LGBTQ+ people and social infertility 

What are our options to have a child if we don’t have eggs, sperm and a uterus readily available?

When you and your partner or partners want to have a child, the path might not be straightforward if you don’t have eggs, sperm and a uterus readily available in your relationship.

Let’s look at what might be challenging and beautiful about growing your family as an LGBTQ+ couple or relationship, and what support can be helpful throughout the process.

What is social infertility?

“Social infertility” is a term that describes people who would like to have a baby, but face challenges due to their physiology and relationship. Basically, the relationship does not include the physiology needed to conceive and develop a pregnancy through to a live birth.

People who experience social infertility include two women in a relationship; two men in a relationship; and people in relationships in which one or both people are trans and do not have the reproductive physiology to create a child with sperm, egg and uterus.

Also relevant to this topic are people who are in a polyamorous relationship; even if there are eggs, sperm and a uterus present, it might not be obvious or simple to determine who will play which part in creating a child.

7 challenges that LGBTQ+ people might face when trying to have a baby

It’s important for all people to be aware of the challenges that people in an LGBTQ+ couple or relationship face when trying to have a baby.

Understanding the challenges can help the people themselves be more prepared, and can help those supporting them be able to show up for them in the ways that they need. There are also laws and policies that need to be changed, so the more people understand these challenges, the better chance we have at changing the rules so LGBTQ+ people can grow their families more easily.

Here are some of the challenges that LGBTQ+ people might face when trying to have a baby.

1. Cost

The often overwhelming costs associated with assisted reproductive technology are not unique to LGBTQ+ people, but unlike couples with a man and a woman, LGBTQ+ people are almost guaranteed to incur costs when trying to have a baby.

When all that is needed is sperm (for example, when two women are trying to have a child together), the costs could be kept low by using a known sperm donor and doing an at-home insemination - but that’s not always an option. And if no one in the relationship has eggs and/or a uterus, the costs of using an egg donor and/or surrogate can be incredibly high.

Some health insurance policies will only cover assisted reproductive technology for heterosexual couples. So, LGBTQ+ people might be blocked from health insurance coverage that heterosexual couples are able to receive.

  1. Time barriers from clinics

Some medical professionals and fertility clinics require that a couple tries to get pregnant for one year before they are able to seek treatment. But if LGBTQ+ people in a relationship are not physically able to conceive unassisted, that time limit is simply wasted time.

  1. Some clinics/countries do not offer double donation

Some people have someone in the relationship who has a uterus, but both donated sperm and donated eggs are needed to create an embryo to implant into the person with a uterus. While many clinics will work with donated eggs or donated sperm, some have limits where the other element (either the egg or the sperm) must come from someone in the relationship. This could be due to the clinic’s policies, or the laws of the country the clinic is in.

  1. Some clinics/countries don’t work with LGBTQ+ people at all

Unfortunately, there are places in the world where the process to have a child as an LGBTQ+ couple or relationship is not possible. It might be in the country’s laws or the clinic’s policy that assisted reproductive technology is only available to men and women who are trying to conceive and have an infertility diagnosis. Adoption is also not available to LGBTQ+ people in some places.

  1. Being misgendered by clinics and medical professionals

Many medical staff are not trained in inclusive language and practices. Trans and genderqueer people are frequently misgendered by the medical field, and this can be harmful and painful when it comes to fertility treatments.

For example, a medical professional might want to consider the options available to a couple in which one or both people are trans. It’s important that the people in the couple are spoken to using the pronouns and genders they identify as, while sensitively and respectfully discussing the possibilities available due to their ASAB (assigned sex at birth). Unfortunately these conversations are often approached without care or regard to a person’s identity.

  1. Laws around adopting your own child

Many states and countries have laws around parenthood that can pose challenges to LGBTQ+ people. In some places, a child’s birth certificate only has space for a mother and a father, and it must be the genetic parents’ names written on the birth certificate.

An example scenario is if two men are using an egg donor, one of the men’s sperm, and a surrogate to have a child. In some places, the man whose sperm is not used must legally adopt the child, rather than being the parent on the birth certificate and considered a father from the time of the child’s birth. The process of adopting your own child can be logically and psychologically challenging.

  1. Not being genetically related to your child

Any person who has a child who is not genetically related to them - whether it’s through egg/sperm/embryo donation or adoption - might struggle with the situation. There might be feelings around your partner being genetically related to your child when you’re not, or the decision of whose DNA will be involved might have been a difficult one to make. While heterosexual couples might also face this challenge due to infertility, LGBTQ+ people are almost guaranteed to have this be part of their experience as a couple or relationship.

What can support LGBTQ+ people wanting to have a baby

As we’ve seen, LGBTQ+ people wanting to have a baby can face many challenges. Fortunately, there are many ways they can be supported through the process. Here is a list of things that LGBTQ+ people and the people who care about them can do to have support as they try to have a child.

Consider for yourself what it means to be a parent.

People who will not be genetically related to their child(ren) might have feelings about what it means to be a parent. As we explored in our article about egg donation, it can be helpful to consider what parenting is to you, beyond DNA. Passing on family and cultural traditions, life lessons, and love and support are things that you might consider to be beautiful aspects of parenthood that you can experience with or without a genetic connection.

Find supportive clinics and medical professionals.

It might take a few tries, but there are doctors who are sensitive and have great expertise when it comes to working with LGBTQ+ people. You deserve to work with people who understand your relationship and goals, and will do everything they can to help you have a baby. Hopefully, you won’t have to travel too far to find them, but it can be worth it to take your time to find the right clinic and doctor for you.

Take action and advocate.

When it comes to the barriers to having children that are dictated by laws and policies, there might be things you can do to change them. This tip is especially aimed at people who support LGBTQ+ people having children, since the LGBTQ+ people themselves shouldn’t have to do this fight alone. We can all play a part in calling decision makers, educating clinics and medical professionals, and spreading the word about unfair and discriminatory policies.

Lean on your community.

Fertility treatments and choices can be overwhelming, and can be a lot to navigate on your own. Try the activity "Building your support network" in the Tilly app to help you, or take some time to consider who in your life can help you in this experience. It can be helpful to talk through difficult decisions with a friend, or have your family cook meals for you when you’re actively in treatment. And if you don’t feel you have people in your life who can show up for you in that way, you can find online support groups filled with people who understand what you’re going through.

About Maya

Maya Maria Brown, M.A., is an infertility mental health expert. She has a master’s in Counseling Psychology, and has worked with individuals and couples on infertility and relationships. She also has personal experience with infertility and is currently in treatment.


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