Fertility & IVF
LGBTQ+ Family Building: Fertility Options in New York
LGBTQ+ people in New York have several paths to biological parenthood: donor sperm with insemination (IUI), IVF, reciprocal IVF (one partner's eggs, the other partner carries), egg donation, and gestational surrogacy, which New York has allowed with legal protections since February 15, 2021. New York insurance rules also bar insurers from discriminating based on sexual orientation, gender identity or marital status.
What's different for most LGBTQ+ families isn't the medicine. It's the number of decisions you make up front: whose eggs, whose sperm, who carries, which donor, which lawyer. This guide lays out the options in the order most people end up deciding them.
Decision 1: Who can carry a pregnancy?
If one of you can carry: donor sperm and insemination
Many lesbian couples, bisexual and queer women, trans men, nonbinary people and single people start with donor sperm.
- Sperm bank donors are screened for infections and genetic conditions under FDA rules. You can usually choose a donor who agrees to future contact, or one who doesn't.
- Known donors, such as a friend or relative, are another option. Clinics may require extra screening and a quarantine period for frozen samples, and a written legal agreement is strongly recommended.
A common question: "How do we pick a donor from a catalog?" Most people start with health history and openness to contact, then narrow by traits that matter to them. Many couples say they spent longer on this than on anything else, and that's normal.
Insemination methods:
- ICI (intracervical insemination): sperm placed near the cervix, sometimes done at home
- IUI (intrauterine insemination): washed sperm placed in the uterus at a clinic, often with ovulation monitoring or medicine
See IUI vs IVF for how those compare.
IVF
IVF may be recommended if insemination hasn't worked, if there are fertility issues such as blocked tubes, or if you want to freeze embryos for future children. See the IVF process step by step.
Reciprocal IVF (co-IVF)
In reciprocal IVF, one partner goes through egg stimulation and retrieval, the eggs are fertilized with donor sperm, and the embryo is transferred to the other partner, who carries the pregnancy. Both partners have a physical role. Some couples switch roles for a second child.
If neither of you can carry: eggs and a carrier
Gay male couples, trans women and single men typically need:
- An egg donor (known, agency or frozen egg bank), and
- A gestational carrier, who carries an embryo created through IVF but isn't genetically related to the baby
Sperm from one or both intended parents can be used. Some couples fertilize half the eggs with each partner's sperm.
Decision 2: Surrogacy and the law in New York
New York's Child-Parent Security Act (CPSA) took effect on February 15, 2021. It:
- Legalized compensated gestational surrogacy in New York
- Set protections for gestational carriers, including the right to independent legal counsel paid for by the intended parents, and requirements for health insurance coverage
- Created a clearer route to legal parentage through a judgment of parentage, including for children born through donor eggs, sperm or embryos
Surrogacy arrangements in New York must meet specific legal requirements. Bring in a family law attorney experienced in assisted reproduction before you match with a carrier, not after.
DFS guidance also says comprehensive insurance policies must cover maternity care for a surrogate enrolled under that policy. The intended parents' insurance generally doesn't cover the carrier's care or IVF.
Decision 3: Fertility preservation for trans and nonbinary people
Gender-affirming hormones and some surgeries can affect fertility. ASRM recommends discussing fertility preservation before starting treatment.
| Option | Who it's for | Notes |
|---|---|---|
| Sperm freezing | People with testes | Simple and effective if done before hormones or after pausing them |
| Egg freezing | People with ovaries | Requires hormone stimulation and transvaginal ultrasounds, which some find distressing; clinics can adapt care |
| Embryo freezing | People with a partner or donor | Requires IVF |
| Ovarian or testicular tissue freezing | Selected cases, including some youth | Available at some centers |
If transvaginal ultrasounds or the clinic environment feel dysphoric, say so at the first visit. Clinics can often adjust language, use abdominal ultrasound when possible, or schedule you at quieter times.
In New York, comprehensive insured individual, small-group and large-group plans must cover medically necessary fertility preservation when a treatment may cause infertility. DFS guidance specifically includes hormone therapy for gender dysphoria. See our guide to egg freezing.
Decision 4: Paying for it
New York DFS has stated that insurers:
- Can't discriminate based on sexual orientation, gender identity or marital status
- Can't require you to pay out of pocket for donor insemination to "prove" infertility when the reason you can't conceive relates to sexual orientation or gender identity
- Can't set age limits on infertility, IVF or fertility preservation coverage
Coverage still depends on plan type. Insured large-group plans must cover three IVF cycles. Self-funded employer plans aren't bound by state mandates, though many offer fertility benefits. Coverage of donor sperm or egg costs and gestational carrier fees isn't specifically required, so ask your plan directly. Our New York IVF insurance guide has more.
Legal steps to protect your family
Even when both parents are on the birth certificate, many attorneys recommend a court judgment of parentage or adoption, because a birth certificate alone may not be recognized everywhere. Ask a family law attorney about:
- Known donor agreements
- Parentage judgments under the CPSA
- Surrogacy contracts
- What happens to frozen embryos if circumstances change
Questions to ask a clinic
- How many LGBTQ+ patients and families do you care for?
- Do your forms and staff use correct names and pronouns?
- Do you offer reciprocal IVF and work with gestational carriers?
- Can you coordinate donor screening and legal referrals?
- Do you have counselors familiar with LGBTQ+ family building?
The way the front desk answers the phone tells you a lot. If you're misgendered on the intake call, it's fine to keep looking.
The emotional side
Picking a donor, deciding who carries, and working through the legal steps takes time and can strain even solid relationships. ASRM recommends counseling when donors or gestational carriers are involved, and many families say it helped them talk through things they hadn't expected, like how to tell a child about their donor someday.
Single people of any orientation can use all of these options. New York insurers may not discriminate based on marital status.
When to see a doctor
Unlike many fertility patients, you don't need to try for 6 or 12 months first. Book a consultation:
- When you're ready to start planning, especially if you're 35 or older
- Before starting gender-affirming hormones or surgery, to discuss fertility preservation
- If insemination hasn't worked after several cycles
Find reproductive endocrinologists in New York, including fertility specialists in Brooklyn, to start the conversation.
Frequently asked questions
What fertility options do lesbian couples have?
Common options include donor sperm with at-home or in-office insemination, IUI, IVF, and reciprocal IVF, where one partner provides the eggs and the other carries the pregnancy.
Is surrogacy legal in New York?
Yes. New York's Child-Parent Security Act, which took effect February 15, 2021, allows compensated gestational surrogacy with legal protections for intended parents, carriers and children.
Does New York insurance cover fertility treatment for same-sex couples?
New York's Department of Financial Services says insurers can't discriminate based on sexual orientation, gender identity or marital status, and can't make you pay out of pocket for donor insemination to prove infertility when the inability to conceive relates to sexual orientation or gender identity.
Should transgender people freeze eggs or sperm before starting hormones?
Fertility preservation is worth discussing before starting gender-affirming hormones or surgery. In New York, insured plans must cover medically necessary fertility preservation when gender-affirming treatment may cause infertility.
Sources
- ASRM — Access to fertility services by transgender and nonbinary persons: an Ethics Committee opinion
- ASRM — Recommendations for practices using gestational carriers and oocyte donation
- NY DFS — Infertility Coverage Consumer FAQ
- NY DFS — IVF and Fertility Preservation Law Q&A Guidance for Issuers
- New York State — Child-Parent Security Act
This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.