Use of assisted reproductive technology by LGBTQ people


Lack of access to assisted reproductive technologies is a form of healthcare inequality experienced by LGBTQ people.
LGBTQ people who wish to have children may use assisted reproductive technology. In recent decades, developmental biologists have been researching and developing techniques to facilitate same-sex reproduction.
The first attempt towards same-sex reproduction involved the investigation of haploid embryonic stem cells, which would allow for the development of female sperm and male eggs. In 2004, by altering the function of a few genes involved with imprinting, Japanese scientists at the Tokyo University of Agriculture combined two mouse eggs to produce daughter mice. In 2018, Chinese scientists created 29 female mice from two female mouse mothers but were unable to produce viable offspring from two father mice. One of the possibilities is transforming skin stem cells into sperm and eggs. In 2023, Japanese scientists created viable mouse pups using eggs artificially derived from male cells, which were fertilized with sperm from another male.

Freezing eggs

LGBT women, trans men, and other people assigned female at birth who possess ovaries, may choose to donate their eggs in order to reproduce by in-vitro fertilization. Trans men in particular may freeze their eggs before transitioning and choose to have a female surrogate carry their child when the time comes, using their eggs and someone else's sperm. This allows them to avoid the potentially dysphoria-triggering experience of pregnancy, or cessation of HRT for collecting eggs at an older age.

Egg banking

of oocytes requires hormonal stimulation and oocyte retrieval, as for IVF treatment, after which the oocytes are vitrified. Vitrification of oocytes has been found to be more successful than slow freezing oocytes. The success of oocyte banking declines significantly with increasing reproductive age. Ovarian stimulation will increase transgender men's serum estradiol levels, and in response transvaginal ultrasound monitoring may be necessary, strategies to minimize estradiol elevations include the concomitant use of aromatase inhibitors during stimulation. There is no data on the success of ovarian stimulation in transgender men who previously had puberty halted with GnRH agonist, followed directly by testosterone administration. There is also no data comparing the number of oocytes retrieved or the live-birth rate after fertility preservation stratified by time off testosterone.

Ovarian tissue banking

A surgical procedure is required to collect tissue samples, if undergoing a hysterectomy and/or ovariectomy, one can choose to cryopreserve some tissue at the same time to avoid an additional surgical procedure. Ovarian tissue cryopreservation has been successful, but so far, there have been no pregnancies recorded after thawing and in-vitro maturation of this tissue, successful pregnancies have only been recorded after auto-transplantation. This method has a very low success rate of blastocyst development as in one study of 83 transgender males, 2 out of the 208 mature oocytes were recovered from thawed ovarian tissue created "good-quality" blastocysts.

Freezing sperm

For the purposes of either in-vitro fertilization or artificial insemination, LGBT individuals may choose to preserve their eggs or sperm.
Trans women may have lower sperm quality before HRT, which may pose an issue for creating viable sperm samples to freeze.
Estrogens suppress testosterone levels and at high doses can markedly disrupt sex drive and function and fertility on their own. Moreover, disruption of gonadal function and fertility by estrogens may be permanent after extended exposure.
Nonsteroidal antiandrogens like bicalutamide may be an option for transgender women who wish to preserve sex drive, sexual function, and/or fertility, relative to antiandrogens that suppress testosterone levels and can greatly disrupt these functions such as cyproterone acetate and GnRH modulators.
Semen can be collected via masturbation, but there are alternatives for those who find masturbation or ejaculation distressing or may have erectile or ejaculatory dysfunction secondary to hypoandrogenism. Options for those with dysfunction include: penile vibratory stimulation and electroejaculation. For those who do not want to ejaculate or have oligospermia or azoospermia can pursue testicular sperm aspiration or microsurgical sperm extraction although they are more invasive. There are currently no studies evaluating the acceptability or success rates of the different options for sperm collection specifically in transgender women. Furthermore, for transgender women on estradiol and/or antiandrogens, it is unclear the length of time needed to be off hormonal treatment medication before normal spermatogenesis resumes, during which time testosterone production will resume and may cause unwanted masculinizing effects.

