LGBTQ+ Family Building: Your Complete Guide to Becoming Parents
Every pathway to parenthood for queer individuals and couples—from IUI to surrogacy to adoption—with real costs, legal protections, and what the straight-focused guides won't tell you
LGBTQ+ individuals and couples have multiple pathways to parenthood: IUI or IVF with donor sperm for those who can carry, gestational surrogacy for those who can't, reciprocal IVF for couples who both want biological connection, and adoption or foster care. Total costs range from ~$3,000 for basic IUI cycles to $150,000+ for gestational surrogacy. The most critical first step? Find LGBTQ+-affirming providers and understand your state's legal protections—parental rights vary dramatically by location.
Key Takeaways
Building Your Family on Your Terms
Let's start with something the mainstream fertility world often gets wrong: LGBTQ+ people have been building families forever. What's new is not queer parenthood—it's the medical and legal infrastructure finally catching up to support it openly.
If you're reading this, you've probably already encountered at least one article or intake form or medical conversation that assumed you're a cisgender heterosexual woman with an infertile male partner. That's exhausting. This guide is written for you, assuming nothing about your gender, anatomy, relationship structure, or reasons for needing assistance.
Your family is just as legitimate, just as planned, and just as wanted as any other.
The pathways available to you depend on several factors: whether you or your partner can carry a pregnancy, whether you want a genetic connection, your budget, your timeline, and your state's legal landscape. Let's map it all out.
Understanding Your Options: A Quick Overview
| Pathway | Who It's For | Cost Range | Timeline |
|---|---|---|---|
| IUI with Donor Sperm | Those who can carry, need sperm | $2,000-$5,000/cycle | 1-6+ months |
| IVF with Donor Sperm | Higher success rates, fertility issues, embryo banking | $15,000-$30,000/cycle | 2-6+ months |
| Reciprocal IVF (RIVF) | Couples where one provides eggs, other carries | $20,000-$35,000 | 3-6+ months |
| IVF with Donor Eggs | Those who can carry but need eggs | $25,000-$45,000 | 3-9 months |
| Gestational Surrogacy | Those who cannot or choose not to carry | $100,000-$200,000+ | 1-3+ years |
| Domestic Adoption | Anyone; no biological connection | $20,000-$50,000 | 1-5+ years |
| Foster-to-Adopt | Anyone; minimal cost | $0-$3,000 | Variable |
| International Adoption | Limited for LGBTQ+; few countries allow | $25,000-$60,000 | 2-4+ years |
Pathways for People Who Can Carry a Pregnancy
IUI (Intrauterine Insemination) with Donor Sperm
The most common starting point for lesbian couples and single people with a uterus. Sperm is placed directly into the uterus around ovulation, either in a natural cycle or with fertility medications to boost your chances.
The Process
IUI success rates are 10-20% per cycle for women under 35 with no fertility issues. It's a numbers game—cumulative rates after 3-4 cycles reach 40-50% for good candidates.
IVF (In Vitro Fertilization) with Donor Sperm
More invasive and expensive than IUI, but with significantly higher success rates. Eggs are retrieved, fertilized in a lab, and embryo(s) transferred back. Best for those over 35, with fertility issues, or who want to bank embryos for future children.
Why Choose IVF Over IUI?
- Higher success rates: 40-65% per transfer vs. 10-20% for IUI
- Genetic testing available: PGT can screen embryos for chromosomal abnormalities
- Embryo banking: Freeze embryos now for siblings later (preserves current egg quality)
- Necessary for certain situations: Blocked tubes, low ovarian reserve, severe endometriosis
- Required for reciprocal IVF if you want both partners biologically connected
Reciprocal IVF (RIVF)
A unique option for couples with two uteruses. One partner's eggs are retrieved and fertilized with donor sperm, then the embryo is transferred to the other partner to carry. Both partners have a biological connection: one genetic, one gestational.
How It Works
Partner A undergoes ovarian stimulation and egg retrieval (the harder part). Eggs are fertilized with donor sperm to create embryos. Partner B undergoes uterine preparation and embryo transfer (the easier part, medically). Partner B carries the pregnancy to term.
RIVF costs more than standard IVF because two people undergo treatment. Budget $20,000-$35,000 including medications, plus donor sperm costs. Some couples do egg retrieval from both partners and decide later who carries—this costs more upfront but provides maximum flexibility.
Who Provides the Eggs?
