Gay IVF Guide

Overview of Gay IVF

What is IVF?

In vitro fertilization (or IVF) refers to the process of creating embryos, by fertilizing egg with sperm, outside the body in a laboratory. The embryos develop in the lab over several days. Most often, these embryos will be cryopreserved (or frozen) until it's time to transfer them to the uterus of your surrogate to attempt pregnancy. The first baby born via IVF was in 1979. Since then, over 8 million babies have been born thanks to this breakthrough reproductive technology — mostly to those struggling with infertility, but increasingly also to LGBTQ couples and individuals hoping to have biological offspring. Read on for an overview of the gay IVF process.

The 6 Phases of Gay IVF

The IVF process is unique for every gay intended dad, but there are some predetermined steps that most have in common. Here are the 6 steps gay men can expect during the IVF process.

Gay IVF Phases

1) Screening of sperm provider

First, the sperm provider(s) will need to undergo a medical screening, which will include an assessment of overall health, an examination of a sperm sample, and genetic testing to see if you are a carrier of certain recessive genetic diseases, such as cystic fibrosis.

2) Find your egg donor

Next, you will need to find and select an egg donor — which you can source from a variety of places, including: your fertility clinic or surrogacy agency, an egg donor agency, an egg bank, or even from a friend or family member. Your egg donor will also undergo extensive screening.

3) Create embryos

Once you and your egg donor are screened and cleared, you will create embryos with the help of your fertility clinic. Most often, these embryos will be frozen until you are matched with a surrogate and ready to conduct an embryo transfer.

4) Match with a surrogate

Once you've created your embryos, you're ready to find and match with a surrogate — the easiest and best way to find a surrogate is with the help of a surrogacy agency, who are responsible for recruiting, screening, and matching gestational carriers with intended parents. Your surrogate will also need to undergo medical screening and clearance by the reproductive endocrinologist at your IVF clinic.

5) Transfer embryo

Once your surrogate is cleared by your IVF clinic, you're ready to conduct your first embryo transfer! Most gestational carrier will achieve pregnancy within the first three embryo transfers — though in some cases it may take longer.

6) Pregnancy and birth

A successful IVF transfer means your surrogate has achieved pregnancy. Your IVF clinic will monitor your surrogate's pregnancy for the first 6 to 8 weeks — after which she will be released to the care of her regular OBGYN. From here on out, your pregnancy will develop just like any other — you get to enjoy watching your baby develop, and begin preparing yourself for fatherhood!

Finding a Fertility Clinic

Where do I find a fertility clinic?

The quality of fertility clinics also varies widely — so it’s important to do your research and interview several before making a decision. You'll want to work with a physician and clinic with a long track record of success and a demonstrated commitment to helping gay, bi and trans men become dads. Be sure to come prepared to your first consult with questions to ask your fertility clinic before signing with them. Check out our directory of GWK-approved and vetted fertility clinics:

Questions to Ask Your Fertility Clinic Before Hiring Them

It is highly recommended that you choose a physician who is double-board certified in both obstetrics & gynecology and reproductive endocrinology. Once you have found a doctor that has the desired qualifications, you should ask them more specific questions about their volume of cases and their success rates. While the process of retrieving eggs, fertilizing the eggs, and transferring the embryo is relatively straightforward, managing egg donor cycles and gestational carrier cycles definitely takes a lot of expertise. That level of expertise is what you are looking for since you are investing so much time, money, and love into the process, you want to make sure it is done right. Here are some of the questions you should ask your fertility clinic before deciding to work with them:

Questions to ask about fertility center experience:

How many cycles of IVF are you performing per year?
How many gestational carrier cycles are you performing per year?
How many egg donor cycles are you performing per year?

Your fertility clinic should be extremely familiar with IVF and working with gestational carriers. Their answers to the below should be in the hundreds, if not thousands — but definitely not in the tens. You want to go to a clinic that has a lot of experience performing these cycles of IVF.

Questions to ask about fertility center team:

Do you have a dedicated team that works with patients using egg donors?
Do you have a dedicated team that works with patients using gestational carriers?

Many fertility clinics are used to working with heterosexual couples who are experiencing infertility — many of these patients may require IVF. However, that does not mean they are experience working with egg donors and gestational carriers. Since your journey will involve both, in addition to IVF, you will want to make sure that the facility is experienced, prepared, and committed to working with intended parents in your circumstances.

Questions about the fertility center's laboratory:

What percentage of your cases are single embryo transfers?
How new is the technology in your lab?
What is the experience of the embryologists?
How large is the embryology team?
How many cases are you doing per year?
How many cases of pre-implantation genetic testing are you doing?

