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LGBTQ+ Family Building: Every Family Starts with Knowing Your Options
Written by Francesca Steyn, NMC-registered fertility practitioner A guide to understanding fertility potential, sperm preservation, and the Malebox Health services available to LGBTQ+ people planning their futures. Fertility health is health. Whoever you are, whatever your path looks like, understanding your reproductive options is a step worth taking early, long before you need the answers. Pride Month is a moment to celebrate visibility and community. It is also a meaningful time to talk about something that often gets left out of LGBTQ+ health conversations: family building, and the practical steps you can take today to protect your options for tomorrow. The routes into parenthood are as varied as the people taking them. For gay men navigating surrogacy or co-parenting, knowing the quality of your sperm matters from the outset. For lesbian couples working with a known sperm donor, having clinical confirmation of that donor's fertility health gives everyone clearer ground to stand on. For trans and non-binary people with testes, sperm testing and preservation can be a meaningful step before gender-affirming care changes the picture. These are not niche concerns. They are practical health questions, and they are exactly the kind of questions Malebox Health is built to help with. Why fertility awareness matters for LGBTQ+ family planning There are many ways to build a family. Adoption, surrogacy, co-parenting, reciprocal IVF, fostering, donor conception: the paths are genuinely varied, and no single route suits everyone. But for anyone who may want to use their own genetic material, or who is relying on someone else's, understanding sperm health gives you options, confidence, and information that matters. Sperm health is rarely talked about until there is a problem. That is true for straight couples and it is even more true in LGBTQ+ contexts, where the conversation around fertility tends to focus on logistics rather than biology. But the biology still matters, and getting ahead of it is always better than finding out too late. Worth knowing According to the Human Fertilisation and Embryology Authority (HFEA), around one in six couples in the UK experience difficulty conceiving. In around half of those cases, sperm health is a contributing factor. Understanding sperm quality early, regardless of how you plan to conceive, gives you more options and more time. For gay men: understanding your fertility health before surrogacy or co-parenting For gay men planning to become parents through surrogacy or co-parenting arrangements, sperm quality is one of the first practical questions a fertility clinic or known surrogate will ask about. Starting that process with a clear, clinical picture of your sperm health puts you in a much stronger position. This is true whether you are at the early thinking stage or actively moving forward with a surrogacy agency or fertility clinic. A semen analysis gives you a baseline: what your sperm count, motility, and morphology look like right now, assessed against World Health Organisation (WHO) reference ranges by HCPC (Health and Care Professions Council) registered clinicians. Why test before you need to Many gay men only encounter sperm testing when they are already in a fertility clinic process, often after significant time and money has already been committed. Testing earlier, on your own terms, gives you time to act on anything unexpected without the pressure of a clinical timeline. It also means you go into any surrogacy or co-parenting conversation with real data rather than assumptions. If both partners are contributing sperm for the same surrogacy cycle, understanding both profiles gives you and your clinical team more to work with. If both partners want to test Malebox Health tests are individual, so each partner would order their own kit. Both can book consultations, and the results can inform a joint conversation with a fertility nurse about your options. There is no clinical reason to delay this, and good reasons to do it early. The Malebox Home Sperm Test with Consultation gives you a comprehensive semen analysis with next-day results, followed by a video consultation with an NMC (Nursing and Midwifery Council) registered fertility practitioner. If there are questions about hormone levels as well, the Sperm Test and Hormone Profile adds a full male hormone panel to the picture. Surrogacy and co-parenting journeys involve a lot of moving parts. Your fertility health does not have to be one of the unknowns. For same-sex female couples using a known sperm donor: why clinical testing matters Using a known donor, whether a friend, family member of a partner, or someone you have met through a co-parenting arrangement, is a deeply personal choice. It comes with real advantages: you know who the donor is, you can build a relationship that works for your family, and you have a level of openness that anonymous donation does not offer. It also comes with questions that are worth answering before you go further. Chief among them: is the donor's sperm actually viable? What clinical testing adds to the picture A friendly conversation and a willingness to help are not the same as confirmed fertility. Sperm