Lesbian, gay, bisexual and queer (LGBQ) women and men are increasingly utilizing fertility treatment services to build their families. This chapter provides an overview of topics to consider when providing fertility counseling to this population of prospective parents. It first explores the decisions that same-sex couples need to make with regard to family building and fertility treatment, including various routes to parenthood, whose gametes to use, or who will serve as the carrier. The chapter further explores many of the challenges couples often face during fertility treatment via the sexual minority stress framework. Particular attention is given to issues of homophobic discrimination, heteronormative bias and stigma, as well as to challenges related to social support, costs and legal rights. Finally, this chapter provides guidance to fertility counselors and treatment professionals on steps to take to provide culturally competent care to LGBQ patients and their partners. Such practices are crucial for offering an inclusive treatment environment to support same-sex couples in their family-building efforts.