LGBTQ+ assisted reproductive technologies overview

  • To build a family of their own, many LGBTQ+ couples and individuals need assistance from a third party and assisted reproductive technologies, which are standard fertility treatments involving the handling of eggs, sperm or embryos.
  • These LBGTQ+ fertility treatments include sperm, egg and embryo donation, gestational carrier surrogacy, assisted reproductive technologies like in vitro fertilization (IVF), and egg and sperm cryopreservation for some prior to hormone treatment or sexual reassignment surgery.
  • In addition, LGBTQ+ individuals also experience infertility detectable by fertility testing and require infertility treatments.
  • More than 60% of LGBTQ+ individuals aged 18 to 35 are thinking about expanding their families, and the providers at Carolina Conceptions continue to be in the forefront of assisting those in the LGBTQ+ community achieve their dreams of family.
  • Due to the variety of sexual and gender orientations in LGBTQ+ couples and individuals, there’s no one-size-fits-all plan when it comes to having a baby. But they can be as successful as any others when it comes to fertility treatments.
  • Because LGBTQ+ reproductive issues are complicated, we recommend consulting an attorney who specializes in third-party reproduction legal issues and a psychological counselor experienced in the same.


Carolina Conceptions is one of the longest-standing gold sponsors of Out! Raleigh Pride.

Assisted reproductive treatments for the LGBTQ+ community

Everyone deserves access to reproductive and fertility services, no matter their sexual or gender identity. We know that LGBTQ+ individuals and couples face unique challenges when they want to start families. Some couples need a little help – from us and from a third party.

Our comprehensive LGBTQ+ assisted reproduction and fertility services offer multiple paths to parenthood. They range from simpler fertility treatments to more complicated procedures often related to IVF and include:

Eighty-four percent of respondents in a 2019 survey said they wished they knew more about LGBTQ+ affirming reproductive healthcare. Unfortunately, about half said they don’t feel comfortable talking to a healthcare provider about their fertility.
That’s where we come in.

LGBTQ+ education, counseling & compassion

LGBTQ+ assisted reproduction treatments are about more than the medical procedures. It starts with a supportive team that can educate and dispel myths and misinformation. For example, did you know that transgender men with ovaries may still have viable eggs up to a year after beginning testosterone therapy? Our providers are thoroughly knowledgeable on all such issues as well as on the latest techniques to assist in LGBTQ+ family building.

We work with each couple and individual to come up with a plan to build the family they want, including their preferences and specific needs. Our compassionate psychologist Ryan W. Blazei, Ph.D., fertility specialists and financial counselors have been doing this a long time, and we have a proven track record of success. We can even recommend reproductive attorneys to help with the legal issues surrounding surrogacy or egg donation.

The role of fertility testing for LGBTQ+ patients

Carolina Conceptions conducts fertility tests on all patients, regardless of sexual or gender orientation. It is vital to the reproductive success of anyone to undergo testing to determine that person’s or couple’s suitability to begin reproductive services and for our doctors to tailor that treatment to their individual medical situation.

The specific testing depends on assisted reproductive treatments needed and may include:

  • Physical and health history
  • Semen analysis to test for sperm quality and quantity
  • Bloodwork to check for hormone levels and other conditions
  • Pelvic exam
  • Hysterosalpingogram (HSG), an X-ray to evaluate the health of the uterus and fallopian tubes
  • Preconception genetic screening as indicated by health history

Third-party egg donation, sperm donation & embryo donation

The fertility options of IVF and intrauterine insemination (IUI) for lesbian couples, LGBTQ+ couples and individuals without a male reproductive system among them require the use of donor sperm. Donor sperm can be obtained from a sperm bank or from a friend or relative. We can help patients with that decision.

Gay male couples and individuals or an LGBTQ+ couple without a female reproductive system among the pair, will need an egg donor. We recommend that patients choose a donor from our private, online database of pre-screened candidates. Eggs can also be donated by a friend or family member.

Using a donated embryo is a possible option in several instances. Patients may be able to use a frozen, healthy embryo donated by a couple who have used our fertility services and decided their family is complete. We can also help patients find a donated embryo through other services.

Using a gestational carrier

or traditional surrogacy

Surrogacy is the most successful fertility treatment, according to the Centers for Disease Control and Prevention. United States fertility centers have a surrogacy success rate of about 75%. That number grows to as high as 95% once the surrogate is pregnant.

This can be the best alternative for gay men or transgender women who want to be parents or women who can’t conceive or carry a child.

The words surrogate and gestational carrier are often used interchangeably. But there are important distinctions between the two terms.

A surrogate has a genetic tie to the baby she carries. Her egg is artificially inseminated with sperm (usually the sperm of the male parent). She then carries the baby to term.

A gestational carrier has no genetic link to the baby she carries. The egg and sperm are provided by the intended parent(s) or donors and the resulting embryo from IVF is implanted in the gestational carrier’s womb. A donated embryo or one the intended parents already had from previous IVF treatment can also be implanted in the gestational carrier.

Surrogates or gestational carriers can be relatives or friends, or patients can choose one from our list of women who have been pre-screened. Whatever option chosen, the patient will be responsible for the surrogate’s/gestational carrier’s medical costs.

Surrogacy is the most expensive part of any fertility treatment since the patient is paying the costs of IVF and the costs of a surrogate or gestational carrier.

Patients need to hire a reproductive law attorney no matter who carries the baby. We can help patients find an experienced lawyer. Due to the complex issues of parenthood including such considerations as whether or not the resulting child is told of parentage details, we highly recommend psychological counseling.

Intrauterine insemination

The simplest and most common fertility method chosen by lesbians and others without a male reproductive system is to use donor sperm for IUI. In this form of artificial insemination, when the person with the female reproductive system ovulates, we inject semen directly into the uterus.

This person may need fertility medications to control the timing of ovulation. We also may perform controlled ovarian hyperstimulation (COH) in older people who have lower quality eggs or who wish to be more aggressive after other treatments haven’t worked.

In vitro fertilization

For IVF, sperm and eggs are collected and fertilized in a lab. (Sometimes, gay male couples will each donate sperm for the procedure.) The resulting embryo(s) are frozen. The healthiest embryo is transferred into the uterus of the LGBTQ+ patient carrying the pregnancy or into the surrogate’s uterus.

Reciprocal IVF

This process allows both female or female-identifying partners to be involved in the pregnancy. The eggs of one (the genetic mother) are fertilized with donated sperm. The resulting embryo is then inserted into the other partner (the gestational mother), who carries the pregnancy.


In this treatment, which is a more natural form of IVF,  the eggs and sperm are placed into a cylindrical capsule called an INVOcell, which is then inserted into the woman’s vagina.

Embryos grow within the INVOcell in the woman’s own body, not in a lab. The pregnant person’s body chemistry of temperature, pH balance and oxygen promote fertilization. After five days, the INVOcell is removed, and the embryo is transferred back to the uterus to implant for pregnancy.

INVOcell costs less than half of the average cost of traditional IVF since there are no expensive labs involved. Patients also require fewer ultrasounds, medications and appointments.

It’s a great option for those using donor sperm.

Egg or sperm preservation

Transgender men and women may want to consider freezing sperm or eggs before hormone treatment or transition surgery.