health varies enormously between individuals, and there is no reliable way to know without testing. Factors including count, motility, and morphology can all affect whether a home insemination or clinical procedure is likely to succeed. Getting a Malebox test done before you begin gives everyone involved clearer information and more realistic expectations. It also means that if there is something to address, you find out before you have invested emotionally and practically in a process that may not work. A practical step for known donors A known donor taking a Malebox Home Sperm Test gets a full semen analysis assessed by HCPC registered clinicians, with results delivered in a video consultation with an NMC registered fertility nurse. The report is easy to read and designed to be shared. It is a straightforward way to give everyone involved a clear and clinically credible picture. There are also legal and clinical considerations worth knowing. In the UK, if insemination takes place at a licensed fertility clinic, the donor's legal status and any parental rights are governed by the Human Fertilisation and Embryology Act. If home insemination is used, the legal position is different and it is important to take independent legal advice. A Malebox fertility practitioner consultation is a good place to ask clinical questions, and your nurse can point you towards appropriate next steps for any legal or clinical referrals you may need. Reciprocal IVF For some couples, reciprocal IVF, where one partner provides the eggs and the other carries the pregnancy, is a route that allows both partners to be directly involved in the process. This requires a fertility clinic and a sperm donor, known or anonymous. If you are using a known donor for reciprocal IVF, the clinic will require a full semen analysis as part of the donor screening process. An at-home Malebox test is not a substitute for clinic-based donor screening, but it can give your donor a clear picture of their baseline before that process begins, and flag anything that needs to be discussed with the clinic team. For trans and non-binary people: understanding and preserving your fertility options For trans and non-binary people with testes, fertility conversations often feel like they are happening in a separate world from the rest of gender-affirming care. They should not be. Sperm health and preservation are practical health decisions that fit naturally alongside any other steps you are taking, and the earlier they happen, the more options remain available. Before starting hormone therapy Oestrogen-based hormone therapy, commonly part of feminising gender-affirming care, can significantly reduce sperm production. In many cases this reduction is reversible if hormone therapy is stopped, but this is not guaranteed, and the timeline for recovery varies considerably between individuals. Preserving sperm before starting hormone therapy means you retain options regardless of how your body responds. Before gender-affirming surgery Some surgical procedures, including orchiectomy (removal of the testes), permanently end the possibility of producing sperm. Preservation before surgery is the only way to retain the option of using your own genetic material in future. The timing question The right time to test and preserve is before starting any treatment that may affect fertility, not after. Once hormone therapy begins, sperm quality and quantity can change quickly. A test ahead of starting treatment gives you the most accurate baseline and the widest range of options. The HFEA recommends that anyone considering hormone therapy or gender-affirming surgery who may wish to have biological children in the future should discuss fertility preservation before starting treatment. This guidance exists because some effects on fertility may be irreversible. If this conversation has not been raised by your care team, it is entirely reasonable to raise it yourself. What a Malebox sperm test actually tells you A semen analysis measures the key markers of sperm health that clinicians use to assess fertility potential. These are the same markers used by the WHO to define normal sperm parameters, and the same ones a fertility clinic would look at. If you want a fuller picture of how testing works from start to finish, our guide to at-home sperm testing in the UK walks through the whole process. What is measured Sperm concentration: the number of sperm present per millilitre of semen. Total motility: the percentage of sperm that are moving, and how well they move. Progressive motility: the percentage swimming purposefully forward, the movement that matters most for conception. Morphology: the proportion of sperm with a normal size and shape. Total sperm count and volume: the overall picture of what is in a sample. Results are not just numbers on a page. They are delivered via a video consultation with an NMC registered fertility practitioner with experience in fertility clinics and the male fertility space, who can walk you through what the results mean in plain language and discuss your next steps. The report is designed to be understood without a medical degree. How Malebox Health can help Malebox Health offers at-home sperm testing that removes the barriers that can make this step feel difficult: no clinical waiting rooms, no referral