My Family, My Choices: How IVF Gives Queer Families More Agency

At a time when LGTBQ+ people face renewed attacks on their dignity, their agency, and their autonomy, the ability to participate in the deeply human urge to build family is more important than ever – and IVF offers a path to parenthood for queer families.

IVF, or in vitro fertilization, is the process by which skilled medical providers bring human gametes together in the form of a sperm and an egg under laboratory conditions and then implant the resulting embryo in the womb of a patient or a gestational carrier. Because the procedure typically yields more than one embryo at a time, additional embryos can be cryopreserved – that is, stored in very cold temperatures – and remain viable for subsequent pregnancies for years or even decades.

Such medical intervention is necessary for prospective parents who face obstacles to reproduction that can range from sterility to the absence of a uterus to health concerns that otherwise might preclude childbearing, such as being past the peak years for fertility or pregnancy. IVF can remove such roadblocks – and, in an even more wondrous turn, IVF can open up entirely new avenues of choice for singles or couples looking to build their families.

Dr. Deborah Ikhena-Abel of Aspire Fertility in Austin, Texas – one of the 90+ clinics that comprise The Prelude Network, North America's largest and fastest-growing network of fertility clinics – provides an illustrative example. "Let's say you have a couple where they both have ovaries," Dr. Ikhena-Abel says. "You can freeze embryos from both partners, and then you can go ahead and do a transfer right away for one partner. You now have these embryos [that were also created], and you can come back in [at a time of your choosing] for a transfer for the other partner.

"And this is very helpful if you have to a couple where both members maybe are older, or maybe one member of the couple has a lower egg count but doesn't really want to move forward yet with having a child from their embryos," the fertility specialist – whose patients call her "Dr. Debo" – notes. "We can say, 'Okay, that's fine, but let's freeze these embryos now, because your count is low now, because in a couple of years you may not have that option.' IVF definitely opens that room for more conversations around what your ideal family looks like, and what we can do to optimize our chances of achieving that family. We can never guarantee an outcome, but we can definitely do our best to optimize those outcomes."

The fact that cryopreserved embryos can be used for future pregnancies also means that families can aim to follow a plan for how to space their children, determine birth order, or to work to balance the composition of a family.

While pop culture sometimes envisions prospective parents setting out to obtain designer babies through IVF, that's not something Dr. Ikhena-Abel sees in her patients. "The overwhelming majority just want to have a child," the provider says. "They may say, 'I want to have one of each,' or 'I want to have two girls and two boys.' But most people just want to have a baby."

When people do have a specific gender in mind, it's usually because they have sons or daughters already and are looking to balance out the gender ratio. "Let's say they've had two boys," Dr. Ikhena-Abel posits. "They're like, 'We want to do IVF to get a girl. Or," the fertility specialist adds, offering a different scenario, "I had a couple that had two boys and one girl, and they wanted to get another girl so that their daughter had a play partner."

In short, IVF can help couples – or prospective solo parents – build strong, healthy families, and do it according to their own vision and their own timetable. The option of genetic screening brings an extra measure of agency to the process.

"In almost all the states, the egg donor or the sperm donor would have been tested for genetic diseases to see if they are carrier for anything," Dr. Ikhena-Abel explains. "A carrier means that you are silently carrying a genetic condition. You have no symptoms of the condition and may not have anyone in your family with this condition, so you're unaware that you may be at risk for this condition. And if you have an egg source and a sperm source that are both carriers for a specific condition, you now have a one-in-four chance of having an embryo with the actual disease."

For this reason, "I very strongly recommend for my couples who are using donor gametes – and all of my couples in general – to have genetic carrier screening done, so they can then choose either an egg source or a sperm source that does not carry the same thing [they might be carrying]. For my same-sex couples who are both planning to use their gametes [for multiple pregnancies using eggs or sperm from the same donor], I recommend that they both have genetic screening done so that they can pick a source that is compatible with both."

Helping families grow is natural for Dr. Ikhena-Abel, who hails from Nigeria. Indeed, in her youth, she saw how two of her aunties – a word that, in Nigeria, refers to women in one's community – turned to IVF to realize their own parenting dreams. That early experience helped shape the path of her career.

"Being able to see the science from behind the scenes, to understand all the things that go into creating a pregnancy, just really pulled me in," Dr. Ikhena-Abel says. "And just also having that very personal connection, it really spoke to me – and just coming from a culture where fertility is so important and a lot of importance is placed in fertility, really drew me into the fertility space."

Another element of agency for queer families is that they are free to seek providers that will treat them with respect and dignity. That's true no matter which clinic in The Prelude Network LGBTQ+ prospective parents might visit. Dr. Ikhena-Abel, like other providers in the network, looks to validate queer families by providing them tailored guidance to help realize their unique hopes.

"I think the first step when I interact with queer families is just making sure that they feel comfortable – not making it feel like they coming to you is an unusual occurrence, and that this is just a normal part of family building," she reflects, adding that it comes down to "simple things like clarifying pronouns when you're meeting for the first time, and not making assumptions about that. I think that can be reassuring. And referring to people as partners, versus making assumptions about relationships, can also be affirming.

"A lot of the time we try to just make sure that when they come in, it's a welcoming space," Dr. Ikhena-Abel adds. "I've come to learn that both in queer communities also in non-queer communities, there are different ways of families are made and created. By making sure it's an open space, we're able to discuss what the goals are and let them know what their options are. Sometimes people will see me and think, 'This is the only way that, as a queer couple, we can move forward with XYZ.' They might not realize, actually, there's this option and there's that option; letting them know what the wide range of possibilities are means they're better educated to make the best decision for themselves."