Often, the younger partner or the one with better ovarian reserve provides eggs (maximizing embryo quality), while the other partner carries. But this isn't a rule—some couples prioritize who wants to experience pregnancy, whose work situation allows for pregnancy, or simply who feels called to which role. There's no wrong answer.
Pathways for People Who Cannot or Choose Not to Carry
Gestational Surrogacy
A gestational carrier (GC) carries a pregnancy created with intended parents' or donor gametes. The GC has no genetic connection to the child. This is the most common path for cisgender gay male couples, trans women, and anyone without a functional uterus.
Traditional vs. Gestational Surrogacy
Gestational surrogacy (most common today): Embryo created via IVF using intended parent(s) or donor eggs/sperm, transferred to carrier. Carrier is not genetically related to child.
Traditional surrogacy (rare, legally complex): Carrier's own eggs are used. She is the genetic mother. Most agencies and attorneys avoid this due to legal complications.
Surrogacy Costs Breakdown
Total range: $100,000-$200,000+ depending on location, whether you need donor eggs, number of transfers needed, and whether complications arise.
Some states (California, Connecticut, Nevada, Oregon) are very surrogacy-friendly with clear laws protecting intended parents. Others (Michigan, Louisiana) criminalize paid surrogacy. Some (New York recently legalized but with restrictions) are evolving. Work with an attorney who specializes in your state's surrogacy laws—this is not DIY territory.
Finding a Gestational Carrier
- Surrogacy agencies: Handle matching, screening, and coordination. More expensive but less stressful. Look for LGBTQ+-affirming agencies.
- Independent matching: Find a carrier yourself (sometimes a friend or family member volunteers). Lower agency costs but requires more self-coordination and legal work.
- Online matching services: Platforms like SurrogacyMatch or various Facebook groups connect intended parents with potential carriers. Still need agency or attorney oversight.
Adoption and Foster Care
Domestic Adoption
Legally, LGBTQ+ couples and individuals can adopt in all 50 states since the 2015 Obergefell decision. Practically, experiences vary significantly based on agency, state, and birth parent preferences.
Types of Domestic Adoption
Private/agency adoption: Work with a licensed agency to be matched with a birth parent who has chosen adoption. More control over the process but expensive ($20,000-$50,000).
Foster-to-adopt: Become a licensed foster parent with the goal of adopting children whose parental rights have been terminated. Much less expensive ($0-$3,000) but less certainty—the goal of foster care is reunification first.
Independent adoption: Birth parent and adoptive parent connect directly, often through an attorney or word-of-mouth. Costs vary; requires careful legal work.
Not all agencies are equally welcoming. Seek out agencies that explicitly serve LGBTQ+ families, have staff training on queer family issues, and can show you successful placements with families like yours. The Family Equality Council and Human Rights Campaign maintain lists of affirming agencies.
What to Know About Adoption
- Home studies are required—a social worker evaluates your home, finances, relationships, and readiness to parent
- Birth parents often choose adoptive families; some prefer LGBTQ+ parents, others don't—this isn't personal
- Open adoption (ongoing contact with birth family) is increasingly common and generally considered healthiest for the child
- Wait times vary enormously—from months to years depending on your openness to different situations
- Adoption tax credits can offset some costs (currently up to ~$15,000)
International Adoption
Reality check: International adoption options for LGBTQ+ individuals and couples are extremely limited. Most countries that allow international adoption explicitly prohibit placement with same-sex couples or single LGBTQ+ individuals.
A few countries have allowed single LGBTQ+ individuals to adopt without disclosing their orientation, but this requires hiding a fundamental part of your identity and carries significant ethical and practical concerns.
If international adoption is important to you, consult with an adoption attorney who specializes in international placements and can give you current, accurate information about which countries might be options.
Choosing Your Donor: Sperm and Eggs
Sperm Donors
Sperm bank (anonymous or open-ID): Browse extensive profiles including health history, physical characteristics, education, personal essays, baby photos, and sometimes audio interviews. Open-ID donors agree to be contactable when the child turns 18. Costs $700-$1,200+ per vial.
Known donor: A friend, acquaintance, or someone found through donor matching sites. Lower cost but requires extensive legal work to protect all parties. The donor must undergo infectious disease testing and often quarantine periods if not going through a clinic.
The donor-conceived community increasingly advocates for open-ID donors, recognizing that many donor-conceived people want to know their genetic origins. Additionally, with DNA testing (23andMe, etc.), true anonymity is increasingly impossible anyway. Consider your future child's potential desires when making this choice.
