LGBTQ+ Fertility: A Guide to Building Your Family with Donor Sperm
For LGBTQ+ folks looking to welcome a child into their family through a biological connection with one or more of the parents, there are many paths to achieving pregnancy. Which path you take depends on several factors. This may include cost, access to various reproductive “ingredients,” personal preferences, and more. Many prospective parents pursue assisted reproduction and insemination with the help of donor sperm. If you’re considering expanding your family with donor sperm, explore this resource to learn more about:
- The different ways that you can get pregnant using donor sperm at home, with the assistance of a provider (such as a midwife), or at a clinic
- Working with known or unknown donors
- The basic steps of starting this journey
This resource belongs to a webinar series sponsored by California Cryobank. It includes insights from guest speakers Eddie Cervantes (California Cryobank) and Disha Mistri. Disha is a dual board-certified nurse practitioner, IVF mom, and founder of OM Fertility.
Types of insemination and assisted reproduction
There are many ways to get pregnant with donor sperm. The right avenue for you and your family will depend on financial, emotional, and biological resources and needs.
What is IVI/ICI?
If you want to explore getting pregnant at home, there are two primary methods of insemination: IVI, when the donor sperm is deposited into the vaginal canal without specifically targeting the cervix and ICI, when the donor sperm is deposited at or near the cervical opening. Both are non-surgical and minimally invasive. They can be done at home without medical providers through needleless syringes, cervical caps, and/or the help of a midwife or nurse practitioner. In both cases, this is best done with fresh sperm from a partner or donor.
These are both the simplest and the least effective ways to conceive for a person with a uterus outside of intercourse. On average, Disha notes that it takes up to a year to achieve pregnancy if there are no other issues.
The cost of at-home insemination
At-home insemination is one of the more cost-effective options for achieving pregnancy, as it doesn’t usually require the additional support of a medical provider. LGBTQ+ couples pursuing pregnancy through insemination will often need either known or unknown donor sperm, which can cost between $25 (the lowest estimated cost for known donors) and $2,500 (the highest estimated cost for unknown donors) per vial. For those using a known donor, there’s an option to test the donor’s sperm, which will cost an additional $25 – $300.
Because it usually takes about a year to achieve pregnancy, prospective parents would be paying for twelve cycles worth of sperm, which can add up quickly. There are ways for prospective parents to offset costs based on certain choices, employment statuses, grants, and loans.
What is IUI?
IUI occurs when donor sperm is inserted via a tube directly into an individual’s uterus to facilitate fertilization. Like at-home insemination options, it’s a minimally invasive procedure, but unlike IVI and ICI, it is typically performed in a doctor’s office and requires the help of a provider. IUIs require washed sperm — which will be different from the vials you may purchase for ICI or IVI. Typically, only one IUI is performed per cycle, and it has a 20% success rate with each attempt.
The cost of IUI
IUI is a relatively inexpensive medical treatment compared to processes like IVF, with a price ranging from $250 to $4,000 per attempt. In addition, LGBTQ+ couples pursuing pregnancy through insemination will often need either known or unknown donor sperm, which can cost between $25 (the lowest estimated cost for known donors) and $2,500 (the highest estimated cost for unknown donors) per vial. For those using a known donor, there’s an option to test the donor’s sperm, which will cost an additional $25 – $300. There are ways for prospective parents to offset costs based on certain choices, employment statuses, grants, and loans.
What is IVF?
IVF is a procedure that involves removing eggs from an individual’s ovaries and fertilizing them outside of the body with sperm in a laboratory dish. The resulting embryos are then transferred into a uterus through the cervix. IVF can also be utilized in conjunction with donor eggs or donor embryos. IVF has the highest success rate of all the methods of getting pregnant with donor sperm.
The cost of IVF
On average, an initial IVF cycle costs between $12,000 – $15,000, plus an additional $1,500 – $6,000 for medication. Subsequent attempts through Frozen Embryo Transfers (FET) average between $4,000 – $7,000 per cycle.
