family on the sofa
It’s been four decades since the first “test-tube baby” was conceived via IVF. Since then fertility treatment and technology have progressed and adapted exponentially and according to a Pew Research survey, 33% of adults in the U.S have either gone through fertility treatment or know someone who has. While assisted reproductive treatments have become more common no two couple’s experiences are the same. The number of LGBTQ+ people becoming parents is increasing and the fertility treatment process may look a little different. One expert explains how a requirement for a diagnosis of infertility means insurers can make the process more difficult.
According to research collated by the Family Equality Council nearly 1.1 million LGBTQ+ people in the U.S are married to someone of the same-sex and between two million and 3.7 million children under the age of 18 have an LGBTQ+ parent. Approximately 200,000 of them are being raised by a same-sex couple. Changes in the law and attitudes have opened up options for LGBTQ+ people to build their families.
While the fertility treatment process can be very similar for LGBTQ+ families to heterosexual parents it can also differ. “Many insurance companies don’t cover our treatments in the absence of a ‘diagnosis of infertility.’” explains Dr. Briana Rudick MD, Director, Third Party Reproduction at Columbia University Fertility Center, “since infertility is a time-based definition based on heteronormative values and family structure, the definition of infertility needs to be changed in order to include this population most of whom don’t really have the option of ‘trying for 12 months.’ Infertility has always been a cultural definition and this is yet another example of how we need to adapt and change.”
Laws on LGBTQ+ parenting, adoption and foster care vary across the U.S. Some states protect the rights and status of LGBTQ+ parents while others don’t. Trans parents are especially at risk of facing discrimination under the law as they’re not recognized as a biological parents and therefore can’t establish rights to their child. Studies have also highlighted that fertility treatment can be more expensive for LGBTQ+ couples and a survey conducted by Modern Fertility found that 46% of LGBTQ+ people don’t feel comfortable talking to a health care provider about their fertility due to misgendering, heteronormative intake forms and a lack of knowledge about LGBTQ+ needs.
“I think some queer couples are hesitant to be interfacing with the medical community at large. They would rather be starting with at-home inseminations and treatments that are less invasive. I find that talking through a plan with these patients can be very helpful,” says Dr. Rudick, “we work with midwives as well that can make at home inseminations easier. It can still be helpful to have a plan and a timeline so that not too much time goes by without success.”
Covid-19 has also had a massive effect on LGBTQ+ couples wanting to start their fertility journey. The pandemic has meant couples across the world have had to adapt their family planning as clinics closed and treatments stopped. As people faced losing their jobs, insurance and way to pay for treatment, clinics also had to establish how they could function safely. “Patients and doctors both are being very cautious and we have to advise patients about what we do and don’t know about Covid-19 during pregnancy,” explains Dr. Rudick, “we have also had to adjust many of our protocols and monitoring timetables to really try to minimize visits to the office, some of which may end up being a better option for patients even outside of the Covid-19 pandemic. We are trying to find the pluses here and there.”
So for LGBTQ+ couples wanting to start their fertility journey but not knowing where to begin Dr. Rudick recommends seeking out organizations and resources that can provide specialist advice. Family Equality Council (FEC) and Fertility IQ are both really helpful. If you know someone who has been through it, it may help to speak to them about their experience. Similarly finding a clinic and physician that understands you, your needs and your family is crucial. “Sometimes just scheduling an appointment with a fertility doctor is a great way to get an overall view of how the process works,” says Dr. Rudick, “I see many patients at the very beginning of their family planning, they are among my favorite patients to see because they are generally excited to be building a family.”
Every family is different and no two fertility journeys are the same. However, LGTBQ+ people come up against barriers that heterosexual couples don’t. Finding a clinic that understands what you need, using research to empower yourself and creating your own timelines are great ways to feel like you’re in control of what is a life-changing time.
