This project compares the reproductive experiences of lesbians and the related treatment decisions of fertility physicians in Germany and the United States, which provide notably different regulatory contexts for lesbian reproduction. In Germany, several facets of regulations serve to discourage lesbian use of fertility medicine, whereas in the United States, few regulations on fertility medicine exist. Drawing on a review of country regulations, content analysis of media coverage, and in-depth interviews with lesbians and physicians, I argue that the regulatory context (including legislation, medical professional guidelines, health insurance policies, and case law regarding families) both reflects and reinforces the reproductive cultural practices in these two countries. Overall, I find that the regulations have notable effects on physician treatment decisions and lesbian reproductive decisions regarding the logistics of conception and the choice of sperm donor. In particular, regulations in Germany discourage lesbian use of fertility medicine and inadvertently encourage novel kinship practices, while the regulatory context in the US encourages the medicalization of lesbian conception and the reproduction of the two-parent, tightly bounded family unit.