If a sperm donor is needed, costs vary from $25 (the lowest estimated cost for known donors) to $2,500 (the highest estimated cost for unknown donors) per vial. For those using a known donor, there’s an option to test the donor’s sperm, which will cost an additional $25 – $300.
If an egg donor is needed, costs can increase by $25,000 – $30,000.
There are ways for prospective parents to offset costs based on certain choices, employment statuses, grants, and loans.
What is R-IVF?
R-IVF is a series of medical procedures in which eggs are harvested from one person’s ovaries, inseminated outside of the body, and transferred to another person’s uterus.
The cost of R-IVF
This version of IVF has the same baseline cost of between $12,000 – $15,000 for the procedure. R-IVF has additional medication costs, adding $3,000 – $8,000 per cycle.
If a sperm donor is needed, costs vary from $25 (the lowest estimated cost for known donors) to $2,500 (the highest estimated cost for unknown donors) per vial. For those using a known donor, there’s an option to test the donor’s sperm, which will cost an additional $25 – $300.
There are ways for prospective parents to offset costs based on certain choices, employment statuses, grants, and loans.
Working with donor sperm
Another consideration for people expanding their family through at-home insemination and assisted reproduction is finding a sperm donor. There are two primary types of donors:
- A known donor: When a donor-conceived person knows the identity of their donor, we call that a “known donor.” Known donors are typically close friends or family members. However, there are apps that you can use to identify known donors. Be cautious while using these apps! While they’re cheaper, they have the same set of guidelines and legal precautions in place as more traditional routes such as cryobanks so there are a lot more risks.
- An unknown donor: Similar to “anonymous donor,” an unknown donor donates sperm or eggs, but they do not intend to be easily identified. Recently, the community adopted “unknown” instead of “anonymous,” because true anonymity isn’t possible with the prevalence of genetic testing today. Cryobanks typically supply unknown donors.
As you consider which donor to choose, Eddie from California Cryobank suggests thinking holistically — beyond simple physical characteristics. By focusing too heavily on a donor’s height or eye color, you might be eliminating a lot of valuable prospects.
If you’re pursuing this journey with a partner, consider making a list of what matters to each of you and then comparing those lists to find the overlap.
Finding donor sperm at a cryobank
Cryobanks are some of the most common methods for accessing donor sperm. At a popular cryobank like California Cryobank, unknown donors will undergo a series of robust background checks, medical examinations, and more. These processes screen for infections, sexually transmitted diseases, and mental health counseling to ensure that the donors are both physically and mentally prepared for donation.
Eddie notes that California Cryobank currently has over 650 highly qualified donors, and they make up “less than 1% of the people who apply to be donors through our program.” He also notes that these tests are consistent and ongoing for the length of time a donor might be working within the program.
At California Cryobank, donors might have “ID disclosure” — which would grant a child access to core information about a donor (name, date of birth, state of residence) when they turn 18 — or they are an “open donor” which means they are open to creating a contract with the donor-conceived child once they turn 18.
Note: There are many different kinds of cryobanks, and you may be motivated to work with one because of a lower price. While all cryobanks must follow the guidelines of the Food and Drug Administration (FDA), not all of them have the same precautions in place to ensure high-quality sperm.
Getting started on your fertility journey
A lot of parents-to-be begin their fertility journey at an OB-GYN or a primary care doctor. These folks often order a handful of tests and redirect patients to the local fertility clinic or IVF center.
But depending on the path to pregnancy you hope to take, this might not always be the best, cheapest, or most sensible step to start the process. Disha Mistri of OM Fertility says the first step is tracking your cycle — specifically your ovulation window. This will give you a better idea of where to go first.
Funding your fertility journey
One of the biggest considerations to starting a family with insemination or assisted reproduction is navigating finances. As you begin this journey, look into your employer’s medical benefits. Eddie from California Cryobank notes that their agency partners with fertility benefit companies like Progyny, Carrot, and Maven to provide support to parents-to-be. He also said that there are financing partners who provide loan options for various vials and fertility processes including PatientFi, Capex MD, and Future Family.