Egg Donors
If you need donor eggs (for gay male couples using surrogacy, for those with diminished ovarian reserve, or for other reasons), you'll work with:
Egg donor agencies: Maintain databases of pre-screened donors. You'll review profiles similar to sperm donor profiles. The donor undergoes ovarian stimulation and egg retrieval. Costs $20,000-$40,000 total including agency fees, donor compensation ($5,000-$15,000+), and medical costs.
Frozen donor egg banks: Purchase eggs already retrieved and frozen. Lower cost ($15,000-$25,000) and faster than fresh cycles, but fewer eggs per batch.
Known egg donors: A friend or family member donates eggs. Requires psychological screening and legal contracts. Medical costs still apply for retrieval.
Legal Protections: Non-Negotiable
LGBTQ+ parental rights are not uniformly protected across the United States. Even if you're legally married, even if you're both on the birth certificate, your parental rights may not be automatically recognized in all states or in federal contexts.
Do not skip the legal protections. Work with a reproductive attorney who specializes in LGBTQ+ family law. The money spent on proper legal documents is insurance against catastrophic outcomes if you travel, move, divorce, or face a legal challenge.
Essential Legal Protections
Donor Agreements
Any time you use a known donor (sperm or eggs), you need a legal contract drafted by an attorney that clearly establishes: the donor's relinquishment of parental rights, the intended parent(s)' full parental rights, financial agreements (or lack thereof), and expectations about future contact or relationship.
Pre-Birth or Parentage Orders
In surrogacy arrangements, a pre-birth order (where available) or post-birth parentage order legally establishes the intended parents—not the gestational carrier—as the legal parents. This is essential for both parents to be on the birth certificate from day one.
Second-Parent Adoption
If only one parent is genetically or gestationally related to the child, the non-biological parent should strongly consider second-parent adoption. This creates an independent legal parent-child relationship that is recognized across all states and internationally. Yes, it's an extra expense ($2,000-$5,000+). Yes, it feels redundant if you're married. Do it anyway.
Scenarios where it protects you: medical emergencies where only "legal" parents can make decisions, custody disputes if your relationship ends, traveling to states or countries that don't recognize your marriage, potential future changes to marriage equality protections, inheritance and survivor benefits after a parent's death.
Wills, Healthcare Proxies, and Guardianship
Every LGBTQ+ parent should have updated wills naming guardians for their children, healthcare proxies allowing your partner to make medical decisions, and powers of attorney. These documents protect your family if something happens to you.
State-by-State Variations
Parental rights for LGBTQ+ parents vary dramatically by state. Some examples:
- California, Washington, Oregon: Very protective. Both married parents automatically recognized. Surrogacy-friendly. Pre-birth orders available.
- Texas, Florida, many Southern states: Less protective. May require second-parent adoption. Some judges hostile to LGBTQ+ parents. Surrogacy laws vary.
- States with religious exemption laws: May allow adoption agencies to refuse LGBTQ+ families on religious grounds.
The Movement Advancement Project (MAP) maintains updated state-by-state guides on LGBTQ+ family laws. Consult this and an attorney before making decisions based on your state.
Finding LGBTQ+-Affirming Providers
"Affirming" means more than "willing to treat you." It means: intake forms that don't assume heterosexuality, staff trained on LGBTQ+ family structures and terminology, policies that explicitly welcome queer patients, experience successfully building families like yours, and no uncomfortable explanations required about your relationship.
How to Find Affirming Providers
- LGBTQ+ family organizations: Family Equality Council, COLAGE, and local LGBTQ+ family groups often maintain provider lists
- Word of mouth: Ask other queer parents in your area who they used and whether they felt welcomed
- SART clinic search: The Society for Assisted Reproductive Technology lists success rates; some clinics note LGBTQ+ specialization
- Ask directly: "Do you have experience working with LGBTQ+ patients? What percentage of your patients are queer families?"
Intake forms with no options for your family structure, staff who seem confused by your situation, having to repeatedly explain or justify your family configuration, providers who refer to the non-biological parent dismissively, and any religious language or imagery that makes you uncomfortable. Trust your gut—if something feels off, it probably is.
Resources for LGBTQ+ Family Building
"The Ultimate Guide to Pregnancy for Lesbians" by Rachel Pepper — Now in its updated edition, this comprehensive guide covers everything from choosing a donor to navigating pregnancy to legal protections.
