pregnancy & fertility

Many queer and transgender people want to become parents, and many do not. Either choice is valid, and what you want might change throughout your life.
There are more ways to become a parent than just through pregnancy. Below you'll find more about pregnancy, fertility preservation, abortion, adoption, IVF, and surrogacy so you can be informed about your potential options if you or a partner become pregnant or if you decide you want to become a parent in the future.

pregnancy

How does someone become pregnant?

Pregnancy is the result of conception, what happens when a sperm fertilizes an egg and implants inside a uterus. Usually, pregnancy happens when someone with a penis and testicles ejaculates during vaginal intercourse with someone with a uterus and ovaries. The first sign of pregnancy is often a missed period, though some people will continue to spot or have a full period during their pregnancy.

What happens during pregnancy?

A full-term pregnancy lasts about 40 weeks, and is divided into three trimesters. To have a healthy pregnancy, it's important to see an obstetrician who can monitor your and your fetus's health. You should also discuss some best practices with your doctor, like what you should incorporate (i.e., prenatal vitamins, exercise, healthy foods) and what you should avoid (i.e., tobacco, alcohol, recreational drugs including cannabis, raw fish and dairy products) during your pregnancy. Throughout a pregnancy, the fetus grows from the size of a poppy seed to the size of a pumpkin, and the uterus expands from the size of a lemon to the size of a watermelon!

During the first trimester, which lasts from conception until week 13, a pregnant person can experience:

Gastrointestinal symptoms like morning sickness, heartburn, and constipation
Fatigue
Tender and swollen breasts
Food cravings or food aversions
Headaches
Mood swings

During the second trimester, which lasts from week 13 until week 28, a pregnant person can experience:

Reduced morning sickness, breast pain, and fatigue
Body and muscle aches
Fetal movement
Weight gain of 10 or more pounds
Dark patches of skin, including a linea nigra (a dark line that runs from the pubic bone to the navel)
Darkening areolas

There are three stages of childbirth: labor, pushing and birth, and delivery of the placenta.

Labor

Before labor begins, usually the amniotic sac ruptures (aka the water breaks).
Contractions, rhythmic surges of the uterine muscles, begin.
The cervix dilates (opens) and effaces (thins).
The first stage is complete when the cervix dilates to 10 centimeters — about the size of your closed fist.

Pushing and birth

The baby moves into the vaginal canal.
Contractions occur every 2-5 minutes, and the parent pushes during them for 1-2 minutes at a time.
The baby's head begins to appear; this is called crowning.
The baby is delivered through the efforts of the parent's pushing and the medical support's guidance.
The umbilical cord is cut by a medical professional or the non-birthing parent.
Alternately, some parents have a C-section, when the baby is removed from the uterus through incisions in the parent's abdomen. Usually, a C-section will be performed if a vaginal delivery would put the parent or baby at risk.

Delivery of the placenta

The placenta is the organ that forms inside the uterus during pregnancy to deliver oxygen and nutrients and remove waste and carbon dioxide to and from the developing fetus.
Several minutes after the birth is complete, contractions resume.
The parent pushes out the placenta, sometimes with external pressure on the abdomen from medical support staff.
Often birthing parents experience vaginal bleeding after placenta delivery.

Congrats! Now you have a baby!

abortion & adoption

Sometimes, people get pregnant without wanting to become a parent.

There are a lot of ways this could happen, including:

contraception failure
contraceptive methods used incorrectly
ineffective contraceptive methods used
no contraceptive methods used
sexual assault resulting in pregnancy

For someone who is pregnant and does not want to become a parent, there are options. Most commonly, someone might look into abortion or adoption.

abortion

Abortions are medical procedures used to terminate pregnancies. There are two options for abortions: medications or in-clinic procedures. Not all abortions happen because the pregnancy was unwanted. Sometimes, people have to undergo medically necessary abortions if the fetus has anomalies that make it unable to survive outside of the womb, or if the pregnancy is life-threatening for the parent if it continues.

Medication abortion

Medication abortions can be an option for people who are pregnant for 11 weeks or less. They can be done in your own home or at a clinic with medical support. Abortion pills are extremely effective; typically they will result in successful pregnancy termination 90-99% of the time.

To have a medication abortion, you will take two pills. The first contains the medication mifepristone, which stops the body from producing progesterone, a hormone necessary for growth of the pregnancy. The second pill contains the medication misoprostol, which empties the uterus by causing it to cramp and bleed. The second pill may be taken right after the first, or you might be instructed to wait up to 48 hours before taking it.

If you have an abortion using pills, you can expect that you will feel tired for a day or two and have abdominal cramping, similar to what you might experience during your period, though potentially more severe. You can also expect to have vaginal bleeding and spotting for a few days afterwards. Having an abortion can be emotionally taxing, too, so it's important to seek support if you need it.

In-clinic abortion procedures

In-clinic abortion procedures involve using suction to remove a pregnancy from the uterus. These abortion procedures can be performed up to 16 weeks into a pregnancy, sometimes later, and they are extremely effective; they will result in successful pregnancy termination 99% of the time.

In-clinic abortion procedures only take 5-10 minutes to complete, but the appointment may take longer since medical staff will need to conduct an exam and administer medication beforehand to reduce discomfort and cramping during the procedure. You will also spend some time in a recovery room after your procedure to ensure that you are feeling better before you leave.

You may have cramping, bleeding, and spotting after an abortion procedure, but usually this clears up after a day or two. Just like with a medication abortion, it's important to seek emotional support if you need it, since an abortion can bring up mixed emotions, even if you know it's the right choice for you.

