What LGBTQ+ Intended Parents Should Know About Embryo Creation and Genetic Testing
Building a family through fertility treatment rarely follows a single path, especially for LGBTQ+ intended parents. Some families may use donor sperm, others donor eggs, or a gestational surrogate, or even a combination of all three. Regardless of which route you take, there's a good chance that in vitro fertilization (IVF) will be part of your journey.
The term "in vitro" is Latin for "in glass," referring to the laboratory dishes used during fertilization. Therefore, in vitro fertilization quite literally describes fertilization that takes place outside the body in a carefully controlled lab environment. Beyond making conception possible, IVF also opens the door to additional options like preimplantation genetic testing, or PGT.
If you're curious aboÅut what might be relevant to your path, here's what you should know.
Family Building Paths for LGBTQ+ Intended Parents
Same-Sex Female Couples & Individuals
For same-sex female couples, there are a few different routes depending on your preferences and reproductive health. Some couples start with intrauterine insemination (IUI) using donor sperm, which is a simpler procedure that doesn't involve IVF.
If IVF is needed, due to factors like ovulation issues, low ovarian reserve, or unsuccessful IUI cycles, it can be done in a few different ways. Some couples pursue standard IVF using one partner's eggs and donor sperm, with that same partner carrying the pregnancy. Others may opt for reciprocal IVF, where one partner provides the eggs and the other carries the pregnancy, giving both partners a biological role. If neither partner has viable eggs, an egg donor can be incorporated into either approach.
Same-Sex Male Couples & Individuals
For same-sex male couples, IVF with an egg donor and a gestational surrogate is the primary path to biological parenthood. The donor egg is fertilized with sperm from one or both partners, and the resulting embryo is carried by a gestational surrogate, who has no genetic connection to the baby.
Transgender Intended Parents
For transgender individuals who may want biological children in the future, fertility preservation before starting hormone therapy or gender-affirming surgery is worth considering, as both can impact future fertility. This might mean freezing eggs or sperm until you're ready to build your family. From there, the path forward will depend on your individual situation and goals.
How Embryos Are Created Through IVF
In a standard IVF cycle, the egg provider takes medication to stimulate the ovaries to produce multiple eggs. Those eggs are then retrieved in a minor procedure, fertilized with sperm in the lab, and monitored as they develop into embryos over several days. In some cases, previously frozen eggs can be used instead. Once ready, one embryo is selected to be transferred into the uterus.
What Is Preimplantation Genetic Testing (PGT)?
When embryos are created through IVF, there is the option to test them genetically before transfer. This is called preimplantation genetic testing, or PGT. A small number of cells are taken from the outer layer of the embryo and analyzed, giving your fertility specialist much more information about its genetic makeup than a visual inspection alone can provide.
There are a few different types of PGT:
- PGT-A screens embryos for abnormal chromosome numbers. Having too many or too few chromosomes is one of the leading causes of failed implantation and miscarriage. Having a different number of chromosomes can also lead to conditions such as Down syndrome, Turner syndrome and Patau syndrome.
- PGT-M tests for specific single-gene conditions, like cystic fibrosis, sickle cell anemia, or muscular dystrophy. This is typically recommended when one or both genetic contributors are known carriers of a heritable condition.
- PGT-SR looks for structural chromosome rearrangements that could lead to health problems or recurrent pregnancy loss.
Why Some Intended Parents Choose PGT
PGT can be a useful tool for intended parents who want more information before proceeding with a transfer. You may be more inclined to pursue PGT if:
- You or a genetic contributor has a known heritable condition or mutation
- There is a history of recurrent miscarriage
- You are using eggs from someone 35 or older, where the likelihood of chromosomal abnormalities is higher
- You have had previous unsuccessful IVF cycles
- You want to reduce the risk of transferring an embryo that is unlikely to implant
For many intended parents, PGT offers peace of mind by helping specialists identify the embryo or embryos most likely to result in a healthy pregnancy.
Why Some Intended Parents May Not Choose PGT
PGT is not the right choice for everyone, and there are legitimate reasons to move forward without it. You may not need PGT if:
The person providing eggs or sperm has already undergone thorough genetic screening and has no known risk factors. If donor gametes are involved, donors typically undergo extensive medical and genetic screening, which can help identify many inherited conditions before treatment begins.
- There is no personal or family history of heritable genetic conditions
- There is no history of recurrent miscarriage
- The egg provider is under 35 with no known fertility concerns
It's also worth noting that PGT adds both time and cost to the IVF process, and there is also a small chance of false positives or negatives. These are all factors worth weighing with your care team.
Personalized Family Building at Chelsea Fertility NYC
One of the most important things LGBTQ+ intended parents should remember is that there is no single approach to treatment. Decisions about IVF, donor selection, embryo creation, genetic testing, and other reproductive procedures are all highly individualized and influenced by medical history, age, fertility goals, financial considerations, and personal preferences.
Whether you're just starting to explore your options or are already mid-process, what matters most is having a care team that understands your specific goals and circumstances. If you have questions about which path might be right for you, we'd love to hear from you. Contact us today to learn more.
