Planning for a family can be overwhelming, even under ideal circumstances. For the LGBTQ+ community, addressing fertility concerns may require more careful planning. 

Nearly half of all LGBTQ+ individuals ages 18-35 are interested in growing their families. 

"Most LGBTQ+ couples I see know they want professional assistance to start their families," says Dr. Jessica Chan, a fertility specialist at the Cedars-Sinai Fertility and Reproductive Medicine Center. 

The demand for assisted reproductive services among the LGBTQ+ community is high, with more than 1.6 million individuals considering biological paths to parenthood.

There are 4 key options for assisted reproduction:

• Timed sexual intercourse: This is an option for same-sex couples who are willing to conceive a child outside of their partnership and also for transgender couples who have preserved their fertility.  
• Intrauterine insemination (IUI): A procedure where doctors place sperm inside a woman's uterus. 
• Home insemination: A form of insemination that couples can perfrom in the comfort of their home, using an "insemination kit" to insert sperm into the vagina, close to the cervix. 
• In vitro insemination (IVF): A procedure that involves extracting eggs, fertilizing them in a laboratory, and transferring one (or more) healthy embryos to a gestational carrier. 

With gay men, the key concern is whether their sperm are healthy.

Both men can provide sperm, or the couples may choose the man with the healthier sperm for assisted reproductive procedures. After that, the process relies on 2 things:

• Egg donation. Some couples prefer anonymous egg donation. Others have someone in mind who is willing to donate their eggs to them.
• Gestational carrier. Gay couples typically use a surrogacy agency to select gestational carriers. After sperm fertilizes the donor eggs to create embryos, doctors transfer the healthiest embryo (or embryos) to the gestational carrier through IVF. 

Read: Supporting LGBTQ+ Youth: Tips for Parents and Family

Lesbian couples require donor sperm to conceive, either from someone they know or from a sperm bank. One or both partners can be involved in the pregnancy/donation process.

"One woman might donate the egg while the other carries the pregnancy," Dr. Chan says.  

Because purchasing sperm is expensive, most reproductive endocrinologists recommend fertility testing upfront to ensure the selected partner is cleared for pregnancy. With healthy donor sperm and healthy eggs, most same-sex female couples can start their fertility journey with IUI.

Women who are over the age of 35, or who have a history of infertility, may need assisted reproduction with fertility treatments to increase their chances of pregnancy.

Transgender men who are seeking services include female-to-male transgender people who have already transitioned or who are beginning the process. Transgender women are male-to-female transgender individuals who are at various stages of their transition.

Available fertility options for these individuals depend on where each person is in their transition. A few of the options are:

• Embryo creation: Transgender men can preserve their fertility before starting testosterone therapy. In this instance, a transgender man may choose to have a cisgender partner carry the pregnancy after embryos are created with donated sperm.
• Egg freezing: Transgender men can freeze or store unfertilized eggs prior to surgery for later use. This may be a preferred option for single transgender men.
• Sperm freezing: Transgender women can freeze and store sperm prior to transition. 
• Pregnancy: If the uterus is retained, a transgender man may choose to carry the pregnancy. 

Read: New Transgender Surgery and Health Program at Cedars-Sinai

No matter your sexual orientation or identity, it's important to remember that most insurance companies do not cover fertility treatments—and for many couples, the out-of-pocket costs can be prohibitive.

"If you think you might want to have a family, start the planning process early," Dr. Chan says.

That advice applies not only to financial preparation, but also to health considerations. A reproductive endocrinologist can review your medical history and make sure you and/or your partner are physically healthy and can support a pregnancy. 

It's also important to make sure that anyone who is planning to carry the pregnancy is taking prenatal vitamins, eating a healthy diet, and is up-to-date on all immunizations for at least 3 months prior to conceiving.

"Starting a family is a team effort, especially for LGBTQ+ individuals. Most LGBTQ+ couples need a reproductive endocrinologist, a sperm or egg donor, legal counsel, and other support services," says Dr. Chan.

The good news is if your doctors are aware of potential obstacles in advance—such as poor sperm quality or uterine fibroids—they'll be better equipped to address them early in the assisted reproduction process.

In the Newsroom: Cedars-Sinai Earns Top Score as LGBTQ Healthcare Leader