Guide | Family Building for Same-Sex Couples: Challenges and Hope Behind Technological Advances
Building a family is an important journey for everyone, but the path is often more complex and difficult for same-sex couples. Because they do not have all three elements needed for unassisted conception—sperm, eggs, and a uterus—same-sex couples generally rely on assisted reproductive technology to become parents.
"To achieve a pregnancy, you need sperm, an egg, and a uterus," said Amanda Adeleye, MD, assistant professor of obstetrics and gynecology and a reproductive endocrinologist at the University of Chicago Medical Center. "If any one is missing, help from a fertility clinic is needed."
The Path to Pregnancy for Male Same-Sex Couples
Male couples have sperm but need eggs and a uterus, and these two elements generally should not come from the same woman. Dr. Jennifer Eaton, associate professor of obstetrics and gynecology at Brown University Medical School and director of reproductive medicine at Women & Infants Hospital, said, "The general consensus is that having the same woman provide the eggs and serve as a surrogate is unethical and creates many legal and emotional concerns."
Most male couples therefore use donor eggs and a gestational surrogate, who may be a friend, relative, or someone found through a professional agency. Dr. Mark Leondires, founder and medical director of RMACT (Reproductive Medicine Associates of Connecticut), and his husband used different surrogates for each of their two children.
Surrogates undergo rigorous screening to confirm uterine health, the absence of infectious disease, and psychological readiness to carry a pregnancy. Dr. Eaton noted that an ideal surrogate is 21 to 45 years old, healthy, and has had at least one successful full-term delivery. "A woman who has previously given birth may be more likely to view the pregnancy as carrying a child for someone else rather than forming a personal parental attachment."
After eggs are selected, the medical team thaws the frozen eggs, fertilizes them with a partner's sperm through in vitro fertilization (IVF), and transfers an embryo to the surrogate's uterus.
The Path to Pregnancy for Female Same-Sex Couples
Female couples have eggs and a uterus but must decide who will provide the eggs and who will carry the pregnancy. This decision combines personal preferences with medical considerations.
When Lorie Mason and her wife Shannon tried to have their first child, Lorie was 42, so they decided that the younger Shannon would provide the eggs and carry the pregnancy. "I would have needed to undergo various fertility treatments," Lorie recalled.
They spent months searching a sperm bank for a donor, "like buying a house." "We wanted a man of Polish ancestry to continue my cultural heritage. We also wanted him to have blue eyes, no genetic disorders, and to agree to open contact so that the child might have the opportunity to know their biological father in the future," Lorie said.
The most common and relatively affordable option is intrauterine insemination (IUI), in which donor sperm is placed directly into the uterus of the partner carrying the pregnancy. It can be performed during a natural or medication-induced ovulation cycle. However, IUI success rates are only 15%-20%. After 7 unsuccessful attempts, they switched to IVF and succeeded on the first attempt.
If both female partners want to participate in the reproductive process, they may choose reciprocal IVF, in which one partner provides the eggs and the other carries the pregnancy. Because it is costly and complex, it is generally not the first option.
Dr. Suneeta Senapati, assistant professor of obstetrics and gynecology at the Hospital of the University of Pennsylvania and director of third-party reproduction at Penn Fertility Care, said, "These techniques require a highly experienced medical team and a carefully customized process."
Multiple Barriers for Same-Sex Couples
Access to Care
Despite technological advances, same-sex couples still face emotional, financial, and legal barriers. Until recently, most same-sex couples had almost no access to medical pathways to parenthood. "That was the price we had to pay," Dr. Leondires said.
One study found that only about half of U.S. fertility clinic websites provided LGBTQ-related content, and inclusivity was lower in the Midwest and South than in the Northeast and West.
High Costs
The family-building process involves many steps and substantial costs, beginning with obtaining eggs or sperm.
Male couples must also cover surrogacy-related costs and may need multiple embryo transfers.
Most insurance plans do not cover assisted reproduction for same-sex couples, often requiring 12 months of unsuccessful attempts at unassisted conception before providing coverage, which excludes same-sex couples.
Nonprofit organizations such as the Cade Foundation, Baby Quest Foundation, and Journey to Parenthood offer family-building grants. Organizations including ASRM (American Society for Reproductive Medicine) and Resolve also provide guidance and resource links.
Legal Barriers
In most states, the non-genetic parent in a same-sex couple must obtain parental rights through legal documentation. Because the person who gives birth has default parental rights, a surrogate must formally relinquish them.
"We recommend that all same-sex couples consult an attorney who specializes in fertility law," Dr. Senapati advised.
Emotional Challenges and Psychological Support
Treatment can be long and difficult, and success may take time. "Success often requires cycle after cycle, along with considerable emotional resilience and perseverance," said Dr. Taraneh Nazem of RMA of New York.
Some same-sex couples also face misunderstanding or a lack of support from family and friends. "Some people may feel very isolated," Dr. Senapati said.
Before treatment, Dr. Leondires and his partner consulted a psychologist familiar with third-party reproduction, which helped them make major decisions. Mental health professionals can also help parents plan how to explain their child's birth story in the future.
Support groups can also provide important emotional support. Dr. Nazem encourages same-sex couples to join online or in-person communities: "Knowing you are not the only person facing these challenges can itself be a source of strength."