A fertility center that has a high percentage of single embryo success rate — while having a large number of cases per year — shows that they are extremely skilled and knowledgeable. This question is one of the best indicators that the fertility center knows what they are doing and is a great choice for you. Considering the quality of the IVF lab is always important. It does not matter if you are the best physician in the world, if your laboratory isn't up to par, then the chances of a successful embryo creation and transfer are very low.

Semen Analysis

A semen analysis is a very basic test to evaluate male fertility. After abstaining from ejaculation for a period of three days to obtain the healthiest sample possible, you will provide a deposit — which will be analyzed by the following:

Sperm count: How many sperm you have.
Sperm motility: How well your sperm move or "swim".
Sperm morphology: What shape your sperm have — are the normal or abnormal?

Together, these three parameters — count, motility and morphology — will help your reproductive endocrinologist make an assessment of how well your sperm will be able to penetrate and fertilize an egg, resulting in an embryo that can later be transferred to your surrogate.

How can I improve the health of my sperm?

The vast majority of men — up to 98% — will have semen normal enough to proceed with the IVF process. The other 2% will work with a urologist to determine next steps. You may be directed to make certain changes in your lifestyle that involve some of the following:

Excessive heat: Exposure to too much heat — from things like saunas and hot tubs — can negatively impact your sperm.
Cigarette smoking: cigarette smoke negatively impacts your sperm.
Alcohol consumption: drinking alcohol excessively can impact sperm quality.
Testosterone usage: testosterone supplementation negatively impacts the health of your sperm.
Diet: healthy eating, such as a diet heavy with vegetables and other foods high in antioxidants, can have a positive impact on sperm quality.

The good news is, by following these simple lifestyle changes, many men with abnormal sperm are able to produce normal sperm samples within just a few months.

Egg Donors

Selecting an egg donor is one of the most important and exciting parts of a surrogacy journey for gay men. Here's what you need to know when selecting an egg donor for your surrogacy journey.

Where Can I Find an Egg Donor?

Fertility clinics: Many fertility clinics have egg donors exclusively available for their IVF patients. These donors may save you some money because they are already screened and approved, but clinics typically have a smaller pool of donors to choose from than other options. Experienced fertility clinics that do not maintain egg donor databases will be happy to help you find one from another source.
Surrogacy agencies: In addition to matching you with a surrogate, some surrogacy agencies also have egg donor databases for you to choose from. Surrogacy agencies that don't maintain their own database will be happy to help you find an egg donor elsewhere.
Egg donor agencies: These agencies focus solely on egg donors, and for that reason tend to offer much larger and more diverse donor pools than surrogacy agencies or fertility clinics. They recruit from across the nation, and they will also help intended parents find donors who meet specific or unusual donor requirements.
Frozen donor egg banks: These facilities offer intended parents frozen eggs that were left over from another donor’s previous egg retrieval process.
Known donors: Some gay couples want their baby to be genetically related to both — and may have a family member (of the man not providing sperm) willing to donate her eggs. Other gay men or couples may have a close friend willing to serve as a known egg donor. This can cut down on costs if your donor is willing to do so for free. This arrangement has many benefits, but all details need to be thoroughly discussed and agreed upon in advance, with the help of a lawyer.

Tips for Choosing an Egg Donor

Selecting an egg donor is one of the most exciting parts of the process, but there are lots of factors to consider — here are some tips to keep in mind to guide you in your search:

Consider working with a "proven donor": these are donors that have already successfully donated egg in the past that resulting in a successful birth a "proven" donors are more expensive, but have successfully donated in the past.
Make a list of important qualities — but don't overemphasize certain characteristics: Many gay couples hope to find an egg donor with specific qualities — such as the same race or background as the father who won't be providing sperm. Don't compromise on important qualities — your perfect egg donor is out there! But also be aware that the more specific you get, the longer it may take to make a match. Also be aware that many characteristics, like attractiveness and intelligence, are not completely determined by DNA alone.
Understand open donor arrangements: Previously, the identity of most egg donors remained anonymous — these days, thanks to years of research, many egg donors are "known" to intended dads, and the kids they help create, to some degree. Research has shown openness to be in the best interest of all involved — the dads, donors and resulting children. But just how "open" your arrangement ends up being will be entirely up to you and your donor.

How Are Egg Donors Screened?

Before you can create embryos, your egg donor will need to undergo extensive screening by your fertility clinic. All fertility clinics must screen donors according to Federal Drug Administration (FDA) regulations and guidelines from the American Society for Reproductive Medicine (ASRM). Typically, this screening takes places over three phases:

Phase 1: Pre-screening: Egg donor will first need to complete a comprehensive profile that includes personal, family, and mental health history. It will also includes information on her educational background, employment history, personal characteristics, and her thoughts on the egg donation process. This profile will be reviewed by the agency or clinic to which the donor is applying, and an interview will be set up if the applicant looks promising. The interview provides an opportunity for the agency or clinic to educate the applicant on the donation process, and assess her ability to manage that process.