requirements, results and consultation delivered to you wherever you are. If you are wondering what the experience involves, here is what you can expect from a fertility test. Both of our products, the Home Sperm Test with Consultation and the Home Sperm Test & Male Hormone Profile, are suitable for anyone with testes who wants to understand their sperm health, regardless of gender identity or sexual orientation. If you are a known donor, a gay man planning for surrogacy, a trans or non-binary person considering preservation, or simply someone who wants to know where they stand, these tests are designed for you. Accessing care that feels right for you We know that healthcare settings have not always been affirming spaces for LGBTQ+ people. From language that does not reflect your identity to clinicians who lack experience in the realities of diverse family building, the barriers to accessing reproductive health support are real. At Malebox Health, we are committed to providing care that is respectful, clear, and free from assumption. Our fertility practitioners are experienced in supporting a range of clients through reproductive health conversations. If you have questions about how we approach identity and language in our consultations, please reach out before booking. A note on language Malebox Health uses the language in this article with the intention of being accurate and inclusive. We recognise that the language around gender, sexuality, and reproduction is evolving, and we are committed to listening and updating how we communicate. If anything here does not sit right with you, we welcome that feedback. You do not have to have all the answers right now Family building decisions are deeply personal, and there is no timeline you are supposed to be on. But information is rarely a bad thing to have early. Understanding sperm health now, before other decisions narrow your options, gives you the freedom to make choices that are genuinely yours. That is what this is really about: not pressure to make any particular decision, but access to the information that makes real choice possible. Fertility health should not be a source of stress or embarrassment. Whatever your path to family looks like, you deserve to walk it with clear information and clinical support that treats you with respect. Frequently asked questions Can a known sperm donor use an at-home sperm test? Yes. A known donor can take a Malebox Home Sperm Test and receive a full semen analysis, assessed by HCPC registered clinicians against WHO reference ranges, with results explained in a video consultation. The report is designed to be shared. For licensed clinic treatment, formal donor screening is still required. Should I preserve sperm before starting hormone therapy? The HFEA recommends discussing fertility preservation before starting hormone therapy or having gender-affirming surgery if you may want biological children in future. Oestrogen-based hormone therapy can significantly reduce sperm production, and recovery is not guaranteed. Testing and preserving before treatment keeps the widest range of options open. What does a sperm test measure? A semen analysis measures sperm concentration, total and progressive motility, morphology, total sperm count, and semen volume, assessed against World Health Organisation reference ranges. Together these markers give a clinical picture of fertility potential, the same one a fertility clinic would use. Do gay men need a sperm test before surrogacy? Sperm quality is one of the first things a fertility clinic or surrogacy agency will ask about. Testing early gives you a clinical baseline and time to act on anything unexpected, before significant time and money are committed. If both partners may contribute sperm, each can test individually. Francesca Steyn is an NMC-registered fertility practitioner with over 20 years in reproductive health. She has served on the NICE guideline committee and the HFEA legislative reform group. Sources and further reading Human Fertilisation and Embryology Authority (HFEA), Fertility preservation and Donor conception: the legal position. NHS, Gender incongruence: clinical guidance for healthcare professionals. World Health Organisation, WHO Laboratory Manual for the Examination and Processing of Human Semen, 6th edition. National Institute for Health and Care Excellence (NICE), Fertility: assessment and treatment for people with fertility problems, CG156. Human Fertilisation and Embryology Act 1990 (as amended). Malebox Health does not provide medical or legal advice. This article is for informational purposes only. If you have questions about your fertility health, gender-affirming care, or the legal aspects of donor conception, please speak with a qualified healthcare or legal professional.
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Are Home Sperm Test Kits Accurate? Here’s What To Know
Male fertility is talked about far less than it should be, yet it accounts for around half of all fertility challenges. In this guest post from The Ribbon Box, fertility writer and TTC veteran Jessie Day breaks down everything you need to know about at-home sperm testing: what makes some kits more reliable than others, how to collect a sample correctly, and why a clinical consultation matters as much as the result itself.