Same-Sex Family Statistics (United States):
114,000 couples: Same-sex couples raising children
Guide | Family Building for Same-Sex Couples: Challenges and Hope Behind Technological Advances
Guide | Family Building for Same-Sex Couples: Challenges and Hope Behind Technological Advances
Building a family is an important journey for everyone, but the path is often more complex and difficult for same-sex couples. Because they do not have all three elements needed for unassisted conception—sperm, eggs, and a uterus—same-sex couples generally rely on assisted reproductive technology to become parents.
"To achieve a pregnancy, you need sperm, an egg, and a uterus," said Amanda Adeleye, MD, assistant professor of obstetrics and gynecology and a reproductive endocrinologist at the University of Chicago Medical Center. "If any one is missing, help from a fertility clinic is needed."
The Path to Pregnancy for Male Same-Sex Couples
Male couples have sperm but need eggs and a uterus, and these two elements generally should not come from the same woman. Dr. Jennifer Eaton, associate professor of obstetrics and gynecology at Brown University Medical School and director of reproductive medicine at Women & Infants Hospital, said, "The general consensus is that having the same woman provide the eggs and serve as a surrogate is unethical and creates many legal and emotional concerns."
Most male couples therefore use donor eggs and a gestational surrogate, who may be a friend, relative, or someone found through a professional agency. Dr. Mark Leondires, founder and medical director of RMACT (Reproductive Medicine Associates of Connecticut), and his husband used different surrogates for each of their two children.
Surrogates undergo rigorous screening to confirm uterine health, the absence of infectious disease, and psychological readiness to carry a pregnancy. Dr. Eaton noted that an ideal surrogate is 21 to 45 years old, healthy, and has had at least one successful full-term delivery. "A woman who has previously given birth may be more likely to view the pregnancy as carrying a child for someone else rather than forming a personal parental attachment."
After eggs are selected, the medical team thaws the frozen eggs, fertilizes them with a partner's sperm through in vitro fertilization (IVF), and transfers an embryo to the surrogate's uterus.
The Path to Pregnancy for Female Same-Sex Couples
Female couples have eggs and a uterus but must decide who will provide the eggs and who will carry the pregnancy. This decision combines personal preferences with medical considerations.
When Lorie Mason and her wife Shannon tried to have their first child, Lorie was 42, so they decided that the younger Shannon would provide the eggs and carry the pregnancy. "I would have needed to undergo various fertility treatments," Lorie recalled.
They spent months searching a sperm bank for a donor, "like buying a house." "We wanted a man of Polish ancestry to continue my cultural heritage. We also wanted him to have blue eyes, no genetic disorders, and to agree to open contact so that the child might have the opportunity to know their biological father in the future," Lorie said.
The most common and relatively affordable option is intrauterine insemination (IUI), in which donor sperm is placed directly into the uterus of the partner carrying the pregnancy. It can be performed during a natural or medication-induced ovulation cycle. However, IUI success rates are only 15%-20%. After 7 unsuccessful attempts, they switched to IVF and succeeded on the first attempt.
If both female partners want to participate in the reproductive process, they may choose reciprocal IVF, in which one partner provides the eggs and the other carries the pregnancy. Because it is costly and complex, it is generally not the first option.
Dr. Suneeta Senapati, assistant professor of obstetrics and gynecology at the Hospital of the University of Pennsylvania and director of third-party reproduction at Penn Fertility Care, said, "These techniques require a highly experienced medical team and a carefully customized process."
Multiple Barriers for Same-Sex Couples
Access to Care
Despite technological advances, same-sex couples still face emotional, financial, and legal barriers. Until recently, most same-sex couples had almost no access to medical pathways to parenthood. "That was the price we had to pay," Dr. Leondires said.
One study found that only about half of U.S. fertility clinic websites provided LGBTQ-related content, and inclusivity was lower in the Midwest and South than in the Northeast and West.
High Costs
The family-building process involves many steps and substantial costs, beginning with obtaining eggs or sperm.
Male couples must also cover surrogacy-related costs and may need multiple embryo transfers.
Most insurance plans do not cover assisted reproduction for same-sex couples, often requiring 12 months of unsuccessful attempts at unassisted conception before providing coverage, which excludes same-sex couples.
Nonprofit organizations such as the Cade Foundation, Baby Quest Foundation, and Journey to Parenthood offer family-building grants. Organizations including ASRM (American Society for Reproductive Medicine) and Resolve also provide guidance and resource links.
Legal Barriers
In most states, the non-genetic parent in a same-sex couple must obtain parental rights through legal documentation. Because the person who gives birth has default parental rights, a surrogate must formally relinquish them.
"We recommend that all same-sex couples consult an attorney who specializes in fertility law," Dr. Senapati advised.
Emotional Challenges and Psychological Support
Treatment can be long and difficult, and success may take time. "Success often requires cycle after cycle, along with considerable emotional resilience and perseverance," said Dr. Taraneh Nazem of RMA of New York.
Some same-sex couples also face misunderstanding or a lack of support from family and friends. "Some people may feel very isolated," Dr. Senapati said.
Before treatment, Dr. Leondires and his partner consulted a psychologist familiar with third-party reproduction, which helped them make major decisions. Mental health professionals can also help parents plan how to explain their child's birth story in the future.
Support groups can also provide important emotional support. Dr. Nazem encourages same-sex couples to join online or in-person communities: "Knowing you are not the only person facing these challenges can itself be a source of strength."
Same-Sex Family Statistics (United States):
114,000 couples: Same-sex couples raising children
24%: Female couples raising children
8%: Male couples raising children
Story source:
Collected online