planning service that specializes in loans for those seeking IVF treatments. Pre-approval happens within 24 hours, plus the service connects you to an account manager, payment specialist, and fertility coach to help you navigate the many twists and turns of this process.
Family Equality is an organization dedicated to the advocacy of legal rights of LGBTQ+ families. They provide many legal resources, but most importantly, a comprehensive list of LGBTQ+ Family-Building Grants to help members of the community who need financial assistance with family-planning.
Pride Counseling is an affordable and accessible resource for those seeking guidance with mental health issues and gender identity. As mentioned earlier, fertility procedures can trigger uncomfortable thoughts and feelings while hormones are fluctuating and sensitive areas are subject to touching or probing by medical professionals. Pride counseling offers text messaging, live chat, video sessions and phone calls with counselors specializing in the LGBTQ+ community. Weekly sessions cost $40-$70.
The baby-making process will look and feel different for everybody — don’t be hard on yourself if the fertility process doesn’t come easy. This journey requires courage, vulnerability and optimism, and fortunately there are many resources and communities available to help you through.