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Trying to Conceive for 6 Months? Here Is What to Do Next
Six months of trying to conceive and no positive test. It's a frustrating place to be - and a completely understandable one to want answers from. The good news: at six months, most couples are still within the statistically normal range. But that doesn't mean you have to just wait and see. There are practical steps worth taking now, starting with the one that's most often overlooked - checking sperm health.
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Before Taking a Fertility Test: What You Can Expect
Deciding to take a fertility test is a meaningful step, and it helps to go into it with a clear sense of what the results might tell you. For many people, a fertility test offers clarity, reassurance and a chance to take control early on. While results can sometimes be surprising, understanding them properly can remove a lot of uncertainty and give you a clearer path forward. Fertility is rarely a simple yes or no. It exists on a spectrum, and most people can improve their position on that spectrum through lifestyle changes, treatment and medical support. A semen analysis can highlight potential issues with male fertility, but it is still only an indication — it gives you useful information about sperm quality on that particular day, rather than a final verdict on your chances of conceiving. What matters most is knowing that a result, whatever it is, can help you make informed choices. Many couples say that having this information earlier would have saved them months of worry. Understanding where you stand is an empowering step, not something to fear. Understanding Fertility Test Results Good result A good semen analysis result does not guarantee natural conception, but it shows that your sperm parameters sit above the sub-fertile thresholds set by the World Health Organisation (WHO). With supportive lifestyle habits, it is often possible to maintain or even improve these levels. Many men find that a good result offers peace of mind and confidence as they start trying to conceive. Borderline result Semen parameters naturally fluctuate, sometimes by a noticeable amount. Because sperm are assessed by a trained technician, there is always an element of variation in how the sample is interpreted. A borderline result is often a sign of this variability. The positive news is that borderline results tend to respond well to lifestyle changes. The NHS recommends taking another semen analysis after 3 months, which reflects a full sperm development cycle. Sub-fertile result A sub-fertile result can feel worrying, but it does not mean you cannot conceive. Only one sperm is needed for conception, and there are many reasons why a result falls into this range. In many cases, sperm quality improves through lifestyle adjustments, treatment or further medical investigation. A small number of men may have no sperm in their sample, known as azoospermia. Although rare, it does require further assessment and can sometimes be addressed through medical intervention. An in-person appointment is usually recommended if you receive a sub-fertile result. Why Testing Matters Getting a fertility test is not just about identifying problems. It gives you a clearer starting point, helps you understand your body better and offers guidance on what to do next. Whether your result is good, borderline or sub-fertile, each outcome can be improved or navigated with the right support. Taking a test early means you are not relying on guesswork. You can make proactive choices, reduce avoidable delays and give yourself the best chance of conceiving — naturally or with help if you need it.
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Why Are We Still Overlooking the 50%?
The road to becoming parents is often long, emotionally draining, and expensive. Yet, according to leading fertility experts, many couples are being pushed toward invasive and costly IVF treatments unnecessarily. Why? Because male infertility is consistently being overlooked by the medical system. This isn't just an issue of fairness — it's about efficiency, mental health, and cost. If you are starting your fertility journey or struggling with delays, understanding this systemic problem is the crucial first step to taking proactive control over your family planning. The Facts: Men Are Half the Equation The data is undeniable: men account for 50% of all infertility cases. Despite this equal split, the medical approach has historically treated fertility primarily as a woman's health concern. Experts have noted that when a couple struggles to conceive, the female partner is often "rapidly submitted to every test you can think of." For the male partner, however, it can take months, or even years, to receive even basic semen analysis and a thorough physical examination. The Problem: A System That Doesn't Prioritise Men This testing bias is caused by fundamental flaws in the health system: Most couples are seen by gynaecologists, who naturally specialise in women's reproductive health, not men's. There is a severe lack of andrologists (dedicated male health specialists) within the NHS. Research found that over 80% of GPs had received virtually no formal education on male fertility issues. This imbalance means that the male factor — which could be the simple key to the problem — is often the last thing to be properly investigated. The Hidden Cost of the Waiting Game The consequence of this neglect is frustrating and expensive. Many causes of male infertility are treatable. Simple conditions like varicocele (a dilated vein that overheats sperm) can be addressed, and straightforward lifestyle changes to improve sperm quality can make a huge difference. When the male factor is missed, couples end up enduring unnecessary emotional turmoil and financial strain, going through rounds of intensive, time-consuming IVF that wasn't properly targeted. Properly assessing men first would provide a "significant cost benefit for the NHS" and, more importantly, ease the heavy mental health burden on couples. Taking Control: Your Proactive Solution While institutions slowly work to update outdated protocols, you have the power to stop waiting and take control of your own data now. Privacy & Comfort: Skip the awkward clinic room and collect your sample when you are relaxed and ready in the comfort of your own home. Zero Delay: Get answers and data right away. If issues are found, you can immediately seek the right help from your GP before the traditional one-year wait period. Empowered Planning: Use clear data to ensure you're addressing the full 50% of the fertility equation right from the start. Source: This post references findings from a Guardian article published November 2025 discussing expert views on male infertility oversight in the IVF process.
