This blog is part of Fertility FAQ, a series in which RMA doctors answer your most pressing questions about treatment.

Today’s physician expert is Dr. Jackie Gutmann, who practices out of RMA Philadelphia.

All my patients come to me needing the same thing: biology has created obstacles to family building, and I help them overcome these obstacles. Whether the patients are cis heterosexuals, gay, lesbian, or gender non-conforming, fertile or infertile, they need help getting pregnant.

Usually, LGBTQ patients need help building their families because one or more pieces of their fertility puzzle are missing.

The required pieces include eggs, sperm, a uterus, and at least one open fallopian tube unless the couple is planning In Vitro Fertilization (IVF).

Though it seems simple to merely replace a missing piece, the problem may lie with one of the pieces already in place.

Same-Sex Female Individuals or Couples

For example, a lesbian couple may come to me because they want to do Intrauterine Insemination (IUI) using donor sperm. Sperm is the missing piece, but diagnostic testing could reveal that the partner planning to get pregnant has a low egg supply.

The couple may then decide that the other partner will try to get pregnant. Or perhaps the partner planning to get pregnant has blocked tubes; we would then consider IVF to achieve pregnancy.

Now let’s focus on all the family-building options for LGBTQ individuals and couples. There are a lot of possibilities.

As noted above, fertility is like a puzzle – we have to figure out what you have and what you need.

The necessary pieces are eggs, sperm, a uterus, and as previously noted, an open fallopian tube unless we are planning IVF.

We work with LGBTQ individuals and couples to help them get what is not available for them to build their families.

For example, when an individual cis female or same-sex female couple comes to me, I first ask how many children they think they want to have and if coupled, whether both partners want to provide oocytes (eggs).

Next, they’ll need to decide if they want to use anonymous or known donor sperm, and what role that donor will play in their family (we offer mental health services to help address family configuration).

And together we can decide whether to pursue IUI or IVF and if they are a couple, whether one partner provides the eggs and the other carries the pregnancy (this allows the couple to share in the pregnancy experience at the same time).

We Are LGBTQ – How Can We Build Our Family? | Dr. Jackie Gutmann - RMA Philadelphia

Same-Sex Male Individuals or Couples

For individual males or same-sex male couples, there are two missing pieces – eggs and a uterus.

The individual or couple will need to decide if they want to use known or anonymous donor eggs, and will need to identify a gestational surrogate (we work with many surrogacy agencies to facilitate this process) to carry the baby.

In the case of a couple, if two kids are desired, they should decide if they each want to provide sperm so that each child would be genetically related to one parent, as well as to each other through the egg donor.

Again, we offer mental health counselors who can walk patients through how big a role, if any, the donor and surrogate will have in the family.

Of course, the individual or couple will need to enter into a legal agreement, or contract, with the surrogate, and known egg or sperm donor as appropriate.

In addition, known donors will be required to undergo certain screening as required by the Food and Drug Administration (FDA).

Gender Non-Conforming Individuals or Couples

For gender non-conforming individuals and couples, we can freeze eggs and sperm prior to gender-affirming surgery for family building in the future.

When the individual or couple is ready to embark upon achieving pregnancy, we again assess what pieces of the puzzle we have and what we might need and initiate treatment, which could include the use of previously frozen eggs or sperm, donor eggs or sperm, and the use of a gestational surrogate.

The bottom line is that no matter your specific situation, we can help you find your missing puzzle pieces and complete your family.