Inclusive Fertility Treatment: Reproductive Options for LGBTQ+ Families

Importance: As access to and research in LGBTQ+ family building continue to expand, clinicians must be familiar with the evolving literature to effectively counsel patients regarding reproductive options. Unique considerations in this population include selection of donor gametes, comparative efficacy of fertility treatments, use of third-party reproduction, and appropriate timing of cessation and resumption of gender-affirming hormone therapy (GAHT). National organizations, including the American Society for Reproductive Medicine (ASRM), have published guidance addressing the distinct needs of LGBTQ+ individuals pursuing family building. Objective: To review available family-building options for LGBTQ+ individuals and their partners in the United States, with a focus on fertility treatments and assisted reproductive technology (ART), and to highlight barriers to care encountered by this population. Evidence Acquisition: A narrative review of obstetrics and gynecology- and LGBTQ-focused research articles and clinical practice guidelines was conducted. Literature searches using relevant keywords related to LGBTQ+ individuals, same-sex couples, transgender and gender-diverse populations, and family building were performed in PubMed and limited to English-language publications. Results: Multiple fertility and ART options exist for LGBTQ+ individuals desiring a genetic connection with their children. Same-sex female couples may pursue donor intrauterine insemination (IUI), in vitro fertilization (IVF), or reciprocal IVF, with pregnancy outcomes comparable to or exceeding those of heterosexual counterparts. Same-sex male couples commonly pursue gestational surrogacy using donor oocytes and a gestational carrier. Transgender and gender-diverse individuals may utilize similar fertility treatments, including IUI, IVF, fertility preservation, and third-party reproduction, with additional considerations related to GAHT. Conclusions and Relevance: LGBTQ+ individuals have a broad range of family-building options. Increasing clinician familiarity with these pathways is essential to provide informed counseling, mitigate barriers to care, and facilitate timely referral to fertility specialists.