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Starting the Journey: Facing the Unknowns of Fertility
Working for Malebox in the fertility space has changed how I think about getting pregnant. Knowing more about fertility challenges and conception rates made me realise that it might not be as straightforward as I once assumed. Hearing friends share their own fertility journeys helped me feel less alone as my wife and I started ours. We agreed to take a low-pressure approach and focus on keeping things natural, hoping to protect our relationship from the stress that often comes with trying to conceive. About a month after my wife stopped using contraception, she took a pregnancy test. It was positive. We were thrilled and a bit shocked because it happened much sooner than we expected. We told close family and friends, even though we were aware of the usual advice to wait until 12 weeks. A short time later, some unexpected bleeding took us to the clinic. The scan showed that the gestational sac was smaller than it should have been. A couple of hours later, we were told we had experienced a miscarriage. Navigating the Challenges: Balancing Hope and Disappointment Even though I understood how common miscarriage is, the reality still hit hard. Well-meaning reminders about how often it happens did little to ease the emotional weight of it. Instead of jumping straight back into trying again, we decided to take the summer off and simply enjoy life. I felt quietly relieved that we had begun our fertility journey when we did. At 31, the awareness of age and its impact on fertility was in the back of my mind, especially for my wife. Through my work at Malebox, I had been involved in male fertility research and had tested my own sperm several times. I still remember the anxiety of waiting for that first result. My uncle had struggled with infertility — my dad once explained it by saying he had issues with his "squiggly tails", a simple reference to sperm morphology. That bit of family history definitely added to my worry. My results were usually positive, although none of those early tests measured morphology, so some uncertainty always stayed with me. Month after month, my wife's period was a reminder of another missed opportunity. I tried to stay positive and kept telling myself that we had conceived once, so surely it could happen again. I was determined not to let sex become too scheduled or mechanical, although this was difficult around ovulation. My wife tracked her cycle with an app, but announcing "it's time" felt too pressurised. We started using a small chilli emoji in our shared calendar instead. It sounds silly, but it helped us communicate without taking the joy out of intimacy. Finding a Way Forward: Resilience, Research and a Bit of Luck As part of product development at work, I volunteered to have my sperm analysed properly in a clinic. I'm glad I did, because it showed me how valuable accurate at-home sperm testing could be. The results revealed that my sperm morphology was lower than expected, which raised new questions about whether male fertility might be playing a role in our difficulty conceiving. Four months later, we saw another positive pregnancy test. This time we stayed cautious and tried not to let ourselves get carried away too quickly. So far everything has been going smoothly, and I feel incredibly grateful for that. This journey has had its challenges, but I know many people face much tougher ones. The more I learn about fertility, sperm health and conception, the more I realise how much luck, timing and patience influence the outcome — whether through natural conception or IVF. What has helped us most is staying honest with each other, taking breaks when needed and remembering that no two fertility journeys look the same.
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