How and where can I access abortion care?

Abortions are controversial and have been increasingly politicized in recent years. It may be difficult for you to access abortion care depending on where you live. Use one of the following tools to help you find all of the help you need before, during, and after an abortion.

If you are thinking about getting an abortion, you can use Planned Parenthood's step-by-step guide to figure out what is right for you and what to expect from the process.

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adoption

Adoption is a legal process where someone can become a parent to a child that is not biologically theirs. If you decide to carry your pregnancy to full term and deliver the baby, but you do not want to be a parent, adoption might be the best choice for you and the baby.

If you have thought through your options and think abortion is right for you, you'll first want to identify an adoption agency to work with. Typically an agency will provide you with support and information about the process of adoption and help you develop an adoption plan.

Your adoption plan will include:

What kind of adoptive family you want
- You have the option to look for adoptive families that have certain characteristics, such as certain religious beliefs, different racial or cultural backgrounds, LGBTQ+ families, single parents, and so on.
What kind of adoption you want — open, closed, or semi-open.
- Open adoptions allow for continued contact between the adoptive family, the biological parent(s), and the adopted child.
- Semi-open adoptions allow for communication through an intermediary, like the adoption agency or a lawyer.
- Closed adoptions do not allow for any contact between the birth and adoptive families.
Details about the hospital and delivery plan

You can change your mind about the adoption at any point until you sign legal adoption documents after the birth of the baby. Once the paperwork is completed, you will no longer be the baby's legal parent.

If you are thinking about adoption, you can check out Adoption Network's resources to learn what to expect from the process.

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fertility preservation

Fertility preservation is the process of saving eggs, sperm, or other reproductive tissue so a person can use them to have biological children in the future. Transgender young people who are thinking about accessing hormone therapy deserve to understand their options for fertility preservation, since it is possible that HRT can impact your future fertility.

The best way to learn more about your options for fertility preservation is to talk to a reproductive endocrinologist before you start HRT. However, it's not too late if you've already started hormones; you can still pursue fertility preservation, though you may need to temporarily pause your HRT until the eggs or sperm are collected.

Keep in mind that fertility preservation can be expensive, so it's a good idea to contact your health insurance provider to find out what they might cover of the cost of the collection procedures and storage for your reproductive tissue.

Usually, fertility preservation consists of freezing either sperm or eggs in a process called cryopreservation.

For people with a uterus and ovaries, the process of preserving your eggs consists of:

injections to stimulate the ovaries to produce eggs
ultrasound monitoring
collection of eggs via
freezing!

This process takes about 2-3 weeks from beginning to end. The longest amount of time between eggs being cryopreserved and then used for a successful birth was 14 years, but eggs could still be used after even longer.

For people with a penis and testes, the process of preserving your sperm consists of:

collecting the semen sample (may be done at a facility or at home)
addition of cryoprotectants
freezing!

Sperm collection can be done quickly and easily, though you will likely need to collect multiple samples over the course of a few days. After your sample is received by the lab that will be storing it, the whole process is done within 3 days! Sperm can be used indefinitely after freezing, so you'll be able to access your reproductive material at any time once you're ready to have biological children.

queer family building

Queer and trans people can build all kinds of families in many different ways. For those who feel like they want to become parents and have children of their own, there are four main options.

Pregnancy
- If you and a partner have reproductive systems that make it possible for you to conceive, you can get pregnant through regular ol' penis-in-vagina intercourse. LGBTQ+ folks can also have biological children from previous relationships.
Adoption and foster care
- Adoption is a legal process where someone can become a parent to a child that is not biologically theirs. It's estimated that around 35,000 same-sex couples have adopted children in the US.
- Same-sex couples can legally adopt in all 50 US states, though some private adoption agencies can refuse to work with LGBTQ+ couples based on religious beliefs. LGBTQ+ people are 4-7x more likely to adopt a child than cishet people.
- Foster care involves temporary placement of a child with caregivers if they cannot live with their birth parents. Children are often placed in foster care if their parents have abused or neglected them, become incarcerated, or died. It's estimated that up to 14,000 same-sex couples are currently fostering children in the US.
- To learn more about how to become a foster or adoptive parent, check out HRC's Resources on Adoption & Foster Care for LGBTQ+ Parents.
Assisted reproduction: IUI and IVF
- Intrauterine insemination (IUI) is the process of introducing sperm into the uterus using a small tube. The sperm can then fertilize an egg in the uterus.
- In vitro fertilization (IVF) is the process of implanting a fertilized embryo into the uterus. With IVF, the sperm and egg are combined in a petri dish, rather than inside the uterus.
- For IUI or IVF, you can use either a sperm donor that you know personally, or a sperm donor from a sperm bank to fertilize the egg. The egg can either be from you, your partner, or from an egg donor (for IVF).
Surrogacy
- Surrogacy is when someone other than you or your partner(s) carries a fetus for you. Surrogacy is most commonly used by gay men or by queer couples who both have penises.
- Surrogacy can be complicated, since the legal landscape varies dramatically from state to state, and it can also be very expensive.
- Using IUI, surrogates can be impregnated with donor sperm from you or a partner and also serve as the egg donor. Using IVF, surrogates can be impregnated with an embryo created from sperm from you, a partner, or another donor, and an egg from you, a partner, or another donor.

Sources: The Williams Institute, 2024; Folx, 2023

Want to learn more about queer and trans family building?
Check out these helpful guides from Folx:

Queer and Transgender Fertility 101 and Queer Family Building 101

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