mothers and children play together in parkShare on Pinterest
Victor Torres/Stocksy United

Are you 1 of the 2 million LGBTQ adults in the United States looking to grow your family? As you can see, you’re certainly not alone.

First off: Congratulations on making the very big decision to become a parent. You may already know about some options regarding how to conceive or adopt — and that’s great.

Here’s more about those options, as well as some answers to questions you may have regarding the various medical, financial, and legal issues you’ll encounter along your path to parenthood.

(Related: Growing your family through gestational surrogacy)

The route you choose to add a child to your family will be unique to you and your circumstances.

You may be entering parenthood on your own. Sometimes one partner desires to be a biological parent, while other times both partners desire to eventually conceive and carry, which can increase your chances of a successful pregnancy. Alternatively, sometimes neither partner wants to be pregnant, instead preferring to adopt, foster, or find a surrogate.

There’s no right or wrong way to make a family, so what you choose boils down to your personal preferences and other factors like cost.

IUI

Intrauterine insemination (IUI) involves one partner choosing to become pregnant using her own eggs. The process uses donor sperm that’s inserted into the uterus using a long, skinny catheter. Sometimes doctors use fertility medications to support ovulation and implantation.

Either way, the hope is that the sperm reaches the egg after the procedure and results in a pregnancy.

Things to consider include the following:

  • IUI may not be covered by your health insurance. According to a fertility clinic estimator, costs can range from a few hundred dollars to over $4,000 for a single cycle.
  • Costs will also depend on whether the procedure includes the use of donor sperm, extra monitoring, fertility medications, and other necessities, so contact your local fertility clinic for more information.
  • Your fertility, which takes into account your age and ovarian reserve, among other factors, will affect the procedure’s success rate.
  • You may use a known or unknown sperm donor.
  • Multiples are a possibility when using fertility medications to stimulate egg production.

The overall success rate of IUI varies depending on many factors, including any underlying fertility issues, the type of sperm used, and other considerations like your age and overall health.

That said, a 2014 study found that success rates among lesbians using fertility treatments were comparable to those of heterosexual women.

There’s also the option of at-home insemination, which can allow you to use IUI for conception in a less clinical setting and for a lower cost. While that may sound appealing, it’s important to know that this method comes with its own challenges and concerns, and it’s not subject to the same health regulations as insemination conducted in a clinic.

IVF

In vitro fertilization (IVF) involves fertilizing an egg or eggs in a lab setting with fresh or frozen donor sperm. As with IUI, you may choose to use a known or unknown sperm donor. With IVF, there’s also the option to use donor eggs, if desired.

To embark on an IVF cycle, one partner injects medications to stimulate her ovaries to produce mature follicles (eggs). Your doctor will retrieve the eggs from the ovaries and then fertilize them with sperm in a lab.

From there, another round of meds will help prepare the uterus for implantation. One or several embryos are then transferred to the uterus to hopefully implant and result in pregnancy.

Things to consider:

  • The entire process takes around 3 weeks to complete.
  • According to a fertility clinic calculator, IVF costs between $4,700 to $30,000 per cycle. It may not be covered by your insurance.
  • IVF success rates vary depending on your age, health status, fertility, and other factors. Your clinic may have specific numbers to share with you regarding its success rates.
  • Multiples are a possibility when transferring more than one embryo.

Another possibility is something called reciprocal IVF. With this process, one partner donates the egg for the procedure, while the other partner carries the pregnancy.

This way, both partners are able to participate in the pregnancy in some way. The process is similar to traditional IVF, except both partners will need to take oral contraceptive pills to synchronize their cycles before the subsequent procedures take place.

Surrogacy

If neither partner wants to be pregnant, or one or both has fertility issues, you might consider surrogacy, which can involve hiring either a gestational carrier or traditional surrogate.

These options involve contracting a woman to undergo IVF using either your egg, hers, or a donor’s, as well as donor sperm, to create one or more embryos. She’ll carry the pregnancy, deliver the child, and then you’ll obtain parental rights as written out in the legal agreement.

Surrogates contracted through an agency must meet certain criteria. They must have a healthy body mass index (BMI) and be between the ages of 21 and 40.

In addition, they have to have carried at least 1 pregnancy to term, and their pregnancy history must be free of complications. Surrogates also go through medical and psychological screenings to ensure they’re fit for the task.

As you can imagine, the cost of surrogacy can get quite steep. For example, West Coast Surrogacy shares that total costs may range between $90,000 and $130,000. The money you pay will cover things like the surrogate fee, medical fees, legal fees, and other areas up to your discretion, such as a maternity clothing stipend.

You can also use a friend or family member as a surrogate. However, she should meet basic health requirements and undergo screenings as well. And be sure to draft up a contract and work with lawyers to protect yourself from sticky legal situations later on.

The cost varies — if your friend/family member is doing this as a favor, you’ll still need to pay medical bills and other fees.