Tracking your cycle
Typically, in any menstrual cycle, there are 24 hours where your ovaries, hormones, and uterus are all aligned in being ready to fertilize an egg. We call this ovulation. Typically, you track ovulation by testing your luteinizing hormone (LH), which will rise halfway through your cycle.
Using a simple urine ovulation testing strip, you can track your cycles for three to four months to see if your ovulation has a predictable pattern. If you notice that your ovulation varies cycle-to-cycle, it’s time to seek out additional support.
Accessing additional support
There are many issues that might lead to an irregular cycle ranging from stress to hormone imbalances and conditions such as polycystic ovary syndrome or PCOS. Holistic providers, herbalities, naturopaths, and midwives can be good sources of support if you’re just beginning to understand what might be going on.
They can also help you if you’re looking for additional help in the less invasive or medically involved paths to pregnancy. For example, midwives are an especially good resource for anyone looking to do unmedicated IUI.
You may also want to research fertility-specific clinics in your area who can act as an intermediate step between a completely DIY process and a more invasive IVF center.
What’s really ticking?
As you begin your fertility journey — or maybe even before you start the process — you might hear a lot of chatter about the “biological clock” ticking. While the biological clock is something to consider, the time constraints usually only pertain to the quality of an egg, not the ability of a uterus to carry a pregnancy to term.
Eggs are developed in utero. After a child with eggs is born, the six to seven million eggs they have will drop to one to two million eggs. At puberty, that number drops to 300,000, and so on.
Every menstrual cycle, a handful of eggs are released, and the older you get, the higher the chances are that the remaining eggs will have genetic mutations.
Disha calls 35 “the magic number,” because after 35, there’s a steep drop-off in the quality of the eggs remaining, resulting in a higher risk of miscarriage and genetic abnormalities.
Tips for your fertility journey — from the experts
The start to a fertility journey can feel overwhelming. There’s a lot of information to take in, and a lot of decisions to make. Disha says, “Don’t let it overwhelm you. Let it empower you. With information, you can make better decisions.”
Keep in mind the following expert advice:
- Start early. This can often be a long process with many twists and turns.
- Don’t cut corners. You need support on this journey. Hire and pay for a lawyer, seek out providers, and know that often going the cheaper route will cost you more money in the long run.
- Keep in mind the big picture. The goal is to create or expand your family. Avoid the instinct to get caught up in specifics too early on. Keep that end goal in mind when you’re in the thick of your process.
- Trust your gut. There is no wrong decision on this journey. You are simply making the best choice possible with the resources and information you have.
- Always ask questions. The more you know, the more prepared you’ll be.
Securing legal parentage after achieving your pregnancy
Once you do achieve pregnancy, there are legal considerations related to genetic connections and establishing legal parentage.
If you’re looking for an attorney near you, visit the LGBTQ+ Bar Association’s interactive map and directory of family law attorneys.
As you search, consider asking the following questions:
- Are you familiar and up-to-date with family laws affecting the LGBTQ+ community?
- What additional legal steps, if any, need to be taken by my partner or by myself once our baby is born?
- Does my partner need their own assisted reproduction attorney? What about our donor, do they require separate legal counsel?
- Do you know of any pending legislation that could affect our family structure?
- How do we initiate a second parent adoption?
- Can both my partner’s name and my name be on the birth certificate?
- Are any additional steps required in order for us to obtain a birth certificate or passport for the child(ren)? Will our baby be recognized as ours when we travel to other states and countries?
- Will you be our liaison at the hospital?
- What are your fees?
Recommended reading
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ResourceAugust 12, 2019
Average Costs for the LGBTQ+ Community to Achieve Pregnancy in the United States
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ResourceDecember 11, 2018
LGBTQ+ Family Building Grants
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ResourceOctober 24, 2023
Securing LGBTQ+ Parentage by State: Stepparent, Second Parent, and Confirmatory Adoption
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