View on Amazon →"The New Essential Guide to Lesbian Conception, Pregnancy, and Birth" by Stephanie Brill — Detailed, practical guide covering medical, emotional, and legal aspects.
View on Amazon →Frequently Asked Questions
It depends on your state and plan. Some states (like California) require fertility coverage regardless of marital status or sexual orientation. Others only cover treatment for "infertility," traditionally defined as inability to conceive after 12 months of unprotected intercourse—a definition that excludes same-sex couples by design. Many plans are updating these discriminatory definitions, but coverage remains inconsistent. Always call your insurance to clarify, and consider advocacy if your plan discriminates.
Both have advantages. Sperm banks offer: extensive health screening, clear legal boundaries, anonymity or open-ID options, and no ongoing relationship to navigate. Known donors offer: your child knowing their genetic origin, complete health/personality knowledge, lower per-vial cost, and potential ongoing relationship. The key with known donors is ironclad legal agreements. We generally recommend sperm banks unless you have a compelling reason for a known donor and are prepared for the legal complexity.
Most commonly: gestational surrogacy using one partner's sperm and donor eggs. This gives one partner a genetic connection. Some couples create embryos with each partner's sperm (half with each) and transfer without knowing whose embryo it is—letting biology decide. Others want both partners genetically connected to different children, so they plan for each partner's sperm to be used for different pregnancies. Adoption and foster care are also excellent options if surrogacy costs are prohibitive or you prefer that path.
Yes. Marriage provides some protections, but not all. Second-parent adoption creates an independent legal parent-child relationship that is recognized everywhere—even in states that might not recognize your marriage, even in countries where same-sex marriage isn't legal, even if marriage equality is ever weakened. It protects against custody challenges, provides clearer inheritance rights, and ensures both parents can make medical decisions. The cost is worth the peace of mind.
There's no right answer—only your answer. Factors couples consider: who has better fertility indicators (ovarian reserve, uterine health), who has a stronger desire to experience pregnancy, whose work/insurance situation is more accommodating, health conditions that might affect pregnancy, and age (the younger partner carrying may have lower-risk pregnancy). Some couples do reciprocal IVF so both contribute; others take turns for different children. Have honest conversations about what matters to each of you.
Trans and non-binary people have many pathways to parenthood, depending on their anatomy and transition status. Trans men may be able to carry pregnancies (though this requires stopping testosterone). Trans women can bank sperm before transition. Non-binary people have options based on their reproductive anatomy. The key is finding providers who are truly affirming—who use correct pronouns, don't misgender you, and have experience with trans fertility care. Organizations like FOLX Health and Plume can help with referrals.
Start early with simple, age-appropriate language. Children who always knew their origin story adjust better than those told later as a "revelation." For young children: "Our family was made with help from a donor (or surrogate). That person helped us because we wanted you so much." As they grow, add more detail. Books like "What Makes a Baby" by Cory Silverberg are excellent resources. The goal: your child should never remember a time when they didn't know their story, and it should feel normal—because it is.
Yes, this is called "altruistic" or "independent" surrogacy. It can be wonderful—you know and trust your carrier, and costs are lower since you're not paying agency fees or (typically) full carrier compensation. However, it still requires: legal contracts drafted by a reproductive attorney, psychological screening for everyone involved, medical screening for the carrier, clear agreements about compensation for expenses, lost wages, etc., and honest conversations about worst-case scenarios. Don't skip the legal and psychological steps just because you're friends.
Your Family, Your Way
Building a queer family requires more planning, more money, and more legal paperwork than straight couples face. That's unfair. It's also the reality right now.
But here's what's also true: LGBTQ+ parents are, by definition, intentional parents. No one becomes a queer parent by accident. Every child in an LGBTQ+ family was deeply wanted, carefully planned for, and deliberately brought into existence. That's a powerful foundation.
The community of LGBTQ+ parents who've come before you is generous with advice, referrals, and support. Lean on them. Learn from their experiences. And when you're on the other side with your family, pay it forward to the next generation of hopeful parents.
Your family is beautiful. Your family is valid. Your family is worth fighting for.
Medical Disclaimer: This content is for informational purposes only and does not constitute medical or legal advice. Laws and medical practices vary by state and change over time. Always consult with qualified healthcare providers and LGBTQ+-affirming attorneys for personalized guidance about your specific situation.