More people than ever are building families through fertility treatment without a male-female couple at the centre. In the UK, the number of female same-sex couples having IVF or donor insemination rose from about 1,300 in 2012 to about 3,300 in 2022. Single patients rose from about 1,400 to about 4,800 over the same period (HFEA, 2024). Clinics are more experienced with these routes than they used to be. The planning still has a few extra steps, and this guide maps them by family type.
The routes at a glance
| Who | What is usually needed | Common routes |
|---|---|---|
| Female couple | Donor sperm | Donor insemination (IUI); IVF with donor sperm; reciprocal IVF, where one partner's eggs are used and the other carries |
| Single woman | Donor sperm, sometimes donor eggs too | Donor IUI; IVF with donor sperm; donor eggs or embryos if her own eggs are unlikely to work |
| Male couple | Donor eggs and a gestational carrier | IVF using one partner's sperm with donor eggs, embryo transferred to a surrogate |
| Single man | Donor eggs and a gestational carrier | As above, with his own sperm |
| Trans or non-binary person | Depends on anatomy and treatment plans | Fertility preservation (egg or sperm freezing) before medical transition, then any of the above |
The UK regulator notes that hormone therapy and surgery for gender dysphoria can affect fertility, so anyone considering transition may want to look at fertility preservation first (HFEA). A fertility clinic can explain what egg or sperm freezing would involve in your case.
IUI first, or straight to IVF?
For female couples and single women using donor sperm, insemination is often the first step. It is less invasive and less expensive than IVF. If tests show no other fertility issues, IUI may be a reasonable starting point. IVF tends to come earlier when there are known problems: blocked tubes, low ovarian reserve, age-related concerns, or several unsuccessful IUIs.
Before deciding, the person who will provide the eggs should have the same baseline assessment any IVF patient would: ovarian reserve testing, a scan and relevant blood tests. Using donor sperm does not remove the effect of egg age. It only removes the sperm question.
Funding rules can push people toward one route. In England, the HFEA notes that female couples generally have to self-fund six IUI cycles before they can qualify for NHS fertility funding, and even then it depends on local policy. Male couples using surrogacy must pay privately (HFEA).
Reciprocal IVF
In reciprocal IVF, sometimes called shared motherhood, one partner goes through stimulation and egg retrieval. Her eggs are fertilized with donor sperm, and the embryo is transferred to her partner, who carries the pregnancy. Both partners have a biological role. Clinically, it is an ordinary IVF cycle plus a frozen or synchronized transfer to a different person. Deciding who provides eggs and who carries often comes down to age, ovarian reserve, uterine health and personal preference. We cover the details, including doing it abroad, in our reciprocal IVF guide.
Choosing a sperm donor
There are two broad options: a donor from a regulated sperm bank or clinic, or a known donor such as a friend.
- Bank or clinic donors have been health-screened and counselled, and the legal position is usually clearer.
- Known donors can be a good choice, but the same screening still applies. The ASRM donation guidance (2024) says directed donors should have the same screening as anonymous ones. It recommends separate and joint counselling and strongly recommends legal advice.
Informal donation carries legal risk
The HFEA warns that private sperm donation outside licensed clinics is unregulated. A private donor may be treated as the child's legal father, with the rights and responsibilities that brings. Going through a clinic, even with a donor you already know, avoids most of that uncertainty in the UK.
Legal parenthood: the part to settle first
For any family that uses a donor or a surrogate, the law decides who the legal parents are. That is not always the same as who the intended parents are.
- Consent paperwork. In the UK, if a female couple is not married or in a civil partnership, both partners must complete specific consent forms before treatment, so the non-birth partner is recognised as a legal parent. Without them, the donor could be treated as a parent, and fixing it later is slow and costly (HFEA).
- Surrogacy. For male couples and single men, the gestational carrier's legal position depends on the country where she gives birth and on your home country's law. Some countries need a court process after birth.
- Cross-border treatment. If treatment, birth and citizenship involve different countries, all of their rules apply. Take advice from a family lawyer who handles cross-border reproduction before you start. See our guides to legal parentage and bringing your baby home and to surrogacy in Colombia.
What the outcomes look like
Because many single people and female couples come to IVF needing donor sperm rather than because of infertility, their per-embryo results can compare well. Among UK patients aged 18 to 37 in 2022 to 2024, the birth rate per embryo transferred was 42% for female same-sex couples, 39% for single patients and 35% for opposite-sex couples (HFEA, 2026). These are population averages, not predictions. Age and personal fertility factors still drive individual chances.
Access and funding gaps
Access has not kept pace with demand. The HFEA reported that around 52% of opposite-sex couples aged 18 to 39 had NHS-funded first IVF, compared with about 16% of female same-sex couples and about 18% of single patients. It urged commissioners to review eligibility rules that may disadvantage these groups (HFEA, 2024). Funding rules elsewhere vary widely, and gaps like these are one reason people look at treatment abroad.
Counselling and support
Donor conception raises questions that are worth working through early: how and when to tell a child, how to talk about the donor, and what to do if treatment takes longer than hoped. ASRM strongly recommends a session with a qualified mental health professional for recipients of donor gametes, and the HFEA encourages individual or joint counselling. For single parents, our guide for single mothers by choice covers support planning in more depth.
If you are travelling for treatment
Treatment abroad adds practical questions to each route. Donor sperm may need to be bought from a bank that ships to the destination clinic, or sourced from a local bank whose donor-identity rules differ from those at home. A known donor may need to travel for screening and collection. For reciprocal IVF, both partners usually need to be present for parts of the cycle. Check early whether the destination clinic routinely treats families like yours, and whether its consent forms reflect your family structure.
Planning checklist
- Baseline fertility tests for whoever will provide eggs, and whoever will carry
- Decide on a donor source: bank, clinic or known donor, and confirm the screening
- For female couples, decide who provides eggs and who carries, if using reciprocal IVF
- Legal advice on parenthood in the country of treatment, birth and residence
- Consent forms completed before treatment begins
- If travelling, confirm how donor sperm will be shipped or sourced locally, and whether consent documents are available in your language
- Counselling booked before the first cycle
Frequently asked questions
Do female couples always need IVF?
No. Many start with donor insemination. IVF becomes more likely if there are fertility problems, age concerns, several unsuccessful IUIs, or a wish for reciprocal IVF so both partners have a biological role.
Can both partners in a male couple be genetic fathers?
Each embryo has one genetic father. Some couples fertilize donor eggs with sperm from each partner and use embryos from each in separate pregnancies over time. Your clinic and lawyer can explain what is permitted where you are treated.
Can I use a friend as a sperm donor?
Yes, in many countries, but the same screening and counselling should apply, and legal advice is strongly recommended. Informal home insemination can leave the donor legally recognised as a parent in some places.
Do clinics accept single patients?
Many do, and single patients are a fast-growing group in the UK. Policies vary by clinic and country, so ask directly at your first consultation.
Is surrogacy legal everywhere?
No. Rules range from prohibited to permitted with conditions, and some countries do not recognise parenthood arranged abroad. Check both the country of treatment and your home country before committing.
Sources
- HFEA — Fertility treatment for LGBT+ people
- HFEA — More single patients and female same-sex couples having fertility treatment (November 2024)
- HFEA — Fertility treatment 2024: trends and figures (2026)
- ASRM — Gamete and embryo donation guidance (2024)
The Takeaway
The medicine is familiar. The decisions that need extra time are the donor or carrier, the order of treatments, and legal parenthood, so get legal advice before your first appointment, not after a positive test.