Adoption or fostering

Many children worldwide need homes. If you don’t feel that biological relation is necessary for your family, you might give adoption a closer look.

There are several types of adoption to consider, including the following:

  • Public. This involves adopting a child through the United States child welfare system, which includes children as young as infants and up to teenagers. You may also notice children with special needs or older children who may be more difficult to place than healthy babies. There’s very little expense involved with adopting this way, and you may even be eligible for certain subsidies or deductions.
  • Private. This involves adopting a child through a private agency. It may cost $20,000 to $45,000, but this will vary depending on your specific agency. There may also be other costs, such as home study fees, added on top of the overall cost. While this option is more expensive, you may have more control over the type of child (age, race, etc.) you adopt, if that’s important to you.
  • International. This involves adopting a child from another country. Keep in mind that not all countries allow lesbians to adopt, so do your research. There may be less information about the physical and mental health of children adopted from other countries. Costs range between $20,000 and $50,000. Again, these will vary and may be higher or lower depending on certain fees, travel expenses, etc.

On the other hand, fostering involves taking in a child in the foster care system, with the goal that the child eventually be reunited with his or her family. This happened in roughly half of the cases in 2018.

This is a temporary placement, and the length of time will vary on a case-by-case basis. Your role involves less of being a primary parent and more of being a support parent to the birth family and child when they’re separated from each other.

While this isn’t what every person has in mind when considering growing their family, even temporary care is a valuable way to provide structure and love for a child —and it can be very rewarding.

Furthermore, there are some cases in which parental rights are terminated and children in the foster care system need adoptive families.

You’ll want to check your state laws regarding both adoption or fostering. Not all states have explicit laws protecting against discrimination based on sexual orientation. You can plot your state on this map to see whether there are protective laws in place where you live.

Intercourse with a partner with a penis

While it may not exactly sound appealing to have penetrative sex with a partner with a penis, you might be surprised to learn that some lesbian couples choose this route to pregnancy.

For one, it takes out doctor visits, monitoring, and other medical stuff you may not be comfortable with. In short: It makes the process less clinical. Plus, it costs less.

Still, you aren’t any more likely to get pregnant the “old-fashioned” way. And it may not be something you’re comfortable doing, and that’s OK.

If you’re interested in this method, know that timing is everything. What ups the odds of conceiving is knowing your menstrual cycle and when to time intercourse. This means having sex in your fertile window, which is from a few days before you ovulate through ovulation day. Using ovulation predictor kits (OPKs) may help you best determine the days to have sex.

(Related: Baby making 101: How to get pregnant faster)

Your head may be a bit dizzy with all this information. Still, it’s important to mention that there are concerns to keep in mind with all these routes. Weighing the pros and cons can help you decide which one is right for your family.

Overall cost

The fees range broadly with these options, and some can get quite expensive, especially if you have to do several procedures to achieve pregnancy. Take a frank look at your bank account and discuss what you can realistically afford with your partner.

If you don’t have all the money upfront, you might consider taking out a loan, applying for a grant, or fundraising.

Legal issues

Laws for gay and lesbian parents vary depending on where you live. When you embark on an adoption, second-parent adoption (for the non-biological parent with procedures like IUI and IVF), or surrogacy journey, you’ll want to be aware of your state’s laws as they apply to your unique situation.

Contact an adoption or surrogacy agency near you for more information specific to where you live. Whatever the case, you’ll want to hire a lawyer with experience in adoption or reproductive law to help guide you through the process.

You can also read more online about securing legal ties for children living in LGBT families.

Medical issues

As you delve deeper into your journey, you may learn that having a baby isn’t as simple as introducing egg to sperm. Even if an embryo is directly placed in the uterus, it still has to implant and grow. There’s a bit of magic to it all — despite all that doctors can do using science.

What’s more, a lot of factors are at play during the conception process. Anything from age to fertility to pure luck may affect any given cycle. That may feel especially hard if you’re spending a lot of money and getting your hopes up. Try your best to accept that it make take several attempted cycles to get a positive pregnancy test.

Your emotions

Of course, dealing with unknowns means you may be in for an emotional rollercoaster — excitement one minute, anxiety the next, sadness the next, elation when it finally works out. Phew! Buckle up for the ride and be sure to check in with your partner about her emotions, too.

Remember that you’re in this together. No matter how things work out, you’ll have each other in the end. You might consider seeing a couples therapist or — at the very least — surrounding yourself with a strong support network of family and friends during this time.

(Related: The best LGBTQIA blogs of 2020)

The good news is that same-sex couples have a variety of options if they want to grow their families. However, there are benefits and considerations with each route. As such, don’t rush into anything without taking the time to look at the whole picture.

Consider meeting with a few doctors or agencies before choosing what’s ultimately right for you and your family. These professionals have been through it all and can help you understand the medical processes, costs, and success rates, as well as field questions about any other concerns you may have.