Storing and selecting sperm

Prospective LGBT parents may pick sperm from a sperm bank to grow their baby. The sperm can come from one partner, either having been frozen before their transition, or being recent in the case of a partner having functioning male organs. Other times, it can come from private sperm donors.
LGBT individuals must carefully consider where they get their donor sperm from. Individual state's laws vary, but many U.S. states have adopted a form of the Uniform Parentage Act. Most, but not all states transfer parental rights from anonymous sperm donors to the intended parents as long as the recipient is a married woman, and a physician is involved. Noncompliance with these laws can result in the failure to terminate sperm donor parental rights. There have been court cases where known sperm donors that privately donated directly were requested to pay child support. For example, of these laws, see . In Australia, there has been legal precedent that sperm donor involvement with the ensuing child's life does grant them parental rights.
Alternative to direct private donation it is possible to purchase sperm from a sperm bank for personal use in fertility treatment. Sperm banks can vary widely, not only in terms of price, but of practice and can offer a variety of services. Major U.S. sperm banks include Fairfax Cryobank, California Cyrobank, Cryos International, Seattle Sperm bank, and Xytex, and many others.

Pregnancy

The LGBT parent may choose a surrogate or their partner for pregnancy, depending on their fertility and personal values. There are many possible ways for an LGBT individual or couple to become pregnant, such as:
In order to accommodate for different gender identities and sexual orientations, a LGBT pregnancy from donated sperm can be done through artificial insemination.
Timing of these procedures are critical for successful fertilization, as the fertile window is the five days before ovulation, plus the day of and after ovulation. To increase the chance of success, the menstrual cycle is closely observed, often using ovulation kits, ultrasounds or blood tests, such as basal body temperature tests over, noting the color and texture of the vaginal mucus, and the softness of the nose of the cervix. To improve the success rate of artificial insemination, drugs to create a stimulated cycle may be used called ovarian stimulation.

Intrauterine insemination (IUI)

Before ovulation there is a surge of luteinizing hormone which can be used to time an IUI procedure. Data suggest that IUI should be performed 1 day after the detection of the LH surge. Most clinics in the U.S. perform IUI in the morning after a positive ovulation predictor kit test. An alternative to LH monitoring is ultrasound monitoring of ovarian follicle size followed by a trigger shot with exogenous human chorionic gonadotropin which mimics the body's LH surge and triggers final follicular maturation and rupture. The trigger shot is typically administered when the dominant follicle reaches 18–20 mm. The recommended timing of IUI after hCG administration is 24–40 hours. IUI cycles stimulated with classical doses of FSH have a high rate of have a multiple pregnancy with rates ranging from 10 to 40%. A meta-analysis showed no difference between pregnancy outcomes between at-home LH monitoring and timed IUI.
IUI can be done without the use of medication. IUI is not recommended in cases where the gestating individuals have cervical atresia, cervicitis, endometritis or bilateral tubal obstruction or when the sperm donor has amenorrhea or severe oligospermia. Prior to IUI, the sperm is "washed" which is necessary to remove seminal plasma to avoid prostaglandin-induced uterine contractions. Insemination with unprocessed semen is also associated with pelvic infection.
Intrauterine insemination involves the opening of the vagina using a speculum, then injecting washed sperm directly into the uterus with a catheter. Insemination in this way means that the sperm do not have to swim through the cervix which is coated with a mucus layer. This layer of mucus can slow down the passage of sperm and can result in many sperm perishing before they can enter the uterus. Donor sperm is sometimes tested for mucus penetration capabilities if it is to be used for ICI inseminations, for if the sperm's chances of passing through the cervix is low, IUI would provide a more efficient delivery of the sperm than ICI. IUI fertilization takes place naturally in the external part of the fallopian tubes in the same way that occurs following intercourse.
The benefit of double IUI has not been found in patients with undocumented infertility using donor sperm, such as lesbian and single women. Typically pregnancy success rates per IUI cycle is approximately 12.4%. According to a study from 2021, lesbian women undergoing IUI had a clinical pregnancy rate of 13.2% per cycle and 42.2% success rate given the average number of cycles at 3.6. IUI has been reported to be more effective than ICI but this has been contested with some citing no strong evidence to confirm a significant difference between the birth rates of the two procedures. It is speculated that IUI is more effective since IUI brings the sperm closer to the oocyte than ICI which might compensate for decreased sperm motility after freezing and thawing. IUI includes risk of endometritis, cramping, bleeding, and anaphylaxis. A systematic review and meta-analysis was not able to demonstrate that bed rest after intrauterine insemination effectively increases in pregnancy rate.