Phase 2: Psychosocial screening: Once a donor passes pre-screening, she will undergo a broader psychosocial evaluation. This typically includes an interview with a licensed clinical social worker. Interviews will also ascertain more about the donor's history, relationships, support system and motivations for becoming an egg donor. The psychosocial evaluations are meant to rule out any concern over a donor's mental health, as well as the potential for underlying psychopathology.

Phase 3: Medical evaluation: The final stage of a donor's screening is the medical evaluation — and typically takes place after you have selected an egg donor. Regardless of where you source your egg donor, this stage of the process will need to be conducted by the professionals at your fertility clinic to ensure she is medically fit to serve as a donor. This phase includes a physical, lab work and genetic screening. Among the most important parts of this phase will also involve checking her ovarian reserve — which refers to the number of healthy eggs a donor is able to produce each cycle. This will involve a blood test called anti-mullerian hormone (AMH) and an ultrasound assessment of her basal antral follicle count. These two pieces of information will predict how many eggs a donor will produce during a treatment cycle.

Creating Embryos

Once both the eggs and sperm are screened and secured, you can move forward with creating embryos. Your fertility clinic will fertilize the eggs from your donor with your sperm source, and then observe them as they grow into a healthy embryo — which is a 150 to 300-cell ball called a blastocyst. Most of the time, these embryos will be "frozen" or cryopreserved for use once your gestational carrier is properly screened and prepared. Many intended dads can have five to 10 embryos created and cryopreserved from a single one egg donation process. Once you are ready to conduct the embryo transfer, an embryo of your choosing will be thawed and placed into the uterus of the gestational carrier. A successful pregnancy can be detected 11 to 12 days after the embryo transfer. Your fertility clinic will provide care for your surrogate for the first 8-10 weeks of her pregnancy before she begins seeing her own OBGYN.

Common Questions for Gay Men When Creating Embryos

How successful is IVF for gay men during a surrogacy journey?

When a sperm source, egg donor, and surrogate have all be thoroughly evaluated and deemed healthy — as is often the case for gay men using IVF and surrogacy to start their families — the success rate is very high. For gay men in these cases, the success rate for IVF is 75% to 85%. The majority of gay men using gestational surrogacy will see a successful pregnancy within three transfers.

What is Pre-Implantation Genetic Testing (PGT)?

Before your first embryo transfer, you can opt to have your clinic conduct preimplantation genetic testing (PGT) to help determine which of the embryos you have created have a higher chance to result in a successful pregnancy. The PGT process will help your clinic identify embryos with any chromosomal abnormalities that can lead to conditions such as Down’s Syndrome. Your clinic will help you interpret your PGT results. In some unique situations PGT can be used to screen out embryos with single gene disorders and even genes that may predispose your child to breast cancer. Testing can also help reveal which embryos contain abnormalities that may increase the likelihood of miscarriage or difficulty conceiving. This process can also be conducted if you hope to transfer an embryo of a particular sex.

Can we "mix" our sperm together when creating embryos?

The short answer here is no. When it comes time to create an embryo, only a single sperm will be used to fertilize a single egg — which can pose a problem for a couple made up of two men. While a gay couple may want to both want the opportunity to become biological fathers through IVF and surrogacy, your fertility clinic will not mix your sperm together when creating embryos to see whose "takes." Instead, your clinic can fertilize half of the eggs retrieved with the sperm of one intended father, and half of the retrieved eggs with the sperm from the other.

How many embryos can we transfer at a time?

Previously, to help increase the odds of IVF, many fertility clinics would transfer two or more embryos at a time to their gestational carrier's uterus. However, IVF technology has improved over the years, meaning the successful rate of IVF when transferring a single embryo is very high. You may still decide to transfer more than one embryo, but your doctor will likely warn you that this with greatly increase your odds of achieving a twins of multiples pregnancy — which often come with additional risks and complications for your surrogate, and your offspring, than a singleton journey.

What if we want twins?

Many gay couples hope to transfer two embryos — one fertilized with the sperm of each intended dad — with the hopes of having twins, one biologically related to each. Many fertility clinics will assist you in this effort if you — and your gestational carrier — both understand and accept the additional risks involved with a twins pregnancy. It may take you longer to match with a surrogate willing to undergo a transfer with more than one embryo. If you and your partner both want to have biological ties to your offspring, other options exist as well — some surrogacy agencies offer discounts on sibling journeys, for instance. You can start a second journey several years after the first — or even undergo the journeys simultaneously, with the help of separate surrogates.